title: Contemporary solutions for the treatment of facial nerve paralysis.
abstract: OBJECTIVE
  After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis.
  
  
  CONCLUSIONS
  Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.
authors.affiliation: Durham, N.C.; Boston, Mass.; Houston, Texas; and East Meadow, N.Y. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center; Massachusetts Eye and Ear Infirmary; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Baylor College of Medicine, The Methodist Hospital; Long Island Plastic Surgical Group; and the Division of Plastic Surgery, Department of Surgery, Nassau University Medical Center.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Garcia
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Klebuc
authors.forename: Roger L
authors.initials: RL
authors.lastname: Simpson
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zenn
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Marcus
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D004502:Education, Medical, Continuing; D004576:Electromyography / Q000379:methods; D005149:Facial Expression; D005152:Facial Muscles / Q000637:transplantation; D005154:Facial Nerve / Q000601:surgery; D005158:Facial Paralysis / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008405:Massage / Q000379:methods; D016067:Nerve Transfer / Q000379:methods*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D013703:Temporal Muscle / Q000637:transplantation*; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins