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Originally published September 2, 2026
Last updated September 2, 2026
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Facial nerve disorders impact approximately 30 out of 100,000 adults in the U.S. annually. Common causes of damage to the facial nerve and subsequent facial paralysis include Bell’s palsy, cancerous tumors, acoustic neuromas and iatrogenic complications.
Although patients often recover from these conditions, many don’t regain full facial function or symmetry. “Maybe they get strength back, but they may still have issues like facial spasms or the discoordinated movement called synkinesis,” says Roxana Moayer, MD, a facial plastic and reconstructive surgeon with the USC Caruso Department of Otolaryngology – Head and Neck Surgery and director of the USC Facial Plastic and Reconstructive Surgery Program, both part of Keck Medicine of USC.
Improving treatment for patients with facial nerve disorders is a growing focus among clinicians and researchers today. “It’s only been within the past 15 years or so that facial plastic and reconstructive surgeons have looked with renewed enthusiasm at what we can do to restore facial function and aesthetic for these patients,” Moayer says. “We’re turning over every rock to find out what’s possible.”
Treatment focuses on leveraging the facial nerve’s ability to regrow. “When we talk about restoring a patient’s facial function,” Moayer says, “we’re talking about reconnecting the ‘wires’ that have been cut and supporting their growth.”
Timing is crucial because delayed intervention can open the door to facial-muscle atrophy, permanent muscle loss or long-term “miswiring” and synkinesis.
Moayer notes, “In the case of tumor surgeries, where no attempt was historically made to reconnected injured nerves during surgery, now I work closely with cancer surgeons and am available as needed to reconnect those nerves at the time of tumor resection to ensure they have an inherent chance to regrow.”
Research also indicates that leaving a small gap between nerve endings during reconnection encourages better regrowth than if surgeons force the nerve endings to overlap. As Moayer explains, “That’s where bioengineered nerve conduits help us guide the axons through this 1-to-5-millimeter gap so that the nerve endings end up in the target organ, which is the muscle.”
Surgeons also use flat, flexible membranes called nerve wraps — often porcine in source — to surround repaired nerves and prevent fibers from escaping and growing where they shouldn’t. These wraps also participate in biological signaling processes that create a more optimal environment for nerve growth.
“A lot needs to happen for nerves to regrow,” Moayer says. “There needs to be a healthy environment, and we’ve found that porcine nerve wraps deliver growth factors to this area that allow for local cell signaling to support the nerve’s regeneration.”
In cases where a facial nerve is damaged proximally — closer to the brain — it’s neither safe nor feasible to connect the distal nerve ending to that input, Moayer says. “Fortunately, we can borrow input from somewhere else through a nerve transfer.”
For example, cranial nerve 5, which innervates the masseter muscle, has redundant branches. “I can identify one of those branches,” Moayer says, “cut, reroute and connect it to the distal branches of the facial nerve, and it can then provide the neural input that allows for facial motion — similar to the hypoglossal nerve that controls the tongue.” But whereas the practice used to involve rerouting the entire nerve and thus sacrificing innervation to the tongue, Moayer says, “Now we can splice the nerve or do an end-to-side window into the nerve, which allows us to use just some of the axons from the nerve end and almost eliminate the risk of tongue weakness.”
The sural nerve and great auricular nerves also commonly supply grafts when length is needed.
No matter the procedure, Moayer stresses the “absolute necessity” of highly specialized facial physical therapy and neuromuscular retraining to achieving optimal recovery.
“When the body’s injured, it compensates,” she points out. “The same thing happens with the face: Sometimes the side that’s not injured becomes problematic because it’s working harder to get facial movement.”
This can lead to spasms, twitches and tightness that, along with synkinesis, can be uncomfortable or even painful for patients. Physical therapy and neuromuscular retraining — often coupled with botulinum toxin treatment — “are tools we can use to actually get patients feeling better,” she says.
Moayer, who directs the USC Facial Plastic and Reconstructive Surgery Program, works closely with the program’s physical therapist to coordinate patient care. “We have a multidisciplinary team that really communicates with each other,” she says. “There needs to be a higher-level discussion about how the patient is progressing.”
Progress is the point. “My goal is to get the patient to a place where changes to their face aren’t what they’re waking up and thinking about,” Moayer says. “If somebody takes a photo or they’re interacting with others, they’re not distracted by this this issue. They’re in the moment, living their life. When they can do that, they’re freed.”
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