Facial Reanimation: Basic Surgical Tools and Creation of an Effective Toolbox for Treating Patients with Facial Paralysis. Part A: Functional Muscle Transfers in the Long-Term Facial Palsy Patient

The literature on facial paralysis is vast; however, detailed videos of the basic tools of dynamic reanimation within the context of patient scenarios accompanied by detailed narrative emphasizing both technique and thought processes are not common. Although not all scenarios of facial paralysis can be discussed in one setting, videographic visualization of basic surgical procedures, including facial marking, facial dissection, donor nerve preparation, cross-facial nerve graft, nerve transfers, and muscle harvest and inset, may provide a strong toolbox. Using these tools in various combinations depending on the unique case details enables the surgeon to treat a great majority of facial palsy patients. Part A, with the first of two videos, concentrates on free functional muscle transfer in the setting of longstanding facial paralysis. It includes preoperative markings, preparation of the patient in the operating room before incision, facial dissection including exposure of the masseter nerve, partial gracilis muscle harvest, and perhaps most importantly, the inset of the muscle on the paralyzed side. Part B (with the second video) concentrates on the cross-facial nerve graft and nerve transfers, used in the context of acute facial palsy, providing the short-term goal of mimetic musculature salvage in addition to longer term specific regional reinnervation by means of cross-facial nerve grafting. We hope that these videos provide a strong learning tool for enthusiastic novice medical students, residents, and fellows wishing to prepare for their cases, and faculty level physicians who wish to use them as a refresher before surgery.