The pathology of facial palsy is complicated because it includes both acute palsy and long-onset palsy with mimetic muscle atrophy, viral infection and surgical abrasion, and both complete and incomplete palsy. Our algorithm for surgical treatment for facial nerve palsy is presented in this article. We divided facial nerve palsy into three groups, 1）complete acute palsy, 2）incomplete palsy with ongoing denervation or re-innervation, and 3）long-onset palsy with mimetic muscle atrophy.
1）For complete acute palsy caused by trauma or tumor abrasion, we perform nerve reconstruction as soon as possible. However, if reconstruction is impossible at the damaged area, interpositional-jump grafting is carried out at the distal facial nerve trunk with axonal switching from the partial hypoglossal nerve.
2）For incomplete palsy with ongoing denervation or re-innervation, network like reconstruction with axonal supercharge from the hypoglossal nerve using an interpositional nerve graft with two end-to-side neurorrhaphies, is performed.
3）For long-onset palsy with mimetic muscle atrophy, static reconstruction or dynamic reconstruction using free muscle transfer is selected or combined, depending on the patient’s needs, age, and complications.
