Predicting Resting Oral Commissure Tone Outcomes Following Masseter Nerve Transfer in Facial Reanimation.

Objective: To quantify the degree of oral commissure resting tone improvement in patients undergoing masseter to facial nerve transfer. Methods: A retrospective cohort study was completed in a tertiary academic medical practice. Consecutive cases of masseter nerve transfer patients within a patient database were evaluated from 6/2012 to 9/2017. Inclusion criteria were patients >18 years of age, with complete unilateral paralysis, receiving a masseter to facial nerve transfer, with at least 12 months of recovery, and possessing complete pre- and postoperative data. Patients were excluded if a simultaneous adjunctive procedure was performed so that tone could not be attributed to masseter transfer alone. The main outcome measure was the facial asymmetry index (FAI): the measured difference in distance between the medial canthus and oral commissure of the healthy and paralyzed sides. Results: Twenty-nine patients met inclusion and exclusion criteria and were further analyzed for this study. The oral commissure symmetry improved from 4.7 ± 2.8 mm preoperatively to 2.2 ± 2.3 mm postoperatively. In multivariate analysis, the preoperative FAI was the only significant predictive factor for improvement in commissure symmetry at rest (r = 0.589). This suggests that for each 1.0 mm of worse preoperatively oral commissure asymmetry, the improvement postoperatively was 0.6 mm. Age, gender, body mass index, side of paralysis, duration of paralysis, and recipient branch of facial nerve were not significant predictors in a multivariate analysis. Conclusion: Masseter to facial nerve transfer yields an estimated 60% correction in the oral commissure asymmetry. This estimation may be helpful in determining if adjunctive procedures should be utilized.

Complications of botulinum toxin and fillers: A narrative review.

BACKGROUND: Cosmetic surgery and esthetic procedures have become a billion dollar industry owing to the ever-growing demand of the population to stay young. The injectable treatments including fillers and botulinum toxin have become highly popular because of their quick, predictable and lasting results in the management of facial wrinkles and rejuvenation. Although these treatment modalities are relatively safe, they are associated with certain side effects. AIMS: In this review, we will focus on the complications of fillers and botulinum toxin. PATIENTS/METHODS: The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review. RESULTS: Brow ptosis and asymmetry are common adverse effects of botulinum toxin while the most common adverse effects associated with fillers are the local injection related effects manifesting as erythema, edema, pain, and ecchymosis. CONCLUSION: It is important that the treating physician is well verse with the various fillers and botulinum toxin complications and their management as some of the complications can be severely debilitating.

Orofacial functions and quality of life in children with unilateral cleft lip and palate

Abstract This study aimed to evaluate the orofacial functions and oral health-related quality of life (OHRQoL) of children with unilateral cleft lip and palate (UCLP). This case-control study included patients with UCLP matched by sex and age with controls (children without UCLP), resulting in the inclusion of a total of 108 eight- to ten-year-old children. Orofacial functions and OHRQoL were evaluated using the Nordic Orofacial Test-Screening (NOT-S) and the Child Perceptions Questionnaire (CPQ 8-1 0 ), respectively. Data normality was assessed by the Kolmogorov-Smirnov test. Differences and correlations in NOT-S and CPQ 8-1 0 scores between and within the groups were evaluated using Mann-Whitney and Spearman´s correlation tests, respectively. The distribution of NOT-S and global ratings of CPQ 8-1 0 for each group were assessed by Chi-squared/Fisher's Exact tests. The UCLP group had a higher NOT-S total and examination scores than the controls. Dysfunctions related to breathing, facial symmetry/expression, and speech were more frequent in the UCLP patients than in the controls. The UCLP group had higher scores on the social well-being domain than the controls. There was a significant difference between the groups in their ratings in regards to the extent to which their oral condition affected their life overall, with controls perceiving it as somewhat better than patients. In both groups, NOT-S total and interview scores were positively correlated with CPQ 8-1 0 total and domain scores. The NOT-S examination score was only significantly correlated with social domain scores in the control group. The presence of UCLP was associated with clinical signs of orofacial dysfunctions related to breathing, facial symmetry/expression, and speech. Children with UCLP reported more orofacial dysfunctions and negative impacts on social well-being than controls.

Temporomandibular Joint Ankylosis: Algorithm of Treatment.

