Tumors such as cholesteatoma and auditory neuroma, which occur in the facial nerve canal or within the skull, may cause damage to the facial nerve during surgical removal and treatment, resulting in manifestations such as inability to close the eyes and distorted corners of the mouth. This brings great physical and mental pain to patients! And timely and effective nerve repair is the key to restore the patient’s original facial muscle function! Unfortunately, due to various reasons, many patients miss the best time for nerve repair, which inevitably leaves various sequelae in the end. So, what should be done after facial nerve injury occurs? First of all, the nature of the tumor should be clarified, whether it is benign, whether it is clear and complete, and whether further surgery is needed? These can be found out from the doctor who treated the primary disease. If the tumor is benign and cleared completely, then early repair of the nerve can be considered. Conversely, the surgeon of the primary disease needs to be consulted to find out if nerve repair can be considered. Usually facial nerve repair is performed in the cheek and does not involve the intracranial lesion site. If the ipsilateral occlusal nerve needs to be used, then the patient needs to consult with the neurosurgeon as to whether there is current involvement of the trigeminal nerve. Second, is the nerve broken? Many times, patients are told that facial nerve continuity still exists and that there is a chance for function to be restored on its own. Unfortunately, many patients have waited for years or longer with hope, tried various medications, acupuncture, etc., but ultimately to no avail, thus missing the best time for nerve repair. So if the nerve is still attached, how can the patient tell? In the case of nerve continuity, patients are advised to dynamically observe whether the facial eyes are closed and the upper lip is lifted and teeth are exposed, and whether there is a deepening of the nasolabial folds. These are all signs of recovery of the facial muscles. If so, it indicates that the nerve is not completely damaged and can continue to be observed. In addition, an early facial nerve electromyogram or F-wave examination can indicate the degree of nerve damage. If the damage is severe, even if continuous, it is difficult to recover on its own, then early nerve repair is needed. There is also a need for regular monthly electromyography, which can observe the recovery of the muscles. However, this needs to be observed together with the combination of indicators from many consecutive months. If there is no improvement, even if there is a partial weak function of the muscle, then it is possible that there is only residual muscle function and the damaged part is not better recovered, then it is still recommended to consider nerve repair. If the nerve is completely severed, or severely damaged, then how should treatment be performed? If the intracranial portion of the facial nerve is severed, treatment can currently be considered through a transfacial nerve graft combined with nutrition of the ipsilateral occlusal nerve. This means that the ipsilateral portion of the occlusal nerve is used to anastomose with the ipsilateral branch of the facial nerve, which allows the facial muscles to be innervated by the occlusal nerve in a relatively short period of time (about three months) to produce movement: eye closure and upper lip movement. At the same time, the healthy facial nerve from the opposite side, through the bridging graft, is able to innervate the facial muscles more precisely, thus producing a synchronized and coordinated smile and eye closure. The combination of the two surgical approaches avoids the shortcomings of a single approach and can improve the function of the patient’s facial muscles more effectively. The partial dissection of the occlusal nerve, on the other hand, does not paralyze the entire muscle and therefore brings no significant impact in function or appearance. Currently, a similar approach is used to repair the affected side with a partial sublingual nerve combined with a trans-facial nerve graft. In the latter case, this approach is located in the neck and therefore at a greater distance from the facial muscles that need to be nourished, thus taking longer to restore the paralyzed muscles. In addition, the need for a bridging nerve graft to connect to the facial nerve increases the anastomosis and weakens the efficacy of the treatment. In addition, the adverse effects of the impaired movement of the tongue are obvious: the patient’s eating and speech are temporarily affected. Because of this, the application of the occlusal nerve has the advantage of less trauma and faster recovery. If nerve repair is needed, when is the best time to do it? and by when at the latest? The best time is as early as possible. After facial palsy occurs, the repair should be performed as early as conditions allow so that there is a better recovery. In addition, later than a year later, the effect of the repair will be significantly weaker. What should I do if I come for a consultation? Before your visit, you should follow up with your original doctor to clarify whether you are currently suitable for surgery. If this is not convenient, I can arrange a consultation with a doctor from the appropriate department to clarify the patient’s current condition. Next, you should bring the original surgery records and pathology examination reports. Also bring recent special examination films and reports (CT or MRI). Finally, I hope that this knowledge will be helpful for those patients who are experiencing painful ordeals.