Selecting an appropriate approach to the chronically deinnervated paralyzed face is complex. The present-day paradigm, employing dynamic muscle reanimation as a first-line approach, with static methods as a fallback, is an oversimplified algorithm that requires refinement. Specific clinical scenarios arise in which a deviation from this strategy is called for in order to achieve the desired outcome. Acknowledging that, in general, dynamic muscle transfer offers superior results in complete, longstanding paralysis (House-Brackmann grade V-VI recovery), we highlight special clinical situations in which static methods may provide compara ble or superior outcomes. In addition, clinical situations exist in which early dynamic muscle transfer provides an adjunct to reinnervation of the transiently completely paralyzed face. Figure 24-1 shows a schematic illustrating one possible facial paralysis management strategy, which includes these particular scenarios.

Figure 24-1 Schematic illustrating management strategy for facial paralysis. HB, House-Brackmann; SMAS, superficial muscu-loaponeurotic system; TPFF, temporoparietal fascia flap.
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