Alagha Mahmoud A, Ju Xiangyang, Morley Stephen, Ayoub Ashraf F
Scottish Craniofacial Research Group, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom.
Medical Device Unit, Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Hospital, Glasgow, United Kingdom.
J Plast Reconstr Surg. 2023 Apr 14;2(3):77-88. doi: 10.53045/jprs.2022-0017. eCollection 2023 Jul 27.
Despite the limited validity of the Sunnybrook grading index, it is routinely used for the clinical evaluation of facial palsy. This study aimed to assess the dynamic asymmetry in unilateral facial palsy and mathematically validate a modified version of the Sunnybrook facial grading system.
The Sunnybrook facial grading system was modified to provide more descriptions of the measured parameters of the distorted facial expression in unilateral facial paralysis. This correlation study was conducted on 16 patients with unilateral facial palsy and a matched control group. Three-dimensional video recordings of six facial expressions - rest, maximum smile, cheek puff, lip purse, eyebrow raising, and eye closure - were used for each case in the analysis. Advanced geometric morphometrics were applied to quantify facial asymmetry and morphology throughout the course of each expression. Seven professional assessors graded facial asymmetry for the 16 cases, twice, using the modified Sunnybrook index. Cross-correlations between the objective mathematical measurements and the subjective clinical grades were calculated.
The inter- and intra-observer reproducibility of the modified Sunnybrook index was high ( = -0.8). Significant positive correlations were detected between the clinical grading of facial palsy and the mathematical measurements at rest, maximum smile, lip purse, and raising of eyebrows. The correlations between the modified Sunnybrook index and mathematical measurements were poor for cheek puff and forceful eye closure.
The modified Sunnybrook grading index proved reproducible and mathematically valid for the grading of unilateral facial paralysis in most facial expressions, except for cheek puff and forceful eye closure.
尽管桑尼布鲁克分级指数的有效性有限，但它仍被常规用于面瘫的临床评估。本研究旨在评估单侧面瘫的动态不对称性，并从数学角度验证改良版的桑尼布鲁克面部分级系统。
对桑尼布鲁克面部分级系统进行改良，以更详细地描述单侧面瘫中面部表情扭曲的测量参数。本相关性研究对16例单侧面瘫患者和一个匹配的对照组进行。分析中对每个病例使用六种面部表情（休息、最大程度微笑、鼓腮、噘嘴、抬眉和闭眼）的三维视频记录。应用先进的几何形态测量学来量化每个表情过程中的面部不对称性和形态。七名专业评估者使用改良的桑尼布鲁克指数对这16例病例的面部不对称性进行两次评分。计算客观数学测量值与主观临床评分之间的交叉相关性。
改良的桑尼布鲁克指数在观察者间和观察者内的可重复性都很高（=-0.8）。在休息、最大程度微笑、噘嘴和抬眉时，面瘫的临床分级与数学测量值之间检测到显著的正相关。对于鼓腮和用力闭眼，改良的桑尼布鲁克指数与数学测量值之间的相关性较差。
改良的桑尼布鲁克分级指数在大多数面部表情中，除了鼓腮和用力闭眼外，被证明对单侧面瘫的分级具有可重复性且在数学上是有效的。
