Immediate Inferior Alveolar Nerve Reconstruction With Ablative Mandibular Resection Results in Functional Sensory Recovery.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
BACKGROUND:Ablative mandibular resection with sacrifice of the inferior alveolar nerve (IAN) results in loss of sensation and decreased quality of life. PURPOSE:The purpose of this study is to evaluate functional sensory recovery (FSR) of immediate IAN allograft reconstruction performed during ablative mandibular resection at 1 year following surgery. STUDY DESIGN, SETTING, SAMPLE:This is a single-center retrospective cohort study that included consecutive subjects who underwent mandibular resection with IAN discontinuity and used a nerve allograft of ≥40 mm. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE:The primary predictor variable is the use of an immediate nerve allograft in mandibular reconstruction. MAIN OUTCOME VARIABLE(S):The main outcome variable is FSR at 1 year using the Medical Research Council Scale. COVARIATES:Covariates include subject age, sex, specific pathology, nerve gap length, and development of neuropathic pain. ANALYSES:Statistical analysis of comparison of neurosensory outcomes was measured by bivariate statistics, weighted values, repeated measures, analysis of variance, and McNemar test. RESULTS:The study sample was composed of 164 subjects, of whom 55 (33.5%) underwent nerve allograft reconstruction and 30 (18.3%) did not have nerve reconstruction. Seventy-nine subjects (48.2%) did not meet the inclusion criteria. In the entire nerve allograft group of 55 subjects, FSR was achieved in 80% at 1 year; however, in benign disease alone, 31 of 33 (94%) achieved FSR at 1 year. In the nonallograft group (all benign disease), only 2 of 30 (7%) achieved FSR at 1 year. The significant covariates were age and pathology. Benign pathologic resections were 5.2 times more likely to achieve FSR than malignancies, and all subjects ≤ 18 years of age achieved FSR. After adjusting for age, sex, pathology, nerve gap length, nerve allograft was significantly associated with achieving FSR at 1 year (adjusted odds ratio = 5.52, 95% confidence interval = (1.03, 29.51), P value = .045 < .05). CONCLUSION AND RELEVANCE:Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with an overall 80% of subjects achieving FSR at 1 year, while benign disease resulted in 94% FSR at 1 year. Immediate IAN reconstruction should be considered with mandibular resection involving the IAN, especially for children and benign disease.
10.1016/j.joms.2023.09.025
The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases.
Marques Faria Jose Carlos,Rodrigues Mônica Lucia,Scopel Gean Paulo,Kowalski Luiz Paulo,Ferreira Marcus Castro
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
A study of the authors' experience with 210 free lateral arm flaps used to repair head and neck oncological defects over an 8-year period. Patients' ages ranged from 4 to 83 years (average: 49.7 years). One hundred and forty-one were male and 66 female. Three patients received two consecutive flaps each. They were used to reconstruct: the tongue, 53 cases; retromolar trigone, 42 cases; soft/hard palate, 34 cases; skin/facial contour, 19 cases; hypopharynx, 17 cases; buccal mucosa, 12 cases; lips, five cases. Flap cutaneous dimensions ranged from 4 x 2 cm to 17 x 8 cm. Flap was composed of: skin and fascia, 18 cases; sensate (neurovascular) skin, six cases; subcutaneous fat tissue, five cases; skin and vascularised nerve graft, three cases, skin and partial triceps muscle, three cases. Nerve coaptations were performed for all lip reconstructions. All flaps survived except for nine (success rate: 95.2%). Severe postoperative clinical complications preceded flap failure and death in two cases. All but six donor sites were closed primarily. Complications related to the donor site were: paresthesia of the forearm, 210 cases; dog ear, 16 cases; hypertropic scar, 14 cases; weakness, nine cases; haematoma, five cases; seroma, three cases; dehiscence, one case. Radial nerve injury was not observed in this series. The lateral arm flap can be considered safe and versatile for most soft tissue head and neck microsurgical reconstructions. The possibility of sensory recovery through neural anastomoses and low donor site morbidity enhances its efficiency.
10.1016/j.bjps.2007.10.035
Repair of the inferior alveolar nerve with a forearm cutaneous nerve graft after ablative surgery of the mandible.
