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