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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Gradjng with complete facial nerve paralysis House-Brackmann Grade 6 were excluded. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License http: We assumed that the difference in grade I may reflect inter-examiner variation.
We found that 43 patients This system is sensitive in assessing changes in facial recovery [ 2 ] and has been reported highly reliable, with intra- and inter-rater reliability similar for beginners and experts [ 9 ]. 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.
Of these, 31 patients had Bell palsy on the right side and 29 on the left side.
House–Brackmann score – Wikipedia
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 houae synkinesis, mass movement or spasm.
This study had several limitations. The SCC was very high, 0. Facial Nerve Grading System 2. All patients were hospitalized for 7 days and followed-up as outpatients at 3 weeks, 6 weeks, and 3 months. On the FNGS 2. To date, however, ffacial studies have compared these two grading systems in real patients and confirmed whether FNGS 2.
First, all patients were evaluated on both systems by a single examiner. When compared with HB grading, the kappa value was 0. The motor function of the facial nerve can be rapidly and conveniently categorized bouse six HB grades. 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. Physicians were provided with printed description of the HBFNGS and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the forehead, eye, nose, and mouth.
Patients were excluded if they 1 presented with Bell palsy more than 1 week after onset; 2 were suspected of having Varicella zoster virus infection, based on physical and serologic examinations; 3 had a history of trauma or otologic surgery; 4 had other types of neurologic deficits; 5 had recurrent facial palsy; or 6 had a psychiatric disease. Because every known scale has subjective characteristics, examiners are unable to fully assess facial function [ 4 ].
Mean time from occurrence to treatment was 2. Search the site Search. Grade V Ecale barely perceptible Incomplete houde closure, slight movement corner mouth Synkinesis, contracture, and spasm usually absent. Introduced inthe Yanagihara system is a regional scale most frequently used in Japan. To minimize these shortcomings, studies have explored the Yanagihara and Sunnybrook grading systems.
The ICC between the two scales was 0. Head Neck Surg ; We found that the rate of complete recovery was lower on the FNGS 2. In theory, normal is normal no matter what scale is used.
Chi squared analysis was used to determine any difference between the two scales in judging recovery. This system evaluates movements of 10 facial muscles, assigning each a score of points, resulting in a maximum score of 40 points. 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.
Grade V – Severe Dysfunction Gross: Among them, one patient scored 2 points in the brow region, and the other four scored 2 points in the oral region in FNGS 2. Plastic and Reconstructive Hoouse, All rights reserved.
House-Brackmann versus Burres-Fisch methods. This is especially applicable when evaluating, for example, the effects of antiviral agents on prognosis in patients with Bell palsy. Proper assessment of complete recovery requires a stricter assessment system. Facial nerve grading system. 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.
Finally, the difference was confirmed by comparing the final results of the two grading systems and the results of regional assessments of the brow, eye, nasolabial fold, and oral region. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.
Reliability of the Sunnybrook Facial Grading System by novice users. However, the time required for FNGS 2.
Previously, evaluators focused primarily on whether the eye closed during different degrees of paralysis of each branch of the facial nerve [ 5 ]. The exact agreements between regional assessment and FNGS 2. Future studies are needed to evaluate these grading systems in patients whose paralysis was due to other causes. At the Sorensen Clinic we routinely use the House-Brackmann scale to evaluate new and existing patients.
Regional assessments using the HB grading system may enhance communication between researchers [ 5 ]. Grade I Normal symmetrical function 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 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 brow 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.
Patients were also evaluated by both scales at each follow-up time point, with each patient evaluated at least twice for both systems by an otolaryngologist who understood both grading systems well.
Patients with facial nerve dysfunction from any cause.