Facial paralysis has fascinated physicians through the centuries. Management of the condition has evolved extensively over the past 50 years, relying largely upon neural repair techniques and static techniques prior to the 1940s, followed by heavy emphasis on regional muscle transfer by the 1970s. With the advent of the operating microscope and the development of microinstrumentation, in the mid-1970s free tissue transfer became technically feasible, and new techniques quickly ensued that introduced functioning muscle as a viable and valuable option in the management of the paralyzed face. These techniques have been subject to continual refinement to improve their reliability and reduce morbidity. In the modern era of evidence-based medicine, the field of facial nerve management has expanded exponentially with critical questions that will help future facial reanimation surgeons refine the approach for patients with acute and long-standing facial paralysis. This article will discuss current research areas with respect to assessment and management of the facial nerve patient, as well as future surgical outcomes. We will also present the state of both clinical research and contemporary basic science issues relevant to facial nerve disorders.
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