House-Brackmann Facial Nerve Grading

Facial nerve function graded from I (normal) to VI (total paralysis).

Grade INormalNormal facial function in all areas. Grade IISlight dysfunctionSlight weakness noticeable only on close inspection; may have very slight synkinesis. Normal symmetry and tone at rest. Forehead: moderate to good function. Eye: complete closure with minimal effort. Mouth: slight asymmetry. Grade IIIModerate dysfunctionObvious but not disfiguring difference between the two sides; noticeable but not severe synkinesis, contracture, or hemifacial spasm. Normal symmetry and tone at rest. Forehead: slight to moderate movement. Eye: complete closure with effort. Mouth: slightly weak with maximum effort. Grade IVModerately severe dysfunctionObvious weakness or disfiguring asymmetry. Normal symmetry and tone at rest. Forehead: no movement. Eye: incomplete closure. Mouth: asymmetric with maximum effort. Grade VSevere dysfunctionOnly barely perceptible motion. Asymmetry at rest. Forehead: no movement. Eye: incomplete closure. Mouth: slight movement. Grade VITotal paralysisNo movement.

Method

The grade is assigned from the overall appearance, the face at rest, and movement of the forehead, eye, and mouth. Complete eye closure separates grade III from grade IV.

The scale was designed to report recovery after vestibular schwannoma surgery and is widely used for facial nerve outcomes in general. It gives one global grade and does not separate regions or quantify synkinesis, so regional scales such as the Sunnybrook Facial Grading System or eFACE are more sensitive to change.

Source: House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–147. Find on PubMed.

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