Post-parotidectomy facial nerve function: comparison between original and modified Sunnybrook Facial Grading Systems

• Published in: Arquivos de neuro-psiquiatria Vol. 81; no. 11; pp. 970 - 979
• Main Authors: Targino da Costa, Márcia Gonçalves e Silva, Maranhão-Filho, Péricles de Andrade, Santos, Izabella Costa, González, Carolina Rocha Aquino, Almeida, Carlos Henrique Stohler de, Luiz, Ronir Raggio
• Format: Journal Article
• Language: English; Portuguese
• Published: Sao Paulo Arquivos de Neuro-Psiquiatria 01.11.2023; Thieme Revinter Publicações Ltda; Academia Brasileira de Neurologia - ABNEURO; Academia Brasileira de Neurologia (ABNEURO)
• Subjects: Avaliação de Resultados da Assistência ao Paciente; Cirurgia; Complications; Facial nerve; Facial Nerve Injuries; Mandible; Metastases; Neoplasias Cutâneas; Neoplasias Parotídeas; NEUROSCIENCES; Original; Parotid Neoplasms; Patient Outcomes Assessment; Postoperative; PSYCHIATRY; Skin Neoplasms; Surgery; Traumatismos do Nervo Facial; Neoplasias Cutâneas; Parotid Neoplasms; Patient Outcomes Assessment; Surgery; Skin Neoplasms; Avaliação de Resultados da Assistência ao Paciente; Neoplasias Parotídeas; Traumatismos do Nervo Facial; Cirurgia; Facial Nerve Injuries
• ISSN: 0004-282X; 1678-4227; 1678-4227
• DOI: 10.1055/s-0043-1777003

Abstract Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. Objective: To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. Methods: Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. Results: 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). Conclusion: The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.