Shibahara T,Noma H,Takasaki Y,Nomura T
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:A method of autologous nerve grafting for repair of the inferior alveolar nerve after mandibular resection using a forearm cutaneous nerve is described. PATIENTS AND METHODS:The lateral cutaneous nerve of forearm served as the donor nerve, and the graft was inserted microsurgically using an epineurial nerve suture technique in 6 subjects. Return of sensation in these 6 patients was measured by the use of Semmes-Weinstein method. RESULTS:Sensibility of the lower lip and chin recovered after about 10 months in all 6 subjects. CONCLUSION:The lateral branch of the forearm cutaneous nerve is a useful graft for repair of the inferior alveolar nerve after mandibular resection in which a forearm flap is used as part of the reconstruction.
10.1053/joms.2000.7252
Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma.
Bagheri Shahrokh C,Meyer Roger A,Khan Husain Ali,Steed Martin B
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:Injuries to the peripheral branches of the trigeminal nerve from maxillofacial trauma can have distressing sensory or functional sequelae. The present study reports the results of trigeminal microneurosurgical repair in a series of patients with maxillofacial trauma. MATERIALS AND METHODS:A retrospective chart review was completed of all patients who had undergone microneurosurgical repair of peripheral trigeminal nerve injuries caused by maxillofacial trauma and who had been treated by one of us (R.A.M.) from March 1986 through December 2005. A physical examination, including standardized neurosensory testing, was completed on each patient preoperatively. All patients were followed up periodically after surgery for at least 1 year with neurosensory testing repeated at each visit. Sensory recovery was evaluated using the guidelines established by the Medical Research Council. The following data were collected and analyzed: patient age, gender, nerve injured, etiology (location of fracture), chief sensory complaint (ie, numbness or pain, or both), interval from injury to surgical intervention, intraoperative findings, surgical procedure, and neurosensory status at the final evaluation. RESULTS:A total of 42 patients (25 males and 17 females) with average age of 37.1 years (range 11 to 61) and a follow-up of at least 12 months were included in the study. The most commonly injured/repaired nerve was the inferior alveolar nerve caused by mandibular angle fracture (n = 21), followed by the mental nerve due to mandibular parasymphysis fracture (n = 12), the infraorbital nerve from zygomaticomaxillary complex fracture (n = 7), and lingual nerve and long buccal nerve from mandibular body fracture (n = 1 each). In 17 patients, the chief sensory complaint was numbness, and 25 patients complained of pain with or without mention of numbness. The average interval from nerve injury to repair was 12.5 months (range 2 to 24). The most common intraoperative finding was a compression injury (n = 19), followed by partial nerve severance (n = 9). The most frequent surgical procedure was external decompression/internal neurolysis (n = 20). Ten injured nerves required reconstruction of a discontinuity defect with an autogenous nerve graft (donor sural or great auricular nerve), all of which were associated with mandibular angle or parasymphysis fractures. After a minimum of 1 year of follow-up, neurosensory testing demonstrated that 6 nerves (14%) showed no sign of recovery, 23 nerves (55%) had regained "useful sensory function," and 13 nerves (31%) showed full recovery as described by the Medical Research Council scale. CONCLUSIONS:Microsurgical repair of peripheral branches of the trigeminal nerve injured by maxillofacial trauma produced significant improvement or complete recovery in 36 (86%) of 42 patients. These results compare favorably with the microsurgical repair of peripheral trigeminal nerve injuries resulting from other causes.
10.1016/j.joms.2009.04.115
Autogenous grafts/allografts/conduits for bridging peripheral trigeminal nerve gaps.
Wolford Larry M,Rodrigues Daniel B
Atlas of the oral and maxillofacial surgery clinics of North America
Nerve repairs and grafting techniques have been around for many years. Autogenous nerve grafts have worked reasonably well in the right circumstances but are associated with difficulties in achieving a proper donor-host match and with postsurgical sequelae at the donor site. Vein grafts seem to work almost as well as autogenous nerve grafts in digital nerve repairs that require a graft less than 3 cm in length. Currently, the most promising nerve graft materials are the polyglycolic acid tubes and processed decellularized allografts, which have shown good results without the morbidity of autogenous nerve grafts. However, more research studies using these materials for TN repairs are essential to validate the superiority of these procedures.
