The Sunnybrook facial nerve grading system, first proposed by Ross et al in 1996, has a number of favorable aspects compared to the House-Brackmann system, including an easily comprehended single percentage (from 0 to 100) to grade the function of the facial nerve, with the logical incorporation of synkinesis, resting symmetry, and surgical adjuncts. It is excellent for communicating with referring physicians and with patients, and is sensitive to even relatively small change over time. The overriding disadvantage of this system is the requirement for writing down a variety of numerical estimations and then performing several calculations to arrive at the result. This disadvantage, which would be a major obstacle to its use in a busy clinical practice, has been eliminated by the creation of a simple HanDBase application which allows quick and easy use of the system in less than 1 minute per patient. I have incorporated this system into a busy private otologic practice with excellent results and feel that this has truly enhanced my evaluation of patients with facial nerve dysfunction. Interested physicians are encouraged to read Ross's original article in Otolaryngology Head and Neck Surgery 114:380-6 (1996) before using this application.
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