Sunnybrook Facial Grading System
The Sunnybrook Facial Grading System, the quantitative regional grading of facial nerve function and the companion to the House-Brackmann grade.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Resting symmetry: Eye
- Normal
- Resting symmetry: Cheek
- Less pronounced
- Resting symmetry: Mouth
- Corner drooped
- Voluntary movement: Forehead wrinkle
- 3
- Voluntary movement: Gentle eye closure
- 4
- Voluntary movement: Open mouth smile
- 3
- Voluntary movement: Snarl
- 3
- Voluntary movement: Lip pucker
- 4
- Synkinesis: Forehead wrinkle
- 1
- Synkinesis: Gentle eye closure
- 1
The other 3 values
- Synkinesis: Open mouth smile
- 2
- Synkinesis: Snarl
- 1
- Synkinesis: Lip pucker
- 1
Result: Sunnybrook composite 52 of 100: movement 68 minus resting 10 minus synkinesis 6.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Resting symmetry
- Eye, cheek and mouth points against the normal side, multiplied by 5.
- Voluntary movement
- Five expressions, each 1 (no movement) to 5 (complete), multiplied by 4.
- Synkinesis
- The same five expressions, each 0 (none) to 3 (severe disfiguring), added up.
- Composite
- Movement minus resting minus synkinesis: 100 is normal symmetry, 0 is complete flaccid paralysis.
What you enter
- Resting symmetry: Eye (palpebral fissure)
- Resting symmetry: Cheek (nasolabial fold)
- Resting symmetry: Mouth
- Voluntary movement: Forehead wrinkle (1 none to 5 complete)
- Voluntary movement: Gentle eye closure (1 none to 5 complete)
- Voluntary movement: Open mouth smile (1 none to 5 complete)
- Voluntary movement: Snarl (1 none to 5 complete)
- Voluntary movement: Lip pucker (1 none to 5 complete)
- Synkinesis: Forehead wrinkle (0 none to 3 severe)
- Synkinesis: Gentle eye closure (0 none to 3 severe)
The other 3 fields
- Synkinesis: Open mouth smile (0 none to 3 severe)
- Synkinesis: Snarl (0 none to 3 severe)
- Synkinesis: Lip pucker (0 none to 3 severe)
How this is calculated
Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg. 1996;114(3):380-386. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.