House–Brackmann score

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]

House–Brackmann score
Purposemeasure degree of damage in facial nerve palsy

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

References
  1. 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. 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. 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.
  • The visual appearance of the defect is described here
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