What is the cable nerve grafting technique for facial nerve repair?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

When the length of facial nerve available is insufficient to permit primary repair, the best option is cable grafting. The same general principles of microsurgery that apply to direct repair also apply to cable grafting. Preoperative considerations must include a discussion with the patient regarding the options for donor nerves for repair. Commonly used nerves include the great auricular nerve and the sural nerve.

The great auricular nerve has the advantages of proximity to the operative field and ease of harvest. The diameter is usually an appropriately sized match for the facial nerve. Because up to 10 cm may be harvested, this nerve is a good choice for most cable nerve grafts. The main disadvantage is the numbness of the ear that inevitably results.

In addition, use of the great auricular nerve has been discouraged in cases of malignant disease because of the possibility of microscopic involvement of the nerve. Those who are concerned about this possibility suggest using an alternative donor out of the field of involvement in cases resulting from facial nerve sacrifice secondary to malignancy, particularly when the tail of the parotid is involved or metastases to the neck are present.

The sural nerve has some advantages over the great auricular nerve, in that it is longer (up to 40 cm) and has a greater number of neural fascicles. Use of this nerve results in lateral foot numbness.

Another nerve that may be used for cable nerve grafting is the medial antebrachial cutaneous nerve of the upper arm. This can provide 15 cm of length and has a branching pattern that can be used to graft to multiple facial nerve branches.


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