Maximizing the Smile Symmetry in Facial Paralysis Reconstruction: An Algorithm Based on Twenty Years' Experience

Abstract Over the last two decades, senior author (B.H.) has had an extensive experience with facial paralysis reconstruction. During this period, techniques have evolved substantially based on and after observing analyzing surgical outcomes. The purpose of article is to relay lessons learned from 20 years' suggest algorithm. In retrospective study, we included 343 cases cases. Complete were 285 58 incomplete paralyses, both requiring procedures. paralyses divided in short term (n = 83) long 202). total, 58% patients women 42% men. age range was 6 82 years. employed direct suture, nerve grafts, cross-facial grafts (CFNGs), masseteric-to-facial transference, hypoglossal-to-facial free muscle transplants, lengthening temporal myoplasty achieve best symmetry reanimation unilateral, bilateral, complete, paralysis. type paralysis, objective measurements, personal patient's smile, gender are key concepts be considered before scheduling a dynamic For unilateral time onset, comorbidities, healthy side status some determining factors when selecting correct technique. preferred for repair, CFNG, transposition, gracilis transfer. transference preferred. bilateral transfer performed stages using masseter as source innervation. authors provide algorithm which simplifies reconstruction greatest while thinking about potential comorbidities developing spontaneity smile according patient.