title: Treatment of facial paralysis:  dynamic reanimation of spontaneous facial expression-apropos of 655 patients.
abstract: BACKGROUND
  Six hundred fifty-five cases of unilateral facial paralysis were treated by different surgical methods to achieve dynamic reanimation of facial muscle movement. In a retrospective study, the recovery of both truly spontaneous smile and facial muscle movement was evaluated independently.
  
  
  METHODS
  The authors performed 505 two-stage gracilis, one rectus abdominis, and 14 single-stage latissimus dorsi microneurovascular muscle transfers, in addition to 28 cross-facial facial nerve neurotization procedures. These procedures were based on neurotization of the paralyzed region by the contralateral healthy facial nerve. Procedures involving motor nerves or muscle beyond the territory of the facial nerve included 73 temporalis muscle transpositions, four lengthening temporalis myoplasty procedures, 26 neurotizations by the hypoglossal nerve, and four neurotizations by the spinal accessory nerve.
  
  
  RESULTS
  Patients treated by techniques based on the motor function of nerves other than the facial nerve did not recover spontaneous smile. Neurotization by the facial nerve, however, did result in the recovery of spontaneous smile in all satisfactory or better outcomes. Recovery of lip commissure movement based on neurotization by the contralateral healthy facial nerve was better than that of the remaining groups (p < 0.0001).
  
  
  CONCLUSIONS
  Temporalis muscle transposition and lengthening myoplasty are acceptable options for patients who are not good candidates for neurotization by the facial nerve. For the restoration of both truly spontaneous smile and facial muscle movement, free microneurovascular muscle transfer neurotized by the contralateral healthy facial nerve has become the authors' first-choice surgical technique.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Tehran, Iran From the Department of Plastic and Reconstructive Surgery, Shahid Beheshti University of Medical Sciences.
authors.forename: Jamal
authors.initials: J
authors.lastname: Gousheh
authors.forename: Ehsan
authors.initials: E
authors.lastname: Arasteh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005149:Facial Expression; D005152:Facial Muscles / Q000294:innervation* / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation / Q000637:transplantation*; D016067:Nerve Transfer / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012904:Smiling / Q000502:physiology*; D055815:Young Adult