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Despite several techniques for reanimation after facial paralysis, the management of these patients continues to challenge us. This paper reviews advances in facial reanimation surgery, provides updates on the timing of intervention, modifications to the traditional gracilis muscle transfer, other novel muscle transfers, synkinesis treatments, minimally invasive procedures, and treatments for ocular paralysis. The authors mention new technologies like application of machine learning and artificial intelligence to develop objective assessment tools for evaluating facial function in patients with facial paralysis. Advances in nerve regeneration, acellular or processed allografts and xenografts and synthetic nerve conduits seem to offer hope to this group of patients. Future treatment options include neuroprosthetic devices using closed loop facial pacing, artificial muscle and use of intraoperative fluorescent dyes to identify facial nerves during parotidectomy. This paper is a must-read for all those with interest in facial plastic surgery and facial reanimation.

Advances and future directions in the care of patients with facial paralysis.
Davis ME, Greene JJ.
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Gauri Mankekar

Department of Otolaryngology-Head Neck Surgery, Louisiana State University Shreveport, Louisiana, USA.

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