John P. Leonetti, Sam J. Marzo, Douglas A. Anderson, Joshua M. Sappington (J Neurol Surg B 2015; 76(06): 416-420)
Facial paralysis has a profound functional, cosmetic, and psychological impact on affected patients. A variety of facial nerve grading systems have been described in the literature. The most commonly used grading method is the House-Brackmann grading scale that was adopted by the American Academy of Otolaryngology-Head and Neck Surgery in 1985. Other notable facial grading scales include the Sunnybrook, Yanagihara, Nottingham, and Sydney. The most commonly used facial nerve grading systems were designed to assess progressive neural recovery with an anatomically intact facial nerve. In their initial paper, House and Brackmann state that their facial nerve grading scale was intended to assess facial nerve recovery of an intact nerve. Patients who undergo surgical procedures for advanced lateral skull base tumors that require facial nerve and adjacent musculature resection and cases of long-standing facial nerve paralysis often require multiple static and mimetic procedures to optimize cosmetic result and return of long-term function. These can include the use of free muscle transfer, in conjunction with neural grafting, oculoplastic techniques, and static soft tissue tightening procedures. Existing facial recovery grading scales do not accurately assess this patient population. Individuals in this population are often automatically assigned a House-Brackmann score of 3 or 4. This void prevents clinicians from properly describing and communicating facial reanimation in this unique patient population.