Nerve transfers in facial palsy.

The facial paralysis patient suffers serious functional, cosmetic, and psychological problems with impaired ability to communicate. Despite the advances of recent years and the number of new techniques proposed in the literature, facial reanimation remains a challenge for the reconstructive surgeon. With the advent of microsurgery, reanimation of the paralyzed face took a major leap forward with the use of cross facial nerve grafts, nerve transfers, and free muscle transplantation. Today, nerve transfers represent the backbone of facial reanimation, especially in cases where reconstruction of the affected facial nerve is not feasible. The suitability of each nerve transfer is related to the type of facial palsy, time elapsed since injury, and the age and general health of the patient. The selected motor nerve must provide strong muscle contraction and allow the patient to control the facial movements. The purpose of this chapter is to present the senior author's (J.K.T.) experience in the selection of motor nerves that can function as possible donor nerves for dynamic facial reanimation. Indications and surgical technique for each procedure is also presented.