House–Brackmann Scale: Difference between revisions

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'''Original Editor '''- [[User:Oyemi Sillo|Oyemi Sillo]]


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== Clinically Relevant Anatomy<br>  ==
== Objective  ==


add text here relating to '''''clinically relevant''''' anatomy of the condition<br>  
The&nbsp;House-Brackmann Scale is one of the most commonly used tool for the clinical evaluation of [[Facial nerve|facial nerve]] function.<ref name="a">Arne Ernst, Michael Herzog, Rainer Ottis Seidl. Head and Neck Trauma: An Interdisciplinary Approach. Thieme: Germany. 2006</ref> The scale is based upon functional impairment, ranging between I (normal) and VI (no movement). This classification system was first described in 1985 by&nbsp;Dr John W. House and Dr Derald E. Brackmann, otolaryngologists in Los Angeles.<ref name="p1">House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg 93: 146–147.</ref>&nbsp;<br>  


== Mechanism of Injury / Pathological Process<br> ==
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== Intended Population  ==


== Clinical Presentation  ==
The scale is used to determine the severity of facial nerve dysfunction in people with [[Facial Palsy|facial palsy]].


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It can be used irrespective of the cause of the palsy.<br>  


== Diagnostic Procedures ==
== Method of Use ==


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The score is determined by measuring:&nbsp;


== Outcome Measures  ==
#the upwards movement of the midportion of the top of the eyebrow, and
#the outwards movement of the oral commissure


add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]])
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== Management / Interventions<br> ==
For both the eyebrow and oral commisure movement, 1 point is assigned for every 0.25 cm motion up to a maximum of 1cm. The scores for each structure are added together to give the House-Brackmann score. The maximum score obtainable is 8, if both structures move the full 1cm.<ref name="p1" /><br>  


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== Differential Diagnosis<br> ==
For objectivity, measurements should be made on both the normal and the affected side.<ref name="p2">Chung How Kau, Stephen Richmond. Three-Dimensional Imaging for Orthodontics and Maxillofacial Surgery. Wiley-Blackwell: United Kingdom. 2011</ref>  


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== Key Evidence  ==
{| width="500" border="1" cellpadding="1" cellspacing="1"
|+ <sub>House-Brackmann Facial Nerve Grading system<ref name="p1" /></sub>
|-
| Grade
| Description
| Measurement
| Function&nbsp;%
| Estimated Function&nbsp;%
|-
| I
| Normal
| 8/8
| 100
| 100
|-
| II
| Slight
| 7/8
| 76 - 99
| 80
|-
| III
| Moderate
| 5/8 - 6/8
| 51 - 75
| 60
|-
| IV
| Moderately Severe
| 3/8 - 4/8
| 26 - 50
| 40
|-
| V
| Severe
| 1/8 - 2/8
| 1 - 25
| 20
|-
| VI
| Total
| 0/8
| 0
| 0
|}


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== Resources <br> ==
== Evidence ==


add appropriate resources here
The House-Brackmann grading system has been found to be of high reliability, however examination of individual grades revealed wide variations between trained observers.<ref name="p3">Coulson SE, Croxson GR, Adams RD, O'Dwyer NJ. Reliability of the "Sydney," "Sunnybrook," and "House Brackmann" facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis. Otolaryngol Head Neck Surg. 2005 Apr;132(4):543-9.</ref>


== Case Studies ==
== Usefulness in assessing results of facial physiotherapy ==


add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
The H-B grading system has marked limitations: it has only 6 possible grades, and it does not provide detailed information about specific dysfuntional areas in the face.


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
There is no specific evaluation of [https://physio-pedia.com/Synkinesis synkinesis] (aberrant linking of movements which is a sequelae of moderate to severe facial nerve damage).
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But its main limitation for physiotherapists is that it is not sensitive enough to detect the small changes that occur during a course of rehabilitation.
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== References ==
Due to the above limitations, many physiotherapists working with facial palsy do not use this scale but instead use the Sunnybrook [https://www.physio-pedia.com/Facial_Grading_System Facial Grading System].<br>
 
== Links ==
 
[http://www.entusa.com/bells_palsy.htm#House%20Brackman%20Facial%20Nerve%20Grading%20System Description of House-Brackmann grades]
 
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== References   ==


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<references />
[[Category:Assessment]]
[[Category:Neurology]]
[[Category:Neurological - Assessment and Examination]]
[[Category:Facial_Palsy]]

Latest revision as of 20:49, 13 September 2020

Original Editor - Oyemi Sillo

Top Contributors - Wendy Walker, Oyemi Sillo, WikiSysop and Kim Jackson  

Objective[edit | edit source]

The House-Brackmann Scale is one of the most commonly used tool for the clinical evaluation of facial nerve function.[1] The scale is based upon functional impairment, ranging between I (normal) and VI (no movement). This classification system was first described in 1985 by Dr John W. House and Dr Derald E. Brackmann, otolaryngologists in Los Angeles.[2] 


Intended Population[edit | edit source]

The scale is used to determine the severity of facial nerve dysfunction in people with facial palsy.

It can be used irrespective of the cause of the palsy.

Method of Use[edit | edit source]

The score is determined by measuring: 

  1. the upwards movement of the midportion of the top of the eyebrow, and
  2. the outwards movement of the oral commissure


For both the eyebrow and oral commisure movement, 1 point is assigned for every 0.25 cm motion up to a maximum of 1cm. The scores for each structure are added together to give the House-Brackmann score. The maximum score obtainable is 8, if both structures move the full 1cm.[2]


For objectivity, measurements should be made on both the normal and the affected side.[3]


House-Brackmann Facial Nerve Grading system[2]
Grade Description Measurement Function % Estimated Function %
I Normal 8/8 100 100
II Slight 7/8 76 - 99 80
III Moderate 5/8 - 6/8 51 - 75 60
IV Moderately Severe 3/8 - 4/8 26 - 50 40
V Severe 1/8 - 2/8 1 - 25 20
VI Total 0/8 0 0


Evidence[edit | edit source]

The House-Brackmann grading system has been found to be of high reliability, however examination of individual grades revealed wide variations between trained observers.[4]

Usefulness in assessing results of facial physiotherapy[edit | edit source]

The H-B grading system has marked limitations: it has only 6 possible grades, and it does not provide detailed information about specific dysfuntional areas in the face.

There is no specific evaluation of synkinesis (aberrant linking of movements which is a sequelae of moderate to severe facial nerve damage).

But its main limitation for physiotherapists is that it is not sensitive enough to detect the small changes that occur during a course of rehabilitation.

Due to the above limitations, many physiotherapists working with facial palsy do not use this scale but instead use the Sunnybrook Facial Grading System.

Links[edit | edit source]

Description of House-Brackmann grades



References[edit | edit source]

  1. ↑ Arne Ernst, Michael Herzog, Rainer Ottis Seidl. Head and Neck Trauma: An Interdisciplinary Approach. Thieme: Germany. 2006
  2. ↑ 2.0 2.1 2.2 House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg 93: 146–147.
  3. ↑ Chung How Kau, Stephen Richmond. Three-Dimensional Imaging for Orthodontics and Maxillofacial Surgery. Wiley-Blackwell: United Kingdom. 2011
  4. ↑ Coulson SE, Croxson GR, Adams RD, O'Dwyer NJ. Reliability of the "Sydney," "Sunnybrook," and "House Brackmann" facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis. Otolaryngol Head Neck Surg. 2005 Apr;132(4):543-9.
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