Seminal Studies in Facial Reanimation Surgery: Consensus and Controversies in the Top 50 Most Cited Articles

Abstract

Facial paralysis can impair one's ability to form facial expressions that are congruent with internal emotion. This hinders communication and the cognitive processing of emotional experience. Facial reanimation surgery, which aims to restore full facial expressivity is a relatively recent undertaking which is still evolving. Due in large part to published techniques, refinements, and clinical outcomes in the scientific literature, consensus on best practice is gradually emerging, whereas controversies still exist. Taking stock of how the discipline reached its current state can help delineate areas of agreement and debate, and more clearly reveal a path forward. To do this, the authors have analyzed the 50 seminal publications pertaining to facial reanimation surgery. In longstanding cases, the free gracilis transfer emerges as a clear muscle of choice but the nerve selection remains controversial with prevailing philosophies advocating cross facial nerve grafts (with or without the support of an ipsilateral motor donor) or an ipsilateral motor donor only, of which the hypoglossal and nerve to masseter predominate. The alternative orthodoxy has refined the approach popularized by Gillies in 1934 and does not require the deployment of microsurgical principles. Although this citation analysis does not tell the whole story, surgeons with an interest in facial reanimation will find that this is a good place to start.

Clinical Experience With Acute Phase Repair of Facial Nerve Dissections

“…The facial muscle control of the facial nerve allows us to communicate our joys and sorrows through micro-expressions, which are essential in our daily lives, and thus patients are highly motivated to treat facial nerve injuries once they occur. 21 Regaining the facial neural control over the muscles of expression is the highest priority in our treatment. With the deepening of research, it has been found that early tension-free anastomosis can achieve the best therapeutic effect when conditions permit, but such literature reports are few.…”

“…The facial muscle control of the facial nerve allows us to communicate our joys and sorrows through micro-expressions, which are essential in our daily lives, and thus patients are highly motivated to treat facial nerve injuries once they occur 21 . Regaining the facial neural control over the muscles of expression is the highest priority in our treatment.…”