American Society for Peripheral Nerve

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Inter-Rater Reliability of the SMILE System in Children with Möbius Syndrome
Tommy Nai-Jen Chang, MD1,2; Emily S. Ho, MD2; Alexandra Weinberg, MD2; Ronald M. Zuker, MD2; Gregory H. Borschel, MD2
1Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, 2The Hospital for Sick Children, Toronto, ON, Canada

Introduction: The SMILE system is a reliable grading system of facial reanimation that measures critical landmarks on pre-operative and post-operative 2D photographs in Adobe Photoshop®. The inter-rater reliability of the SMILE system has been established in adults, but not yet in a pediatric population.

Materials and Methods: A total of 107 patients with Möbius syndrome from a single cohort at The Hospital for Sick Children underwent facial reanimation surgery with free segmental gracilis muscle transplantation between 1985 to 2014. A retrospective analysis of 2D photographs was used to evaluate the inter-rater reliability of the SMILE system. Two independent raters evaluated the pre- and post-operative pictures of patients with Mobius syndrome. Inter-rater reliability of the excursion angles on both right and left sides were analyzed between the two raters.

Results: Sixty-two children had pre- and post-operative photos available for analysis. Nine cases were excluded because of poor photo quality and/or missing data. Of the 53 patients analyzed, 41 underwent motor nerve to masseter transfers and 12 had cross face nerve grafts to reinnervate the gracilis muscle flap for facial reanimation. The mean age was 9.2 ± 4.0 years old at the time of surgery. Intraclass Correlation Coefficient (ICC (2,1) ) of left /right angle measurements between the two raters were 0.957/0.904 pre-operatively and 0.974/0.951 post-operatively.

Conclusion: The SMILE system demonstrated excellent inter-rater reliability to evaluate preoperative and postoperative outcomes of facial reanimation in a pediatric population.

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