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 |