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Updated: May 16, 2026

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Published on: May 5, 2020
A comparison of facial nerve grading systems
Linda N Lee1, Srinivas M Susarla, Marc H Hohman
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA. Linda_lee@meei.harvard.edu
Purpose:
This study aimed to compare a computerized tool to standard objective clinical scales for global and zone-specific assessment of facial nerve function.
Methods:
This was a retrospective review of 77 patients with facial paralysis who underwent facial videography. Videos were independently scored by 3 facial nerve specialists using the House-Brackmann Scales (HBI and HBII). Digital scoring was performed with Facogram software. Scores were recorded and compared using intraclass and Pearson (r) correlations.
Results:
Interobserver correlation was high with HBII, with overall scores in excellent agreement (intraclass correlation range, 0.78-0.95; P ≤ 0.0001). There were strong correlations between Facogram and HBII (r ≥ 0.67, P ≤ 0.0001) and strong intraobserver correlations between HBI and HBII (r ≥ 0.71, P ≤ 0.0001). The HBII required more clinician time [mean (SD), 72 (21) seconds per case], compared with Facogram, which did not require any clinician time.
Conclusions:
An automated, zone-specific facial analysis tool can eliminate clinician subjectivity and allow standardized assessment of facial paralysis.
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