Surgical anatomy of the platysma motor branch as a donor for transfer in brachial plexus repair

  • Mariano Pablo SocolovskyEmail author
  • Jayme Augusto Bertelli
  • Gilda Di Masi
  • Alvaro Campero
  • Lucas Garategui
  • Horacio Conesa
  • Marcos Flávio Ghizoni
Anatomic Bases of Medical, Radiological and Surgical Techniques



Nerve transfers have become a major weapon in the battle against brachial plexus lesions. Recently, a case involving the successful use of the platysma motor branch to re-innervate the pectoralis major muscle was reported. The present anatomical study was conducted to clarify the surgical anatomy of the platysma motor nerve, in view of its potential use as a donor for transfer.


Microsurgical dissections of the facial nerve and its terminal branches were performed bilaterally in five formaldehyde-fixed cadavers, thereby yielding ten samples for study. The relationships between the platysma motor branch and adjacent structures were studied and measurements performed. Specimens were removed and histologically studied.


The platysma branch of the facial nerve was found to arise from the cervicofacial trunk. In five instances, one main nerve innervated the platysma muscle, and there was a smaller accessory nerve; in four cases, there was just a single branch to the muscle; and in one case, there was a main branch and two accessory branches. The distance between the gonion and the platysma motor branch averaged 0.8 cm (range 0.4–1.1 cm). The platysma branch received thin anastomotic rami from the transverse superficial cervical plexus. The neural surface of the platysma motor branch, on average, was 76% the surface area of the medial pectoral nerve.


The anatomy of the platysma motor branch is predictable. Contraction of the platysma muscle is under voluntary control, which is an important quality for a donor nerve selected for transfer. The clinical usefulness of platysma motor branch transfer still must be elucidated.


Brachial plexus Nerve grafting Nerve transfer Neurotization Facial nerve 



This study was performed in the Laboratory of Anatomy at the University of Buenos Aires School of Medicine, Buenos Aires, Argentina.


