Fast Five Quiz: Bell Palsy Essentials

Helmi L. Lutsep, MD

Disclosures

February 06, 2019

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

Read more about Bell palsy.

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