Appendix 2. House-Brackmann Grading System

Grade	Description	Characteristics
I	Normal	Normal facial function in all areas
II	Mild dysfunction	Gross	slight weakness noticeable on close inspection; may have very slight synkinesis
		At rest	normal symmetry and tone
		Motion	Forehead : moderate to good functionEye : complete closure with minimum effortMouth : slight asymmetry
III	Moderate dysfunction	Gross	obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contrature, and/or hemifacial spasm
		At rest	normal symmetry and tone
		Motion	Forehead : slight to moderate movementEye : complete closure with effortMouth : slightly weak with maximum effort
IV	Moderately severe dysfunction	Gross	obvious weakness and/or disfiguring asymmetry
		At rest	normal symmetry and tone
		Motion	Forehead : noneEye : incomplete closureMouth : asymmetric with maximum effort
V	Severe dysfunction	Gross	only barely perceptible motion
		At rest	asymmetry
		Motion	Forehead : noneEye : incomplete closureMouth : slight movement
VI	Total paralysis	No movement