The surgical management of facial nerve injury.

The surgical management of facial nerve injuries is dependent upon a thorough understanding of facial nerve anatomy, nerve physiology, and microsurgical techniques. When possible, primary neurorrhaphy is the "gold standard" repair technique. Injuries resulting in long nerve gaps or a significant delay between the time of injury and repair requires alterative techniques, such as nerve grafts, nerve transfers, regional muscle transfers, free tissue transfers, and static procedures. Scrupulous technique, selection of the appropriate surgical management, and aggressive physiotherapy with motor reeducation are all critical to obtaining a functionally and aesthetically acceptable result while minimizing synkinesis and facial asymmetry. This review of the literature provides an overview of current concepts in the surgical management of facial nerve injuries.