TY - JOUR
T1 - Facial nerve grading instruments
T2 - Systematic review of the literature and suggestion for uniformity
AU - Fattah, Adel Y.
AU - Gurusinghe, Anthony D.R.
AU - Gavilan, Javier
AU - Hadlock, Tessa A.
AU - Marcus, Jeff R.
AU - Marres, Henri
AU - Nduka, Charles C.
AU - Slattery, William H.
AU - Snyder-Warwick, Alison K.
N1 - Publisher Copyright:
Copyright © 2015 by the American Society of Plastic Surgeons.
PY - 2015
Y1 - 2015
N2 - Background: A variety of facial nerve grading scales have been developed over the years with the intended goals of objectively documenting facial nerve function, tracking recovery, and facilitating communication between practitioners. Numerous scales have been proposed; however, all are subject to limitation because of varying degrees of subjectivity, reliability, or longitudinal applicability. At present, such scales remain the only widely accessible modalities for facial functional assessment. The authors' objective was to ascertain which scales(s) best accomplish the goals of objective assessment. Methods: A systematic review of the English language literature was performed to identify facial nerve grading instruments. Each system was evaluated against the following criteria: convenience of clinical use, regional scoring, static and dynamic measures, features secondary to facial palsy (e.g., synkinesis), reproducibility with low interobserver and intraobserver variability, and sensitivity to changes over time and/or following interventions. Results: From 666 articles, 19 facial nerve grading scales were identified. Only the Sunnybrook Facial Grading Scale satisfied all criteria. The Facial Nerve Grading Scale 2.0 (or revised House-Brackmann Scale) fulfilled all criteria except intraobserver reliability, which has not been assessed. Conclusions: Facial nerve grading scales intend to provide objectivity and uniformity of reporting to otherwise subjective analysis. The Facial Nerve Grading Scale 2.0 requires further evaluation for intraobserver reliability. The Sunnybrook Facial Grading Scale has been robustly evaluated with respect to the criteria prescribed in this article. Although sophisticated technologybased methodologies are being developed for potential clinical application, the authors recommend widespread adoption of the Sunnybrook Facial Grading Scale as the current standard in reporting outcomes of facial nerve disorders.
AB - Background: A variety of facial nerve grading scales have been developed over the years with the intended goals of objectively documenting facial nerve function, tracking recovery, and facilitating communication between practitioners. Numerous scales have been proposed; however, all are subject to limitation because of varying degrees of subjectivity, reliability, or longitudinal applicability. At present, such scales remain the only widely accessible modalities for facial functional assessment. The authors' objective was to ascertain which scales(s) best accomplish the goals of objective assessment. Methods: A systematic review of the English language literature was performed to identify facial nerve grading instruments. Each system was evaluated against the following criteria: convenience of clinical use, regional scoring, static and dynamic measures, features secondary to facial palsy (e.g., synkinesis), reproducibility with low interobserver and intraobserver variability, and sensitivity to changes over time and/or following interventions. Results: From 666 articles, 19 facial nerve grading scales were identified. Only the Sunnybrook Facial Grading Scale satisfied all criteria. The Facial Nerve Grading Scale 2.0 (or revised House-Brackmann Scale) fulfilled all criteria except intraobserver reliability, which has not been assessed. Conclusions: Facial nerve grading scales intend to provide objectivity and uniformity of reporting to otherwise subjective analysis. The Facial Nerve Grading Scale 2.0 requires further evaluation for intraobserver reliability. The Sunnybrook Facial Grading Scale has been robustly evaluated with respect to the criteria prescribed in this article. Although sophisticated technologybased methodologies are being developed for potential clinical application, the authors recommend widespread adoption of the Sunnybrook Facial Grading Scale as the current standard in reporting outcomes of facial nerve disorders.
UR - http://www.scopus.com/inward/record.url?scp=84926189021&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000000905
DO - 10.1097/PRS.0000000000000905
M3 - Review article
C2 - 25357164
AN - SCOPUS:84926189021
SN - 0032-1052
VL - 135
SP - 569
EP - 579
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 2
ER -