I have a lady in her 60s who had Bell’s Palsy 6 years ago looking for smile reanimation. Her face in repose looks just like a flaccid paralysis patient (effaced NLF, mouth pulled contralaterally, nasal deviation, etc). and she has no voluntary smile movement with effort. However, with blinking I see a slight twitch of her upper lip (looks like mostly levator, not much zygomaticus, no movement at commissure). I am waiting on her EMG. Would it be reasonable to consider a nerve transfer (5-7 and possibly 12-7) in this situation if there is evidence of viable muscle?
Thanks for your input to this case.