10.1016/j.cxom.2010.11.008
Microanatomic analysis of the medial antebrachial nerve as a potential donor nerve in maxillofacial grafting.
McCormick S U,Buchbinder D,McCormick S A,Stark M
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:To histologically compare the anterior branch of the medial antebrachial cutaneous nerve (MACN) with the sural nerve using biometric techniques. PATIENTS AND METHODS:Twenty-centimeter segments of the right and left (MACN) and sural nerves from three cadavers were analyzed. The number of fascicles within the nerves were counted and the neural to connective tissue ratio was estimated. RESULTS:Sural nerves consistently showed greater amounts of connective tissue between the fascicles than the MACN. Fascicle diameter varied less throughout the length of the MACN. Fascicle diameter varied less throughout the length of the MACN and it showed fewer and larger fascicles, more closely approximating the anatomy of the inferior alveolar nerve. CONCLUSION:These preliminary data suggest that the MACN, on anatomic grounds, is theoretically more suited for grafting to the alveolar and lingual nerves than the sural nerve.
The vascularized sural nerve graft based on a peroneal artery perforator for reconstruction of the inferior alveolar nerve defect.
Hayashida Kenji,Hiroto Saijo,Morooka Shin,Kuwabara Kaoru,Fujioka Masaki
Microsurgery
The sural nerve has been described for nerve reconstruction of the maxillofacial region since it provides many advantages. We report a case of a vascularized sural nerve graft based on a peroneal artery perforator for immediate reconstruction after the removal of intraosseous neuroma originating in the inferior alveolar nerve. The patient had a neuroma caused by iatrogenic injury to the inferior alveolar nerve. A 4-cm long neuroma existed in the inferior alveolar nerve and was resected. A peroneal perforator was chosen as the pedicle of the vascularized sural nerve graft for the nerve gap. The graft including the skin paddle for monitoring the perfusion supplied by this perforator was transferred to the lesion. The nerve gap between the two stumps of the inferior alveolar nerve was repaired using the 6-cm long vascularized sural nerve. The perforator of the peroneal artery was anastomosed to the branch of the facial artery in a perforator-to-perforator fashion. There was no need to sacrifice any main arteries. The skin paddle with 1 cm × 3 cm in size was inset into the incised medial neck. Perceptual function tests with a Semmes-Weinstein pressure esthesiometer and two-point discrimination in the lower lip and chin at 10 months after surgery showed recovery almost to the level of the normal side. This free vascularized sural nerve graft based on a peroneal artery perforator may be a good alternative for reconstruction of inferior alveolar nerve defects.
10.1002/micr.22346
Inferior alveolar nerve reconstruction with interpositional sural nerve graft: a sensible addition to one-stage mandibular reconstruction.
Chang Yang-Ming,Rodriguez Eduardo D,Chu Yong-Ming,Tsai Chi-Ying,Wei Fu-Chan
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
BACKGROUND:This study was to evaluate the sensory recovery in the lower lip and chin in patients who underwent segmental mandibulectomy involving inferior alveolar nerve and simultaneous reconstruction with fibular osteoseptocutaneous flap and interposition sural nerve graft. MATERIAL AND METHOD:From 1993 to 2004, a total of 20 patients underwent segmental mandibulectomy, simultaneous fibula osteoseptocutaneous flap reconstruction and interpositional sural nerve graft. Twelve patients were available for the study. There were seven male and five female patients with average age of 35.8 years (16-52 years). The sense at the lower lip and chin was measured by two-point discrimination both at the operated and non-operated side at an average of 64.3 months (12-146 months). RESULT:The operated side revealed an average of 13.7 mm for static (STPD) and 13.3 mm for moving two-point discrimination (MTPD) at the lower lip and 13.7 mm for static and 13.4 mm for MTPD at the chin. Data from the non-operated side averaged 3.4 mm for static and 3.2 mm for MTPD at lower lip and 5.1 mm for static and 4.5 mm for moving discrimination at the chin. All patients recovered better than protective sensation on the operated side, which was sufficient to prevent self-mutilation, preserve comprehensible speech and maintain oral competence. No patient complained of significant donor site morbidity. CONCLUSION:Simultaneous reconstruction of a segmental mandibulectomy involving inferior alveolar nerve with a fibula osteoseptocutaneous flap and interpositional sural nerve graft offers simultaneous replacement of mandibular architecture and restoration of protective perioral sensation.
