Methods of Rehabilitating the Paralyzed Face

The closer one is to restoring the facial nerve to its native state, the closer to a normal-appearing and functioning face will be the result. The best results are obtained on patients with facial paralysis who have an intact nerve with mild neuropraxia; the worst results occur in cases in which the integrity of the facial nerve is completely lost. There is no question that if the nerve is transected, but the proximal and distal ends are available, either a primary anastamosis or interposition nerve graft is preferable. However, if the continuity of the nerve cannot be reestablished then there are three possible conventional solutions: hypoglossal to facial nerve crossover, temporalis muscle transposition, and static facial suspension. Free muscle transfer with cross-facial nerve grafting has been mentioned in the literature, but the numbers are low and results sporadic. Although free muscle transfer may be a mainstream choice in the future, it is probably best reserved for young patients with no other options.1-4

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