Sunnybrook Facial Grading System

Resting Symmetry Symmetry of Voluntary Movement Synkinesis

Compared to normal side Degree of muscle excursion Rate the degree of Involuntary Muscle
compared to normal side Contraction associated with each expression

s
Eye (choose one only)

esi

mu ovem is/
syn ot

ent
s
ring s but n
kin

eve ss m kine
normal 0

es
of s s ma g syn
mil
narrow 1

sis

scl
mo sis or

dis bviou
ent

ent

ine
ith
wide 1

vem

n
figu

Gro figuri
nt w
vem

ynk

O
ma nkine

ral
eyelid surgery 1

te
ple

ht s
ost
ion veme
ent iate
mo

Dis
:

s
sy
ss
com
ple alm
ent t

Slig

te
vem ligh
vem init
/no

No
o

ra

:
exc ted m

re
com ent

ent
ss
mo le to

te

:
Cheek (naso-lablal fild)

de
ne
vem

vem
iate

ve
urs

ld
Standard

ia
b
normal 0

Mo
Una

No
Init

Init

Se
mo

Mo

Mo

Mi
Expressions
absent 2
less pronounced
more pronounced
1
1
Forehead
Wrinkle (FRO) 1 2 3 4 5
❑ 0 1 2 3
❑
Gentle eye
closure (OCS) 1 2 3 4 5
❑ 0 1 2 3
❑
Mouth
normal 0
Open mouth
smile (ZYG/RIS) 1 2 3 4 5
❑ 0 1 2 3
❑
❑ ❑
corner dropped 1 Snarl
corner pulled up/out 1 (LLA/LLS) 1 2 3 4 5 0 1 2 3

Total ❑
Lip Pucker
(OOS/OOl) 1 2 3 4 5
❑ 0 1 2 3
❑
y

mm ild
y

Sym mal
tr y
Asy evere
y
Asy rate
y
Asy Gross

etr
etr

etr

etr

❑ ❑
M

me
Nor
mm

mm

mm
d e

Resting
S

Mo

Asy

symmetry Total X 5 Total

score

Patient’s name

Dx
Voluntary movement score: Total X 4
❑ Synkinesis score: Total
❑
Vol Resting
mov’t - symmetry - Synk
score = Composite score
Date score score
Ross, Fradet, Nedzelski 1992