: Temporomandibular joint ankylosis, according to age of onset, causes severe functional and morphological disorders, as well as stunted craniofacial growth and development.The primary goal of treatment is to resolve the functional and morphological disorders. METHOD: Pre- and posttreatment clinical and cephalometric registries were conducted in 15 patients with temporomandibular joint ankylosis over a 10-year period (2002-2012). All the patients underwent complete removal of the ankylotic block, gap arthroplasty, and ipsilateral coronoidectomy. Distraction osteogenesis was performed on 12 patients. RESULTS: Fifteen patients, 8 female and 7 male, ranging from 3 to 30 years of age, were included in this study. The posttreatment follow-up period ranged from 3 to 13 years.The mean preoperative maximum mouth opening was 3 ± 1.7 mm, and the mean postoperative maximum mouth opening was 36 ± 6.5 mm. The labial inclination with respect to the true horizontal decreased considerably (6.2° ± 2.3° preoperative to 1° ± 1.6° postoperative). A correction of the mandibular deviation was measured at the symphysis with respect to the facial midline (8° ± 2° preoperative to 2° postoperative). Finally, the height ratio of both mandibular rami (the healthy side and the affected side) decreased considerably (1.27 ± 0.05 preoperative to 1.07 ± 0.06 postoperative).Reankylosis only occurred in 2 patients, who were then successfully treated by means of gap arthroplasty. CONCLUSIONS: The therapeutic algorithm proposed in the present work provides favorable functional and morphological results. Early and aggressive functional physiotherapy is essential to minimize the risk of reankylosis.

Surface electromyography before and after orthognathic surgery and condylectomy in active laterognathia: a case report.

BACKGROUND: Condylar hyperplasia is a rare bone disease characterised by excessive development of mandibular condyle, which can lead to the development of asymmetric facial deformity together with malocclusion, mandibular deviation, TMJ and masticatory musculoskeletal system dysfunction. There is not a treatment protocol universally accepted. In order to determine the correct management, treatment and intervention timing of these patients, morphological examinations should be coupled with functional assessments. CASE REPORT: In the present case report, morphological (bone scintigraphy; orthopantomography; posteroanterior and lateral cephalograms; 3D facial photographs) and functional (surface electromyography of masseter and temporalis muscles) quantitative data of a 20-year-old male patient affected by unilateral condylar hyperplasia are presented. The patient underwent a surgical treatment with high unilateral condylectomy associated to a maxillary Le Fort I osteotomy; as well as orthodontic treatment before and after surgery. Facial morphology and masticatory muscles activity were assessed before surgery and followed-up 6, 12 and 24 months after surgery. Twenty-four months after surgery, all electromyographic values were normal, and soft-tissue facial asymmetry was negligible at 3D assessment. CONCLUSION: Surface electromyography joins a set of clinical and morphological diagnostic tests that help the surgeon in planning the operation and managing the post-surgical patient.

Maxillofacial features and systemic malformations in expanded spectrum Hemifacial Microsomia.

Hemifacial microsomia (HFM) is a rare, multisystemic congenital disease with estimated frequency of 1/26370 births in Europe. Most cases are sporadic and caused by unilateral abnormal morphogenesis of the first and second pharyngeal arches. The aim of this study is to define the types and frequency of maxillofacial and systemic malformations in HFM patients. This is a case series study of patients with HFM evaluated at a single institution. Data were acquired through history, physical examination, photographs, diagnostic radiology, and laboratory and analyzed by the FileMakerPro database on 95 patients (54F; 41M) of which 89 met the inclusion criteria. Mandibular hypoplasia was observed in 86 patients with right-side preponderance (50). One patient had bilateral mandibular hypoplasia. Seventy-four had external ear anomalies (anotia or microtia). Eleven had bilateral malformed ears. Hearing impairment, associated with stenosis or atresia of the external ear canal, was found in 69 patients (eight with bilateral canal defects). Ocular anomalies were seen in 41 (23 with dermoid cysts) and 39 had orbital malformations. Facial nerve paralysis was observed in 38 patients. Cleft lip/palate (10), preauricular tags (55), and macrostomia (41) were also described. A total of 73/86 had systemic malformations, mainly vertebral (40), genitourinary (25), and cardiovascular (28). Sixteen had cerebral anomalies (four with intellectual disability). All patients suspected of HFM should undergo a complete systematic clinical and imaging investigation to define the full scope of anomalies. Since the disease is rare and complex, affected patients should be monitored by specialized multidisciplinary team centers.

