MEDIAL ANTEBRACHIAL CUTANEOUS NERVE - A NEW DONOR GRAFT FOR REPAIR OFFACIAL-NERVE DEFECTS AT THE SKULL BASE

When grafting a facial nerve defect after resection of a skull base ca ncer, the use of the greater auricular nerve is generally contraindica ted because of concern of malignant involvement. In the past, the sura l nerve was used as a donor graft for reconstruction of the facial ner ve. We have found a sensory branch of the median nerve of the upper ar m, the medial antebrachial cutaneous (MAC) nerve, to be a suitable opt ion for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction o f the distal facial nerve in the parotid bed. The length is adequate t o graft from the brainstem to the distal facial branches, Loss of sens ation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facia l nerve defects. No complications have been encountered, and the funct ional return appears to be similar to other grafts. In our practice th e MAC nerve is a valuable option for facial nerve repair at the skull base.