Immediate and single-stage facial reanimation after radical parotidectomy and oncologic facial nerve sacrifice: A systematic review.

Background: Radical parotidectomy with facial nerve sacrifice produces major functional and aesthetic deficits. Immediate or single-stage facial nerve reconstruction and facial reanimation may restore symmetry, ocular protection, oral competence, and dynamic movement while avoiding the limitations of delayed intervention. This review synthesizes the available evidence on reconstructive strategies and outcomes in this setting. Methods: A systematic review was performed of studies evaluating immediate, concurrent, or single-stage facial nerve reconstruction or facial reanimation at the time of radical parotidectomy or oncologic facial nerve sacrifice. PubMed, Embase, Scopus, and Web of Science were searched from database inception through April 2026. Eligible studies were original clinical series reporting postoperative functional outcomes, patient-reported outcomes, complications, or revision procedures. Data were synthesized descriptively because of heterogeneity in techniques and outcome reporting. Results: Nineteen studies comprising 277 patients met inclusion criteria. Reconstructive strategies included cable or interpositional nerve grafting, concurrent masseteric nerve transfer, vascularized nerve grafting, temporalis-based dynamic reanimation, free functional muscle transfer, and composite flap-based reconstruction. Across studies, immediate reconstruction was associated with restoration of resting symmetry, oral competence, and ocular protection, while dynamic approaches more often reported smile recovery and oral commissure movement. Interpositional cable grafting resulted in a postoperative recovery in the House-Brackmann III range. Reported complication rates were acceptable, with low donor-site morbidity and uncommon flap loss. Limited radiotherapy-specific analyses suggested that postoperative radiotherapy did not uniformly preclude functional recovery after immediate reconstruction. Conclusions: Immediate or single-stage facial nerve reconstruction and facial reanimation after radical parotidectomy appear feasible across a range of oncologic defects and are associated with reported postoperative restoration of facial tone, symmetry, oral competence, ocular protection, and, in selected series, dynamic facial movement. However, the current evidence is limited by retrospective design, small sample sizes, and heterogeneous outcome reporting. Larger comparative studies using standardized functional and patient-reported outcome measures are needed to better define the optimal reconstructive strategy.