Abstract
The objective of this paper is to assess synkinesis associated with post paretic voluntary facial movements using the objective OSCAR method and to investigate the correlation between synkinesis and paresis to compare the objective results with the subjective scaling systems of Fisch and House–Brackmann. The development of an objective assessment of synkinesis with the OSCAR method is focused on the clinically most relevant eye-mouth and forehead-mouth synkinetic movements. Thirteen patients with unilateral facial paralysis and synkinesis of the University Hospital Zurich were examined. Two types of clinically relevant facial synkinesis were found: a maximal synkinesis and a relative synkinesis. Neither Synkinesis-Index correlates well with the underlying degree of global facial palsy. The relative Synkinesis-Index (rSI) correlates well with the subjective evaluation of synkinesis according to the Fisch Grading, but shows a poor correlation with the traditional House–Brackmann grading. Therefore a single scaling index combining the degree of facial nerve palsy and synkinesis is inappropriate and we propose the use of two independent scaling systems for the evaluation of facial palsy: one for the voluntary facial movements, the other for the involuntary synkinetic movements. The adequate evaluation of the post paretic face should include the results of both scaling systems.
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Acknowledgements
We are very grateful to Prof. Ugo Fisch for the fruitful discussions, the enormous support and the review of this paper. We thank the patient for his informed consent to publish the photographs.
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Author Verena Meier-Gallati declares that she has no conflict of interest. Author Henning Scriba declares that he has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
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Meier-Gallati, V., Scriba, H. Objective assessment of the reliability of the House–Brackmann and Fisch grading of synkinesis. Eur Arch Otorhinolaryngol 274, 4217–4223 (2017). https://doi.org/10.1007/s00405-017-4770-x
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DOI: https://doi.org/10.1007/s00405-017-4770-x