Postoperative facial palsy is the most common complication of surgery for auditory neuroma, especially for giant auditory neuroma (up to 4 cm in diameter). Facial palsy not only affects the patient’s aesthetics, but also the facial expressions are often followed by psychological changes: the patient is reluctant to go out, unwilling to meet people, and closes himself off from society. In addition, because the eyelids cannot be closed in severe facial palsy, coupled with abnormal tear secretion, it often leads to exposure keratitis, which can lead to vision loss in the affected eye and even blindness, so the correct management of post-operative facial palsy after auditory neuroma is very important. There are two types of postoperative facial palsy: (a) facial palsy in which the anatomy of the facial nerve is preserved during surgery: that is, facial palsy in which the structure of the facial nerve remains intact and the continuity is not interrupted due to mechanical stimulation of the facial nerve during surgery. At present, for giant auditory neuroma, the highest international record of nerve anatomy preservation rate is 92% by Professor Samii, a German neurosurgeon; in China, it is about 80%; for these patients, active facial muscle exercises (insisting on forehead wrinkles, frowning, eye closing, teeth baring, cheek puffing, etc. in the morning, midday and evening), passive massage, rubbing, physiotherapy and acupuncture should be used to promote the recovery of facial palsy. In most patients, facial palsy will recover to varying degrees within six months after surgery. However, if the facial palsy has not recovered in more than six months, facial nerve anastomosis (facial-sublingual nerve anastomosis or facial-paraneoplastic nerve anastomosis) should be considered, because the effect of nerve anastomosis is inversely proportional to the duration of facial palsy, and the earlier the anastomosis, the better the effect; conversely, the later the anastomosis, the worse the effect. (2) The facial nerve is not preserved anatomically during the operation, i.e., if the facial nerve is broken during the operation, or even if the facial nerve is removed together with the tumor, then the possibility of recovery of facial palsy on its own is slim, and the nerve anastomosis should be performed as soon as possible without hesitation. At present, in the neurosurgery department of Xuanwu Hospital, if the facial nerve is severed during the removal of a giant auditory neuroma, direct anastomosis of the severed end of the nerve is preferred, and if the nerve defect is large, a facial-sublingual nerve anastomosis is performed immediately. (In view of protecting the patient’s privacy, we cannot upload the facial photos before and after the nerve anastomosis). Therefore, for post-operative facial palsy after auditory neuroma, it is important to ask your surgeon if the facial nerve was preserved during surgery. So that you can decide on the next step of treatment.