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House-Brackmann Facial Paralysis Scale

last modified on: Tue, 03/06/2018 - 13:27

return to: Facial Paralysis (surgery for facial nerve paralysis weakness)

see also:  Facial Reanimation ;   Platinum-Gold eyelid weighting ;
Gracilis Muscle Transfer for Facial Paralysis; Unilateral Brow Lift for Facial Paralysis

House-Brackmann facial paralysis scale






Mild dysfunction (slight weakness, normal symmetry at rest)


Moderate dysfunction (obvious but not disfiguring weakness with synkinesis, normal symmetry at rest)  Complete eye closure w/ maximal effort, good forehead movement


Moderately severe dysfunction (obvious and disfiguring asymmetry, significant synkinesis)  Incomplete eye closure, moderate forehead movement


Severe dysfunction (barely perceptible motion)


Total paralysis (no movement)


*Please note: This scale is used to evaluate facial paralysis at the nerve trunk, and is not a descriptive scale to describe injury to specific distal facial nerve branches.

Spontaneous nystagmus
  • First degree: nystagmus on gaze toward the quick component
  • Second degree: nystagmus on gaze toward the quick component and on straight gaze
  • Third degree: nystagmus in all directions of gaze


1. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. Apr 1985;93(2):146-7