Approaches to the treatment of facial paralysis: an integrative review of surgical therapeutic strategies

Abstract

Facial paralysis is a condition with significant functional and aesthetic impact, compromising facial expressions, communication, and quality of life. Given the diversity of etiologies and the complexity of rehabilitation, identifying effective surgical strategies to restore function and facial symmetry is essential. The aim of this study was to conduct an integrative literature review on the surgical approaches used in the treatment of facial paralysis, focusing on techniques applied during both the acute and chronic phases. The search was performed in the PubMed, SciELO, and LILACS databases using descriptors related to facial paralysis and facial reanimation techniques. Articles published between 2016 and 2025, in English and Portuguese, exclusively addressing surgical interventions, were included. After applying the inclusion and exclusion criteria, 12 studies comprised the final sample. The results demonstrated that, in the acute phase, techniques such as direct neurorrhaphy, interposition nerve grafts, and nerve transfers, including masseteric and hypoglossal nerve anastomoses, showed better outcomes when performed early. In chronic cases, temporalis muscle transposition and functional gracilis muscle transfer were the most frequently described techniques, standing out for their ability to restore dynamic movement and improve smile symmetry. The selection of the surgical technique varies according to the duration of paralysis, neuromuscular integrity, and functional goals. It is concluded that surgical management should be individualized, taking into account the patient’s clinical characteristics and expectations, since different techniques demonstrate consistent outcomes when appropriately indicated.