Surgical Treatment of Congenital Facial Palsy: A Retrospective Analysis of More than 20 Years' Experience in Smile Surgery

Background and Objectives: Congenital facial palsy, either isolated or associated with syndromic conditions such as Moebius syndrome, is a rare disorder that poses significant functional and psychological challenges for patients, families, and healthcare teams. Dedicated care pathways and a multidisciplinary approach are essential for optimal management. This study presents our experience of more than 20 years in smile surgery, highlighting clinical outcomes with an objective analysis of facial symmetry and movement as well as a review of our progressive improvements of surgical techniques and patient management over time. Materials and Methods: Patients diagnosed with congenital facial palsy who were referred to our institution for rehabilitative treatment and surgical management between January 2003 and December 2025 were retrospectively reviewed. In those with standardized preoperative and postoperative photographs, commissure excursion (CE) and commissure excursion deviation (CEdev) were measured with Emotrics and compared before and after surgery within three groups defined by the laterality of the palsy and of the reanimation.