Fast Five Quiz: How Much Do You Know About Bell Palsy?

Selim Benbadis, MD

Disclosures

September 29, 2015

The grading system developed by House and Brackmann categorizes Bell palsy on a scale of I to VI. Grade I is normal facial function.

Grade II is mild dysfunction. Characteristics include the following:

  • Slight weakness is noted on close inspection

  • Slight synkinesis may be present

  • Normal symmetry and tone are noted at rest

  • Forehead motion is moderate to good

  • Complete eye closure is achieved with minimal effort

  • Slight mouth asymmetry is noted

Grade III is moderate dysfunction. The following characteristics are found:

  • An obvious, but not disfiguring, difference is noted between the two sides

  • A noticeable, but not severe, synkinesis, contracture, or hemifacial spasm is present

  • Normal symmetry and tone are noted at rest

  • Forehead movement is slight to moderate

  • Complete eye closure is achieved with effort

  • A slightly weak mouth movement is noted with maximal effort

Grade IV is moderately severe dysfunction. Signs include the following:

  • Obvious weakness or disfiguring asymmetry is noted

  • Symmetry and tone are normal at rest

  • No forehead motion is observed

  • Eye closure is incomplete

  • An asymmetrical mouth is noted with maximal effort

Grade V is severe dysfunction. Characteristics include the following:

  • Only barely perceptible motion is noted

  • Asymmetry is noted at rest

  • No forehead motion is observed

  • Eye closure is incomplete

  • Mouth movement is only slight

Grade VI is total paralysis. The following are noted:

  • Gross asymmetry

  • No movement

For more on the grading of Bell palsy, read here.

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