Descrbe briefly House-Brackman Grading system of facial nerve paralysis.

The most commonly used clinical grading scale is the House Brackmann (HB) facial nerve grading system which has proposed a six point scale for reporting the result of surgery for acoustic tumours. This system was modified and called House Brackmann system. The American academy of Otolaryngy0logy – Head and Neck surgery has adopted this system to standardize the reporting of disorder of the facial nerve and treatment result. It differentiates six grades of facial function (I-IV), grade I is normal function and grade VI complete absence of facial motor function and grades II-V are intermediate. It has two domains of assessment:

1) Gross observation

2)Movement of forehead/eye/mouth

 

Grade	Description of degree of injury	Characterstics
I	Normal	Normal symmetrical function is all area
II	Mild dysfunction (1-2)(Briefly noticeable)	Gross- Slightly weakness noticeable only on close inspection, very slightly synkiness. At rest- Normal symmetry and tone Motion: Forehead- moderate to good fxn Eye- Complete closure c minimum effort Mouth- Slight asymmetry of smile c maximumal effort Contractuce and spasm
III	Moderate dysfunction (2-3) (ovious difference)	Gross: Obvious but not disfiguring difference b/w 2 sides At rest: Normal symmetric and tone. Motion: Forehead symmetric and tone Motion: Forehead- slight to moderate movement Eye- Complete closure c maximal effort mouth- Asymmetric c maximum effort Noticeable but severe synkiness contache or spasm
IV	Moderately serve dysfxn(3)	Grass: Obvious weekness or disfigueing At rest: N symmetry and tone Motion: Forehead- none Eye- incomplete closure c max effort mouth- asymmetric c max effort Severe Synkiness mass movement and spasm
V	Severe dusfunction (3-4)	Gross: Motion barely perceptible At rest: asymmetry Motion: Forehead- none Eye-incomplete closure Mouth- slight movementcorhea Synkiness, contracture and spasm usually
VI	Total paralysis	No movement Loss of tone No synkiness/ Contracture or spasm

 

However, the House brackmann scale is not a perfect grading system because of:

• the problems of inter-observer and intra-observer variability
• It is applicable only to disorder of the nerve proximal to the pes-anserinus
• It is not appropriate for single branch injuries such as penetrating injury to the face affecting only the buccal branch.

The House brackmann scale is not useful in assessing transected/ repaired nerves for 3 reasons

• All repair causes mass movement
• Most patients can eventually close their eyes and have good oral sphincter function
• Almost no patients are able to raise the eyebrow or forehead .

The House brackmann system works well as long as there is an intact nerve sheath or incomplete nerve injury (sunderland grades I-IV)

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