House Brackmann

Facial nerve dysfunction (facial paralysis) manifests in various symptom patterns. To objectively describe facial function, clinicians use a number of standardised scales - the most common being the House-Brackmann facial nerve grading system.


Symptoms of facial nerve injury may vary due to age, facial anatomy and the extent of nerve-damage. Frequent patient concerns relate to brow position, movement abnormalities, eyelid closure issues, inability to smile, mid-facial asymmetries, poor oral function and lower lip asymmetry.


A light degree of facial nerve weakness may only be visible as subtle asymmetries following repeated and exhausting muscle function, whereas severe dysfunction can be easily recognised even at rest.


Many of these symptoms will change over time, for example following a spontaneous recovery of nerve function or as a result of different therapeutic modalities (i.e after surgical treatment).

Standarised assessment of facial function

House-Brackmann (HB) is one of several analysis tools developed to quantify facial function and provide reproducible information. It is a widely accepted system, simple, sensitive, accurate and reliable - grading facial function in six steps from normal (HB I) to total paralysis (HB VI).


At the Sorensen Clinic we routinely use the House-Brackmann scale to evaluate new and existing patients. In addition we include a description of segmental weakness (zone-specific information), changes in the facial soft tissues and synkinesis.

House-Brackmann facial nerve grading system


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; eye - 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; eye - 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; eye - incomplete closure; mouth - asymmetric with maximum effort.


Grade V - Severe Dysfunction

Gross: only barely perceptible motion

At rest: asymmetry

Motion: forehead - none; eye - incomplete closure; mouth - slight movement


Grade VI - Total Paralysis

No movement


House, J.W., Brackmann, D.E. Facial nerve grading system. Otolaryngol. Head Neck Surg, [93] 146–147. 1985.