House-Brackmann Grading System

House-Brackmann Grading System Facial paralysis can result from trauma, infection, congenital, metabolic, neoplastic, toxic, iatrogenic, or idiopathic etiologies.

Whatever the cause, the consequences for the patient can be devastating depending on the level of facial dysfunction. Several modalities exist to clinically rate the degree of facial function; including the widely used House-Brackman classification.

 

 


 

HOUSE-BRACKMANN CLASSIFICATION of Facial Function

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 the two 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 - Asymmetric 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

BELL'S PALSY

ACOUSTIC NEUROMA

PAROTID TUMOR

SYNKINESIS

FACELIFT SURGERY

NERVE INJURY

MOBIUS SYNDROME

HEMIFACIAL MICROSMIA

PAROTID

HEMIFACIAL SPASM

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MEET DR. AZIZZADEH

MASSETERIC-FACIAL NERVE

BABAK AZIZZADEH, MD FACS
Director, The Facial Paralysis Institute - Associate Clinical Professor - Facial Plastic & Reconstructive Surgery David Geffen School of Medicine at UCLA

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FACIAL NERVE TEXTBOOK

Dr. Azizzadeh’s facial nerve textbook is the preeminent textbook for doctors on the subject.