Facial palsy is a debilitating condition for patients suffering of it. It has both functional as well as aesthetic significance for the individual. Causes of facial nerve palsy are various: it may be idiopathic (Bell’s palsy), a complication of surgical removal of a tumour (vestibular schwannoma, parotid tumor) or traumatic.

Treatment strategies used in facial nerve palsy depend completely on (a) cause of the lesion (b) severity and level of the lesion and (c) latency between lesion and treatment, in other words, how long the lesion has been persistent before treatment was undertaken.

Surgical treatment with primary nerve repair, if indicated in the individual case, should be undertaken as quickly as possible from the moment of injury or lesioning.

In direct nerve transections, e.g., parotid tumor surgery, both the nerve ends are found, and joined directly or with an intervening nerve graft.

When the proximal stump of the facial nerve is absent, then either the hypoglossal nerve itself or its descending branch are used as axonal donors in a nerve transfer procedure to restore static and dynamic facial symmetry.

In patients with long standing facial palsy (many years of persistent static and dynamic facial asymmetry), secondary procedures play a role in the treatment strategy and depends on the age and general health of the patient. For example, in a young patient in generally good health, with a long standing facial palsy, a free functional muscle transfer (FMT) is used to restore the facial nerve function; in the elderly, local muscle transfers offer better results and free of risks involved in a more profound FMT.