Grading facial nerve function: House-Brackmann versus Burres-Fisch methods

Many systems for reporting results of facial function tests have been proposed, but after five International Facial Nerve Symposia, a perfect system for reporting has yet to be developed. In 1985 the American Academy of Otolaryngology-Head and Neck Surgery adopted the House-Brackmann (H-B) six-point subjective grading scale as a universal standard. This decision was based on the recommendation of the Facial Nerve Disorders Committee. The next year, 1986, Burres and Fisch proposed the Linear Measurement Index (B-F LMI) as an alternative, objective grading system. To determine the ability of each system to grade the facial function of patients with facial palsy, and the relative merits of each system, 41 patients with facial weakness and one normal patient were studied. The H-B grading system is easy to use and provides simple, concise criteria for each separate grade of facial function. The B-F LMI grading system is time-consuming and labor-intensive, and requires a complex calculation to derive a percentage value that represents facial function. The most important finding of this study was the high degree of correlation between the two systems, in spite of the fact that the H-B system is subjective and qualitative while the B-F LMI system is objective and quantitative. Until the perfect grading system is developed, the authors favor combining the H-B and B-F LMI systems as the best method available at the moment to evaluate facial function.