Three-dimensional surgical simulation improves the planning for correction of facial prognathism and asymmetry: A qualitative and quantitative study.

Traditional planning method for orthognathic surgery has limitations of cephalometric analysis, especially for patients with asymmetry. The aim of this study was to assess surgical plan modification after 3-demensional (3D) simulation. The procedures were to perform traditional surgical planning, construction of 3D model for the initial surgical plan (P1), 3D model of altered surgical plan after simulation (P2), comparison between P1 and P2 models, surgical execution, and postoperative validation using superimposition and root-mean-square difference (RMSD) between postoperative 3D image and P2 simulation model. Surgical plan was modified after 3D simulation in 93% of the cases. Absolute linear changes of landmarks in mediolateral direction (x-axis) were significant and between 1.11 to 1.62 mm. The pitch, yaw, and roll rotation as well as ramus inclination correction also showed significant changes after the 3D planning. Yaw rotation of the maxillomandibular complex (1.88 ± 0.32°) and change of ramus inclination (3.37 ± 3.21°) were most frequently performed for correction of the facial asymmetry. Errors between the postsurgical image and 3D simulation were acceptable, with RMSD 0.63 ± 0.25 mm for the maxilla and 0.85 ± 0.41 mm for the mandible. The information from this study could be used to augment the clinical planning and surgical execution when a conventional approach is applied.

Evaluation of Repairing Facial Depression Deformities Secondary to Lupus Erythematosus Panniculitis With Autologous Fat Grafting.

BACKGROUND: A facial depression deformity secondary to lupus erythematosus panniculitis results from fat necrosis, which seriously alters the patients' appearance and thus affects their psychological health. Few studies have discussed the repair of depression deformities. The authors repaired depression deformities due to atrophic lesions by using autologous fat grafting to obtain volumetric restoration of the facial skin, and the authors report our outcomes. METHODS: In this series, 30 depression deformities in 18 patients were repaired. The authors suctioned fat grafts from the abdomen and centrifuged them at 500×g for 2 minutes. After discarding the upper oil and bottom liquid, the middle fat was injected into the depressed areas (ie, the cheek, temple, and zygoma) by using multiplane and multitunnel injections. The patients, plastic surgeons on staff, and laypersons evaluated the cosmetic outcome of each patient. RESULTS: No infection, subcutaneous nodules or cysts, cutaneous necrosis, blood vessel embolism, or other complications were found in any patient. Five patients had 1 injection, 5 had 2 injections, and 8 had 3 injections. All depression deformities improved. Regarding the cosmetic outcome, 33.3% of patients, 27.8% of laypersons, and 38.9% of doctors were satisfied with the results; 44.4% of patients, 55.6% of laypersons, and 50.0% of doctors were mostly satisfied. CONCLUSION: Autologous fat grafting can be a good choice for repairing facial depression deformities in patients with lupus erythematosus panniculitis, although 1 or more subsequent injections may be required to maintain the improved outcome.

Congenital and acquired mandibular asymmetry: Mapping growth and remodeling in 3 dimensions.

INTRODUCTION: Disordered craniofacial development frequently results in definitive facial asymmetries that can significantly impact a person's social and functional well-being. The mandible plays a prominent role in defining facial symmetry and, as an active region of growth, commonly acquires asymmetric features. Additionally, syndromic mandibular asymmetry characterizes craniofacial microsomia (CFM), the second most prevalent congenital craniofacial anomaly (1:3000 to 1:5000 live births) after cleft lip and palate. We hypothesized that asymmetric rates of mandibular growth occur in the context of syndromic and acquired facial asymmetries. METHODS: To test this hypothesis, a spherical harmonic-based shape correspondence algorithm was applied to quantify and characterize asymmetries in mandibular growth and remodeling in 3 groups during adolescence. Longitudinal time points were automatically registered, and regions of the condyle and posterior ramus were selected for growth quantification. The first group (n = 9) had a diagnosis of CFM, limited to Pruzansky-Kaban type I or IIA mandibular deformities. The second group (n = 10) consisted of subjects with asymmetric, nonsyndromic dentofacial asymmetry requiring surgical intervention. A control group (n = 10) of symmetric patients was selected for comparison. A linear mixed model was used for the statistical comparison of growth asymmetry between the groups. RESULTS: Initial mandibular shape and symmetry displayed distinct signatures in the 3 groups (P <0.001), with the greatest asymmetries in the condyle and ramus. Similarly, mandibular growth had unique patterns in the groups. The dentofacial asymmetry group was characterized by significant asymmetry in condylar and posterior ramal remodeling with growth (P <0.001). The CFM group was characterized by asymmetric growth of the posterior ramus (P <0.001) but relatively symmetric growth of the condyles (P = 0.47). CONCLUSIONS: Forms of CFM are characterized by active and variable growth of the dysplastic side, which has a distinct pattern from other disorders of mandibular growth.

