The contralateral long thoracic nerve as a donor for upper brachial plexus neurotization procedures: cadaveric feasibility study

2009 ◽  
Vol 110 (4) ◽  
pp. 749-753 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Ghaffar Shokouhi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Long Thoracic Nerve ◽  
Neural Connections ◽  
Thoracic Nerve ◽  
Mean Diameter ◽  
Human Cadavers ◽  
Neck Rotation ◽  
Left And Right ◽  
The Mean ◽  
Neurovascular Structures

Object Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for brachial plexus neurotization procedures. Neurotization to proximal branches of the brachial plexus using the contralateral long thoracic nerve (LTN) has, to the authors' knowledge, not been previously explored. Methods In an attempt to identify an additional nerve donor candidate for proximal brachial plexus neurotization, the authors dissected the LTN in 8 adult human cadavers. The nerve was transected at its distal termination and then passed deep to the clavicle and axillary neurovascular bundle. This passed segment of nerve was then tunneled subcutaneously and contralaterally across the neck to a supra- and infraclavicular exposure of the suprascapular and musculocutaneous nerves. Measurements were made of the length and diameter of the LTN. Results All specimens were found to have a LTN that could be brought to the aforementioned contralateral nerves. Neural connections remained tension free with left and right neck rotation of ~ 45°. The mean length of the LTN was 22 cm with a range of 18–27 cm. The overall mean diameter of this nerve was 3.0 mm. No gross evidence of injury to surrounding neurovascular structures was identified in any specimen. Conclusions Based on the results of this cadaveric study, the use of the contralateral LTN may be considered for neurotization of the proximal musculocutaneous and suprascapular nerves.

The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study

2007 ◽  
Vol 106 (4) ◽  
pp. 677-679 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Skin Incision ◽  
Digastric Muscle ◽  
Facial Muscle ◽  
Muscle Paralysis ◽  
Mean Diameter ◽  
Human Cadavers ◽  
The Mean ◽  
Anterior Belly ◽  
Neurovascular Structures

Object Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. Reanimation of the facial nerve has been performed using different regional nerves. The nerve to the mylohyoid has not been previously explored as a donor nerve for facial nerve reanimation procedures. Methods Five fresh adult human cadavers (10 sides) were dissected to identify an additional nerve donor candidate for facial nerve neurotization. Using a curvilinear cervicofacial skin incision, the nerve to the mylohyoid and facial nerve were identified. The nerve to the mylohyoid was transected at its point of entrance into the anterior belly of the digastric muscle. Measurements were made of the length and diameter of the nerve to the mylohyoid, and this nerve was repositioned superiorly to the various temporofacial and cervicofacial parts of the extracranial branches of the facial nerve. All specimens had a nerve to the mylohyoid. The mean length of this nerve available inferior to the mandible was 5.5 cm and the mean diameter was 1 mm. In all specimens, the nerve to the mylohyoid reached the facial nerve stem and the temporofacial and cervicofacial trunks without tension. No gross evidence of injury to surrounding neurovascular structures was identified. Conclusions To the authors' knowledge, the use of the nerve to the mylohyoid for facial nerve reanimation has not been explored previously. Based on the results of this cadaveric study, the use of the nerve to the mylohyoid may be considered for facial nerve reanimation procedures.

The long thoracic nerve as a donor for facial nerve reanimation procedures: cadaveric feasibility study

2008 ◽  
Vol 108 (6) ◽  
pp. 1225-1229 ◽  
Author(s):  
R. Shane Tubbs ◽  
William A. Shaffer ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
W. Jerry Oakes
Keyword(s):  
Facial Nerve ◽  
Head Rotation ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve ◽  
Stylomastoid Foramen ◽  
The Face ◽  
Human Cadavers ◽  
Neurovascular Structures ◽  
Gross Examination

