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Imagen
House-Brackmann facial nerve grading system










Grade I - Normal

Normal facial function in all areas

 
Grade II - Slight Dysfunction

Gross: slight weakness noticeable on close inspection; may have very slight synkinesis

At rest: normal symmetry and tone

Motion: forehead - moderate to good function; eye - complete closure with minimum effort; mouth - slight asymmetry.

 
Grade III - Moderate Dysfunction

Gross: obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contracture, and/or hemi-facial spasm.

At rest: normal symmetry and tone

Motion: forehead - slight to moderate movement; eye - complete closure with effort; mouth - slightly weak with maximum effort.

 
Grade IV - Moderate 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.

 
Grade V - Severe Dysfunction

Gross: only barely perceptible motion

At rest: asymmetry

Motion: forehead - none; eye - incomplete closure; mouth - slight movement

 
Grade VI - Total Paralysis

No movement




Reference

House JW, Brackmann DE. Facial nerve grading system. Otolaryngol. Head Neck Surg 1985; 93: 146–147.


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