Evaluation and surgical decision making in facial paralysis

Facial paralysis is a complex condition requiring a multidisciplinary and systematic approach to develop a comprehensive treatment regimen that will result in optimal outcomes. A multitude of surgical and non-surgical options are available. The time from onset of facial paralysis, type of paralysis (flaccid vs non-flaccid), continuity of facial nerve, and viability of the facial musculature are important factors to consider in the selection of treatment options. Other considerations include underlying etiology, patient preferences and comorbidities, degree of injury, involved facial zones, and laterality (unilateral vs bilateral). The reconstructive surgeon should be familiar with management options for both flaccid and non-flaccid facial paralysis. A wide array of dynamic and static surgical options is available for both early and delayed reanimation. In most cases, patients receive a combination of both dynamic and static treatments. In this article, we aim to discuss the evaluation of the patient with facial paralysis and provide a framework for decision making in treatment selection.