This House Brackmann scale for facial paralysis calculator evaluates degree of palsy induced by facial nerve damage in the HB grading system. Below the form you can find more information on the clinical assessment of facial nerve paralysis.


Gross function: General


Gross function: At rest


Motion function: Forehead


Motion function: Eyes


Motion function: Mouth

How does this House Brackmann scale for facial paralysis calculator work?

This health tool is based on the House Brackmann standardized facial nerve grading system used in the evaluation of facial paralysis. This grading looks at gross function in general at effort and at rest and at the motion function of the forehead area, the eyes and mouth area.

There are 6 grades in this scale which are assigned the Roman numbers I to VI, I being suggestive for normal function while VI indicates complete paralysis.

House Brackmann scale calculator for facial paralysis aims to give a grading to each of the five domains described above based on the physical examination performed on the patient, similar to examinations of responsiveness (ER).

The House Brackmann scale is the most commonly used facial function grading system in clinical practice in delineating between symptoms and nerve damage.

The overall grading system is described in the following table:

Grade I - Normal Normal facial function in all areas.
Grade II - Slight Dysfunction Gross: slight weakness noticeable on close inspection; may have very slight synkinesis; At rest: normal symmetry and tone; Motion: Forehead - moderate to good function; Eyes - complete closure with minimum effort; Mouth - slight asymmetry.
Grade III - Moderate Dysfunction Gross: obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contracture, and/or hemi-facial spasm; At rest: normal symmetry and tone; Motion: Forehead - slight to moderate movement; Eyes - complete closure with effort; Mouth - slightly weak with maximum effort.
Grade IV - Moderate Severe Dysfunction Gross: obvious weakness and/or disfiguring asymmetry; At rest: normal symmetry and tone; Motion: Forehead - none; Eyes - incomplete closure; Mouth - asymmetric with maximum effort.
Grade V - Severe Dysfunction Gross: only barely perceptible motion; At rest: asymmetry; Motion: Forehead - none; Eyes - incomplete closure; Mouth - slight movement;
Grade VI - Total Paralysis No movement.

During the clinical assessment, the measurements taken are that of 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. In each reference region 1 point is awarded for each 0.25 cm of movement up to 1 cm. Once the points are summed, as the higher score possible is 8, the results is given as the number of points obtained out of 8. The numeric score is often used in the monitoring of recovery after Bell palsy.

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

Despite its wide adoption, application simplicity and high reliability, this standardized method has also received criticism in comparison to other facial function assessment tools.

The main criticism is that the simple grading does not fully communicate facial function and does not correlate entirely with best or worst function in the studied domains.

The highest correlation of the overall grading is with the regional scoring of the eye at 61% while the lowest is with the forehead region at 18%.

For example, in patients with HB scores of grade III and above, there is evidence of regional grading of II or even I in one or more face areas, not supporting the overall grading description of moderate dysfunction.

Facial paralysis

Facial nerve dysfunction, resulting in facial paralysis, evidences a varied range of symptom patterns which depend on individual facial anatomy, the extend of damage to nerve  VII and even on age related aspects.

At the same time, a light degree of dysfunction requires a lot more specialist examination than the severe degrees which can be recognized even at rest.

The most common symptoms experienced by patients and which trigger them to ask for medical help include:

Movement abnormalities;

Abnormal brow position;

Eyelid closure issues;

Mid-facial asymmetries;

Lower lip asymmetry;

Inability to smile;

Poor oral function;

No neuropathic sensation of pain.

In cases where intervention is early, there can be observed a recovery of function, either after spontaneous recovery of nerve function or after corrective surgery.

The normal function of facial musculature is essential for mastication, speech and emotion expression, therefore facial nerve injury, either complete or partial is of concern.

Some of the most common causes of facial paralysis include unilateral Bell palsy, viral etiologies such as the herpes simplex virus, malignancy, the Ramsay Hunt syndrome or Lyme disease.


1) House JW, Brackmann DE. (1985) Facial nerve grading system. Otolaryngol Head Neck Surg; 93(2):146-7.

2) Danner CJ. (2008) Facial nerve paralysis. Otolaryngol Clin North Am; 41(3):619-32.

3) Kang TS, Vrabec JT, Giddings N, Terris DJ. (2002) Facial nerve grading systems (1985-2002): beyond the House-Brackmann scale. Otol Neurotol; 23(5):767-71.

4) Yen TL, Driscoll CL, Lalwani AK. (2003) Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function. Otol Neurotol; 24(1):118-22.

22 Mar, 2016 | 0 comments

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