Download PDF
Semin Plast Surg 2004; 18(1): 13-21
DOI: 10.1055/s-2004-823119
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Approaches to Grading Facial Nerve Function

Michael J. Brenner1 , J. Gail Neely1
  • 1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
Further Information

Publication History

Publication Date:
20 April 2004 (online)

    Permissions and Reprints

Systematic evaluation of facial nerve paralysis allows the clinician to determine objectively the severity of disability, record and communicate this information to colleagues, and evaluate response to therapy. An ideal grading system would be precisely calibrated-at once accurate, reliable, and conducive to use in both the clinic and the research laboratory. Developing such a system has proved difficult, however. The complexity of facial nerve anatomy allows tremendous variation in clinical presentation, and assessments of facial expression are inherently subjective in nature. Carefully defined parameters are therefore crucial in performing objective and quantitative analyses. This article reviews the clinical considerations involved in grading facial function and traces the evolution of current approaches. Emphasis is placed upon advances in computer-based facial nerve grading.

KEYWORDS

Facial nerve paralysis - facial nerve palsy - facial expression - facial nerve

REFERENCES

  • 1 Neely J G, Neufeld P S. Defining functional limitation, disability, and societal limitations in patients with facial paresis: initial pilot questionnaire.  Am J Otol. 1996;  17 340-342
    CrossrefPubMedGoogle Scholar
  • 2 Brach J S, VanSwearingen J, Delitto A, Johnson P C. Impairment and disability in patients with facial neuromuscular dysfunction.  Otolaryngol Head Neck Surg. 1997;  117 315-321
    CrossrefPubMedGoogle Scholar
  • 3 Kahn J B, Gliklich R E, Boyev K P, Stewart M G, Metson R B, McKenna M J. Validation of a patient-graded instrument for facial nerve paralysis: the FACE scale.  Laryngoscope. 2001;  111 387-398
    CrossrefPubMedGoogle Scholar
  • 4 VanSwearingen J M, Brach J S. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system.  Phys Ther. 1996;  76 1288-1298
    CrossrefPubMedGoogle Scholar
  • 5 VanSwearingen J M, Cohn J F, Turnbull J, Mrzai T, Johnson P. Psychological distress: linking impairment with disability in facial neuromotor disorders.  Otolaryngol Head Neck Surg. 1998;  118 790-796
    CrossrefPubMedGoogle Scholar
  • 6 Duchenne B. Mécanisme de la physionomie humaine ou analyse éléctrophysiologique de l'expression des passions. Paris; Bailliére 1862
    Google Scholar
  • 7 Frois-Wittman J. The judgment of facial expression.  J Exp Psychol. 1942;  13 113-151
    PubMedGoogle Scholar
  • 8 Fulcher J S. ‘Voluntary’ facial expression in blind and seeing children.  Arch Psychol. 1942;  38 5-49
    PubMedGoogle Scholar
  • 9 Landis C. Studies of emotional reactions. II: General behaviour and facial expression.  J Comp Psychol. 1924;  4 447-509
    PubMedGoogle Scholar
  • 10 Thompson J. Development of facial expression of emotion in blind and seeing children.  Arch Psychol. 1941;  37 5-47
    PubMedGoogle Scholar
  • 11 May M. Facial paralysis, peripheral type: a proposed method of reporting. (Emphasis on diagnosis and prognosis, as well as electrical and chorda tympani nerve testing).  Laryngoscope. 1970;  80 331-390
    PubMedGoogle Scholar
  • 12 House J W. Facial nerve grading systems.  Laryngoscope. 1983;  93 1056-1069
    PubMedGoogle Scholar
  • 13 Botman J W, Jongkees L B. The result of infratemporal treatment of facial palsy.  Pract Otorhinolaryngol. 1955;  17 80-100
    PubMedGoogle Scholar
  • 14 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
    Google Scholar
  • 15 Pieterson E. Natural history of Bell's palsy. In: Disorders of the Facial Nerve: Anatomy, Diagnosis and Management. New York; Raven Press 1982: 307-312
    Google Scholar
  • 16 Adour K K, Swanson Jr P J. Facial paralysis in 403 consecutive patients: emphasis on treatment response in patients with Bell's palsy.  Trans Am Acad Ophthalmol Otolaryngol. 1971;  75 1284-1301
    PubMedGoogle Scholar
  • 17 Janssen F P. Over de postoperative facialis-velamina.  , Thesis, University of Amsterdam, 1963. Cited in House JW Facial nerve grading systems.  Laryngoscope. 1983;  93 1056-1069
    PubMedGoogle Scholar
