CONTEMPORARY CONCEPTS AND SURGICAL TECHNIQUES IN FACIAL REANIMATION: A SCOPING REVIEW.

Paralysis of the facial nerve represents an exceptional functional, social and cos- metic problem for the patient. Loss of function directly leads to the inability to protect the eyes, as well as oral competence, while indirectly affecting breathing and verbal communication. Patients often encounter social stigmatization and isolation, which is direct consequence of the loss of mimic function and disfiguration that is necessary for everyday nonverbal communication. Thus, the quality of life is strongly impaired, and patients are prone to developing depression. The primary goal of reanimation is establishment of facial tone at rest, mimic function, and symmetry. The method of choice is directly dependent on the time elapsed from the onset of paralysis. Facial reanimation methods can be divided into static and dynamic. In reanimation procedures, we usually divide the face into thirds. Procedures for reanimation of the upper third of the face include oculoplastic procedures, which are divided according to the place of intervention into procedures aimed at the eyebrow, upper and lower eyelid. Static methods predominate here, i.e., endoscopic eyebrow lifting, tightening of the upper eyelid, and tightening of the lower eyelid. Procedures for reanimation of the lower third of the face are mainly based on restoring oral competence and smile, therefore the method of choice is dynamic reanimation. Direct repair of the nerve either by direct anastomosis or interposition provides the best results. In the absence of the proximal part of the facial nerve, and functional distal branches, local motor nerves and/or cross facial nerve graft (CFNG) are used as a source. In the case of long-term paralysis of the facial nerve (>2 years), muscle tissues are used in reanimation using local or innervated free flaps. Of the local muscle flaps, we most often use the minimally invasive temporalis tendon transfer (MIT3) method. The gracilis free flap is most often used in younger patients who desire to achieve a more accentuated smile, and the procedure can be performed in one or two acts. Reanimation of the face is an often neglected but extremely important procedure that should provide the patient with partial function resumption while significantly improving the quality of life.