How is cable nerve grafting performed in facial nerve repair?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The great auricular nerve is found by drawing a line between the angle of the jaw and the mastoid tip. This line is bisected at a right angle by the great auricular nerve as it passes around the posterior border of the sternocleidomastoid muscle just behind the external jugular vein. The nerve is the largest of the ascending branches of the superficial cervical plexus and arises from C2-3. Extra branches can be found by following the nerve toward its origin behind the sternocleidomastoid muscle.

The sural nerve can be located between the lateral malleolus and Achilles tendon. It lies just deep or posterior to the saphenous vein. It then runs superiorly up the back of the lower leg in a subcutaneous plane until it descends between the 2 heads of the gastrocnemius toward the popliteal fossa and its origin off the tibial nerve.

The sural nerve may be harvested either by making a single long incision from the ankle to the popliteal fossa (depending on the length of nerve required) or a series of shorter transverse incisions. The nerve may be dissected under direct vision with the single incision or by using a fascia stripper and making the stepwise incisions.

The technique of nerve grafting is the same as for primary repair. In the case of cable grafting, obtaining enough nerve graft length to allow the graft to have some redundancy between the ends of facial nerve may be helpful. This would create a C or S shape and ensure tension-free coaptation.

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