Surgical Approach to the Accessory Nerve in the Posterior Triangle of the Neck

The auricular conchal cavity is a shallow structure in the central part of the ear. It is not only 3-dimensional, but it is a gateway to the external ear canal. Many methods have been described for reconstruction of the defect of concha-antihelix: split- or full-thickness skin grafts, regional skin, chondrocutaneous and musculocutaneous flaps, but none of the authors have described this flap with neurovascular pedicle. We used postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches to the skin color, thickness and texture; scars are well hidden, and there is no donor-site morbidity. Moreover, it has a constant and reliable neurovascular pedicle. The flap edema which was present in the early postoperative period began to resolve gradually after 3 weeks and disappeared in a few months. The esthetic results were excellent in all of the patients and very satisfying for the patients, too. The sensibility was positive by light touch, pin-prick, temperature and static 2-point discrimination in the postoperative control. The static 2-point discriminations in the transferred flap and in the other ear, which corresponds to the same area, were measured. The results were nearly the same as normal values. We advocate postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches the skin color, thickness and texture; scars are well hidden, and there is no donor site morbidity. Moreover, it has a constant and reliable neurovascular pedicle.

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“…The posterior branch supplies blood to the skin over the mastoid process and two thirds of the lower external ear. 6,7,9,10 …”

Section: Anatomymentioning

confidence: 99%

Reconstruction of the Anterior Surface of the Ear Using a Postauricular Pull-Through Neurovascular Island Flap

Turan¹,

Turkaslan²,

Kul³

et al. 2006

Annals of Plastic Surgery

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“…The nerve gives off a motor branch to the sternocleidomastoid muscle before passing deep to or through that muscle. 1 Several connections exist between the nerve and the C2 to C3 roots of the cervical plexus; these connections usually are located under the sternocleidomastoid muscle. 3 The nerve then emerges from the posterior border of the sternocleidomastoid muscle, variably between the junction of the upper and middle thirds to halfway down.…”

Section: Anatomic Considerationsmentioning

confidence: 99%

“…[1][2][3] Here we describe the identification of the spinal accessory nerve during a primary exploration of the brachial plexus in infants with obstetric palsy.…”

mentioning

confidence: 98%

“…1 In adult brachial plexus palsy the accessory nerve also is identified easily because it is relatively large in size. The nerve can be identified proximally as it emerges from the posterior border of the sternocleidomastoid muscle, or its terminal branches can be identified underneath the trapezius muscle after partial division of the trapezius muscle insertion at the clavicle.…”

mentioning

confidence: 99%

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Identification of the Spinal Accessory Nerve Within the Surgical Field During Primary Exploration of the Brachial Plexus in Infants With Obstetric Palsy

Al‐Qattan

El-Shayeb

2005

The Journal of Hand Surgery

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“…The nerve leaves the sternocleidomastoid muscle 0-3.8 (average 1.53) cm above Erb's point (Salgarelli et al, 2009). At Erb's point, the bundle of sensory nerves from the cervical plexus emerges from the posterior border of the sternocleidomastoid muscle (Aramrattana et al, 2005;Leung et al, 2004;Salgarelli et al, 2009), midway between the mastoid process and clavicle. Erb's point lies two finger-widths above the clavicle and one finger-width from the posterior border of the sternocleidomastoid muscle.…”

Section: Anatomymentioning

confidence: 99%