10.1016/j.bjps.2011.12.028
Preventing Early-Stage Graft Bone Resorption by Simultaneous Innervation: Innervated Iliac Bone Flap for Mandibular Reconstruction.
Wang Lei,Wei Jian-Hua,Yang Xi,Yang Zi-Hui,Sun Mo-Yi,Cheng Xiao-Bing,Xu Li-Qun,Lei De-Lin,Zhang Chen-Ping
Plastic and reconstructive surgery
BACKGROUND:Postoperative resorption of vascularized bone grafts jeopardizes the success of dental implant(s) and functional rehabilitation of the jaw. Recent evidence supports the crucial role of innervation in bone regeneration and turnover. METHODS:This study reports a new technique for simultaneous innervation of vascularized iliac flaps in mandibular reconstruction, through neurorrhaphy between ilioinguinal nerves, which innervate iliac bone, and inferior alveolar nerves or great auricular nerves. Twenty-two patients (aged 50 to 69 years) with postoncologic continuity defects of the mandible underwent mandibular reconstruction (10 innervated flaps and 12 control flaps). Graft bone resorption was analyzed by computed tomographic scans at 6 and 12 months postoperatively, and bone quality was evaluated for dental implantation, with histologic and histomorphometric analyses for graft samples. RESULTS:At 12-month follow-up, graft bone density loss in the control group was significantly higher than in the innervated group (p < 0.05). Bone quality evaluation indicated a suitable condition for dental implantation in all patients in the innervated group but in 41.7 percent of patients in the control group. Histologic and histomorphometric analyses showed successful innervation in the innervated group but not in the control group. Osteoclast activity was significantly higher in the control group than in the innervated group (p < 0.05). CONCLUSIONS:Innervated iliac flaps may effectively prevent bone resorption of grafts in mandible reconstruction that otherwise jeopardize the success of dental implants. This new strategy of innervation of bone flaps appears clinically valuable and provides insights into the homeostasis of grafts for functional reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
10.1097/PRS.0000000000003263
Nerve Sharing Between the Lingual and Mental Nerve to Restore Lower Lip Sensation After Segmental Resection of the Mandible.
Murata Takuya,Abukawa Harutsugi,Satomi Takafumi,Chikazu Daichi
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
This report demonstrates a successful new procedure for reconstructing the inferior alveolar nerve by transplanting the great auricular nerve (GAN) between the mental nerve and the remaining submandibular ganglion to achieve nerve sharing of the lingual nerve. A 59-year-old woman with discomfort in the left mandibular retromolar region and ipsilateral neck was referred to our hospital by a local dentist. Physical examination showed mild swelling and redness at the left mandibular retromolar region. The histologic diagnosis showed central mucoepidermoid carcinoma of the jaw. With the patient under general anesthesia, segmental resection of the mandible followed by level 1 selective neck dissection was performed. The resected mandible was reconstructed with a titanium plate. The submandibular incision was extended to the lower edge of the tragus for harvesting of the GAN. The GAN was grafted, and an epineural neurorrhaphy was carried out with the mental nerve, as well as the submandibular ganglion, under a microscope. After the operation, submental sensation was evaluated with a Semmes-Weinstein pressure esthesiometer. The Semmes-Weinstein pressure esthesiometer test showed a loss of perception at the third week after surgery. Within 12 months, nerve sensation was substantially improved and the patient was free from discomfort.
10.1016/j.joms.2016.04.017
An Anatomical Feasibility Study Using a Great Auricular Nerve Graft for Ipsilateral Inferior Alveolar Nerve Repair.
