Functional reconstruction after facial paralysis: a survey.

The attempt to achieve symmetrical harmonious facial expression represents a complex surgical challenge, necessitating an individualized approach. Clinical investigations and laboratory experiments have demonstrated how to better reconstruct a "smile." In long-standing deformities, ipsilateral or crossfacial nerve grafting followed by functional muscle transfer in a 2-stage procedure seems to give the most acceptable results; however, hypoglossal-facial anastomosis and dynamic muscle techniques such as temporal muscle transposition and others can result in adequate functional reconstruction. The development of these techniques with special emphasis on those made during the last 10 years is discussed and compared with our own experiences.