Validation of a new graphic facial nerve grading system: FAME scale

Pawan T Ojha; Shashank Nagendra; Afroz Ansari; Nikhil Dhananjay Kadam; Ajay Mathur; Neeraja Gopinathan; Nishu Ojha; Hardik Patel; Akshay Bansode; Orpah Kalel; Kishan P Morwani; Digvijay Jagtap; Sumant Kumar; Vinod Vij

doi:10.4103/aian.aian_662_21


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ORIGINAL ARTICLE

Year : 2022 | Volume : 25 | Issue : 3 | Page : 464-472

Validation of a new graphic facial nerve grading system: FAME scale

Pawan T Ojha¹, Shashank Nagendra², Afroz Ansari², Nikhil Dhananjay Kadam², Ajay Mathur³, Neeraja Gopinathan⁴, Nishu Ojha⁵, Hardik Patel⁶, Akshay Bansode⁶, Orpah Kalel⁷, Kishan P Morwani⁷, Digvijay Jagtap¹, Sumant Kumar⁸, Vinod Vij⁹
¹ Department of Neurology, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
² Department of Neurology, Grant Medical College and JJ Hospital, Mumbai, Maharashtra, India
³ Department of Dentistry, Grant Medical College and JJ Hospital, Mumbai, Maharashtra, India
⁴ Department of Dentistry, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
⁵ Department of Neurophysiology, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
⁶ Department of Physiotherapy, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
⁷ Department of ENT, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
⁸ Department of Research Co-Ordinator, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India
⁹ Department of Plastic Surgery, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India

Correspondence Address:
Pawan T Ojha
Fortis Hiranandani Hospital, Mini Seashore Rd, Sector 10, Vashi, Navi Mumbai, Maharashtra – 400 703
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/aian.aian_662_21

Background and Objective: Most of the existing qualitative facial nerve grading systems are very subjective while the quantitative grading systems are more complex, require longer data input time and specific software. There is a need for having a scoring system with graphic criteria to improve the subjectivity, reliability and convenience. We aimed to develop and validate such a reliable graphic scale for use in Bell's palsy. Methods: Face videos of patients with unilateral facial paralysis were recorded using smartphones and analyzed for six items including five voluntary facial movements apart from complications of facial palsy (synkinesis, hyperkinesis, and contracture). 15 videos were used for pilot study, 75 for the development of scale and 110 for its validation. Each video was rated on two separate occasions by 3 independent raters, a score of 0-4 was assigned to each item using the graphic scoring criteria, and a composite score was obtained (range 0–24). Five disease severity categories: normal (score 0), mild (score 1–6), moderate (score 7-12), severe (score: 13–18) and profound facial weakness (score: 19-24). Results: The proposed scale and its component items had high inter-rater and intra-rater reliability (Kappa >0.7). Good correlation (Pearson co-efficient >0.7) was seen among the voluntary movements. The proposed scale is a valid tool to score motor deficits and complications of facial palsy. Conclusions: The proposed scale is a valid and reliable graphic scale to describe facial motor dysfunction and its secondary defects.

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