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Media Gallery

Child with Möbius syndrome, eyes open. Image courtesy of M.J. Biavati.
Child with Möbius syndrome, eyes closed. Image courtesy of M.J. Biavati.
Child with congenital heart disease and left lower lip palsy suggestive of velocardiofacial syndrome. Image courtesy of M.J. Biavati.
Incision marking for a XII-VII crossover with jump graft. Image courtesy of A.D. Bruns.
Surgical exposure of the facial nerve, hypoglossal nerve, and great auricular nerve. Image courtesy of A.D. Bruns.
Surgical photo of a XII-VII crossover with jump graft. The great auricular nerve graft is sutured to the proximal portion of the facial nerve and to a partial sectioned hypoglossal nerve (preserving approximately two thirds of the axons going to the tongue). Image courtesy of A.D. Bruns.

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Author

Alan D Bruns, MD, FACS Chief, Department of Surgery, Evans Army Community Hospital; Clinical Assistant Professor of Surgery, Uniformed Services University of the Health Sciences

Alan D Bruns, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Michael J Biavati, MD, FACS, FAAP Clinical Assistant Professor of Otolaryngology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Private Practice, ENT Care for Kids, Dallas, TX

Michael J Biavati, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, American Academy of Pediatrics, American Cleft Palate-Craniofacial Association, American College of Surgeons, The Triological Society, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author Kim Lundstrom, MD, to the development and writing of this article.

Grade	Characteristics
I. Normal	Normal facial function in all areas
II. Mild dysfunction	Gross Slight weakness noticeable on close inspection May have slight synkinesis At rest, normal symmetry and tone Motion Forehead - Moderate-to-good function Eye - Complete closure with minimal effort Mouth - Slight asymmetry
III. Moderate dysfunction	Gross Obvious but not disfiguring difference between sides Noticeable but not severe synkinesis, contracture, or hemifacial spasm At rest, normal symmetry and tone Motion Forehead - Slight-to-moderate movement Eye - Complete closure with effort Mouth - Slightly weak with maximum effort
IV. Moderately severe dysfunction	Gross Obvious weakness and/or disfiguring asymmetry At rest, normal symmetry and tone Motion Forehead - None Eye - Incomplete closure Mouth - Asymmetrical with maximum effort
V. Severe dysfunction	Gross Only barely perceptible motion At rest, asymmetry Motion Forehead - None Eye - Incomplete closure Mouth - Slight movement
VI. Total paralysis	No movement

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