Facial reanimation after nerve sacrifice in the treatment of head and neck cancer

Purpose of review This article reviews literature on the facial reanimation technique, from direct facial nerve repair and grafting to neuromuscular-free transplantation. The discussion will focus on the indications of the different approaches based on timing of the facial palsy and on patient's features. Recent findings Facial nerve coaptation technique with masseteric nerve, babysitter procedures, and neuromuscular transplantation represent today the gold standard for facial reanimation after facial nerve sacrifice. Surgeon's experience and patient selection have to be considered as other important factors for surgical approach selection. Summary Facial animation represents a difficult challenge for the reconstructive surgeon. A large number of surgical techniques and modifications have been published, and the appropriate approach must be selected based on the kind of facial palsy, its timing, and the patient's age, prognosis, and general condition. A complete grasp of all the approaches that allows for a target surgery represents today an essential assumption for the facial reanimation.