Objectives The objective and universal grading system for the facial nerve palsy is needed to the objectification of treatment in Oriental medicine. In this study, the facial nerve palsy grading was developed with combination of image processing technique and Nottingham scale. Methods The developed system is composed of measurement part, image processing part, facial nerve palsy evaluation part, and display part. With the video data recorded by webcam at measurement part, the positions of marker were measured at image processing part. In evaluation part, Nottingham scales were calculated in four different facial expressions with measured marker position. The video of facial movement, time history of marker position, and Nottingham scale were displayed in display part. Results & Conclusion The developed system was applied to a normal subject and a abnormal subject with facial nerve palsy. The left-right difference of Nottingham scores was large in the abnormal compared with the normal. In normal case, the change of the length between supraorbital point and infraorbital point was larger than that of the length between lateral canthus and angle of mouth. The abnormal case showed an opposite result. The developed system showed the possibilities of the objective and universal grading system for the facial nerve palsy.