The long thoracic nerve as a donor for facial nerve reanimation procedures: Cadaveric feasibility study: Laboratory investigation

Abstract

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, tensionfree to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 458. 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.