Weighting of Facial Grading Variables to Disfigurement in Facial Palsy.

IMPORTANCE: A universal, health care professional-graded scale for facial assessment would be a useful tool for reporting, comparing, and assessing facial function among patients with facial paralysis. OBJECTIVES: To correlate scores of an assessment tool, the eFACE scale, with expert-rated facial disfigurement and to determine the relative contributions of facial features to facial palsy-related disfigurement. DESIGN, SETTING, AND PARTICIPANTS: The eFACE scale yields 15 individual variable scores, in addition to subscores for static, dynamic, and synkinesis elements, and a total score that is based on 100-point scales. Two hundred patients with varying degrees of unilateral facial palsy underwent independent eFACE assessment and assignment of a disfigurement score by 2 facial nerve surgeons. The mean scores were determined, and multivariate regression analysis was performed to fit eFACE subset scores (static, dynamic, and synkinesis) to disfigurement ratings. A hybrid regression model was then used to weight each of the 15 eFACE variables, using stepwise regression to control for the effect of the other variables. Scoring was performed during an 8-week period from March 16 to May 8, 2015. MAIN OUTCOME AND MEASURE: Use of the 100-point eFACE variables, together with a 100-point visual analog scale of disfigurement, with 0 representing the most extreme disfigurement possible from a facial nerve disorder and 100 representing no discernible facial disfigurement. RESULTS: In the 200 patients included in analysis (126 [63.0% female]; mean [SD] age, 46.5 [16.4] years]), predicted disfigurement scores based on eFACE subset scores demonstrated excellent agreement with surgeon-graded disfigurement severity (r2 = 0.79). Variable weighting demonstrated that the 6 key contributors to overall disfigurement were (in order of importance) nasolabial fold depth at rest (normalized coefficient [NC], 0.18; P < .001), oral commissure position at rest (NC, 0.15; P < .001), lower lip asymmetry while pronouncing the long /e/ (NC, 0.09; P < .001), palpebral fissure width at rest (NC, 0.09; P < .001), nasolabial fold orientation with smiling (NC, 0.08; P = .001), and palpebral fissure width during attempts at full eye closure (NC, 0.06; P = .03). CONCLUSIONS AND RELEVANCE: A mathematical association between eFACE-measured facial features and overall expert-graded disfigurement in facial paralysis has been established. For those using the eFACE grading scale, predictions of the specific effects of various interventions on expert-rated disfigurement are now possible and may guide therapy. LEVEL OF EVIDENCE: NA.

Changes in occlusal function after orthognathic surgery in mandibular prognathism with and without asymmetry.

This study aimed to evaluate the postoperative changes in masticatory function in patients with jaw deformities with or without asymmetry treated by orthognathic surgery. Thirty female patients who underwent a Le Fort I osteotomy with sagittal split ramus osteotomy (SSRO) were enrolled. The patients were divided into symmetry and asymmetry groups. The bite force, occlusal contact area, and bite force balance were measured before and at 1, 3, and 6 months and 1 year after surgery; these measurements were compared statistically within and between the two groups. In the symmetry group, there was a significant difference in the preoperative bite force and the 1 month postoperative bite force (P=0.0033). In the asymmetry group, the bite force before surgery was significantly different from that at 1 month (P=0.0375) and at 1 year (P=0.0353) after surgery. Significant differences in the bite force were also observed between the following time points: 1 month and 1 year (P=0.0003), 3 months and 1 year (P=0.0034), and 1 month and 6 months (P=0.0486). The occlusal contact area, bite force, and occlusal balance tended to change after Le Fort I osteotomy with SSRO, with a significantly improved bite force in patients with asymmetry before surgery.

Evaluation of intra-articular distance narrowing during temporomandibular joint movement in patients with facial asymmetry using 3-dimensional computed tomography image and tracking camera system.

