{"id":311,"date":"2017-06-30T09:38:41","date_gmt":"2017-06-30T08:38:41","guid":{"rendered":"https:\/\/charlesnduka.co.uk\/plastic-surgery\/?page_id=311"},"modified":"2017-06-30T09:39:21","modified_gmt":"2017-06-30T08:39:21","slug":"cads-grading-scale-towards-better-grading-ophthalmic-involvement-facial-nerve-paralysis","status":"publish","type":"page","link":"https:\/\/charlesnduka.co.uk\/plastic-surgery\/research\/cads-grading-scale-towards-better-grading-ophthalmic-involvement-facial-nerve-paralysis\/","title":{"rendered":"CADS grading scale: towards better grading of ophthalmic involvement in facial nerve paralysis"},"content":{"rendered":"<pre><em><span style=\"font-family: UICTFontTextStyleBody;\">Malhotra R, Ziahosseini K, Litwin A, Nduka C, El-Shammah N. <\/span><span style=\"font-family: UICTFontTextStyleBody;\">Br J Ophthalmol. 2016 Jun;100(6):866-70. doi: 10.1136\/bjophthalmol-2015-<wbr \/>307167.<\/span><\/em><\/pre>\n<p>&nbsp;<\/p>\n<h3>Abstract<\/h3>\n<div class=\"\">\n<h4>INTRODUCTION:<\/h4>\n<p>Ophthalmologists lack a\u00a0<span class=\"highlight\">facial<\/span>\u00a0<span class=\"highlight\">nerve<\/span>\u00a0<span class=\"highlight\">grading<\/span>\u00a0instrument (FNGI) that comprehensively encompasses the\u00a0ophthalmic sequelae of\u00a0<span class=\"highlight\">facial<\/span>\u00a0<span class=\"highlight\">nerve<\/span>\u00a0<span class=\"highlight\">paralysis<\/span>\u00a0(FNP). Assessment and management of\u00a0<span class=\"highlight\">ophthalmic<\/span>\u00a0sequelae remain inconsistent, and outcomes of clinical studies are incomparable. We have developed and successfully adopted an FNGI based on four aspects of periorbital\u00a0<span class=\"highlight\">involvement<\/span>: cornea, asymmetry, dynamic function and synkinesis. This\u00a0<span class=\"highlight\">CADS<\/span>\u00a0classification is specific for periorbital\u00a0<span class=\"highlight\">involvement<\/span>, with objective and subjective parameters, to standardise\u00a0<span class=\"highlight\">grading<\/span>. We present this classification and the results of a validation study in clinical practice.<\/p>\n<h4>METHODS:<\/h4>\n<p>A cross-sectional, validation study. Two clinicians independently assessed and graded each patient on the same day, blinded to each other&#8217;s\u00a0<span class=\"highlight\">grading<\/span>. Each grader assigned a score to each of four parameters: C (0-3, \u00b1a), A (0-2), D (0-3), S (0-2).<\/p>\n<h4>RESULTS:<\/h4>\n<p>Thirty patients (19 females, mean age 60, range 30-84 years) with unilateral\u00a0<span class=\"highlight\">facial<\/span>\u00a0<span class=\"highlight\">paralysis<\/span>\u00a0were graded. A total of 60 assessments were conducted.\u00a0<span class=\"highlight\">CADS<\/span>\u00a0scores ranged from C0A0D1S1 to C3aA2D3S0. In the first 30 assessments (of the first 15 patients), the two assessors disagreed over the corneal\u00a0<span class=\"highlight\">grading<\/span>\u00a0in four patients. The last 30 assessments of 15 patients showed complete agreement in all four parameters of the\u00a0<span class=\"highlight\">grading<\/span>\u00a0<span class=\"highlight\">scale<\/span>. The overall inter-observer agreement was 86.7% for cornea, 93.3% for resting asymmetry, 93.3% for dynamic function and 86.7% for synkinesis. After the first six patients, Cohen&#8217;s \u03ba reached 1 for all but synkinesis that ranged between 0.9 and 1.<\/p>\n<h4>CONCLUSIONS:<\/h4>\n<p>We present a validation study of an FNGI specifically designed for\u00a0<span class=\"highlight\">ophthalmic<\/span>\u00a0<span class=\"highlight\">involvement<\/span>\u00a0of FNP. Objective and subjective parameters helped standardise\u00a0<span class=\"highlight\">grading<\/span>\u00a0and management planning.<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<h4><\/h4>\n","protected":false},"excerpt":{"rendered":"<p>Malhotra R, Ziahosseini K, Litwin A, Nduka C, El-Shammah N. Br J Ophthalmol. 2016 Jun;100(6):866-70. doi: 10.1136\/bjophthalmol-2015-307167. &nbsp; Abstract INTRODUCTION: Ophthalmologists lack a\u00a0facial\u00a0nerve\u00a0grading\u00a0instrument (FNGI) that comprehensively encompasses the\u00a0ophthalmic sequelae of\u00a0facial\u00a0nerve\u00a0paralysis\u00a0(FNP). Assessment and management of\u00a0ophthalmic\u00a0sequelae remain inconsistent, and outcomes of clinical studies are incomparable. We have developed and successfully adopted an FNGI based on four aspects [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":38,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-311","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CADS grading scale: towards better grading of ophthalmic involvement in facial nerve paralysis | Charles Nduka - Plastic Surgery<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/charlesnduka.co.uk\/plastic-surgery\/research\/cads-grading-scale-towards-better-grading-ophthalmic-involvement-facial-nerve-paralysis\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CADS grading scale: towards better grading of ophthalmic involvement in facial nerve paralysis | Charles Nduka - Plastic Surgery\" \/>\n<meta property=\"og:description\" content=\"Malhotra R, Ziahosseini K, Litwin A, Nduka C, El-Shammah N. Br J Ophthalmol. 2016 Jun;100(6):866-70. doi: 10.1136\/bjophthalmol-2015-307167. &nbsp; Abstract INTRODUCTION: Ophthalmologists lack a\u00a0facial\u00a0nerve\u00a0grading\u00a0instrument (FNGI) that comprehensively encompasses the\u00a0ophthalmic sequelae of\u00a0facial\u00a0nerve\u00a0paralysis\u00a0(FNP). Assessment and management of\u00a0ophthalmic\u00a0sequelae remain inconsistent, and outcomes of clinical studies are incomparable. 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