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Introduction/Background Surgery in facial palsy aims to restore the face's symmetry in rest as well as reanimation of the smile. Gracilis flap is a therapeutic option for patients with long-term facial palsy. Our objective is to describe evolution and functional results of patients treated surgically through gracilis transposition. Material and method 27 patients with chronic (> 12 months) unilateral facial palsy were treated with gracilis transposition to reanimate smile. Demographic information such as age, gender and personal history was gathered, as well as onset of facial palsy, affected side, etiology, date and kind of surgery, complications and initiation of movement. Functional results were evaluated with the Facial Disability Index and the smile item on the Sunnybrook Scale. Results Mean age was 50 years old and a slight prevalence of women over men and right-sided palsy over left was observed. Most prevalent etiology was iatrogenic after acoustic neuroma surgery (33.3%). Fifty-nine percent of palsies were less than 5 years old in evolution. Donor nerve most frequently used was the masseter (48%), followed by the cross-face sural nerve graft with masseter babysitter (33.4%) and lastly, cross-face nerve graft (18.6%). Four patients required a second reanimation surgery. Most common complication was scar retraction at the angle of the mouth. Majority of patients initiated smile around 2–4 months after surgery, being a complete or almost complete movement in 66.6% of patients. Facial Disability Index Global Score was less than 100/200 in 20% of patients and more than 150/200 in 44% of them. Conclusion Functional results were good in more than half the patients, with mild-moderate facial disability. There is a tendency to associate the use of masseter donor with better smile movements and facial disability indexes, even though results are not statistically significant was scar retraction at the angle of the mouth.

Introduction/Background The treatment for facial palsy is complex and requires specialized units as well as a multidisciplinary team to assess the patient globally and respond to the problems of each phase. To unify criteria and define the best treatment for each phase of the facial palsy, to improve facial function and quality of life. Material and method Both doctors and physical therapists from the Facial Palsy Units from the Rehabilitation Services of two university hospitals in Barcelona, Spain, got together to revise scientific articles, share clinical experiences and introduce new technique for facial palsy management. Afterwards, a consensus document was created as a protocol for both medical centers. Results Consensus on best treatment for each phase was achieved, as follows: – hypotonic phase: neurosensory stimulation through Perfetti method, proprioceptive and cognoscitive activities with neurosensory feedback, and movement induction by neuromuscular training (ill side). Treatment with botulinum toxin helps diminish hypercontractility of the sound side; – initiation of movement: neuromuscular training and Perfetti's neuromuscular stimulation; – synkinetic phase: neuromuscular retraining with dissociated movements of the synkinetic muscles. Relaxation treatment of the maintained muscle contractures. Treatment with botulinum toxin helps control aberrant movements and induces facial symmetry. Myofascial techniques (dry needling and mesotherapy) may help diminish maintained muscular contraction. After dynamic surgery, treatment must be based on the physiology of the reconstruction implemented, inducing movement according to the given nervous stimuli. In congenital/obstetric palsies, treatment will be similar to that of adults’ Bell's palsy, adjusting treatment to patient's age. Conclusion We believe this consensus will allow for a better clinical practice, to offer the patient the best treatment to improve functionally, mentally and socially, thus improving quality of life.