The evolution of facial reanimation techniques

This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.

Automated summary

This review article provides updated information on evidence-based practices for the evaluation and management of facial paralysis. The goals of facial reanimation are to achieve facial symmetry at rest, protect the cornea, restore smile symmetry, and improve facial movement. Recent advancements in facial reanimation techniques have allowed clinicians to approach challenging cases with reliable strategies. The article discusses the use of machine learning software for assessments and explores controversial topics such as timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. It also highlights the evolution of conservative management strategies and innovations in surgical techniques, particularly the gracilis free muscle transfer.