Nerve guide conduits, nerve transfers, and local and free muscle transfer in facial nerve palsy.

Purpose Of Review: To highlight the recent literature on reinnervation options in the management of facial nerve paralysis using nerve conduits, and nerve and muscle transfers.

Recent Findings: Engineering of natural and synthetic nerve conduits has progressed and many of these products are now available on the market. The use of the masseter nerve has become more popular recently as a choice in nerve transfer procedures due to various unique advantages. Various authors have recently described mimetic muscle reinnervation using more than one nerve transfer, as well as dual and triple innervation of free muscle transfer.

Summary: The ideal nerve conduit continues to be elusive, however significant progress has been made with many natural and synthetic materials and designs tested and introduced on the market. Many authors have modified the classic approaches in motor nerve transfer, as well as local and free muscle transfer, and described new ones, that aim to combine their advantages, particularly the simplification to a single stage and use of multiple reinnervation to the mimetic muscles. These advances are valuable to the reconstructive surgeon as powerful tools that can be tailored to the unique challenges of patients with facial nerve palsy looking for dynamic reanimation options.