  • 18 Yanagihara N. Grading of facial palsy. In: Fisch U Facial nerve surgery. Proceedings of the Third International Symposium on Facial Nerve Surgery; Zurich; 1976. pp 533-535 Birmingham; Aesculapius Publishing Company 1977
    Google Scholar
  • 19 Stennert E. Facial nerve paralysis scoring system. In: Facial Nerve Surgery. Proceedings of the Third International Symposium on Facial Nerve Surgery; Zurich; 1976. pp 543-547 Birmingham; Aesculapius Publishing Company 1977
    Google Scholar
  • 20 Brackmann D E, Barrs D M. Assessing recovery of facial function following acoustic neuroma surgery.  Otolaryngol Head Neck Surg. 1984;  92 88-93
    PubMedGoogle Scholar
  • 21 Kang T S, Vrabec J T, Giddings N, Terris D J. Facial nerve grading systems (1985-2002): beyond the House-Brackmann scale.  Otol Neurotol. 2002;  23 767-771
    PubMedGoogle Scholar
  • 22 Yen T L, Driscoll C L, Lalwani A K. Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function.  Otol Neurotol. 2003;  24 118-122
    CrossrefPubMedGoogle Scholar
  • 23 King T T, Sparrow O C, Arias J M, O'Connor A F. Repair of facial nerve after removal of cerebellopontine angle tumors: a comparative study.  J Neurosurg. 1993;  78 720-725
    PubMedGoogle Scholar
  • 24 Lewis B I, Adour K K. An analysis of the Adour-Swanson and House-Brackmann grading systems for facial nerve recovery.  Eur Arch Otorhinolaryngol. 1995;  252 265-269
    PubMedGoogle Scholar
  • 25 Smith I M, Murray J A, Cull R E, Slattery J. A comparison of facial grading systems.  Clin Otolaryngol. 1992;  17 303-307
    PubMedGoogle Scholar
  • 26 Burres S, Fisch U. The comparison of facial grading systems.  Arch Otolaryngol Head Neck Surg. 1986;  112 755-758
    CrossrefPubMedGoogle Scholar
  • 27 Murty G E, Diver J P, Kelly P J, O'Donoghue G M, Bradley P J. The Nottingham system: objective assessment of facial nerve function in the clinic.  Otolaryngol Head Neck Surg. 1994;  110 156-161
    CrossrefPubMedGoogle Scholar
  • 28 Ross B G, Fradet G, Nedzelski J M. Development of a sensitive clinical facial grading system.  Otolaryngol Head Neck Surg. 1996;  114 380-386
    CrossrefPubMedGoogle Scholar
  • 29 Johnson P C, Brown H, Kuzon Jr W M, Balliet R, Garrison J L, Campbell J. Simultaneous quantitation of facial movements: the maximal static response assay of facial nerve function.  Ann Plast Surg. 1994;  32 171-179
    PubMedGoogle Scholar
  • 30 Wood D A, Hughes G B, Secic M, Good T L. Objective measurement of normal facial movement with video microscaling.  Am J Otol. 1994;  15 61-65
    PubMedGoogle Scholar
  • 31 Helling T D, Neely J G. Validation of objective measures for facial paralysis.  Laryngoscope. 1997;  107 1345-1349
    PubMedGoogle Scholar
  • 32 Moran C J, Neely J G. Patterns of facial nerve synkinesis.  Laryngoscope. 1996;  106 1491-1496
    CrossrefPubMedGoogle Scholar
  • 33 Neely J G, Cheung J Y, Wood M, Byers J, Rogerson A. Computerized quantitative dynamic analysis of facial motion in the paralyzed and synkinetic face.  Am J Otol. 1992;  13 97-107
    PubMedGoogle Scholar
  • 34 Neely J G, Jekel J F, Cheung J Y. Variations in maximum amplitude of facial expressions between and within normal subjects.  Otolaryngol Head Neck Surg. 1994;  110 60-63
    PubMedGoogle Scholar
  • 35 Neely J G, Joaquin A H, Kohn L A, Cheung J Y. Quantitative assessment of the variation within grades of facial paralysis.  Laryngoscope. 1996;  106 438-442
    PubMedGoogle Scholar
  • 36 Meier-Gallati V, Scriba H, Fisch U. Objective scaling of facial nerve function based on area analysis (OSCAR).  Otolaryngol Head Neck Surg. 1998;  118 545-550
    PubMedGoogle Scholar
  • 37 Scriba H, Stoeckli S J, Veraguth D, Pollak A, Fisch U. Objective evaluation of normal facial function.  Ann Otol Rhinol Laryngol. 1999;  108 641-644
    PubMedGoogle Scholar
  • 38 Isono M, Murata K, Tanaka H, Kawamoto M, Azuma H. An objective evaluation method for facial mimic motion.  Otolaryngol Head Neck Surg. 1996;  114 27-31
    PubMedGoogle Scholar
  • 39 Linstrom C J, Silverman C A, Susman W M. Facial-motion analysis with a video and computer system: a preliminary report.  Am J Otol. 2000;  21 123-129
    CrossrefPubMedGoogle Scholar
  • 40 Linstrom C J, Silverman C A, Colson D. Facial motion analysis with a video and computer system after treatment of acoustic neuroma.  Otol Neurotol. 2002;  23 572-579
    PubMedGoogle Scholar
