An approach to bilateral facial paralysis.

Möbius syndrome is characterised by a congenital paralysis of the Facial and Abducens nerves. Treatment centres around functional free muscle transfers. We present 20 cases of Möbius reanimation, currently the largest published series. Our preferred approach has evolved over time to be a single stage bilateral procedure using segmental Latissimus dorsi muscles driven by the masseteric branch of the Trigeminal nerve. All cases showed significant improvement when reviewed by the senior surgeon and independent panel of observers. It was the senior authors' opinion that a more spontaneous smile was achieved in patients under ten years of age.