We appreciate the letter from Dr. Orlando Guntinas-Lichius in which he expresses his concern that we did not cite Dr. Stennert's article, which was published in the German literature in 1977. We note that Stennert et al.1 provide a system for developing an index to assess paresis and defective healing. Although some measurements are used, “Yes-No” evaluation criteria are the main input for his index. The article by Stennert et al. is not a measurement process.
The focus of our article2 is the development and assessment of a simple measurement system that can easily be used by any clinician. Our system measures the location of various points on the face at rest and the amount of movement of these points with animation of the face. Measurement of the location and movement of points has been done previously by many investigators, including Stennert et al., but none has done it in a simple manner that lends itself to everyday clinical use. This is the reason for the development of our measurement system and for the publishing of the article. Not only does our measurement system provide reproducible numbers that define the location and movement of key points on the face, it also accurately provides these measurements without any instrumentation other than a handheld ruler. This ease of use makes the technique valuable in the clinic and is a significant advance over other techniques.
Ralph T. Manktelow, M.D.
Ronald M. Zuker, M.D.
Toronto General Hospital
Toronto, Ontario, Canada
1. Stennert E, Limberg CH, Frentrup KP. [An index for paresis and defective healing: An easily applied method for objectively determining therapeutic results in facial paresis (author's transl.)] (in German). HNO.
2. Manktelow RT, Zuker RM, Tomat LR. Facial paralysis measurement with a handheld ruler. Plast Reconstr Surg
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