Brain-Computer Interface Applications in Craniofacial Nerve Functional Reconstruction: A Narrative Review

Brain-computer interface (BCI) technology is increasingly relevant to craniofacial nerve functional reconstruction because it can decode cortical motor intent and convert it into physical or digital output when peripheral motor pathways are impaired. Facial nerve palsy, dysphagia, and oromandibular motor dysfunction remain difficult to treat when conventional nerve repair, muscle transfer, or electrical stimulation cannot restore coordinated and natural movement.

This narrative review synthesized peer-reviewed literature on BCI-related craniofacial functional reconstruction. A targeted search of PubMed, Embase, Web of Science, and Google Scholar was performed, covering English-language articles published from 2014 to April 12, 2026. Eligible core articles addressed BCI-based facial motor restoration, swallowing or oromandibular BCI paradigms, speech or orofacial neuroprosthetics, neural interface integration in craniofacial surgery, flexible facial bioelectronic sensing, or functional electrical stimulation systems with direct relevance to craniofacial nerve recovery. Background literature was cited separately to contextualize disease burden, conventional reconstruction, dysphagia, outcome assessment, calibration, and neuroethical issues.

Twenty-two core articles were included in the final thematic synthesis and organized into 3 domains: facial expression motor reconstruction, oromandibular and swallowing rehabilitation, and neural interface integration in craniofacial surgery. EEG-based facial-expression decoding has shown promising accuracy under controlled laboratory conditions, speech neuroprosthetics provide potentially transferable frameworks for orofacial motor decoding that remain unproven in facial palsy or dysphagia rehabilitation, swallowing motor-imagery studies support physiological feasibility for dysphagia-oriented BCI, and flexible facial biosensors may support future closed-loop systems.

BCI technology should be regarded as a potential complement to conventional craniofacial reconstruction rather than a replacement for established surgical techniques. Current evidence supports technical feasibility, but clinical translation will require naturalistic decoding, durable interfaces, faster patient-specific calibration, meaningful outcome measures, and early attention to ethical issues.