How is congenital facial paralysis staged?

Updated: Jan 07, 2019
  • Author: Alan D Bruns, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

To grade the severity of the facial paralysis, many grading systems exist, such as the Terzis-Noah scale. [32] The most commonly used scale is the House-Brackmann listed below. [33] The higher the grade, the least likely full recovery will occur.

Table. The House-Brackmann Scale (Open Table in a new window)

Grade

Characteristics

I. Normal

Normal facial function in all areas

II. Mild dysfunction

 

Gross

Slight weakness noticeable on close inspection

May have slight synkinesis

At rest, normal symmetry and tone

Motion

Forehead - Moderate-to-good function

Eye - Complete closure with minimal effort

Mouth - Slight asymmetry

III. Moderate dysfunction

 

Gross

Obvious but not disfiguring difference between sides

Noticeable but not severe synkinesis, contracture, or hemifacial spasm

At rest, normal symmetry and tone

Motion

Forehead - Slight-to-moderate movement

Eye - Complete closure with effort

Mouth - Slightly weak with maximum effort

IV. Moderately 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

V. Severe dysfunction

 

Gross

Only barely perceptible motion

At rest, asymmetry

Motion

Forehead - None

Eye - Incomplete closure

Mouth - Slight movement

 

VI. Total paralysis

No movement


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