General Editor: Daniel Buchbinder

Authors: Damir Matic, John Yoo

Facial nerve - Irreversible paralysis, midface and mouth - Innervated free muscle transfer (Gracilis)

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The need for aftercare is to reduce the chance of inadvertent release of the suspension procedure. This can include maintaining soft diet 2-3 weeks postoperatively and minimizing exertion and trauma to the area during this period.

Generally, 4-6 weeks postoperatively patients are encouraged to return to normal activities without restrictions.

Infrequently, some patients may need formal mouth opening exercise if they develop trismus.

Specific physiotherapy exercises are started after this time. The goals are to improve symmetry both at rest and during function, through biofeedback and patient practice (in front of a mirror).

Postoperative free flap management

When a free flap is utilized, it should be regularly monitored to ensure vascular integrity. Hand-held Doppler or indwelling probes can be used to assess blood flow. In case of doubt of the vitality of the flap, surgical exploration may be necessary.

Aftercare of the donor site

Routine post-surgical wound care is required. A closed-suction drain is placed at the time of surgery and removed when minimal output (usually day 3). Patients ambulate and return to normal function without the need for directed physiotherapy.