Question
Can you please explain the Brackmann facial nerve grading system? I see patients every month or two with Bell's palsy, and the physicians refer to the Brackmann system. Please explain.
Answer
The House-Brackmann Facial Grading Scale is probably the most common scale used to approximate the degree of facial motion. The scale was originally published in 1985 (see - Otolaryngology - Head and Neck Surgery, 93 (2) 146-147) and it is quite easy to use, once you're used to it!
In essence there are 6 grades. Grade ONE is a normal face, bilaterally symmetric, no detectable problems with facial motion. Grade TWO is a slight weakness, perhaps a little hint of an asymmetry when the patient volitionally moves their face. Grade THREE is a moderate weakness, visible to the untrained eye. That is, when the patient smiles or grimaces, there is a clear weakness on one side. Importantly, the grade three patient has normal eye closure. A grade FOUR patient is the same as a grade three (moderate weakness on one side), but the grade four patient does not have complete volitional eye closure. Grade FIVE means the patient has only the slightest hint of motion of the weak side. Grade SIX means there is absolutely no motion on the involved side of the face. Beck and Hall recently published an article on topics relating to this issue, and it is available online via Audiology Online. Please see: Electroneuronography (ENoG): Neurophysiologic Evaluation of the Facial Nerve
Douglas L. Beck Au.D. is the Editor-In-Chief of Audiology Online. Dr. Beck has been an audiologist for 18 years and he has lectured and published extensively on intraoperative neurophysiologic monitoring, electroneuronography and related topics.
For more information please read the article, Electroneuronography (ENoG): Neurophysiologic Evaluation of the Facial Nerve by Douglas L. Beck, Au.D., Editor-In-Chief, Audiology Online and James W. Hall III, Ph.D., University of Florida Health Science Center.
