Management of the paralyzed face with microneurovascular free muscle transfer

Facial paralysis is a devastating physical condition in which no single therapeutic approach consistently restores mimetic facial expression. The purpose of this article is to review the current treatment modalities for facial paralysis with particular emphasis on the indications for using free flaps to achieve facial reanimation. Primary attention is given toward rehabilitation of the lower two thirds of the face. The various neuromuscular free flaps used for facial reanimation are described and their merits and deficiencies are discussed.