Canadian Facial Reanimation Services: An Exploratory National Survey.

Abstract

Background : Canada has a strong historical legacy in facial reanimation, yet few comprehensive programs exist nationally. Facial reanimation requires specialized expertise, multidisciplinary care, and resource-intensive interventions, which naturally centralize services in high-volume centers. Conversely, timely assessment and longitudinal follow-up are essential, creating challenges in a geographically vast country with provincially siloed healthcare systems. This study aimed to characterize the availability, structure, and perceived barriers to facial reanimation care across Canadian academic centers. Methods : A 15-item cross-sectional survey was distributed to department heads or delegates from Canadian university-affiliated plastic surgery (N = 15) and otolaryngology departments (N = 12). The survey assessed available services, multidisciplinary resources, outcome tracking, and perceived barriers. Responses were collected anonymously using REDCap and analyzed descriptively. Results : Fifteen of 27 departments responded (55.6%), representing six provinces. Core interventions including static suspension, periocular procedures, and nerve transfers were widely available. Cross-facial nerve grafting (80%), regional muscle transfer (67%), and free muscle transfer (73%) were less consistently offered. Only 53% of departments performed surgical procedures for non-flaccid facial paralysis. Outcome evaluation relied primarily on clinician-graded scales and subjective patient reports, with limited use of validated patient-reported outcome measures and standardized photo/video documentation. Half of centers reported a formal multidisciplinary team, with variable access to neuromuscular retraining therapists and psychologists. Common barriers included limited awareness among referring physicians, restricted operating room time, and insufficient allied health resources. Conclusion: Canadian centers provide broad access to foundational facial reanimation interventions, but gaps remain in advanced procedures, multidisciplinary support, and standardized outcomes tracking. Respondents unanimously supported expanding facial reanimation services.