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Table 2 Plan by stages for facial reanimation (Modified after. [35])

From: Modern concepts in facial nerve reconstruction

Surgical method Comments
A. Early reconstruction of extratemporal lesion  
   Step I:  
A.1 Primary direct nerve suture  
A.2 Interpositional graft  
A.3 Upper lid weight A.3. lid weight better than tarsorrhaphy
   Step II:  
A.4 Adjuvant measures  
B. Early up to delayed reconstruction of proximal lesion or impossibility to use reconstruction A (see above)  
   Step I:  
B.1 Hypoglossal-facial jump anastomosis B.1 better than classical hypoglossal-facial anastomosis
B.2 Upper lid weight  
B.3 Cross-face nerve suture  
B.4 Temporalis muscle transfer B.4 better than masseter muscle transfer
B.5 Digastric muscle transfer  
B.6 Sling plasty  
   Step II:  
B.7 Cross-face nerve suture  
B.8 Eye brow lift B.8. in case of brow ptosis
B.9 Rhinoplasty B.9 in case of nasal asymmetry
B.10 Rhytidectomy B. 10 in case of cheek or chin ptosis
B.11 Botulinum toxin, Myectomies  
C. Late reconstruction or congenital disease  
   Step I:  
   Mimic musculature existing:  
C.1 Hypoglossal-facial jump anastomosis C.1 Hypoglossal nerve: better than any other donor nerve
C.2 Upper lid weight  
C.3 Cross-face nerve suture  
   Mimic musculature not existing, but nerve supply existing:  
C.4 Microvascular muscle transfer C.4 Best choice for congenital lesions
C.5 Temporalis muscle transfer  
   Mimic musculature not existing, and nerve supply not existing:  
C.6 Sling plasty C. 6 Use palmaris longus tendon or fascia lata
   Step II:  
C.7 Eye brow lift  
C.8 Rhinoplasty  
C.9 Rhytidectomy  
C.10 Botulinumtoxin, Myectomies C.10 Correction of defective healing or facial asymmetry on lesioned and healthy side