INTRODUCTION: Functional overloading can lead to disc displacement in the temporomandibular joint (TMJ), and a high incidence of disc displacement has been reported in patients with facial asymmetry. The aim of this study was to assess the dynamic condylar movement in patients (n = 26) with facial asymmetry using a simulation system with 3-dimensional computed tomographic images and tracking camera system. MATERIAL AND METHODS: The intra-articular distance (IAD) between the condyle and glenoid fossa was recorded during TMJ movement as a parameter for functional overloading and compared between Group I with severe asymmetry and Group II with mild asymmetry. RESULTS: The average IAD was shorter in Group I than Group II, especially at the lowest point (P < 0.05). The ratio of IAD narrowing in Group I was significantly larger than in Group II (P < 0.05). The mean IAD were slightly smaller on the deviated side (3.41 mm) than on the nondeviated side (3.55 mm) in Group I, even though there was no statistical significance. The maximum displacement in Group I was longer than in Group II and had no significant difference between deviated side and nondeviated side. CONCLUSION: We suggested that the reduced IAD resulting from TMJ overloading can lead to internal derangement in severe facial asymmetry.

Mandibular asymmetry in patients with the crouzon or apert syndrome.

The aim of this study was to describe directional and fluctuating mandibular asymmetry over time in children with Crouzon or Apert syndrome. Mandibular asymmetry of children between 7.5 and 14 years of age with Crouzon syndrome (n = 35) and Apert syndrome (n = 24) were compared with controls (n = 327). From panoramic radiographs, mandibular directional and fluctuating asymmetry was determined for the three groups. Multilevel statistical techniques were used to describe mandibular asymmetry changes over time. Patients with Crouzon and Apert syndromes showed statistically significant more fluctuating asymmetry for mandibular measures than did controls. Between the Crouzon and Apert syndromes groups, no statistical differences were found in directional and fluctuating asymmetry. The control group showed statistically significantly more directional asymmetry than did patients with Crouzon or Apert syndrome. The controls showed no change over time for the directional asymmetry of condylar-ramal height; however, the directional asymmetry of the gonial angle increased. Patients with Crouzon syndrome showed side dominance for only condylar-ramal height; whereas, patients with Apert syndrome did not show dominance for any of the measurements. Apert and Crouzon syndromes showed developmental instability, in contrast to the controls. No statistically significant longitudinal differences were found for either the directional or the fluctuating asymmetry between Crouzon and Apert syndromes. Findings for fluctuating and directional asymmetry for both syndromes may indicate an inability to cope with genetic and environmental stress during development and treatment, compared with untreated nonsyndromic individuals.

On facial asymmetry and self-perception.

Self-perception has been an enduring human concern since ancient times and remains a significant component of the preoperative and postoperative consultation. Despite modern technological attempts to reproduce the first-hand experience, there is no perfect substitute for human, stereoscopic, three-dimensional vision in evaluating appearance. Nowadays, however, the primary tools available to a patient for examining his or her own appearance, particularly the face, are photographs and mirrors. Patients are often unaware of how cameras and photographs can distort and degrade image quality, leading to an inaccurate representation of true appearance. Everyone knows that mirrors reverse an image, left and right, and most people recognize their own natural facial asymmetry at some level. However, few realize that emotions are not only expressed unequally by the left and right sides of the face but also perceived unequally by others. The impact and effect of this "facedness" is completely reversed by mirrors, potentially creating a significant discrepancy between what a patient perceives of himself or herself and what the surgeon or other third party sees. This article ties together the diverse threads leading to this problem and suggests several ways of mitigating the issue through technology and patient counseling.

Surgical treatment of unilateral condylar hyperplasia with piezosurgery.

INTRODUCTION: Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in association with orthognathic surgery can improve the occlusion and the facial aesthetics. MATERIALS AND METHODS: Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation. RESULTS: The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth. CONCLUSIONS: High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy.

Detection and perceptual impact of side-to-side facial movement asymmetry.

