Sunnybrook Facial Grading System

Synkinesis

Compared to normal side

Degree of muscle excursion

compared to normal side

Rate the degree of Involuntary Muscle

Contraction associated with each expression

Mouth
normal
corner dropped
corner pulled up/out

Total
Resting
symmetry
score

Total X 5

0
1
1

Forehead
Wrinkle (FRO)

Gentle eye
closure (OCS)

Open mouth
smile (ZYG/RIS)

Snarl
(LLA/LLS)

Lip Pucker
(OOS/OOl)

Voluntary movement score:

Patients name
Dx
Date

Vol
movt
score

Resting
symmetry
score

Total

Total X 4

Synk
score

:
ne
No

Standard
Expressions

M
mm ild
etr
y
Nor
Sym mal
me
tr y

0
2
1
1

Asy

Cheek (naso-lablal fild)

normal
absent
less pronounced
more pronounced

S
Asy evere
mm
etr
y
Mo
d
e
Asy rate
mm
etr
y

0
1
1
1

Asy Gross
mm
etr
y

Eye (choose one only)

normal
narrow
wide
eyelid surgery

No
sy
ma nkine
ss
mo sis or
Mi
vem
ld
ent
:
Slig
ht s
ynk
Mo
ine
de
sis
ra
te
:
O
dis bviou
figu
Se
ring s but n
ve
re
syn ot
:
kin
Dis
esi
s
Gro figuri
n
s
of s s ma g syn
eve ss m kine
ral
s
mu ovem is/
ent
scl
es

Symmetry of Voluntary Movement

Una
b
mo le to
vem init
ent iate
/no
Init
mo
iate
vem
ss
mo
ent
vem ligh

ent t
Init
ia
exc ted m
urs
o
ion veme
nt w
Mo
ith
vem
mil
com ent
d
ple alm
te
ost
Mo
vem
ent
com
ple
te

Resting Symmetry

Synkinesis score:

Total

Composite score
Ross, Fradet, Nedzelski 1992