Object Injury of the facial nerve with resultant facial muscle paralysis may result in other significant complications such as corneal ulceration. To the authors' knowledge, neurotization to the facial nerve using the long thoracic nerve (LTN), a nerve used previously for neurotization to other branches of the brachial plexus, has not been explored previously. Methods In an attempt to identify an additional nerve donor candidate for facial nerve neurotization, 8 adult human cadavers (16 sides) underwent dissection of the LTN, which was passed deep to the clavicle and axillary neurovascular bundle. The facial nerve was localized from the stylomastoid foramen onto the face, and the distal cut end of the previously dissected LTN was tunneled to this location. Measurements were made of the length and diameter of the LTN. Long thoracic nerve innervation to the first and second digitations of the serratus anterior was maintained on all sides. Results All specimens were found to have an LTN with more than enough length to be tunneled superiorly, tension-free to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 45°. The mean length of this part of the LTN was 18 cm with a range of 15–22 cm. The overall mean diameter of this nerve was 2.5 mm. No evidence of injury to the surrounding neurovascular structures was identified on gross examination. Conclusions To the authors' knowledge, the LTN has not been previously examined as a donor nerve for facial nerve reanimation procedures. Based on the results of this cadaveric study, the use of the LTN may be considered for such surgical maneuvers.

Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Chase Kluemper ◽  
Mike Aversano ◽  
Scott Kozin ◽  
Dan A. Zlotolow
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve

2006 ◽  
Vol 104 (5) ◽  
pp. 792-795 ◽  
Author(s):  
R. Shane Tubbs ◽  
E. George Salter ◽  
James W. Custis ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Artery ◽  
Surgical Anatomy ◽  
Proximal Portion ◽  
Neurosurgical Procedures ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Scalene Muscle ◽  
Thoracic Nerve ◽  
Two Sides

Object There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. Methods Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 ± 4.5 cm (mean ± standard deviation) and a mean diameter of 3 ± 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 ± 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 ± 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 ± 3.4 cm lateral to the jugular notch and a mean of 22 ± 4.2 cm lateral to the xiphoid process of the sternum. Conclusions The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.

Long Thoracic Nerve Neurotization for Restoration of Shoulder Function in C5-7 Brachial Plexus Preganglionic Injuries: Case Report

2010 ◽  
Vol 35 (9) ◽  
pp. 1427-1431 ◽  
Author(s):  
Tetsuya Yamada ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Shushi Hoshino ◽  
Soutetsu Sakamoto ◽  
...  
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Shoulder Function ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Shrug radiographs for the diagnosis of long thoracic nerve palsy in traumatic brachial plexus injury

2020 ◽  
Vol 29 (12) ◽  
pp. 2595-2600
Author(s):  
Kiminori Yukata ◽  
Kazuteru Doi ◽  
Toshitaka Okabayashi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Nerve Palsy ◽  
Brachial Plexus Injury ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

scholarly journals Effects of peripheral sympathetic denervation induced by guanethidine administration on the mechanisms regulating puberty in the female guinea pig

1998 ◽  
Vol 156 (1) ◽  
pp. 91-98 ◽  
Author(s):  
L Riboni ◽  
C Escamilla ◽  
R Chavira ◽  
R Dominguez
Keyword(s):  
Luteal Phase ◽  
Relative Weight ◽  
Follicular Phase ◽  
Sympathetic Denervation ◽  
Vaginal Opening ◽  
Late Luteal Phase ◽  
Mean Diameter ◽  
Left And Right ◽  
The Mean ◽  
Late Follicular Phase

