ENT Evaluation of acute facial paralysis House-Brackman grade system V, moderate severe dysfunction Obvious weakness and disfiguring asymmetry At rest: normal symmetry and tone motion no movement of forehead Inability to close eye completely with maximal effort u Asymmetrical movement of corners of mouth with maximal effort Patients with synkinesis, mass action, and hemifacial spasm severe enough to interfere with function are grade 4 regardless of degree of motor activityEvaluation of acute facial paralysis ◼ House-Brackman grade system ◼ IV, moderate severe dysfunction: ◼ Obvious weakness and disfiguring asymmetry ◼ At rest: normal symmetry and tone ◼ motion: ◼ no movement of forehead ◼ Inability to close eye completely with maximal effort ◼ Asymmetrical movement of corners of mouth with maximal effort ◼ Patients with synkinesis, mass action, and hemifacial spasm severe enough to interfere with function are grade 4 regardless of degree of motor activity