Graphic-visual adaptation of House-Brackmann facial nerve grading for peripheral facial palsy

Objective: To determine if the diagram with schematic drawings of the face based on House-Brackmann facial nerve grading scale can be of easier use than the original grading scale for facial palsy patients. Study design: Prospective case study of 32 patients with facial palsy. Setting: Tertiary referral center-university hospital. Patients: Patients with different degrees of acute peripheral facial palsy from any cause. Main outcome measures: The patients were photographed and then classified by degree of facial palsy through analysis of the pictures. At first, three of the authors individually utilised the original classification described by House-Brackmann facial nerve grading and then, after 7 days, they employed the illustration table proposed. After 30 days, the same methods were again used by the same authors for both House-Brackmann facial nerve grading and the illustration table. Results: The analysis of the obtained data reveals that the classification described by House and Brackmann (Otolaryngol. Head Neck Surg. 1985;93:146) presents several items to be evaluated, making it difficult to use and demanding greater time for correct application. On the contrary, the proposed illustration table allows faster evaluation and easier memorisation, not being subject to possible interpretation or translation mistakes, as illustrations are a universal language. Neither method presented absolute reproducibility, however, we found slightly larger concordance indexes among the authors for the proposed illustration table. We noticed average values of reproducibility were approximate to 65% in the House-Brackmann classification, and 75% in the evaluation using the diagram of the schematic drawings. Conclusions: The authors concluded that the illustration table could be utilised in substitution for the original description of House-Brackmann facial nerve grading; they also concluded that the illustration table allows faster evaluation and easier memorisation.