The long thoracic nerve as a donor for facial nerve reanimation procedures: cadaveric feasibility study

Laboratory investigation

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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.


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.


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.


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.

Abbreviation used in this paper: LTN = long thoracic nerve.

Article Information

Address correspondence to: R. Shane Tubbs, Ph.D., Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, ACC 400, Birmingham, Alabama 35233. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Artist's rendition of neurotization of the facial nerve with the left LTN. The LTN is dissected over the lateral chest wall and transposed superiorly deep to the pectoralis muscles and underlying neurovascular bundle to the facial nerve.

  • View in gallery

    Photograph of the skin incision used to expose the supra-and infraclavicular parts of the left LTN in a cadaver.

  • View in gallery

    Photograph of a cadaver specimen after dissection of the LTN. The LTN is seen superficial to the serratus anterior muscle infraclavicularly and also seen piercing the middle scalene muscle (MS) supraclavicularly (upper arrow). The pectoralis major tendon has been cut and the muscle belly retracted. For reference, note the pectoralis minor (PM) with underlying neurovascular bundle, subclavius muscle (SC), trapezius (T) and its innervation via the spinal accessory nerve (XI). Infraclavicularly, the lateral thoracic artery (LTA), latissimus dorsi (latissimus), and intercostobrachial nerve (lower arrow) are seen. Note the deltoid muscle and cephalic vein traveling superficial to the proximal pectoralis minor (PM) tendon.

  • View in gallery

    Photograph of cadaver specimen following transposition of the infraclavicular LTN to the posterior cervical triangle and tunneling of this nerve to the extracranial facial nerve (colored for clarity, arrow). Note the excessive length of the LTN after this repositioning.



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