Table 5.

Comparison of various major facial scales

Scale	Reliability	Scale details	Limitations/comments.
House Brackmann Score	Mean weighted kappa 0.67.	Global scale, 6 grades.	Although rapid, it is a subjective, discontinuous scale that inadequately
			considers the regional deficits and secondary defects. Marked intra-observer variation especially in assigning grade 3 and 4.
MoReSS score	ICC of 0.882, 95% confidence interval (0.821, 0.927)	Measures movements, rest symmetry, synkinesis and subjective scoring by patient. Total score is Mo12, Re8, S6, S10.	The scale is complex and subjective as deficits grading based on terms such as mild, moderate, severe.
Nottingham score	Component of variance 7%	Continuous scale, measures movements and secondary defects	Cumbersome to use, requires calculation of percentage deficits and applying complex formula for score.
Yanagihara	Used as a prognostic scale	It measures of 10 separate functions in facial muscles on a scale of 0 to 4.	The scoring is subjective as it relies on vague terms such as mild moderate, severe palsy. Although less accurate but is still accepted as the standard in Japan.
Sunnybrook	Reliability: mean intraclass correlation coefficient 0.63: good	Measures resting symmetry, five voluntary movements and synkinesis. Composite score=Voluntary score-(resting symmetry + synkinesis scores)	Scoring is subjective as it relies on terms such as slight, mild, almost complete.
			The methods are time-consuming, and the calculations of the linear measurement index are complex.
FNGS 2.0	Intra-class Correlation: 0.843 (CI: 0.701-0.968.	Measures voluntary movements deficits on a scale of 1-6 in 4 face regions and synkinesis on scale of 0-3, added to provide composite score.	Scores assigned on the basis of estimation of percentage deficits (25%, 50%, 75% etc.) in voluntary movements, causing inherent subjectivity. Synkinesis are scored globally and not region-wise.
Facogram	Mean intra class correlation is 0.72	Analysis of video pixel data using computerised artificial neural networks (ANNs).	It does not assess resting symmetry or synkinesis and cannot be used in bilateral weakness or in presence of strabismus, extraocular palsy.
Auto eFACE	The intraclass correlation coefficient is 0.97.	App based scale, for use in electronic gadgets. 16 items scored in a visual analogue scale format to assess resting symmetry, voluntary facial function, synkinesis and provide an overall facial disfigurement score.	Shortcomings of the tool: can be time consuming, depends on availability of an electronic device, lacks utility in patients with bilateral facial paralysis. Requires more upfront “learning” to establish definitions of different levels of function.
FAME (proposed)	Intra-class correlation: 0.876 (CI: 0.778-0.974.	Scores voluntary movements and synkinesis on graphic scale, minimizes subjectivity of scoring.	Difficulty in scoring bilateral palsy. Synkinesis can be scored separately for different face regions.