  1. 1.
    Asfazadourian H, Tramond B, Dauge MC, Oberlin C (1999) Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies. Chir Main 18(4):243–253PubMedCrossRefGoogle Scholar
  2. 2.
    Bertelli JA, Ghizoni MF (2006) Concepts of nerve regeneration and repair applied to brachial plexus reconstruction. Microsurgery 26:230–244PubMedCrossRefGoogle Scholar
  3. 3.
    Bertelli JA, Ghizoni MF (2004) Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction. J Neurosurg 101:770–778PubMedCrossRefGoogle Scholar
  4. 4.
    Bertelli JA, Taleb M, Mira JC, Ghizoni MF (2005) Variation in nerve autograft length increases fiber misdirection and decreases pruning effectiveness: an experimental study in the rat median nerve. Neurol Res 27(6):657–665PubMedCrossRefGoogle Scholar
  5. 5.
    Bertelli JA (2007) Platysma motor branch transfer in brachial plexus repair: report of the first case. J Brachial Plexus Peripheral Nerv Inj 2:12 ( (accessed 24 October, 2007)Google Scholar
  6. 6.
    Chickering GJ, Sokoloff AJ (1996) Innervation of propatagial musculature in a flying squirrel, Glaucomys Volans (Rodentia Sciuridae). Brain Behav Evol 47:1–7PubMedCrossRefGoogle Scholar
  7. 7.
    Chuang DC (1995) Neurotization procedures for brachial plexus injuries. Hand Clin 11:663–645Google Scholar
  8. 8.
    Cruveilhier J (1863) Anatomie descriptive, In: Tome IV, Béchet Jeune, Paris, pp 943–950Google Scholar
  9. 9.
    Daane SP, Owsley JQ (2003) Incidence of cervical branch injury with “marginal mandibular nerve pseudo-paralysis” in patients undergoing facial nerve lift. Plast Reconstr Surg 111:2414–2418PubMedCrossRefGoogle Scholar
  10. 10.
    Davis RA, Anson BJ, Budinger JM, Kurth LR (1956) Surgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. Surg Gynecol Obstet 102:382–412Google Scholar
  11. 11.
    de Sèze MP, Rezzouk J, de Sèze M, Uzel M, Lavignolle B, Midy D, Durandeau A (2004) Does the motor branch of the long head of the triceps brachii arise from the radial nerve? An anatomic and electromyographic study. Surg Radiol Anat 26:459–461PubMedCrossRefGoogle Scholar
  12. 12.
    Narakas AO (1995) Brachial plexus lesions. In: Leung PC, Gu YD, Ykuta Y, Narakas A, Landi A, Weiland AJ (eds) Microsurgery in orthopedic practice. World Scientific, Singapore, pp 188–254Google Scholar
  13. 13.
    AO Narakas, Hentz VR (1988) Neurotization in brachial plexus injuries. Indication and results. Clin Orthop Relat Res 237:43–56Google Scholar
  14. 14.
    Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am] 19(2):232–237CrossRefGoogle Scholar
  15. 15.
    Ogawa Y, Sakakibara R (2005) Platysma sign in high cervical lesion. J Neurol Neurosurg Psychiatry 76:735PubMedCrossRefGoogle Scholar
  16. 16.
    Rohen J, Yokochi CH (1988) Color atlas of anatomy, 2nd edn edn. Igaku-Shoin, New York, pp 72–75Google Scholar
  17. 17.
    Rouviére H, Delmas A (1999) Anatomía humana, 10th edn edn. Masson, Barcelona, pp 286–287Google Scholar
  18. 18.
    Savary V, Robert R, Rogez JM, Armstrong O, Leborgne J (1997) The mandibular marginal ramus of the facial nerve: an anatomic and clinical study. Surg Radiol Anat 19:69–72PubMedCrossRefGoogle Scholar
  19. 19.
    Songcharoen P, Mahaisavariya B, Chotigavanich C (1996) Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus. J Hand Surg [Am] 21(A):387–390CrossRefGoogle Scholar
  20. 20.
    Testut-Latarjet (1988) Anatomía Humana 9th edn. In: Tomo III, Salvat, Barcelona, pp 140–143Google Scholar
  21. 21.
    Waikanul S, Wongtragul S, Vanadurongwan V (1999) Restoration of elbow flexion in brachial plexus avulsion injury: comparing spinal accessory nerve transfer with intercostals nerve transfer. J Hand Surg [Am] 24(A):571–577CrossRefGoogle Scholar
  22. 22.
    Wang TM, Lin CL, Kuo KJ, Shih C (1991) Surgical anatomy of the mandibular ramus of the facial nerve in Chinese adults. Acta Anat (Basel) 142(2):126–131CrossRefGoogle Scholar
  23. 23.
    Williams-Warwick (1998) Anatomía de Gray, 38th edn. Harcourt Brace, Madrid, pp 1246–1248Google Scholar
  24. 24.
    Ziarah HA, Atkinson ME (1981) The surgical anatomy of the mandibular distribution of the facial nerve. Br J Oral Surg 19(3):159–179PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Mariano Pablo Socolovsky
    • 1
    • 2
    • 5
    Email author
  • Jayme Augusto Bertelli
    • 3
    • 4
  • Gilda Di Masi
    • 1
  • Alvaro Campero
    • 1
    • 2
  • Lucas Garategui
    • 2
  • Horacio Conesa
    • 2
  • Marcos Flávio Ghizoni
    • 4
  1. 1.Peripheral Nerve Section, Department of Neurosurgery, Hospital de ClínicasUniversity of Buenos AiresBuenos AiresArgentina
  2. 2.Instituto de Morfología J.J. NaonUniversity of Buenos AiresBuenos AiresArgentina
  3. 3.Department of Orthopedic Surgery, Center of Biological and Health Sciences, Governador Celso Ramos HospitalUniversity of the South of Santa Catarina (Unisul)TubarãoBrazil
  4. 4.Center of Biological and Health SciencesUniversity of Southern Santa Catarina (Unisul)TubarãoBrazil
  5. 5.Buenos AiresArgentina

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