title: Quantitative measurement of evolution of postparetic ocular synkinesis treated with botulinum toxin type A.
abstract: BACKGROUND
  The Sunnybrook Facial Grading System is considered one of the best scales available to grade facial motility and postparetic synkinesis. To measure facial landmarks and movement excursion, a new software, the Facial Assessment by Computer Evaluation, has been proposed. The aim of this study was to quantify eye synkinesis improvement after botulinum toxin type A injections using the new software and to compare this method with the Sunnybrook grading system.
  
  
  METHODS
  The study included 40 injection sessions on 29 Caucasian outpatients with facial synkinesis. Before and 2 weeks after the injection, patients were evaluated using the Italian version of the Sunnybrook system. Eyelid fissure size at rest, during lip puckering, and while smiling was measured with the new software.
  
  
  RESULTS
  After botulinum infiltration, the Sunnybrook grading system showed a global facial improvement with reduction of synkinesis and increase of static and dynamic symmetry. The Facial Assessment software detected an increase of ocular fissure measure at rest, during lip puckering, and especially during smiling, and the improvement was positively correlated with initial asymmetry. A single point of the Sunnybrook system synkinesis score corresponded to a mean difference of 0.77 mm during smiling and 1.0 mm during lip puckering.
  
  
  CONCLUSIONS
  The Facial Assessment by Computer Evaluation measure allowed the authors to quantify the improvement of eye synkinesis after botulinum toxin type A injection. The Sunnybrook Facial Grading System provided an immediate instrument with which to monitor treatment in routine clinical practice, whereas the Facial Assessment system gave a more accurate quantitative assessment.
  
  
  METHODS
  Diagnostic, II.
authors.affiliation: Pavia, Italy From the Department of Physical Medicine and Rehabilitation and the Public Health Department, University of Pavia; and the Rehabilitation Unit, Fondazione IRCCS Policlinico San Matteo; and Rehabilitation Unit, Fondazione Don Carlo Gnocchi ONLUS, "Santa Maria alle Fonti" Medical Center.
authors.forename: Miriam
authors.initials: M
authors.lastname: Cecini
authors.forename: Chiara
authors.initials: C
authors.lastname: Pavese
authors.forename: Mario
authors.initials: M
authors.lastname: Comelli
authors.forename: Ettore
authors.initials: E
authors.lastname: Carlisi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Sala
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bejor
authors.forename: Elena Dalla
authors.initials: ED
authors.lastname: Toffola
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005123:Eye; D005146:Facial Asymmetry / Q000188:drug therapy; D005152:Facial Muscles / Q000187:drug effects*; D005155:Facial Nerve Diseases / Q000188:drug therapy*; D005158:Facial Paralysis / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D046608:Synkinesis / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A