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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.
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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 |
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