A comprehensive review of the great auricular nerve graft
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REVIEW
A comprehensive review of the great auricular nerve graft Cassidy Werner 1 & Anthony V. D’Antoni 2,3 & Joe Iwanaga 1,4,5 R. Shane Tubbs 1,5,6,7,8
Koichi Watanabe 4 & Aaron S. Dumont 1 &
&
Received: 10 September 2020 / Revised: 6 October 2020 / Accepted: 16 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years, the GAN has become the nerve graft donor of choice for many surgeons for reconstructing injured facial nerves. In this review, we discuss the anatomy and function of the GAN, while focusing on surgical landmarks and the characteristics that make it a suitable nerve graft donor. In addition, we present and summarize published case reports on use of the GAN for grafting. We hope that this review will provide surgeons with an up-to-date and concise reference. Keywords Great auricular nerve . Nerve graft . Donor . Recipient . Anatomy . Internal jugular vein . Sternocleidomastoid muscle
Introduction In 1935, Dott performed one of the first reported sural nerve grafts to repair a resected facial nerve [15]. Since then, many technical advances have promoted successful grafting including microsurgery, artificial composites, cross-facial techniques, and various donor nerve sites [37]. In 1962, Alberti discussed the benefits of using a great auricular nerve (GAN) graft for reconstructing facial nerves [1]. The predominant choice for surgeons at that time was a lower extremity nerve such as the sural or lateral femoral cutaneous nerve, but Alberti proposed the GAN owing to its closer proximity to the surgical site. Since then, many authors have reported the use of GAN grafts and successful facial nerve regenerations [12, 14, 24, 33, 35, 42, 51, 56, 59, 63]. In this article, we discuss the anatomy and function of the GAN and review the literature concerning its use as a nerve graft donor.
* Joe Iwanaga [email protected] 1
2
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Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA 70112, USA Physician Assistant Program, Wagner College, Staten Island, NY, USA Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
Anatomy and function of the great auricular nerve Embryology During the fourth week of embryonic development, the paraxial mesoderm gives rise to 42–44 paired somites located along the neural axis [61]. These somites go on to form the bones, muscles, and connective tissues of the vertebral column [61]. As the neural tube develops, spinal nerves start to grow laterally between the developing vertebrae. Studies of chick embryos have shown that somites five to eight give rise to the cervical vertebrae and musculature, and thus form the scaffolds for the cervical spinal nerves [25, 58]. As the ventral rami of the upper four cervical nerves grow, they branch and connect to fo
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