According to the House-Brackmann grading system, Grade IV facial palsy is characterised by:

• A Normal function on both sides; no weakness
• B Moderately severe dysfunction; incomplete eye closure, barely perceptible movement on forehead, asymmetrical smile with maximum effort ✓
• C Moderate dysfunction with obvious weakness, complete eye closure with effort, slight movement around the mouth
• D Total paralysis with no movement

Explanation

The House-Brackmann scale grades facial nerve function from I (normal) to VI (total paralysis). Grade IV (moderately severe dysfunction) is characterized by obvious weakness, inability to close the eye completely, barely detectable forehead movement, and a grossly asymmetric smile with maximum effort. Grade III is moderate dysfunction with complete eye closure with effort and slight mouth movement; Grade V is severe with only barely perceptible motion. Grade VI is complete paralysis.

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

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Written and medically reviewed by the StethoPrep medical team.