Introduction: Marginal mandibular nerve palsy presents a challenging problem with significant impact on quality of life. Oral continence, speech and social functioning can all be impacted. A range of static and dynamic reconstructive techniques have been described. The descendens hypoglossi nerve transfer is one dynamic technique that is explored further in this study. Aim: Review trends and outcomes in patients undergoing in descendens hypoglossi nerve transfer to the marginal mandibular nerve to restore function Methods: This is a 10 year single centre retrospective review of 21 patients who underwent descendens hypoglossi nerve transfer between 2015 to 2025 at the Royal Brisbane and Womens Hospital. Results: We identified 202 patients who had facial nerve sacrificing procedures for treatment of neoplasms, most commonly metastatic squamous cell carcinoma. 21 (10%) of the 202 patients underwent descendens hypoglossi nerve transfer. 19 (90%) of patients did not require any further revisionary surgery on the lip following the descendens hypoglossi nerve transfer. 1 patient (0.5%) required two subsequent procedures on the lip and 1 patient (0.5%) required ongoing Botox injections for lip asymmetry. There were no patients that had a single revisionary procedure on the lip. Conclusions: The vast majority of patients (90%) undergoing descendens hypoglossi nerve transfer to the marginal mandibular nerve did not require any further revisionary surgery to the lip. We think it is a worthwhile procedure for reconstruction of the cut marginal mandibular nerve. One limitation of this study is the retrospective nature resulting in outcome measures being limited to the extent of detail included in documentation of facial muscle activity, lip asymmetry and oral function. Nevertheless, this represents a large case series of descendens hypoglossi nerve transfers, a valuable procedure.