  • 41 Linstrom C J. Objective facial motion analysis in patients with facial nerve dysfunction.  Laryngoscope. 2002;  112 1129-1147
    CrossrefPubMedGoogle Scholar
  • 42 Scheirman G L, Cheetham P J. Motion measurement using the PEAK Performance Technologies system.  Soc Photo-optical Instrument Engin Proceed. 1990;  1356 63-70
    PubMedGoogle Scholar
  • 43 Scholz J P, Milford J P. Accuracy and precision of the PEAK Performance Technologies motion measurement system.  J Mot Behav. 1993;  25 2-7
    PubMedGoogle Scholar
  • 44 Frey M, Giovanoli P, Gerber H, Slameczka M, Stussi E. Three-dimensional video analysis of facial movements: a new method to assess the quantity and quality of the smile.  Plast Reconstr Surg. 1999;  104 2032-2039
    PubMedGoogle Scholar
  • 45 Giovanoli P, Tzou C H, Ploner M, Frey M. Three-dimensional video-analysis of facial movements in healthy volunteers.  Br J Plast Surg. 2003;  56 644-652
    CrossrefPubMedGoogle Scholar
  • 46 Inokuchi I. Quantitative assessment of facial palsy by moiré topography [in Japanese].  Nippon Jibi Inkoka Gakkai Kaiho. 1992;  95 715-725
    PubMedGoogle Scholar
  • 47 Karlan M S. Contour analysis in plastic and reconstructive surgery.  Arch Otolaryngol. 1979;  105 670-679
    PubMedGoogle Scholar
  • 48 Ekman P. Measuring facial movement.  Environ Psych Nonverbal Behav. 1976;  1 56-75
    PubMedGoogle Scholar
  • 49 Ekman P, Friesen W V. Facial action coding system: a technique for the measurement of facial movement. In: Investigator's Guide. Palo Alto, CA; Consulting Psychologists Press 1978: 1-42
    Google Scholar
  • 50 Donato G SBM, Hager J C, Ekman P, Sejnowski T J. Classifying facial actions.  IEEE Trans Pattern Anal Mach Intell. 1999;  21 974-989
    CrossrefPubMedGoogle Scholar
  • 51 Cohn J F, Zlochower A J, Lien J, Kanade T. Automated face analysis by feature point tracking has high concurrent validity with manual FACS coding.  Psychophysiology. 1999;  36 35-43
    CrossrefPubMedGoogle Scholar
  • 52 Schmidt K L, Cohn J F, Tian Y. Signal characteristics of spontaneous facial expressions: automatic movements in solitary and social smiles.  Biol Psychol. 2003;  65 49-66
    CrossrefPubMedGoogle Scholar
  • 53 Caribom I, Hsu W M, Klinker G et al.. Modeling and analysis of empirical data in collaborative environments.  Commun ACM. 1992;  35 76-84
    PubMedGoogle Scholar
  • 54 Mase K. Recognition of facial expression from optical flow.  IEICE Trans. 1991;  74 3474-3483
    PubMedGoogle Scholar
  • 55 Terzopoulos D, Waters K. Analysis and synthesis of facial image sequence using physical and anatomical models.  IEEE Trans Pattern Anal Mach Intell. 1993;  15 569-579
    CrossrefPubMedGoogle Scholar
  • 56 Vannier M W, Pilgram T K, Bhatia G, Brunsden B, Commean P. Facial surface scanner.  IEEE Comput Graphics Appl. 1991;  11 72-80
    PubMedGoogle Scholar
  • 57 Vannier M W, Marsh J L. Craniofacial imaging: principles and applications of three-dimensional imaging.  Lippincott's Rev Radiol. 1992;  1 193-209
    PubMedGoogle Scholar
  • 58 Vannier M W, Bhatia G, Commean P, Pilgram T K, Brunsden B. Medical facial surface scanner.  SPIE. 1992;  1653 177-184
    PubMedGoogle Scholar
  • 59 Vannier M W, Pilgram T K, Bhatia G, Brunsden B, Nemecek J R, Young V L. Quantitative three-dimensional assessment of face-lift with an optical facial surface scanner.  Ann Plast Surg. 1993;  30 204-211
    PubMedGoogle Scholar
  • 60 Croxson G, May M, Mester S J. Grading facial nerve function: House-Brackmann versus Burres-Fisch methods.  Am J Otol. 1990;  11 240-246
    PubMedGoogle Scholar
  • 61 Frey M, Jenny A, Giovanoli P, Stussi E. Development of a new documentation system for facial movements as a basis for the international registry for neuromuscular reconstruction in the face.  Plast Reconstr Surg. 1994;  93 1334-1349
    CrossrefPubMedGoogle Scholar
  • 62 Rickenmann J, Jaquenod C, Cerenko D, Fisch U. Comparative value of facial nerve grading systems.  Otolaryngol Head Neck Surg. 1997;  117 322-325
    CrossrefPubMedGoogle Scholar
  • 63 Smith I M, Murray J A, Cull R E, Slattery J. Facial weakness. A comparison of clinical and photographic methods of observation.  Arch Otolaryngol Head Neck Surg. 1991;  117 906-909
    PubMedGoogle Scholar

J. Gail NeelyM.D. 

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine

660 South Euclid Avenue, Box 8115

St. Louis, MO 63110

      >