Iwanaga Joe,Altafulla Juan J,Kikuta Shogo,Tubbs R Shane
The Journal of craniofacial surgery
The great auricular nerve (GAN) has been used for trigeminal and facial nerve repair and the inferior alveolar nerve (IAN) are often sacrificed during segmental mandibulectomy. To our knowledge, only 1 case report has discussed IAN repair using GAN after segmental mandibulectomy. The goal of this study is to clarify the feasibility of using GAN for IAN repair. Eleven sides from 6 fresh frozen Caucasian cadavers were used for this study. The mean age at the time of death was 82.3 years. A submandibular skin incision was made 2 finger breadths below and parallel to the inferior border of the mandible. The GAN was identified and then the mental foramen was found via extraoral dissection. The buccal cortical bone was removed 5 mm posterior to the mental foramen to the wisdom tooth area. Next, the anteroposterior length of the window was measured. The diameter of the IAN at the first molar tooth area was measured. Finally, the GAN was cut with maximum available length to compare to the length of the window in the mandible. The anteroposterior length of the window and diameter of the IAN ranged from 23.1 to 31.2 mm and 1.2 to 2.1 mm, respectively. The length of the available GAN was longer than the ipsilateral bony window of the mandible on all sides. This study might encourage surgeons to consider a new way to treat patients who undergo segmental resection of the mandible with surgical neck dissection with injury to their IAN.
10.1097/SCS.0000000000005739
Neurosensory recovery of inferior alveolar nerve gap reconstruction: a systematic review.
The British journal of oral & maxillofacial surgery
Numerous procedures can potentially injure the inferior alveolar nerve during oral and maxillofacial surgery, eventually causing loss or alteration of local sensitivity. When its total rupture occurs, a conduit, such as an autogenous graft, can be used to join it. Due to the morbidity resulting from this technique, alternative forms of sensorineural repair have been investigated. This systematic review includes an electronic search of PubMed, Embase, LILACS, and Web of Science databases, in addition to a grey literature and manual search. Article selection was performed by two independent researchers following a predetermined inclusion criterion: human studies evaluating the regression of sensorineural disorders after any form of grafting (autogenous, allogeneic, and synthetic). Of the 789 studies, 648 were analysed. Only 11 articles met the eligibility criteria. After analysing the results, it was noted that regaining normal sensitivity was uncommon, but the majority of reconstructed nerves recovered their protective abilities. Allografts showed success rates similar to autogenous grafts, making them a viable alternative. However, clinical trials are still needed to provide solid evidence. Prognosis for sensory recovery was impacted by grafting time and patient age.
10.1016/j.bjoms.2023.10.020
Nerve grafts in head and neck reconstruction.
Hoshal Steven G,Solis Roberto N,Bewley Arnaud F
Current opinion in otolaryngology & head and neck surgery
PURPOSE OF REVIEW:This article reviews recent literature on repair of peripheral nerve injuries in the head and neck with a focus on autografts, allografts, nerve conduits, and technical considerations. RECENT FINDINGS:Contemporary nerve grafting techniques offer the potential to improve peripheral nerve outcomes and reduce donor site morbidity. A variety of donor nerves autografts have been described that offer favorable outcomes for segmental reconstruction of facial nerve defects. Recent studies have demonstrated promising results in repair of inferior alveolar nerve injuries with human allografts. Animal models describe successful reinnervation of small defects with neural conduits. The latest data do not favor protocolled nerve graft polarity or use of a motor versus sensory donor nerves. SUMMARY:Interposition nerve grafting is the gold standard for repair of peripheral nerve injuries when a tension-free primary neurorrhaphy is not possible. Autografts are the work-horse for the majority of head and neck neural defects, however, can result in some degree of donor site morbidity. Recent developments in allografting and neural conduits have the potential to further diversify the head and neck reconstructive surgeon's armamentarium. It is unclear if nerve graft makeup or polarity affect functional outcome.
10.1097/MOO.0000000000000649
Recovery of Sensation Over the Distribution of the Inferior Alveolar Nerve Following Mandibular Resection Without Nerve Reconstruction.
Pogrel M Anthony
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:To assess the long-term recovery of sensation in the lower lip after mandibular resection without reconstruction of the inferior alveolar nerve. MATERIAL AND METHODS:Thirty patients who had mandibular resection carried out without reconstruction of the inferior alveolar nerve were examined after an interval ranging from 6 to 33 years. RESULTS:Only 1 patient, seen 10 years after resection, was totally numb over the distribution of the inferior alveolar nerve. The other 29 patients had some return of sensation and many had a significant return, though it may take several years to reach the final result. Utilizing the MRC scale 70% of patients achieved S3 (return of superficial cutaneous pain and tactile sensibility without over response) CONCLUSION: This study can serve as a baseline for comparison with patients who have had mandibular resection with reconstruction of the inferior alveolar nerve to assess if this procedure improves the outcomes.
