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.

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.

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.

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.

scholarly journals Pectoralis Major Transfer for Treatment of Serratus Anterior Dysfunction in the Setting of Long Thoracic Nerve Palsy

2017 ◽  
Vol 6 (4) ◽  
pp. e1347-e1353
Author(s):  
George Sanchez ◽  
Márcio B. Ferrari ◽  
Anthony Sanchez ◽  
Nicholas I. Kennedy ◽  
Matthew T. Provencher
Keyword(s):  
Nerve Palsy ◽  
Pectoralis Major ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve ◽  
Pectoralis Major Transfer

scholarly journals Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 689-694 ◽  
Author(s):  
Shelley S. Noland ◽  
Emily M. Krauss ◽  
John M. Felder ◽  
Susan E. Mackinnon
Keyword(s):  
Decision Making ◽  
Nerve Stimulation ◽  
Nerve Palsy ◽  
Clinical Decision Making ◽  
Treatment Algorithm ◽  
Nerve Transfer ◽  
Clinical Decision ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Background: Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. Methods: In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. Results: In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. Conclusions: A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

scholarly journals Winged scapula following axillary thoracotomy with long thoracic nerve preservation

2020 ◽  
Vol 13 (2) ◽  
pp. e232970
Author(s):  
Tomomi Isono ◽  
Shigeshi Mori ◽  
Hidenori Kusumoto ◽  
Hiroyuki Shiono
Keyword(s):  
Rare Condition ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Nerve Preservation ◽  
Thoracic Nerve ◽  
Winged Scapula ◽  
The Right ◽  
A Site ◽  
Electric Scalpel ◽  
Fourth Intercostal Space

Winged scapula is a rare condition caused by injuries to the long thoracic nerve (LTN) and accessory nerves. A 69-year-old man underwent surgery for right lung cancer. Video-assisted thoracic surgery was converted to axillary thoracotomy at the fourth intercostal space. The latissimus dorsi was protected, and the serratus anterior was divided on the side anterior to the LTN. Two months after discharge, he presented with difficulty in elevating his right arm and protrusion of the scapula from his back. Active forward flexion of the right shoulder was limited to 110° and abduction to 130°. He was diagnosed with winged scapula. After 6 months of occupational therapy, the symptoms improved. The LTN may have been overstretched or damaged by the electric scalpel. We recommend an increased awareness of the LTN, and to divide the serratus anterior at a site as far as possible from the LTN to avoid postoperative winged scapula.

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.

Sign in / Sign up

Export Citation Format

Share Document