Citations 2
International, Multispecialty Expert Consensus on Nomenclature for Facial Paralysis
Oyer, Samuel L. , Baptista, Rachel, Boahene, Kofi , Byrne, Patrick J., Chuang, David Chwei‐Chin , Dey, Jacob K. , Diels, Jackie , Hadlock, Tessa A. , Hetzler, Laura , Klebuc, Michael, Labbé, D., Loyo, Myriam , Miller, Matthew Q. , Pepper, Jon‐Paul , Rozen, Shai M. , Snyder‐Warwick, Alison K. , Stephan, Scott J., Tzafetta, Kallirroi , Azizzadeh, Babak , Byrne, Patrick , Dey, Jacob K , Lassaletta, Luis , Loyo, Myriam , Miller, Matthew Q , Pepper, Jon-Paul , Rozen, Shai , Azizzadeh, Babak , Borschel, Gregory Howard , Guerreschi, Pierre , Gur, Eyal , Kim, Jennifer , Mardini, Samir
Facial Plastic Surgery & Aesthetic Medicine | September 30, 2025 | Volume: 27 | Issue: 5 | Pages: 408-415
Background: Variable terminology is used in the literature to describe facial synkinesis and hypertonicity following incomplete recovery from facial paralysis and its associated medical and surgical treatments. Study Objectives: Establish a nomenclature consensus for this condition among a group of facial nerve experts. Design Type: Consensus study. Methods: Using modified Delphi methodology, an international, multidisciplinary group of facial nerve experts reviewed the terminology for the name of the clinical condition and treatments of interest. Online surveys and a virtual discussion were performed to establish consensus, defined a priori as agreement by 80% of the group. Results: Twenty-five facial nerve experts established consensus after three Delphi rounds. Consensus terminology for the condition is “facial synkinesis” with 84% agreement. Medical treatment is termed “chemodenervation” with 100% agreement. Surgical treatments including “selective facial neurectomy,” “selective facial neurotomy,” “selective facial myectomy,” and “selective facial myotomy,” were defined and reached agreement of 100%. Conclusions: This international group of facial nerve experts has recommended standardized nomenclature for the condition of facial synkinesis and its various treatments. While “facial synkinesis” reached consensus as the preferred term, some experts noted it may insufficiently describe the full clinical spectrum, which includes muscle hypertonicity, weakness, and spontaneous twitching.
Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group
Carlson, Matthew L. , Lohse, Christine M. , Babu, Seilesh C. , Barker, Frederick G., Barnett, Samuel , Biggs, Nigel, Boahene, Kofi , Breen, Joseph T. , Brown, Kevin D. , Cayé‐Thomasen, Per , Cosetti, Maura K. , Deep, Nicholas L. , Dornhoffer, James R. , Forner, David , Hansen, Marlan R. , Kalamarides, Michel , Kim, Irene A., Kircher, Matthew L., Link, Michael J., Lloyd, Simon , Lund‐Johansen, Morten , Marinelli, John P. , Matthies, Cordula , Moore, Eric J. , Nassiri, Ashley M. , Neff, Brian A., Patel, Neil S. , Celda, María Peris, Plitt, Aaron , Sweeney, Alex D. , Tasche, Kendall K. , Tatagiba, Marcos , Tveiten, Øystein Vesterli , Vrabec, Jeffrey T. , Wanna, George B. , Weisskopf, Peter A., Tatagiba, Marcos , Agazzi, Siviero , Bi, Wenya Linda , Dey, Jacob K. , Gurgel, Richard Klaus , Hunter, Jacob B. , King, Andrew Thomas , Lassaletta, Luis , Mehta, Vikas , Nelson, Rick F , Olson, Jeffrey J. , Price, Daniel L. , Roland, J. Thomas , Gompel, Jamie J. Van
Otology & Neurotology | October 24, 2023 | Volume: 44 | Issue: 10 | Pages: e747-e754
Objective The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. Study Design Survey. Setting A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. Results House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. Conclusions Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.