House-Brackmann Classification of Facial Function 

Updated: Dec 08, 2014
  • Author: Buck Christensen; Chief Editor: Buck Christensen  more...
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House-Brackmann Classification of Facial Function

The House-Brackmann Facial Nerve Grading System is widely used to characterize the degree of facial paralysis. In this scale, grade I is assigned to normal function, and grade VI represents complete paralysis. Intermediate grades vary according to function at rest and with effort.

Table 1. House-Brackmann Classification of Facial Function [1, 2] (Open Table in a new window)

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