House-Brackmann grading of facial palsy: a patient with obvious facial weakness, asymmetry at rest, moderate to severe forehead dysfunction, with eye closure only possible with effort, is classified as:

• A Grade IV (moderately severe dysfunction) ✓
• B Grade II (slight dysfunction)
• C Grade III (moderate dysfunction)
• D Grade V (severe dysfunction)

Explanation

House-Brackmann grades: I = normal; II = slight (forehead movement slight-moderate, eye closure complete with minimal effort); III = moderate (obvious difference, forehead slight movement, eye closure with effort); IV = moderately severe (obvious weakness/disfigurement, no forehead movement, eye closure incomplete); V = severe (barely perceptible movement, no forehead motion, incomplete eye closure); VI = complete paralysis. The key distinguishing feature for Grade IV is inability to close the eye completely (incompetence), no forehead movement, and obvious asymmetry at rest — matching the described patient.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.