Simultaneous use of static support and free muscle transfer

The most important goals for facial palsy patients receiving treatment is to be perceived as "normal" by society, and subsequently this is the most important goal for the reconstructive surgeon. The literature is abundant in descriptions of dynamic reanimation techniques, but less detailed on addressing asymmetry at rest. Facial palsy treatment should therefore not solely focus on restoring facial motion but also tone to obtain an optimal result. The exact chosen surgical approach depends on several variables as patient presentation (flaccid vs. partial vs. synkinesis), palsy duration (acute vs. subacute, vs. longstanding) and etiology (cancer vs. benign vs. infectious), nerve continuity (residual vs. reconstructed nerve continuity vs. no nerve continuity), and more. These factors and their influence on facial palsy treatment, more specifically the use of static support in combination with free muscle transfer will be elaborated on in this chapter. The most important message of this chapter is that, to achieve an optimal outcome, all available reconstructive and aesthetic surgical tools and the combination thereof must be considered despite of their perceived "classification."