House–Brackmann score

The House–Brackmann score is a score to grade the degree of nerve damage in a facial nerve palsy. The measurement is determined by measuring the upwards (superior) movement of the mid-portion of the top of the eyebrow, and the outwards (lateral) movement of the angle of the mouth. Each reference point scores 1 point for each 0.25 cm movement, up to a maximum of 1 cm. The scores are then added together, to give a number out of 8.^[1] The score predicts recovery in those with Bell's palsy.^[2]

The score carries the name of the Dr John W. House and Dr Derald E. Brackmann, otolaryngologists in Los Angeles, California, who first described the system in 1985.^[1] It is one of a number of facial nerve scoring systems, such as Burres-Fisch, Nottingham, Sunnybrook,^[3] and Yanagihara.^[4] Of these, the Nottingham scale has been identified as possibly being easier and more reproducible.^[3] A modification of the original House–Brackmann score, called the "Facial Nerve Grading Scale 2.0" (FNGS2.0) was proposed in 2009.^[4]

Of note, a score of 1-3 indicates full eye closure, whereas a score of 4-6 indicates incomplete eye closure.