Facial nerve palsy with the functional and cosmetic problems it presents, it creates maximum communication dysfunction and psychological burden on the patient.

Paralysis can be congenital (congenital) or acquired and appear at any stage of life. Injuries and intra- or extra-cranial tumors, as well as various inflammations are the main causes of facial nerve paralysis.

The characteristics of the paralysis are asymmetry of the face with drooping of the corner of the mouth, widening of the eyelid fissure, inability to close the eyelids, dysfunction of the mouth sphincter, etc.

Restoration of symmetrical harmonious expression of the face, is the goal. The surgical treatment of each patient varies depending on the functional disorders that arise after the paralysis. The two main factors influencing the method of rehabilitation are the duration of the paralysis and the level of damage to the course of the facial nerve.

Other factors likely to differentiate surgical planning are the patient’s age, life expectancy, functional deficit, patient preference, and the involvement of other cranial nerves in the palsy.

The time that has passed since the establishment of the paralysis determines the possibility of regeneration (restoration of function) of the facial muscles. After 1-1.5 years it is no longer possible to recover the function of the facial muscles. The level of damage to the facial nerve determines the availability (or not) of its central stump. Therefore, the following situations may occur:

I) Duration of paralysis less than 1 year.

1) If the interruption of the continuity of the facial nerve has occurred outside the skull, an attempt is made to connect the two parts of the nerve either by direct suturing of them, or with nerve grafts as long as there is tissue loss.

2) Facial nerve palsy within the skull is treated by reinnervation of its extracranial distal part by other nerves, such as the nerve of the corresponding masseter muscle, or part (40%) of the hypoglossal nerve, or by interfacial nerve grafts from the facial nerve of the other side of the person, or with a combination of the above interventions.

II) Duration of paralysis beyond a year (chronic paralysis).

In this case the facial muscles have atrophied so much that they cannot function again. Therefore, a muscle from another part of the body, usually the thigh, is transferred to the face, where its vessels join with vessels in the area, while the muscle’s nerve is sutured to the extracranial central stump of the facial nerve, if present (rare).

If a central facial nerve stump is not available, the nerve of the transferred muscle may be sutured either with interfacial nerve grafts from the facial nerve of the other side of the face, or sutured to another cranial nerve, such as part of the hypoglossal nerve or the nerve of masseter muscle.

Transplantation of regional muscles in the form of pedicle flaps (temporal and/or masseter) is sometimes applied to enhance and improve the results of microsurgical operations.

III) Congenital paralysis of the facial nerve.

The operations mentioned for the chronic, beyond the year, paralysis of the facial nerve are also applied to the treatment of the related paralysis. Treatment is determined by the extent of the functional deficit, ipsilateral or bilateral with or without involvement of other cranial nerves (Möbius syndrome).

In conclusion, no surgical technique provides the perfect result.

The sooner after the paralysis of the facial nerve is established, the attempt at rehabilitation is made, the better the results, because regeneration of the indigenous facial muscles is achieved. Substitution of facial muscles with another muscle achieves satisfactory functional improvement, so that despite the fact that the result is not perfectly symmetrical, patients can continue their lives without interruption.