The House-Brackmann (HB) grading system for facial nerve function is standardized. A patient who has near-normal facial function at rest, slight weakness on close inspection with effort, complete eye closure with minimal effort, and slight mouth asymmetry — is classified as:

• A House-Brackmann Grade I (normal function)
• B House-Brackmann Grade II (slight dysfunction) ✓
• C House-Brackmann Grade III (moderate dysfunction)
• D House-Brackmann Grade IV (moderately severe dysfunction)

Explanation

House-Brackmann Grade II (slight dysfunction): normal symmetry at rest, slight weakness visible on close inspection, complete eye closure with minimal effort, slight asymmetry of the mouth with maximal effort. Grade I = normal; Grade III = obvious asymmetry, complete eye closure with effort; Grade IV = obviously asymmetric with incomplete eye closure; Grade V = barely perceptible motion; Grade VI = total paralysis. Grades I-III in Bell's palsy generally have a good prognosis; Grades IV-VI after 3 weeks indicate need for EMG/ENG testing to assess degeneration.

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

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Written and medically reviewed by the StethoPrep medical team.