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) 1 2 3 4 5 Gentle eye closure (OCS) 1 2 3 4 5 Open mouth smile (ZYG/RIS) 1 2 3 4 5 Snarl (LLA/LLS) 1 2 3 4 5 Lip Pucker (OOS/OOl) 1 2 3 4 5 ❑ Voluntary movement score: Patient’s name Dx Date Vol mov’t 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 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 Synkinesis score: = Total ❑ ❑ ❑ ❑ ❑ ❑ Composite score Ross, Fradet, Nedzelski 1992
