Palsies of the facial nerve can be classified into 6 different grades according to the House and Brackmann classification1.
Classification
| House and Brackmann Grade | Description | Characteristics |
|---|---|---|
| Grade I | Normal function | Normal function in all areas |
| Grade II | Mild dysfunction | Gross: Slight weakness, visible only on close inspection. Partial, very mild synkinesis. <br/>At rest: Normal tone and symmetry. <br/>Movement forehead: Moderate to good function. <br/>Movement eyes: Complete closure with little effort <br/>Movement mouth: Slight asymmetry |
| Grade III | Moderate dysfunction | Gross: Obvious, but not disfiguring, difference between the two sides. Detectable, but not severe, synkinesis. Contractures and/or hemifacial spasm. <br/>At rest: Normal tone and symmetry. <br/>Forehead movement: Slight to moderate movement. <br/>Eye movement: Complete closure with effort. <br/>Mouth movement: Mild weakness with maximal effort. |
| Grade IV | Moderately severe dysfunction | Gross: Obvious weakness and/or disfiguring asymmetry. <br/>At rest: Normal tone and symmetry. <br/>Forehead movement: None. <br/>Eye movement: Incomplete eyelid closure. <br/>Mouth movement: Asymmetry with maximal effort. |
| Grade V | Severe dysfunction | Gross: Barely perceptible movement. <br/>At rest: Asymmetry. <br/>Forehead movement: None. <br/>Eye movement: Incomplete eyelid closure. <br/>Mouth movement: Slight movement. |
| Grade VI | Complete paralysis | No movement. |
Figure
References