Medial antebrachial cutaneous nerve: a new donor graft for repair of facial nerve defects at the skull base.

When grafting a facial nerve defect after resection of a skull base cancer, the use of the greater auricular nerve is generally contraindicated because of concern of malignant involvement. In the past, the sural nerve was used as a donor graft for reconstruction of the facial nerve. We have found a sensory branch of the median nerve of the upper arm, the medial antebrachial cutaneous (MAC) nerve, to be a suitable option for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction of the distal facial nerve in the parotid bed. The length is adequate to graft from the brainstem to the distal facial branches. Loss of sensation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facial nerve defects. No complications have been encountered, and the functional return appears to be similar to other grafts. In our practice the MAC nerve is a valuable option for facial nerve repair at the skull base.