Arch Plast Surg.  2021 May;48(3):269-277. 10.5999/aps.2020.01844.

Computerized Sunnybrook facial grading scale (SBface) application for facial paralysis evaluation

  • 1Plastic and Reconstructive Surgery Unit, Department of Surgery, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
  • 2Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
  • 3Department of Otorhinolaryngology, Buddhasothorn Hospital, Chachoengsao, Thailand


The Sunnybrook facial grading scale is a comprehensive scale for the evaluation of facial paralysis patients. Its results greatly depend on subjective input. This study aimed to develop and validate an automated Sunnybrook facial grading scale (SBface) to more objectively assess disfigurement due to facial paralysis.
An application compatible with iOS version 11.0 and up was developed. The software automatically detected facial features in standardized photographs and generated scores following the Sunnybrook facial grading scale. Photographic data from 30 unilateral facial paralysis patients were randomly sampled for validation. Intrarater reliability was tested by conducting two identical tests at a 2-week interval. Interrater reliability was tested between the software and three facial nerve clinicians.
A beta version of the SBface application was tested. Intrarater reliability showed excellent congruence between the two tests. Moderate to strong positive correlations were found between the software and an otolaryngologist, including the total scores of the three individual software domains and composite scores. However, 74.4% (29/39) of the subdomain items showed low to zero correlation with the human raters (κ<0.2). The correlations between the human raters showed good congruence for most of the total and composite scores, with 10.3% (4/39) of the subdomain items failing to correspond (κ<0.2).
The SBface application is efficient and accurate for evaluating the degree of facial paralysis based on the Sunnybrook facial grading scale. However, correlations of the software-derived results with those of human raters are limited by the software algorithm and the raters’ inconsistency.


Facial paralysis / Scale / Mobile application / Photographic / Software validation
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