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House-Brackmann facial nerve grading

Also called House Brackmann, HB grade, facial palsy grading, Bell's palsy grade

Six-grade gross classification of facial nerve function (I normal to VI total paralysis).

Best-fitting description

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Formula and scoring

Gross clinical grading by appearance at rest and on movement of forehead, eye and mouth (House & Brackmann 1985; endorsed by the AAO-HNS Facial Nerve Disorders Committee).

Exam and ward pearls

  • Incomplete eye closure = grade IV or worse — protect the cornea (lubricants, taping, lid procedures).
  • Forehead sparing points to an upper motor neuron (central) lesion; House-Brackmann is meant for peripheral (LMN) palsy.

When not to rely on it

  • A gross scale: regional differences and synkinesis are poorly captured; Sunnybrook or House-Brackmann 2.0 are more granular.
  • Published reprints differ slightly in wording for grades II–III; the original 1985 table is the reference.

Source

  1. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-7. doi:10.1177/019459988509300202 · PMID 3921901
  2. Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol. 2024;90(3):101374 (Table 1 reproduces House-Brackmann 1985). doi:10.1016/j.bjorl.2023.101374

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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