The House-Brackmann Scale is the most commonly used tool for the clinical evaluation of facial nerve function. 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.
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
The score is determined by measuring:
- the upwards movement of the midportion of the top of the eyebrow, and
- 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.
For objectivity, measurements should be made on both the normal and the affected side.
|Grade||Description||Measurement||Function %||Estimated Function %|
|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|
The House-Brackmann grading system has been found to be of high reliability, however examination of individual grades revealed wide variations between trained observers.
Usefulness in assessing results of facial physiotherapy
The H-B grading system has marked limitations: it has only 6 possible grades, and it does not provide detailed informations 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.
- Arne Ernst, Michael Herzog, Rainer Ottis Seidl. Head and Neck Trauma: An Interdisciplinary Approach. Thieme: Germany. 2006
- House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg 93: 146–147.
- Chung How Kau, Stephen Richmond. Three-Dimensional Imaging for Orthodontics and Maxillofacial Surgery. Wiley-Blackwell: United Kingdom. 2011
- 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.