American Society for Peripheral Nerve

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Surgical Approach to Injuries of the Cervical Plexus and its Peripheral Nerve Branches
David L. Brown, MD1; A. Lee Dellon, MD, PhD2;
1University of Michigan, Ann Arbor, MI, 2Johns Hopkins University, Baltimore, MD

Introduction: Located in the neck beneath the sternocleidomastoid muscle, the cervical plexus comprises a coalition of nerve fibers from C1 through C4, which ultimately provides input to four cutaneous, seven motor and three cranial nerves, as well as the sympathetic trunk. Diagnosis and treatment of painful neuromas of the cervical plexus remain under-appreciated and incompletely described.

Methods: A retrospective cohort of eleven patients with painful cervical plexus neuromas is described. There were combinations of injury to the Lesser Occipital, Greater Auricular, Transverse Cervical and Supraclavicular nerves. Inciting events included prior facelift, migraine and thoracic outlet procedures, as well as traumatic events including seatbelt trauma during a motor vehicle crash, a fall, and a clavicular fracture. Diagnoses were confirmed with nerve blocks. Neurectomy with intramuscular transposition into the sternocleidomastoid muscle was performed for three nerve branches in one patient, two branches in two patients, and one branch in the remaining eight patients.

Results: Nine of the eleven patients had complete relief of their cervical plexus-related pain following neuroma(s) resection and muscle implantation. There was no pain at the site of muscle implantation and no pain with head movement. The two failures were in patients with pain after previous face lift surgery. In each of these patients residual perception of neck tightness and "choking" sensation persisted despite relief of cheek and ear pain.

Conclusion: Knowledge of the anatomy of the cervical plexus and its branches is crucial for any surgeon operating in this area to minimize iatrogenic nerve injury. Proper diagnosis and surgical intervention can help 90% of patients with these debilitating pain problems.

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