House–Brackmann Scale and Facial Palsy Grades: How Doctors Measure Severity and Your Progress

During an examination you might hear your doctor say “grade three” or “House–Brackmann 4”. What do these numbers mean — and how do you know you’re improving? This guide explains facial palsy grading scales in plain language, and how to track your own progress.

Why use a scale at all?

“My face looks a bit better” isn’t enough to follow recovery. Scales help to:

• Define severity at the start.
• Predict recovery and identify cases that need closer follow-up.
• Measure improvement objectively over weeks.
• Create a shared language between doctors and physiotherapists.

The House–Brackmann scale

Published in 1985, this is the most widely used scale in the world. The doctor assesses movement of the forehead, eye and mouth and facial symmetry at rest, then gives a grade from I to VI:

Grade	Description	What the doctor sees
I	Normal	Normal movement in all areas
II	Mild dysfunction	Slight weakness on close inspection; eye closes fully with minimal effort
III	Moderate dysfunction	Obvious but not disfiguring difference; eye closes fully with effort; synkinesis may appear
IV	Moderately severe	Obvious weakness or disfiguring asymmetry; incomplete eye closure; no forehead movement
V	Severe	Barely perceptible movement; asymmetry even at rest
VI	Total paralysis	No movement

What your grade means for recovery

• Partial palsy (grades II–IV) at onset is usually linked to excellent recovery odds.
• Complete palsy (grade VI) at onset doesn’t mean you won’t recover, but recovery may be slower and lasting issues such as synkinesis more likely.
• Early corticosteroids improve the odds at every grade — see our treatment guide.

The Sunnybrook scale

One limitation of House–Brackmann is that it gives the whole face a single grade. Many specialists therefore use the Sunnybrook Facial Grading System, which scores three things separately:

1. Resting symmetry — eye, cheek and mouth.
2. Voluntary movement in 5 expressions — brow lift, gentle eye closure, open-mouth smile, snarl and lip pucker.
3. Synkinesis during each movement.

It produces a score from 0 to 100. Because it picks up small changes, it’s excellent for tracking week-by-week progress.

Other tests your doctor may order

• Electroneurography (ENoG): usually between days 3 and 14 in complete palsy, to estimate how many nerve fibres are affected.
• Electromyography (EMG): detects nerve signals reaching the muscles.
• Imaging: for atypical cases, or when there is no improvement after 3–4 months, to rule out other causes.

How to track your progress at home

You don’t need to be a doctor to see your progress. Try this weekly routine:

1. Photograph your face in the same place, lighting and distance.
2. Capture 5 poses: rest, eyebrow raise, gentle eye closure, smile and lip pucker.
3. Compare weekly, not daily — daily change is slow and hard to see.
4. Note observations: does the eye close better? Is drinking easier? Any unwanted movement?
5. Share the photos with your doctor or physiotherapist at follow-ups.

See also Bell’s palsy recovery time for what to expect at each stage.

How Raq helps you track progress

Raq makes it easier to stay consistent and follow your progress: a structured 3-month plan, regular reports and charts of your adherence and progress, and real-time AI guidance through your camera during every exercise so each movement is precise. Raq doesn’t give a diagnosis or medical grade — it supports your doctor’s plan and makes your rehab journey clearer.