IMPORTANCE: In this study, we examined whether specific facial movements have different time-delay detection thresholds, and to what extent such side-to-side facial movement asymmetry affects subjective ratings of movement naturalness. Ratings of dynamic asymmetry in experimentally manipulated video recordings demonstrate that there are different side-to-side time-delay thresholds for distinct regions of the face, with a strong inverse correlation between naturalness rating and the length-of-time delay. These findings will be helpful for counseling patients with unilateral facial paralysis and guide the design of neural interfaces for facial reanimation. OBJECTIVE: To determine the detection threshold of side-to-side facial movement timing asymmetry and measure its effect on perceived movement naturalness. DESIGN, SETTING, AND PARTICIPANTS: Videos of 5 symmetrical facial movements (eye blink, rapid eyebrow raising, slow eyebrow raising, smiling, and lip depression) were edited to introduce 6 levels of side-to-side timing asymmetry, ranging from 33 to 267 milliseconds. Participants (N = 58) viewed video clips through an online survey service, indicating whether they noticed side-to-side asymmetry and judging movement naturalness on a 5-point scale. RESULTS: There was a significant difference among facial movements in asymmetry detection threshold. There was a strong correlation between naturalness ratings and amount of delay across movements (R = 0.823), with greater asymmetry being judged as progressively less natural. Blink was judged as less natural at 33, 67, 100, and 133 milliseconds of side-to-side delay compared with all other movements (P < .005). CONCLUSIONS AND RELEVANCE: Side-to-side asymmetry in blink timing is detected sooner and viewed as less natural compared with asymmetry of the eyebrow and lips. At 100 milliseconds of delay, nearly all movements are detected as asymmetric, although blink is judged as the least natural. These findings will help set timing goals for facial pacing technologies treating unilateral paralysis. LEVEL OF EVIDENCE: NA.

Tension adjusted multivectorial static suspension with plantaris tendon in facial paralysis.

Facial paralysis in the midface causes loss of cheek tonus, asymmetry at rest, and inability to smile. Static suspension is generally performed in patients who cannot tolerate time-consuming dynamic reanimation. Current methods for static slings are overly simplistic. A sling, which is generally fascia lata or palmaris tendon, is placed between the modiolus and the zygomatic arch or the temporalis fascia, with further extension to the midline of the upper end lower lips in 1 vector. Recently, sutures are placed in a multivectorial approach, but suture failure via breakage is the main problem. In this study, the long, thin, and powerful plantaris tendon was used and divided into 3 slips. Placement of these slips and their tension adjustment were revised to provide strong and long-lasting upper lip and the modiolus pull, along with creation of a well-defined nasolabial fold, and to create sufficient cheek tonus. The first slip was positioned at 35 to 45 degrees to the horizontal plane between the modiolus and the upper preauricular area, second slip at 55 to 60 degrees between the upper lip and the deep temporal fascia, and the third slip at 0 to 10 degrees between the lower lip and lower preauricular area with gradually decreasing tension from above to below in 9 patients. Upper 2 slings were also sutured to the dermis of the nasolabial fold to define it optimally. Results were assessed both objectively and subjectively. Symmetry at rest, sufficient cheek tightness to prevent drooling, and a well-defined fold were obtained.

A step backward: the 'Rough' facial nerve grading system.

OBJECTIVES: Several modalities currently exist to rate the degree of facial function clinically but even though it has significant limitations, the most widely used scale is the House-Brackmann grading system (HBGS). A simplified scale is introduced here, the 'Rough' Grading System (RGS - Grade I: normal movement; Grade II: slight paralysis; Grade III: frank paralysis with eye closure; Grade IV: frank paralysis without eye closure; Grade V: almost complete paralysis with only slight movements; Grade VI: total paralysis). The aim of the present study was to verify the interrater reliability and the interscale validity of this simplified grading system. STUDY DESIGN: Scale validation study based on a prospective cohort. METHODS: Fifty patients with facial palsy, consecutively referred to our department were filmed while performing some codified facial movements. Then two independent groups (one rating using the HBGS, the other rating using the RGS) assigned a grade after reviewing the videos. The time required for the rating was also noted. RESULTS: The HBGS showed a mean value of interrater agreement of 0.46 while the RGS showed a mean value of 0.59. The concurrent validity between HBGS and RGS ranged from 0.86 to 0.90 (p < 0.001 for every comparison). There was no statistically significant difference between HBGS and RGS in the mean time taken for rating (p = 0.15). CONCLUSIONS: The RGS reached an adequate level of interrater reliability, higher than the HBGS. The correlation between the two scales is high and the times required for rating are similar. The present results may justify the use of the RGS in routine clinical practice. LEVEL OF EVIDENCE: N/A.