A systematic review of methods used in facial nerve reconstruction

Objective: The underlying idea behind this review was to present the most recent and well-established findings concerning methods of facial nerve reconstruction in a comprehensive albeit concise fashion. Methods: The Google scholar, The Medline/Pubmed and Cochrane databases have been used to select the most relevant and influential experiences on the reconstruction of the facial nerve. Authors searched for publications written strictly in English. The authors considered the date of the publication, the presented cases and the overall significance of the paper. The references of the publications of interest were also screened for relevant papers. Conclusions: Facial nerve reconstruction is a highly formidable challenge, prompting reconstructive surgeons to rely on a wide spectrum of tools ranging from microsurgery, through peripheral nerve management to aesthetic procedures. Advances in the field of reconstructive surgery have resulted in more ambitious goals, as surgeons strive not only to restore function but also for a highly aesthetic outcome. The vascularized nerve graft is recommended in cases with a long nerve gap, inadequate soft-tissue coverage and in patients with previous irradiation at the wound. Motor nerve grafts seem to be superior to sensory nerve grafts. A cross-facial nerve graft (CFNG) is recommended when a proximal nerve stump is unavailable. The gracilis muscle is effective in the dynamic reconstruction of the oral commissure movement. Postoperative radiotherapy does not prevent recovery of facial function after sural nerve grafting. Individual factors and level of proficiency with a given technique should guide reconstructive surgeons during the selection of the method.