House Brackmann Scale

What is facial paralysis?

Facial paralysis is a condition that causes the loss of facial muscle function. It usually affects one side of the face but can affect both sides in rare cases. The most noticeable symptom is the inability to control facial expressions like smiling or blinking.

Causes of facial paralysis

Facial paralysis can have several causes, including:

• Bell's palsy: This is the most common cause of facial paralysis, characterized by sudden, temporary weakness or paralysis. Its exact cause is unknown but may be related to viral infections.
• Stroke: A stroke can interrupt the blood supply to the part of the brain that controls facial muscles, leading to paralysis.
• Lyme disease: This bacterial infection, transmitted by ticks, can cause neurological problems, including facial paralysis.
• Tumors: Benign or malignant tumors can compress and damage the facial nerves.
• Infections: Certain viral infections like herpes simplex and herpes zoster (shingles) can affect the facial nerves.
• Neurological disorders: Conditions like multiple sclerosis or Guillain-Barré syndrome can also cause facial paralysis.

How to diagnose facial paralysis

To diagnose facial paralysis, doctors evaluate a patient's medical history, perform a physical examination, and use diagnostic tests to understand the extent of nerve involvement and identify the underlying cause.

Medical history and physical examination

Before diagnosing a patient, a healthcare provider will ask questions about their current symptoms, accompanying symptoms, and recent illnesses or injuries. During a physical examination, the doctor will assess the patient's facial muscles by asking them to perform simple movements like closing their eyes, smiling, and raising their eyebrows.

Diagnostic tests

Tests can help determine the cause and severity of facial paralysis, assisting in diagnosis and treatment. Some of these tests include:

• Imaging tests: Magnetic resonance imaging (MRI) and computed tomography (CT) scans can reveal structural causes, such as tumors or brain abnormalities.
• Electromyography (EMG): This test measures the electrical activity of muscles and can determine the extent of nerve damage.
• Blood tests: These can identify infections, inflammatory conditions, or other underlying health issues.
• Lyme titer: A specific blood test for Lyme disease if considered a potential cause.

Depending on the findings, further specialized tests might be recommended to explore other potential causes or to plan treatment.

What is the House Brackmann Scale?

The House Brackmann Scale is a system used to assess facial nerve function, particularly in cases where there might be damage, such as with Bell’s palsy or after facial nerve surgery. It helps to gauge the severity of facial nerve paralysis and monitor recovery or progression over time. Here's how it works and what it measures:

How to use the House Brackmann Scale

Observe the patient's facial movements using the House Brackmann Scale to assess facial nerve function. Ask the patient to perform various expressions such as raising their eyebrows, closing their eyes, smiling, and puckering their lips. Check for symmetry, range, and smoothness of these movements. This helps detect signs of weakness or paralysis. A systematic and consistent approach to observation is necessary to ensure accurate grading.

During the grading phase, each movement is compared to its normal function to determine the extent of impairment. This grading system helps categorize each movement based on how well it mirrors the unaffected side of the face and outlines the severity of facial nerve dysfunction.

Facial nerve function can be assessed through a scoring system that assigns a score on a scale from I to VI. The score indicates the level of facial function, with I indicating normal function and VI indicating complete paralysis. Scores II through V represent varying levels of dysfunction. A score of II may indicate mild weakness, while a score of V indicates severe dysfunction with minimal movement. This tracks patient progress and determines treatment efficacy in a standardized way.

Possible results and interpretations

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The scale provides a clear framework for evaluating the degree of facial nerve dysfunction, allowing for a standardized assessment across different clinical settings. The results of this scale are categorized into six grades, each reflecting a specific level of facial nerve function. This helps clinicians tailor appropriate treatments and manage patient expectations regarding recovery.

• Grade I (normal): Normal facial function in all areas.
• Grade II (mild dysfunction): Slight weakness is noticeable on close inspection; slight synkinesis (involuntary movements) may occur.
• Grade III (moderate dysfunction): Obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contracture, or hemifacial spasm.
• Grade IV (moderately severe dysfunction): Obvious weakness and disfiguring asymmetry.
• Grade V (severe dysfunction): Only barely perceptible motion.
• Grade VI (total paralysis): No movement at all.

How does our House Brackmann Scale template work?

Our House Brackmann Scale template is designed for medical professionals to evaluate and document facial nerve function in patients. It involves observing the patient as they perform specific facial movements: raising eyebrows, closing eyes, and moving the mouth. Each movement is assessed for signs of dysfunction, ranging from average to total paralysis. 

The template includes sections for patient information, a detailed checklist for each facial movement, a section for overall grading, and additional notes where the evaluator can record observations and recommendations. 

This structured format ensures consistency in assessments and helps track changes over time, aiding in the clinical management and recovery monitoring of patients with facial nerve impairments.

What are the next steps?

After using the scale and obtaining results, follow several next steps to ensure comprehensive patient care. Some actions to consider:

• Perform nerve conduction studies, electromyography, MRI, or CT scans to identify nerve dysfunction or structural abnormalities.
• Tailor a treatment plan based on the damage, involving physical therapy, medication, or botulinum toxin injections.
• Consider surgery like nerve grafts or muscle transfers for severe paralysis (Grades V or VI), assessing risks and benefits.
• Educate patients on their condition, recovery timeline, and at-home exercises.
• Refer complex cases to neurologists, otolaryngologists, or facial plastic surgeons for comprehensive evaluation.
• Schedule follow-up visits to adjust treatment plans and track progress.
• Connect patients to support groups or counseling for emotional and psychological challenges.