of (near) normal function does not take place, surgical reanimation may be indicated. Some head and neck tumours invade or compress the facial nerve leading to facial paresis or paralysis. Examples of such tumours are facial neuromas, cholesteatomas, hemangiomas, acoustic neuromas, parotid gland neoplasms or metastases. Sometimes, the facial nerve cannot be preserved during resection of these tumours. Congenital facial paralysis occurs usually unilaterally and may be complete or incomplete. The most common congenital cause is the Moebius syndrome. Moebius syndrome is a congenital neurological disorder with bilateral paralysis of both the facial and abducens nerves. Therefore, lateral eye movement and facial animation are absent. In Moebius-like syndrome, only one side of the face is affected, but with additional nerve palsies of the affected facial and abducens nerve. Surgical techniques Selection of the type of nerve transfer is based on the individualised needs and condition of the patient. Individual factors can be patient age, type of paralysis (partial or complete, uni- or bilateral), denervation time of the mimetic muscles, availability of nerve grafts and medical condition of the patient. If facial paralysis is caused by trauma or tumour surgery, direct reinnervation of the facial muscles (ideally within 72 hours after facial nerve damage) can be achieved by neurorrhaphy, with or without an interposition nerve graft. (Algorithm 1) Neurorrhaphy is a primary end-to-end reconnection of the facial nerve stumps. However, tension-free reconnection is needed, otherwise scar formation can occur and axons will regenerate outside the facial nerve. If a tension-free reconnection is not possible, interposition nerve grafts are an option. Mostly the great auricular nerve or sural nerve is used as a graft between the two facial nerve stumps. In more long standing acquired facial paralysis either a CFNG procedure or "babysitter" procedure are the indicated techniques, with or without a free muscle transfer.(Algorithm 1) Secondary facial paralysis with a denervation time of less than 6 months can be treated with one or more cross facial nerve grafts (CFNGs). During a cross facial nerve graft procedure one or more branches of the non-paralysed facial nerve are divided and connected to one or more sural nerve grafts which are tunnelled to the affected side of the face. Whether these nerve grafts are immediately attached to the paralysed facial nerve branches or after 9 to 12 months depends on the chosen procedure. If facial paralysis lasts between 6 months and 2 years, the