Table 3.
Proposal for documentation of facial ENoG, nEMG, blink reflex testing (adapted from [11])
| Name of the patient | ||||||||||||
| Date of birth | MM-DD-YYYY | |||||||||||
| ID | ||||||||||||
| Diagnosis | ||||||||||||
| Side of the facial paralysis | R | L | Bilateral | Other | ||||||||
| Comorbidity of relevance for facial electrodiagnostics | Blood thinner? Neurological diseases? | |||||||||||
| Date of the examination | MM-DD-YYYY | |||||||||||
| Examiner | ||||||||||||
| Electrodiagnostic equipment used | Of relevance, if there are several workplaces | |||||||||||
| ENoG | ||||||||||||
| Simulation site | Stylomastoid groove/foramen | Other | ||||||||||
| Recording site | Nasal alae | Other | ||||||||||
| Supramaximal stimulation | mA | |||||||||||
| CMAP contralateral side | Side | mV peak-to-peak amplitude | ||||||||||
| CMAP affected side | Side | mV peak-to-peak amplitude | ||||||||||
| Ratio paralyzed/healthy side | % | |||||||||||
| nEMG | Frontalis | Oculi | Oris | Zygomaticus | Other muscle | R | L | |||||
| Insertion activity | ||||||||||||
| No activity | ||||||||||||
| Normal activity (< 300 ms) | ||||||||||||
| Increased activity | ||||||||||||
| Highly increased activity | ||||||||||||
| Pathologic spontaneous activity | ||||||||||||
| No reproducible pathologic spontaneous activity | ||||||||||||
| Little pathologic spontaneous activity | ||||||||||||
| Moderate pathologic spontaneous activity | ||||||||||||
| Dense pathologic spontaneous activity | ||||||||||||
| Volitional activity | ||||||||||||
| No activity | ||||||||||||
| Single fiber pattern | ||||||||||||
| Strongly decreased recruitment pattern | ||||||||||||
| Mildly decreased recruitment pattern | ||||||||||||
| Normal/dense recruitment pattern | ||||||||||||
| Morphology of waveform | ||||||||||||
| Normal biphasic motor unit potential | ||||||||||||
| Early polyphasic reinnervation potentials with low amplitude and long duration | ||||||||||||
| Giant polyphasic reinnervation potentials with high amplitude and long duration | ||||||||||||
| Myogenic polyphasic potentials with low amplitude but normal duration | ||||||||||||
| Synkinesis | Activity seen in: | |||||||||||
| Frontalis | Oculi | Oris | Zygomaticus | Other muscle | R | L | ||||||
| Task 1: Closing eyes | ||||||||||||
| Task 2: Pursing lips | ||||||||||||
| Task 3: | ||||||||||||
| Task 4: | ||||||||||||
| Taske5: | ||||||||||||
| Blink reflex | ||||||||||||
| Simulation site | Supraorbital nerve | Other | ||||||||||
| Recording site | Orbicularis oris muscle, bilateral | Other | ||||||||||
| Supramaximal stimulation | mA | |||||||||||
| Latency R1 ipsilateral | ms (normal ≤ 12 ms) | |||||||||||
| Latency R2 ipsilateral | ms (normal ≤ 40 ms) | |||||||||||
| Latency R2 contralateral | ms (normal ≤ 40 ms | |||||||||||
| Latency R2 side difference | ms (normal ≤ 5 ms) | |||||||||||
| Interpretation | ||||||||||||