[Role of micro-anastomosed muscular transplantation in corrective surgery of permanent facial paralysis].

Vascularized and reinnervated transfer of a muscle from the body to the face is never a simple procedure. It is important to evaluate the pre-operative state of facial muscles. It is difficult to define the correct indications for the various surgical techniques proposed: muscle selection, selection of recipient vessels, selection of a reinnervation method, the positioning of the transferred muscle. The authors present a series of 12 cases of long standing facial paralysis for more than 3 years. Results are presented. The authors think that the ideal muscular transfer is still unknown. In principle, nothing can replace facial muscles except facial muscles. Currently, the authors prefer the latissimus dorsi flap with partial transfer. For reinnervation, the facial nerve must take the priority, while all other reinnervation technics should take second place. In all cases, great attention must be paid to the positioning of the muscle, the usefulness of conventional palliative procedures and the continuous moral support to all of these patients.