10.1016/j.joms.2021.04.029
Efficacy of Acellular Nerve Allografts in Trigeminal Nerve Reconstruction.
Yampolsky Andrew,Ziccardi Vincent,Chuang Sung-Kiang
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:During trigeminal nerve repair, a gap is sometimes encountered that prevents the tension-free apposition of nerve endings. The use of a processed acellular nerve allograft is a novel technique that shows promise in overcoming this problem. The goal of the present study was to support the slowly evolving body of evidence that acellular processed nerve allografts (Avance; Axogen, Alachua, FL) are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve. PATIENTS AND METHODS:The study design consisted of a retrospective review of the medical records of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries from July 2008 to August 2014. Sixteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (V.Z.). Serial neurosensory testing was performed by 1 clinician (V.Z.) in a standardized fashion. The primary outcome variable was the interval to functional sensory recovery as defined by the Medical Research Council Scale. RESULTS:The participants ranged in age from 16 to 62 years (mean 32). Of the 16 patients, 12 were female (75%) and 4 were male (25%), and 3 were smokers (18.75%) and 13 were nonsmokers (81.25%). One half of the patients (n = 8; 50%) underwent surgery on the inferior alveolar nerve, and 8 (50%) underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal (n = 9; 56.25%) Of the 16 patients, 15 (93.75%) achieved functional sensory recovery during the study period. CONCLUSIONS:The results of the present study support the hypothesis that processed nerve allografts are effective in reconstructing small (<2-cm) trigeminal nerve defects.
10.1016/j.joms.2017.02.015
Outcomes of Immediate Allograft Reconstruction of Long-Span Defects of the Inferior Alveolar Nerve.
Salomon David,Miloro Michael,Kolokythas Antonia
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons
PURPOSE:Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine the outcomes of immediate reconstruction of long-span defects (≥50 mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts. MATERIALS AND METHODS:A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50 mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period. RESULTS:Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7 years (range, 18 to 61 yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7 months (range, 10 to 27.5 months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0). CONCLUSIONS:Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5 cm) is a viable and predictable option to achieve useful functional sensory recovery.
10.1016/j.joms.2016.05.029
Inferior alveolar nerve preservation during resection and reconstruction of the mandible for benign tumors as a factor improving patient's quality of life.
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients. The authors assessed the inferior alveolar nerve's sensory dysfunction by measuring the electroexcitability of skin receptors using an electro-odontometer. Study participants' quality of life was estimated with the oral health impact profile (OHIP)-14 and short-form (SF)-36 questionnaire. All the patients in whom the inferior alveolar nerve was sacrificed experienced persistent numbness in the area of innervation with mental nerve on the affected side. The average pain threshold reached preoperative levels (point 1-22.7 ± 2.5, p-value = .025; point 2-25.8 ± 2.7, p-value = .023) 6 months after the operation in patients in whom the IAN was preserved (point 1-23.7 ± 2.3, p-value = .022; point 2-25.4 ± 2.8, p-value = .025). The results of the OHIP-14 and SF-36 showed that patients with preserved IANs had a significantly better quality of life than the patients in whom the IAN was sacrificed. The results of OHIP-14 twelve months after the operation in unilateral resection: control group - 16.0 ± 1.6, p-value = .029; study group - 8.0 ± 0.8, p-value = .029, and in bilateral resection: control group - 26.0 ± 3.2, p-value = .044; study group - 9.0 ± 0.7, p-value = .027. The possibility of sparing the inferior alveolar nerve should not be ignored when planning mandibular resection and reconstruction.
10.1016/j.jcms.2022.02.008
Reconstructive Options for Inferior Alveolar and Lingual Nerve Injuries After Dental and Oral Surgery: An Evidence-Based Review.
