Objective <p>To evaluate surgical techniques and therapeutic outcomes of early nerve coaptation and autologous nerve grafting for the repair of temporal facial nerve injuries.</p> Methods <p>A retrospective analysis was performed on consecutive patients undergoing facial nerve reconstruction for traumatic or iatrogenic temporal branch injuries. Eleven cases received early (within 3 months) surgical exploration and debridement, including one case managed by suture-removal decompression with intact neural continuity. The transected temporal branch was repaired through direct end-to-end neurorrhaphy or autologous grafting using the auriculotemporal nerve, cervical transverse nerve or supraclavicular nerve, according to the length of the nerve defect. Epineurial suture was performed under high-power microscopic visualization.</p> Results <p>Recovery of frontal muscle movement was observed in all patients during 6-to-12-month postoperative follow-up, accompanied by visible forehead wrinkles formation. Postoperative measurements demonstrated a significant increase in margin reflex distance (MRD) on the affected side by 2.55 mm (1.99–3.10), reaching comparable measurements to the unaffected side. Eyebrow elevation recovered from complete paralysis to an average 5.36 mm (4.67–6.05), achieving 77% of contralateral functional restoration. Eyebrow and upper eyelid ptosis showed marked improvement.</p> Conclusions <p>Early surgical management of temporal facial nerve injuries achieves favorable functional restoration through precise neural pathway reconstruction.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>