The facial nerve grading system of House and Brackmann separates facial nerve paralysis into 6 grades based on the severity of findings.
Parameters evaluated during the examination:
(1) overall macroscopic/gross appearance
(2) appearance at rest
(3) forehead movement
(4) eyelid closure
(5) mouth appearance
(6) synkinesis, contracture, hemifacial spasm
Parameter |
Grade I |
Grade II |
Grade III |
overall appearance |
normal |
slight weakness on close inspection |
obvious but not disfiguring difference between both sides |
at rest |
normal symmetry |
normal symmetry |
normal symmetry |
forehead movement |
normal with excellent function |
moderate-to-good function |
slight-to-moderate |
eyelid closure |
normal closure |
complete with minimum effort |
complete with maximal effort |
mouth |
normal and symmetrical |
slight asymmetry |
slight asymmetry with maximum effort |
synkinesis, contracture, hemifacial spasm |
none |
may have very slight synkinesis; no contracture or hemifacial spasm |
obvious but not disfiguring synkinesis, contracture and/or hemifacial spasm |
Parameter |
Grade IV |
Grade V |
Grade VI |
overall appearance |
obvious weakness and/or dysfiguring asymmetry |
only barely perceptible motion |
no movement |
at rest |
normal symmetry |
asymmetry |
asymmetry |
forehead movement |
none |
none |
none |
eyelid closure |
incomplete with maximal effort |
incomplete with maximal effort |
no movement |
mouth |
asymmetry with maximum effort |
slight movement |
no movement |
synkinesis, contracture, hemifacial spasm |
synkinesis, contracture and/or hemifacial spasm disfiguring or severe enough to interfere with function |
synkinesis, contracture and/or hemifacial spasm usually absent |
no movement |
Specialty: Neurology, Emergency Medicine, Surgery, general, Otolaryngology
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