Facial nerve grading systems (1985-2002): Beyond the House-Brackmann scale

Objective: To assess methods of evaluating the function of the facial nerve that have been introduced over the past 15 years, particularly in comparison with the House-Brackmann scale. Data Sources: A Medline search was undertaken of the English-language medical literature between 1983 and 2000 to identify proposed methods of evaluating facial nerve function. Study Selection: Although all grading systems were considered, attention was focused on the systems that provided improvements in either precision or case of use. Conclusions: Because of the limitations and subjectivity of the House-Brackmann scale, several new scales of various degrees of objectivity and ease of use have been introduced. The Nottingham system offers a more objective but easy-to-use facial nerve grading system that has been demonstrated to be valid and that would be easy for the average practitioner to adopt. The authors propose a more systematic evaluation of this system to determine whether its widespread application is appropriate.