The House–Brackmann score is a score to grade the degree of nerve damage in a facial nerve A modification of the original House–Brackmann score, called the “Facial Nerve Grading Scale ” (FNGS) was proposed in KEYWORDS. Facial paralysis;. Evaluation;. Scales;. Classification; necessário treinamento prévio; na escala de House & Brackmann, . Assessment of facial movement according to House & Brackmann (). Grade. House-Brackman Scale facial nerve palsy The House-Brackmann scale ranges between I normal and VI no movement. Grade I Normal symmetrical function.

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At the Sorensen Clinic we routinely use the House-Brackmann scale to evaluate new and existing patients. Patients were re-evaluated if there was any difference in the results of each grading system, and the final result was documented. The exact agreements between regional assessment and FNGS 2.

House Brackman Scale – ANZ Journal of Surgery

Grading of facial palsy. The reasons for the disagreement over grade I outcomes between the two scales remains unclear. When compared with Gradign grading, the kappa value was 0. This system evaluates movements of 10 facial muscles, assigning each a score of points, resulting in a maximum score of 40 points.

Grade III Obvious weakness, but not disfiguring May not be able to lift eyebrow Complete eye closure and strong but asymmetrical mouth movement Obvious, but not disfiguring synkinesis, mass movement or spasm. Symptoms of facial nerve injury may vary due to age, facial anatomy and the extent of nerve-damage. Results The overall intraclass correlation coefficient ICC was 0.

We assumed that the difference in grade I may reflect inter-examiner variation. These problems may be overcome and long term results obtained by a multi-center study with larger numbers of patients. On the FNGS 2. Proper assessment of complete recovery requires a stricter assessment system. Our site uses cookies to improve your experience. Reliability of the Sunnybrook Facial Grading System by novice users.

Finally, the difference was confirmed by comparing the final results of the two grading systems and the results of regional assessments of the brow, eye, nasolabial fold, and oral region. The future use of the FNGS 2. In addition we include a description of segmental weakness zone-specific informationchanges in the facial soft tissues and synkinesis.

Previously, evaluators focused primarily on whether the eye closed during different degrees of paralysis of each branch of faciall facial nerve [ 5 ]. This study was approved by the Ethical Committee of Kyung Hee University Hospital, and all patients provided written informed consent. Facial nerve dysfunction facial paralysis manifests in various symptom patterns. However, the purpose of this study was to compare the two grading systems brakcmann patients with unilateral Bell palsy.


The Sunnybrook system grades paralysis by evaluating symmetry at rest and during voluntary movements, and, following a series of calculations, is used to gauge synkinesis on a point scale. The ICC between the two scales was 0. Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function. Plastic and Reconstructive Surgery, All rights reserved. Grading facial nerve function: This system, which can overcome the shortcomings of the existing system may be a good tool for the more accurate evaluation of patients.

House–Brackmann score

In contrast, one patient showed full recovery on the FNGS 2. Facial nerve grading system. To objectively describe facial function, clinicians use a number of standardised scales – the most common being the House-Brackmann facial nerve grading system. We had hypothesized that patients with Bell’s “paresis” would completely recover within 3 months [ 10 ], and we therefore regarded 3 months as the minimum period for determining patient facia.

All statistical analyses were performed using SPSS ver. In patients with variable facial weakness, the single House-Brackmann score did not fully communicate their facial function. Grade II Slight weakness noticeable only on close inspection Complete eye closure with minimal effort Slight asymmetry of smile with maximal effort Synkinesis barely noticeable, contracture, or spasm absent. Chi squared analysis was used to determine any difference between the two scales in judging recovery.

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Although not identical, as the evaluation criteria differ for the “regional” grading system and FNGS 2. However, it faclal been difficult for this system to replace HB grading. Physicians were provided with printed description of the HBFNGS and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the huose, eye, nose, and mouth. Grade I Normal symmetrical function Grade II Slight weakness noticeable only on close inspection Complete eye closure with minimal effort Slight asymmetry of smile with maximal effort Faciall barely noticeable, contracture, or spasm absent Grade III Obvious weakness, but not disfiguring May not be able to lift eyebrow Complete eye closure and strong but asymmetrical mouth movement Obvious, but not disfiguring synkinesis, mass scxle or spasm Grade IV Obvious disfiguring weakness Inability to lift brow Incomplete eye closure and asymmetry of mouth with maximal effort Severe synkinesis, mass movement, spasm Grade V Motion barely perceptible Faxial eye closure, slight movement corner mouth Synkinesis, contracture, and spasm usually absent Grade VI No movement, loss of tone, no synkinesis, contracture, or spasm Reference House JW, Brackmann DE.


Due to the convenience and simplicity of the HB scale, it remains the most widely used facial nerve grading system [ 1 ]. The HB grading system, however, has various shortcomings, including its inability to accurately evaluate synkinesis and contracture. Mean time from occurrence to treatment was 2.

House–Brackmann score – Wikipedia

Reliability of the “Sydney”, “Sunnybrook”, and “House Brackmann” facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis.

Patients with complete facial nerve paralysis House-Brackmann Grade 6 were excluded. Head Neck Surg ; Search the site Houee. To date, however, few studies have compared these two grading systems in real patients and confirmed whether FNGS 2.

First, all patients were evaluated on both systems by a single examiner.

In theory, normal is normal no matter what scale is used. Although this possibility cannot be excluded, we believe that the principal reason for the difference between the scales is the ambiguity of HB grading in most cases, preventing accurate analysis without strict regional assessment [ 4 ]. The motor function of the facial nerve can be rapidly and conveniently categorized into six HB grades. It is a widely accepted system, simple, sensitive, accurate and reliable – grading facial function in six steps from normal HB I to total paralysis HB VI.

Alternate grading systems include the “Yanagihara” and “Sunnybrook” scales [ 23 ]. Frequent patient concerns relate to brow position, movement abnormalities, eyelid closure issues, inability to smile, mid-facial asymmetries, poor oral function and lower lip asymmetry.