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