Update in facial reanimation: neurorrhaphy, interposition grafting, nerve transfers and bioengineered options

PURPOSE OF REVIEW: The purpose of this review is to summarize recent advances in facial nerve repair and facial reanimation as it relates to neurorrhaphy techniques, bioengineered options and nerve transfers. RECENT FINDINGS: Direct neurorrhaphy is the gold standard for facial nerve repair when tension-free repair is achievable. Interposition grafting with autologous donor nerves facilitates repair when a tension-free repair is not feasible. Adjunctive bioengineered materials have been developed to enhance nerve repair, but high-quality clinical evidence supporting their use in facial nerve reconstruction remains limited. Nerve transfers can be employed when direct repair or interposition grafting is not possible, such as when the proximal nerve stump is absent, or when recovery after primary or interposition repair is unlikely. SUMMARY: Significant advances have been made in facial nerve reconstruction. Multiple bioengineered materials are now available with the potential for improved outcomes; however, few have shown significant efficacy in clinical studies. High-quality clinical research and prospective investigation are needed to justify and predict when to best use these materials.