TY - JOUR
T1 - Surgical approach to injuries of the cervical plexus and its peripheral nerve branches
AU - Brown, David L.
AU - Dellon, A. Lee
N1 - Publisher Copyright:
Copyright © 2018 by the American Society of Plastic Surgeons.
PY - 2018/4
Y1 - 2018/4
N2 - Background: Located in the neck beneath the sternocleidomastoid muscle, the cervical plexus comprises a coalition of nerves originating from C1 through C4, which provide input to four cutaneous, seven motor, and three cranial nerves and the sympathetic trunk. Sporadic instances of injury to these superficial nerves have been reported. Nevertheless, this specific anatomical cause of neurogenic pain remains incompletely described and underrecognized. Methods: Twelve patients presented with pain and were diagnosed with various combinations of injury to the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves. Inciting events included prior face lift, migraine, and thoracic outlet procedures; and traumatic events including seatbelt trauma, a fall, and a clavicular fracture. History and examination suggested injury to the cervical plexus, and nerve blocks confirmed the diagnoses. Neurectomy with intramuscular transposition was performed for three nerve branches in one patient, two branches in two patients, and one branch in the remaining nine patients. Results: Nine of the twelve patients had complete relief of their cervical plexus–related pain. The three failures were in patients with pain after previous face-lift surgery. Residual perception of neck tightness and choking sensation persisted despite relief of cheek and ear pain. Conclusions: Knowledge of the cervical plexus anatomy and its branches is crucial for surgeons operating in this area to minimize iatrogenic nerve injury. In addition, neuromas should be considered a likely cause of pain and dysesthesia following surgery or injury. Proper diagnosis and surgical intervention can have a significantly positive effect on these debilitating problems.
AB - Background: Located in the neck beneath the sternocleidomastoid muscle, the cervical plexus comprises a coalition of nerves originating from C1 through C4, which provide input to four cutaneous, seven motor, and three cranial nerves and the sympathetic trunk. Sporadic instances of injury to these superficial nerves have been reported. Nevertheless, this specific anatomical cause of neurogenic pain remains incompletely described and underrecognized. Methods: Twelve patients presented with pain and were diagnosed with various combinations of injury to the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves. Inciting events included prior face lift, migraine, and thoracic outlet procedures; and traumatic events including seatbelt trauma, a fall, and a clavicular fracture. History and examination suggested injury to the cervical plexus, and nerve blocks confirmed the diagnoses. Neurectomy with intramuscular transposition was performed for three nerve branches in one patient, two branches in two patients, and one branch in the remaining nine patients. Results: Nine of the twelve patients had complete relief of their cervical plexus–related pain. The three failures were in patients with pain after previous face-lift surgery. Residual perception of neck tightness and choking sensation persisted despite relief of cheek and ear pain. Conclusions: Knowledge of the cervical plexus anatomy and its branches is crucial for surgeons operating in this area to minimize iatrogenic nerve injury. In addition, neuromas should be considered a likely cause of pain and dysesthesia following surgery or injury. Proper diagnosis and surgical intervention can have a significantly positive effect on these debilitating problems.
UR - http://www.scopus.com/inward/record.url?scp=85052803990&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052803990&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004240
DO - 10.1097/PRS.0000000000004240
M3 - Article
C2 - 29595737
AN - SCOPUS:85052803990
SN - 0032-1052
VL - 141
SP - 1021
EP - 1025
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 4
ER -