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R. Shane Tubbs, Robert G. Louis Jr., Christopher T. Wartmann, Marios Loukas, Mohammadali M. Shoja, Mohammad R. Ardalan and W. Jerry Oakes

of voluntary facial movement. 11 Some authors have reported unsatisfactory results, however, when using such standard nerves as the hypoglossal and spinal accessory nerves. 1 The majority of authors have agreed that the most important prognostic factor in facial reanimation is a tensionless anastomosis. 13 Considering the mediocre results demonstrated in association with currently available techniques, a search for alternative donor sites seemed plausible. To our knowledge, the suprascapular nerve and, for that matter, branches of the brachial plexus have not

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R. Shane Tubbs, Marios Loukas, Mohammadali M. Shoja, Mohammad R. Ardalan, Nihal Apaydin, Candice Myers, Ghaffar Shokouhi and W. Jerry Oakes

S tandard anatomical texts state that the brachial plexus is contributed to by C5–T1 spinal nerves, 4 but recent studies have identified contributions from outside of this “normal” range. For example, Loukas et al. 8 found that 100% of their 150 cadaveric specimens had communications between T-2 and the brachial plexus. These connections were identified either intra- or extrathoracically and occurred in non-postfixed specimens (that is, a brachial plexus that is primarily composed of C6–T2 ventral rami). It is also known that the brachial plexus may have