In this system, grades I and II Bell palsy are considered good outcomes, grades III and IV represent moderate dysfunction, and grades V and VI describe poor results. Grade VI is defined as complete facial paralysis; all the other grades are defined as incomplete. An incomplete facial paralysis denotes an anatomically and, to some degree, functionally intact nerve. The degree of facial nerve function should be noted in the chart at the patient's initial visit.
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:
An obvious weakness and/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 a 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
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Cite this: Helmi L. Lutsep. Fast Five Quiz: Bell Palsy Essentials - Medscape - Feb 06, 2019.
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