Selective Peripheral Denervation and Selective Nerve Injury for the Treatment of Cervical Dystonia Through a Periauricular Incision

TL;DR

This paper describes a new surgical approach for treating cervical dystonia using a periauricular incision to selectively weaken or denervate neck muscles.

Contribution

The novel contribution is an anterior surgical approach using a periauricular incision for selective nerve injury in cervical dystonia.

Findings

An anterior surgical approach via a periauricular incision allows for selective denervation of anterior and posterior neck muscles.

Sunderland third-degree nerve injury can be used to partially weaken nonexpendable muscles, avoiding functional limitations.

This method improves nerve identification at the target muscle entry point compared to traditional posterior approaches.

Abstract

Traditional selective peripheral denervation methods for treating cervical dystonia (CD) involve complete transection of the nerves to muscles through a posterior incision proximally after they exit the spinal cord. This report presents a case where anterior muscles involved in CD cannot be easily addressed through the traditional posterior approach. Furthermore, complete denervation of certain muscles, such as the trapezius, can lead to functional limitations. The objective of this report is to describe an anterior surgical treatment approach for focal CD. Specifically, we describe the use of a periauricular incision to perform selective peripheral denervation of anterior and posterior neck muscles at a more peripheral location near their target muscle entry point. Complete denervation was performed for expendable muscles while Sunderland third-degree nerve injury was performed to weaken nonexpendable muscles. This approach facilitates clearer identification of nerves as they enter the pathologic target muscle. Additionally, the therapeutic use of Sunderland third-degree nerve injury in the treatment of CD is a useful adjunct to muscles that are nonexpendable as it allows for only partial denervation as opposed to complete denervation with traditional methods.

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