The effects of peripheral sympathetic denervation induced by guanethidine administration to newborn and 10-day-old female guinea pigs on puberty, ovulation and the follicular population were analysed. Peripheral sympathetic denervation beginning at birth resulted in the loss of ovarian norepinephrine content (0.95. +/- 0.1 ng/mg wet tissue in untreated control animals vs non detectable in treated animals). Guanethidine administration to newborn or 10-day-old guinea pigs advanced puberty (age of vaginal opening: 27 +/- 1.2 days (newborn), 26 +/- 1.7 (10-day-old) vs 37 +/- 0.7 (control), P < 0.001) and ovulation. The number of corpora lutea in control and denervated animals was similar (3.5 +/- 0.2 vs 3.3 +/- 0.3). The relative weight (mg/100 g body weight) of the ovaries and adrenals in the denervated animals autopsied during the late follicular phase (24-48 h after vaginal opening) increased (ovaries: 27.8 +/- 1.3, 28.9 +/- 3.0 vs 20.9 +/- 0.8, P < 0.05; adrenals 36.4 +/- 1.4, 37.0 +/- 0.8 vs 31.6 +/- 1.5, P < 0.05), while the uterine weight diminished (179 +/- 13, 149 +/- 28 vs 292 +/- 20). When the animals were killed during the late luteal phase (9-11 days after vaginal closure), the relative weight of the ovaries of newborn guanethidine-treated animals was higher than that of the control animals (21.4 +/- 1.7 vs 16.8 +/- 1.4, P < 0.05). The mean number of follicles counted in the ovaries of denervated animals was significantly higher than in control animals (1736 +/- 230 vs 969 +/- 147, P < 0.05). The mean diameter of the follicles in the untouched control ovary in animals killed in the late follicular phase was significantly larger than from animals killed in the late luteal phase (263 +/- 3.9 microns vs 248 +/- 3.0 microns, P < 0.01). The mean diameter of the follicles measured in the ovaries of denervated animals was significantly higher than in controls (animals treated from birth 274 +/- 2.0 microns vs 255 +/- 2.4, P < 0.05; animals treated from day 10, 286 +/- 2.3 microns vs 257 +/- 2.3, P < 0.05). When the mean diameter of the follicles in the left and right ovary of the untouched control was analysed, the follicular diameter in the left ovary was significantly larger than in the right ovary (309 +/- 6.0 microns vs 214 +/- 3.9, P < 0.01); the response of the left and right ovaries to sympathetic denervation was the opposite. The results obtained in the present study suggest that ovarian innervation plays a role in the regulation of follicular growth, maturation and atresia which is not related to changes in steroid secretion by the ovary, but to other regulatory mechanisms.

Suprascapular nerve as a donor for extracranial facial nerve reanimation procedures: a cadaveric feasibility study

2008 ◽  
Vol 108 (1) ◽  
pp. 145-148 ◽  
Author(s):  
R. Shane Tubbs ◽  
Robert G. Louis ◽  
Christopher T. Wartmann ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Head Rotation ◽  
Suprascapular Nerve ◽  
Suprascapular Notch ◽  
Splitting Technique ◽  
Stylomastoid Foramen ◽  
The Face ◽  
Human Cadavers ◽  
The Mean ◽  
Neurovascular Structures

Object Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. To the auhtors' knowledge, neurotization of the facial nerve using a branch of the brachial plexus has not been previously performed. Methods In an attempt to identify an additional nerve donor candidate for facial nerve neurotization, 5 fresh adult human cadavers (10 sides) underwent dissection of the suprascapular nerve distal to the suprascapular notch where it was transected. The facial nerve was localized from the stylomastoid foramen onto the face, and the cut end of the suprascapular nerve was tunneled to this location. Measurements were made of the length and diameter of the supra-scapular nerve. In 2 of these specimens prior to transection of the nerve, a nerve-splitting technique was used. Results All specimens were found to have a suprascapular nerve with enough length to be tunneled, tension free, superiorly to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 45°. The mean length of this part of the suprascapular nerve was 12.5 cm (range 11.5–14 cm). The mean diameter of this nerve was 3 mm. A nerve-splitting technique was also easily performed. No gross evidence of injury to surrounding neurovascular structures was identified. Conclusions To the authors' knowledge, the suprascapular nerve has not been previously explored as a donor nerve for facial nerve reanimation procedures. Based on the results of this cadaveric study, the authors believe that use of the suprascapular nerve may be considered for surgical maneuvers.

Quantitation of the lower subscapular nerve for potential use in neurotization procedures

2006 ◽  
Vol 105 (6) ◽  
pp. 881-883 ◽  
Author(s):  
R. Shane Tubbs ◽  
Charles A. Khoury ◽  
E. George Salter ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Upper Extremities ◽  
Subscapularis Muscle ◽  
New Information ◽  
Teres Major ◽  
Left And Right ◽  
The Mean ◽  
Potential Use

Object New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of the lower subscapular nerve (LSN). Methods The authors dissected and measured the LSN in 47 upper extremities (left and right sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found within the confines of an anatomical triangle previously described by the authors. Conclusions The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.

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