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.
WHAT IS THE HOUSE-BRACKMANN SCALE?
The House-Brackmann scale is a nerve grading system developed in 1985 by Los Angeles otolaryngologists Dr. John W. House and Dr. Derald E. Brackmann. It is used to characterize the severity of a facial paralysis patient’s symptoms.
House-Brackmann classification scores include the following:
- Grade I: Normal
- Grade II: Slight facial weakness or other mild dysfunction. Normal tone and symmetry at rest. Complete closure of the eye without effort. Slight asymmetry of the mouth when facial movements occur.
- Grade III: Assigned to patients dealing with moderate dysfunction; these patients generally do not display any noticeable facial weakness with synkinesis, they maintain complete eye closure and good forehead movement with effort.
- Grade IV: Assigned to patients dealing with severe dysfunction. Obvious facial weakness. Incomplete eye closure, no forehead movement, asymmetrical mouth movement, and synkinesis.
- Grade V: Assigned to patients who have little to no ability to smile, frown or make other facial expressions. The closure of the eye is incomplete, and there is no forehead movement.
- Grade VI: No facial motion.
A House-Brackmann score is determined based on a measurement of the upward movement of a facial paralysis patient’s eyebrow and the outward movement of the mouth. One point is assigned for every 0.25 cm of motion for both eyebrow and mouth movement, with a maximum of 1 cm. The scores are then added together, resulting in a House-Brackmann score.
The maximum House-Brackmann score is 8; in this instance, a facial paralysis patient’s eyebrow and mouth move 1 cm. All House-Brackmann classification scores are made based on eyebrow and mouth movement on the non-paralyzed side of a patient’s face.
Is the House-Brackmann Scale Accurate?
Some research indicates the House-Brackmann scale provides accurate measurements of the severity of a facial paralysis patient’s symptoms. However, it is important to note that the House-Brackmann classification offers only six grades. The House-Brackmann grading system also does not include a specific evaluation of synkinesis, and it does not allow physiotherapists to identify minor improvements in a facial paralysis patient’s symptoms during treatment.
The Bottom Line on the House-Brackmann Scale
The House-Brackmann scale is one of the options used to measure the severity of a facial paralysis patient’s symptoms, but it offers no guarantees. It is therefore crucial for a facial paralysis patient to meet with an expert facial paralysis and reconstructive surgeon, like Dr. Babak Azizzadeh of The Facial Paralysis Institute to discuss his or her symptoms.
During a first consultation with Dr. Azizzadeh, a facial paralysis patient will receive a full evaluation. Then, Dr. Azizzadeh offers a personalized treatment plan to help his patient address his or her facial paralysis.
The Facial Paralysis Institute is the pre-eminent Center for patients needing treatment for facial paralysis. If you live in Southern California, please contact us to arrange for an in-person consultation with Dr. Babak Azizzadeh, the Director of the Institute. If you are from out of the region, please email close-up photos (front, below the nose and profiles) to info@facialparalysisinstitute.com. For more information, please call us at (310) 657-2203.
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