Facial nerve grading system

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The House–Brackmann score is a score to grade the degree of nerve damage in a facial nerve palsy. The measurement is determined by measuring the upwards (superior) movement of the mid-portion of the top of the eyebrow, and the outwards (lateral) movement of the angle of the mouth.

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The HB grading system, which was chosen as the standard by the FND Committee of the American Academy in , remains the most widely used facial nerve grading system. The motor function of the facial nerve can be rapidly and conveniently categorized into six HB grades.


Facial nerve grading system. House JW, Brackmann DE. PMID: [Indexed for MEDLINE] Publication Types: Research Support, Non-U.S. Gov't; MeSH terms. Facial Nerve/physiopathology* Facial Paralysis/classification* Facial Paralysis/physiopathology; Humans. Facial Grading System Video demonstration. Dr. Nedzelski demonstrating the Sunnybrook Facial Grading System. Please note that this video is a videotape transfer. It is a large video file that may take up to 30 seconds to start playing depending on your internet connection speed.
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A, A patient with acute right-sided flaccid facial paralysis from Ramsay Hunt syndrome receives a score of 20 for resting facial symmetry on the Sunnybrook Facial Grading System (FGS).

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A comprehensive, accurate, and valid system for reporting results of facial nerve surgery and disease is needed. This study describes and statistically analyzes eight currently available systems. The addition of subscores within grades 3 and 4 may be useful in defining outcomes after facial nerve grafts. Additional study of the grading scale will be necessary to examine this issue. Bilateral paralysis is problematic to grade when a grading system is based on direct comparison with the contralateral side.

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The Nottingham system offers a more objective but easy-to-use facial nerve grading system that has been demonstrated to be valid and that would be easy for the average practitioner to adopt. Objective: To present an updated version of the original Facial Nerve Grading Scale (FNGS), commonly referred to as the House-Brackmann scale. Study Design: Controlled trial of grading systems using a series of 21 videos of individuals with varying degrees of facial paralysis.

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