Facial reanimation with microneurovascular free flaps

Numerous options are available for rehabilitation of chronic facial nerve paralysis, ranging from simple slings to complex procedures such as microneurovascular tissue transfer. Microneurovascular muscle transfer is generally indicated: 1) if the patient desires dynamic facial reanimation, particularly restoration of involuntary emotional facial expressions; 2) in the absence of distal facial nerve fibers or motor endplate function; 3) with an associated large soft tissue defect in the cheek; and 4) when other dynamic reanimation procedures have not been successful. The most commonly used free flaps for facial reanimation are gracilis, latissimus dorsi and inferior rectus abdominus muscle. When successfully performed free flaps yield excellent functional and aesthetic results in facial reanimation.