The surgical treatment of extratemporal facial paralysis: an overview

At present there is no single surgical approach that is ideally suited to rehabilitation of the paralyzed face. Dynamic reconstruction and neural reconstitution are usually preferred to static methods, except under special circumstances. Experience with over 150 autogenous facial-nerve grafts using epineural suture technique has resulted in return of movement in 95% of properly selected patients. When grafting is not feasible, as in the obliterated central facial nerve, hypoglossal-facial-nerve crossover is a simple and powerful source of reinnervation, usually resulting in minimal intraoral crippling and mild mass movement. A newer procedure, the cross-face nerve graft, is an alternative to hypoglossal crossover, although it results in less axonal input and longer regenerative time. In cases of long-standing facial paralysis with muscle atrophy, temporalis and masseter transfers are dependable and may sometimes be combined with a nerve graft.