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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Results The overall intraclass correlation coefficient ICC was 0. The exact agreements between regional assessment and FNGS 2. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade. No potential conflict of interest relevant to this article was reported. Clinical and Experimental Otorhinolaryngology ; 6 3: Agreement between the Facial Nerve Grading System 2. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License http: Due to the convenience and simplicity of the HB scale, it remains the most widely used facial nerve grading system [ 1 ].

House–Brackmann score – Wikipedia

The HB grading system, however, has various shortcomings, including its inability to accurately evaluate synkinesis and contracture. Thus, this scale cannot be used for systematic regional assessment and is limited in determining prognosis. Alternate grading systems include the “Yanagihara” and “Sunnybrook” scales [ 23 ].

To date, however, few studies have compared these two grading systems in real patients and confirmed whether FNGS 2. We therefore analyzed the rate of agreement of the two scales and confirmed the properties and usefulness of FNGS 2. 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.

This study was approved by the Ethical Committee of Kyung Hee University Hospital, and all patients provided written informed consent. None of the patients received an antiviral agent. All patients were hospitalized for 7 days and followed-up as outpatients at 3 weeks, 6 weeks, and 3 months. 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.

House Brackmann

Patients were re-evaluated if there was any difference in the results of each grading system, and the final result hluse documented.

Agreement between the grading systems and their evaluation of patient prognosis were calculated by intraclass correlation coefficient ICCSpearman correlation analysis SCCand overall percentage agreement. Grade I at 3 months was considered the standard for complete recovery for evaluation hoise prognosis. Chi squared fxcial was used to determine any difference between the two scales in judging recovery. 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.


All statistical analyses were performed using SPSS brack,ann. Of these, 31 patients had Bell palsy on the right side and 29 on the left side. Mean time from occurrence to treatment was 2. The ICC between the two scales was 0. The SCC was very high, 0. Use of the two scales in patient prognosis Recovery status was evaluated at 3 months, with grade I of both grading systems defined as complete recovery. We found that 43 patients Among them, one patient scored 2 points in the brow region, and the gouse four scored 2 points in the oral region in FNGS 2.

In contrast, one patient showed full recovery on the FNGS 2. On the FNGS 2. The motor function of the facial nerve can be rapidly and conveniently categorized into six HB grades. However, this system provides only gross impressions, gradinv limiting its usefulness.

HB grading has several shortcomings, including: To minimize these shortcomings, studies have explored the Yanagihara and Sunnybrook grading systems. Introduced inthe Yanagihara system is a regional scale most frequently faciial in Japan.

This system evaluates movements of 10 facial muscles, assigning each a score of points, resulting in a maximum score of 40 points. When compared with HB grading, the kappa value was 0. In addition to not being widely used outside Japan, this system is too difficult for convenient use as the evaluation criteria are rather complex.

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 scalw point scale.

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 ].

However, it has been difficult for this system to replace HB grading. 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.

We found that the rate of complete recovery was lower on gradkng FNGS 2.

Moreover, among patients with incomplete recovery, grades II and III were distributed differently on the two scales. These differences are likely due to the more detailed analysis on the FNGS 2. Thus, the FNGS 2. Proper assessment of complete recovery requires a stricter assessment system. This is especially applicable when evaluating, for example, the effects of antiviral agents on prognosis in patients with Bell palsy.

The reasons for the disagreement over grade I outcomes between the two scales remains unclear. In theory, normal is normal no matter what scale is used. We assumed that the difference in grade I may reflect inter-examiner variation. Because every known scale has subjective characteristics, examiners are unable to fully assess facial function [ 4 ].

Although this possibility cannot be excluded, we believe that the principal reason for the difference between the scales is the ambiguity of HB grading in most cases, preventing accurate analysis without strict regional assessment [ 4 ].

When we compared the results of regional assessment with the final grade, it differed from results observed using existing “regional” HB grading [ 5 ]. Previously, evaluators focused primarily on whether the eye closed during different degrees of paralysis of each branch of the facial nerve [ 5 ]. Although not identical, as the evaluation criteria differ for the “regional” grading system and FNGS 2. Our more systematic regional assessment confirmed that the FNGS 2. This study had several limitations.


First, all patients were evaluated on both systems by a single examiner. Had patients been evaluated by two or more examiners, we could have calculated interobserver differences, enhancing the value of our results.

Second, the final follow-up was performed 3 months after treatment; bdackmann, this period is too short to make decisions on facial paralysis. We had hypothesized that patients with Bell’s “paresis” would completely recover within 3 months [ 10 ], and we therefore regarded 3 months as the minimum period for determining patient prognosis.

Facial nerve grading system.

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.

In other studies, many observers watch videos of patients [ 491112 ]. In addition, a longer follow-up period increases the likelihood that some patients will drop out of the study, especially since patients may go elsewhere for a second opinion or seek alternative treatments.

These problems may be overcome and long term results obtained by a multi-center study with larger numbers of patients. Another limitation of this study was that we did not evaluate patients whose paralysis was due to other causes such as external injury or surgery. However, the purpose of this study was to compare the two grading systems in patients with unilateral Bell palsy.

Future studies are needed to evaluate these grading systems in patients whose paralysis was due to other causes. The future use of the FNGS 2. Regional assessments using the HB grading system may enhance communication between researchers [ 5 ]. Due to its simplicity and convenience, the HB grading system will be difficult to replace. However, the time required for FNGS 2. This system, which can overcome the shortcomings of the existing system may be a good tool for the more accurate evaluation of patients.

In conclusion, FNGS 2. The regional assessment capacity of the FNGS 2. Facial nerve grading system. Otolaryngol Head Neck Surg. Development of a sensitive clinical facial grading system. Grading of facial palsy. Facial Nerve Grading System 2. Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function. Agreement between the Sunnybrook, House-Brackmann, and Yanagihara facial nerve grading systems in Bell’s palsy.

Fscial facial nerve function: House-Brackmann versus Burres-Fisch methods. A comparison and conversion table of ‘the House-Brackmann facial nerve grading system’ and ‘the Yanagihara grading system’.

Reliability of the Sunnybrook Facial Grading System by novice users. The management of peripheral facial nerve palsy: Reliability of the “Sydney”, “Sunnybrook”, and “House Brackmann” brrackmann grading systems to assess voluntary movement and synkinesis after facial nerve paralysis.