A unilateral facial palsy can be considered established and therefore unlikely to recover, if a year has passed since the injury which initiated it. Fascial slings and muscle transfers have still a place in maintaining static position and preventing the mouth swinging to the animated side on smiling. They do not, however, produce a smile responsive to emotion. Crossed facial nerve grafting is rather unreliable and rarely produces a symmetrical smile. Since the mid 1970s vascularised muscle grafts have been employed to compensate for the degeneration of the paralysed facial musculature. The pectoralis minor is a particularly suitable muscle for transplantation to the face because of size and shape. Experience with these techniques and the results of the first 30 cases using this muscle are presented.
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