Ducic Ivica,Yoon Joshua
Annals of plastic surgery
PURPOSE:The investigators wanted to evaluate, analyze, and compare the current microsurgical repair modalities (primary repair, autograft, tube conduit, and allograft reconstruction) in achieving functional sensory recovery in inferior alveolar and lingual nerve reconstructions due to injury. METHODS:A literature review was undertaken to identify studies focusing on microsurgical repair of inferior alveolar and lingual nerve injuries. Included studies provided a defined sample size, the reconstruction modality, and functional sensory recovery rates. A Fischer exact test analysis was performed with groups based on the nerve and repair type, which included subgroups of specific nerve gap reconstruction modalities. RESULTS:Twelve studies were analyzed resulting in a sample consisting of 122 lingual nerve and 137 inferior alveolar nerve reconstructions. Among the nerve gap reconstructions for the lingual nerve, processed nerve allografts and autografts were found to be superior in achieving functional sensory recovery over the conduits with P values of 0.0001 and 0.0003, respectively. Among the nerve gap reconstructions for the inferior alveolar nerve, processed nerve allografts and autografts were also found to be superior in achieving functional sensory recovery over the conduits with P values of 0.027 and 0.026, respectively. Overall, nerve gap reconstructions with allografts and autografts for inferior alveolar and lingual nerve reconstruction were superior in achieving functional sensory recovery with a P value of <0.0001. CONCLUSIONS:The data analyzed in this study suggest that primary tension-free repair should be performed in inferior alveolar and lingual nerve reconstructions when possible. If a bridging material is to be used, then processed nerve allografts and autografts are both superior to conduits and noninferior to each other. In addition, allografts do not have the complications related to autograft harvesting such as permanent donor site morbidity. Based on the conclusions drawn from these data, we provide a reproducible operative technique for inferior alveolar and lingual nerve reconstruction.
10.1097/SAP.0000000000001783
Inferior alveolar nerve allogenic repair following mandibulectomy: A systematic review.
Journal of stomatology, oral and maxillofacial surgery
PURPOSE:Processed nerve allografts (PNA) are an alternative to nerve autografts to reconstruct the inferior alveolar nerve (IAN) when it is damaged. The purpose of this study was to report the results of IAN reconstruction using PNA in the context of aggressive benign mandibular pathology. MATERIAL AND METHOD:A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement through the MEDLINE (Pubmed) and SCOPUS (Elsevier) databases. Studies concerning reconstructive surgeries of IAN by PNA, performed at the same time as the surgical resection of the benign pathologies of the mandible were included. The following data were analyzed: gender and patient age, cause of mandibular resection, graft dimensions, sensory recovery at least 6 months after surgery according to the MRC scale, and adverse events related to the intervention. RESULTS:The initial search yielded 290 studies and 5 were included in the final review. A total of 33 patients underwent 36 IAN reconstructions; 14 patients were female (42.4%) and mean age was 30 years old. The mean length of graft used was 64.0 ± 9.1 mm. The most common pathology that led to nerve resection was ameloblastoma (52%). Among the reconstructions for which follow-up data were available, functional sensory recovery occurred in 92.9% of cases. CONCLUSION:PNA are a reliable, safe, and effective alternative to nerve autografts for the rehabilitation of the IAN with 92.9% of functional recovery according to the reported literature, avoiding any comorbidity associated with the use of a donor site.
10.1016/j.jormas.2021.04.007
Inferior alveolar nerve reconstruction in extensive mandibular resection: Technical notes.
Manfuso A,Pansini A,Tewfik K,Copelli C
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
The inferior alveolar nerve (IAN) is a sensitive branch of the mandibular nerve innervating the lower lip, the chin, the buccal mucosa and the teeths. Lesions of the IAN are reported to occur in the 64,4% of maxillo-facial procedures, leading to anesthesia, hypoestesia and/or neurogenic discomfort. An extensive segment of the nerve can be moreover removed during mandibular resection for benign or malignant pathologies. Nervous grafts can be used in these cases to restore the nerve continuity. In order to optimize the procedure and to allow a concomitant mandibular osseous reconstruction, the Authors identified several standardized steps. The technique described allows to perform confortable and safe nervous anastomoses and to reduce the risk of damage and tension during the flap insetting phases.
10.1016/j.bjps.2020.11.040