Facial palsy is a devastating condition with profound functional, aesthetic, and psychosocial implications. Although the complexity of facial expression and intricate synergy of facial mimetic muscles are difficult to restore, the goal of management is to reestablish facial symmetry and movement. Facial reanimation surgery requires an individualized treatment approach based on the cause, pattern, and duration of facial palsy while considering patient age, comorbidities, motivation, and goals. Contemporary reconstructive options include a spectrum of static and dynamic procedures. Controversies in the evaluation of patients with facial palsy, timing of intervention, and management decisions for dynamic smile reanimation are discussed.
Determining the cause, pattern, and duration of facial palsy is critical. Timely intervention is perhaps the most important factor that influences outcome after facial reanimation.
Smile reanimation options include regional muscle transfer, neurotization, and free muscle transfer. The selection of a donor nerve for the last two is highly individualized.
Dual innervation by the masseteric nerve and cross-facial nerve graft may optimize both strength and spontaneity of movement when free muscle transfer is used.
Analysis of clinical outcomes in facial nerve reconstruction remains limited because of the lack of universal evaluation methods and standardized outcome measures.