Facial reanimation: evolving from static procedures to free tissue transfer in head and neck surgery.
OBJECTIVE
The purpose of this article is to review and evaluate the surgical options for treating patients with facial paralysis, covering primary neurorrhaphy to facial reanimation, with microvascular free tissue transfer.


RESULTS
In recent years, free tissue transfer has been increasingly common for rehabilitating the paralyzed face, providing a more dynamic and aesthetic outcome, than has been possible prior to microvascular surgery in facial plastic and head and neck surgery.


CONCLUSIONS
Although primary facial nerve repair attains the best results, nerve grafting with the sural nerve and commercially available motor nerve allografts can be used alone, or in combination with masseteric nerve grafts to attain facial tone and protect eyelid function. The workhorse for reanimation is the gracilis free tissue transfer innervated by the masseteric nerve or contralateral facial nerve using a cross-face nerve graft. The orthodromic temporalis tendon transfer has minimal donor site morbidity and acceptable reported outcomes. Static procedures continue to be used alone and in combination with other paradigms for facial nerve reanimation.
Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, California, USA.
Brianna N
BN
Harris
Travis T
TT
Tollefson
D005149:Facial Expression; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D019651:Plastic Surgery Procedures; D013709:Tendon Transfer