House–Brackmann score

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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. Each reference point scores 1 point for each 0.25 cm movement, up to a maximum of 1 cm. The scores are then added together, to give a number out of 8.[1] The score predicts recovery in those with Bell's palsy.[2]

The score carries the name of the Dr John W. House and Dr Derald E. Brackmann, otolaryngologists in Los Angeles, California, who first described the system in 1985.[1] It is one of a number of facial nerve scoring systems, such as Burres-Fisch, Nottingham, Sunnybrook,[3] and Yanagihara.[4] Of these, the Nottingham scale has been identified as possibly being easier and more reproducible.[3] A modification of the original House–Brackmann score, called the "Facial Nerve Grading Scale 2.0" (FNGS2.0) was proposed in 2009.[4]

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


  1. ^ a b House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg. 93: 146–147. PMID 3921901. 
  2. ^ Danner CJ (June 2008). "Facial nerve paralysis". Otolaryngol. Clin. North Am. 41 (3): 619–32. doi:10.1016/j.otc.2008.01.008. PMID 18436002. 
  3. ^ a b Kang TS, Vrabec JT, Giddings N, Terris DJ (September 2002). "Facial nerve grading systems (1985-2002): beyond the House-Brackmann scale". Otol. Neurotol. 23 (5): 767–71. doi:10.1097/00129492-200209000-00026. PMID 12218632. 
  4. ^ a b Vrabec JT, Backous DD, Djalilian HR, et al. (April 2009). "Facial Nerve Grading System 2.0". Otolaryngol Head Neck Surg. 140 (4): 445–50. doi:10.1016/j.otohns.2008.12.031. PMID 19328328. 

External links[edit]

  • The visual appearance of the defect is described here