The use of the facial clinimetric evaluation scale as a patient-based grading system in Bell's palsy

Abstract

Objectives/hypothesis: The severity of Bell's facial palsy is monitored through physician-graded instruments, like the House-Brackmann or Sunnybrook Facial Grading System (FGS). These instruments primarily measure the degree of facial muscle impairment and its resulting asymmetry, but neglect the other functional aspects of facial disability. The aim of this study is therefore to compare the FGS with a patient-graded quality-of-life (QOL) instrument, Facial Clinimetric Evaluation Scale (FaCE).

Study design: Prospective longitudinal study.

Methods: Twenty-one patients with newly diagnosed Bell's palsy were recruited. All patients received standard treatment with a corticosteroid. They were scored with the FGS at every visit, and they also completed the FaCE at baseline and when they recovered from their palsy.

Results: At presentation, there was a positive correlation between the FGS score and the total FaCE score (ρ = 0.63, P = .002). However, when individual domains of the FaCE score were analyzed separately, the domains of facial comfort and lacrimal score did not have significant correlation with the FGS. Similarly, at the end of follow-up, the amount of improvement in FGS and the amount of improvement in the FaCE domains of facial comfort, lacrimal control, and social function showed insignificant and low correlation (P < .05).

Conclusions: This is the first longitudinal study comparing scores on the FGS and FaCE in patients with Bell's palsy. Our findings suggest that without patient-based QOL assessments such as the FaCE, certain functional aspects of facial disability may be overlooked by physician-graded instruments, which focus on facial aesthetics.

Level of evidence: 4.