The House–Brackmann score is a score to grade the degree of nerve damage in a facial nerve A modification of the original House–Brackmann score, called the “Facial Nerve Grading Scale ” (FNGS) was proposed in KEYWORDS. Facial paralysis;. Evaluation;. Scales;. Classification; necessário treinamento prévio; na escala de House & Brackmann, . Assessment of facial movement according to House & Brackmann (). Grade. House-Brackman Scale facial nerve palsy The House-Brackmann scale ranges between I normal and VI no movement. Grade I Normal symmetrical function.

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In addition we include a description of segmental weakness zone-specific informationchanges in the facial soft tissues and synkinesis. Bracomann patient concerns relate to brow position, movement abnormalities, eyelid closure issues, inability to smile, mid-facial asymmetries, poor oral function and lower lip asymmetry.

This is an open-access article distributed under the terms nouse the Creative Commons Attribution Non-Commercial License http: Regional assessments using the HB grading system may enhance communication between graeing [ 5 ]. Introduced inthe Yanagihara system is a regional scale most frequently used in Japan. Head Neck Surg, [93] — On the FNGS 2.

We therefore analyzed the rate of agreement of the two scales and confirmed the properties and usefulness of FNGS tacial. House-Brackmann versus Burres-Fisch methods. All statistical analyses were performed using SPSS ver. To determine the clinical significance of the House-Brackmann facial nerve grading scale HBFNGS in the setting of differential function along the branches of the facial nerve.

Further, the single grade did not always correlate with the best or worst function along the four facial regions.

Facial nerve grading system.

When compared with HB grading, the kappa value was 0. This system is sensitive in assessing changes in facial recovery [ 2 ] and has been reported highly reliable, with wcale and scalw reliability similar for beginners and experts [ 9 ]. Of these, 31 patients had Bell palsy on the right side and 29 on the left side.

Agreement between the grading systems and their evaluation of patient prognosis were calculated gradjng intraclass correlation coefficient ICCSpearman correlation analysis SCCand overall percentage agreement.

Development of a sensitive clinical facial grading system. In conclusion, FNGS 2. When we compared the results of regional scaale with the final grade, it differed from results observed using existing “regional” HB grading [ 5 ]. 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.

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Since the main objective of this study was to assess the difference between the two facial nerve grading systems, the follow-up period itself was not a huge limitation. We specialise in plastic surgery, cosmetic surgery, reconstructive surgery of the face, microsurgery, eyelid and oculoplastic surgery, facial nerve surgery, breast surgery and breast augmentation.

These problems may be overcome and long term sdale obtained by a multi-center study with larger numbers of patients. Standarised assessment of facial function House-Brackmann HB is one of several analysis tools developed to quantify facial function and provide reproducible information.

House–Brackmann score

The Sunnybrook system grades paralysis by evaluating symmetry at rest and during voluntary movements, and, following a series of calculations, is used to gauge synkinesis on a point scale. This system, which can overcome the shortcomings of the existing system may be a good tool for the more accurate evaluation of patients.

Had patients been evaluated by two or more examiners, we could have calculated interobserver differences, enhancing the value of our results. Grade II Slight weakness noticeable only on close inspection Complete eye closure with minimal effort Slight asymmetry of smile with maximal effort Synkinesis barely noticeable, contracture, or spasm absent. Houss were re-evaluated if there was any difference in the results of each grading system, and the final result was documented.

House–Brackmann score – Wikipedia

Grade V Motion barely perceptible Incomplete eye closure, slight movement corner mouth Synkinesis, contracture, and spasm usually absent. Grading of facial palsy. Agreement between the traditional global score and the regional scores was analyzed. Grade I Normal symmetrical function Grade II Slight weakness noticeable only on close inspection Brackmanj eye closure with minimal effort Slight asymmetry of smile with maximal effort Synkinesis barely noticeable, contracture, or spasm absent Grade III Obvious weakness, but not disfiguring May not be able to lift eyebrow Complete eye closure and strong but asymmetrical mouth movement Obvious, but not disfiguring synkinesis, mass movement or spasm Grade IV Obvious disfiguring weakness Inability to lift brackman Incomplete eye closure and asymmetry of mouth with maximal effort Severe synkinesis, mass movement, spasm Grade V Motion barely perceptible Incomplete eye closure, slight movement corner mouth Synkinesis, contracture, and spasm usually absent Grade VI No movement, loss of tone, no synkinesis, contracture, or spasm Reference House JW, Brackmann DE.


Synkinesis was graded as none, mild, or severe. Our site uses cookies to improve your experience.

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Moreover, among patients with incomplete recovery, grades II and III were distributed differently on the two scales. Chi squared analysis was used to determine any difference between the two scales in judging recovery. In addition to not being widely used outside Japan, this system is too difficult for convenient use as the evaluation criteria are rather complex. First, all patients were evaluated on both systems by a single examiner. Plastic and Reconstructive Surgery, All rights reserved.

The exact agreements between regional assessment and FNGS 2. Although unquantifiable sensory deficits cannot be evaluated, detailed regional assessments of the brow, eye, nasolabial fold, and oral regions are possible, as are assessments of movement at any point of paralysis. Clinical and Experimental Otorhinolaryngology ; 6 3: Patients were also evaluated by both scales at each acale time point, with each patient evaluated at least twice for both systems by an otolaryngologist who understood both grading systems well.

Facial nerve grading system.

Mean time from occurrence to treatment was 2. Alternate grading systems include the “Yanagihara” and “Sunnybrook” scales [ 23 ].

Another limitation of this study housd that we did not evaluate patients whose paralysis was due to other causes such as external injury or surgery. In theory, normal is normal no matter what scale is used. 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.

None of the patients received an antiviral yrading. Thus, this scale cannot be used for systematic regional assessment and is limited in determining prognosis. Facial nerve grading system.