John R Zuniga1, Fayette Williams2, Daniel Petrisor3. 1. Robert V. Walker DDS Chair in Oral and Maxillofacial Surgery and Professor, Departments of Surgery and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX. Electronic address: John.zuniga@utsouthwestern.edu. 2. Director, Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, Fort Worth, TX. 3. Assistant Professor and Director, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
Abstract
PURPOSE: This study determined whether immediate reconstruction of the inferior alveolar nerve with a long (>4.5 cm) processed nerve allograft (PNA) in conjunction with simultaneous ablation and reconstruction of the mandible would be effective in safely restoring subjective sensation and achieving functional sensory recovery. MATERIALS AND METHODS: Patients (5 to 70 yr old) requiring resection of the unilateral or bilateral mandible for benign pathology were included. The graft had to be longer than 4.5 cm. Results of sensory nerve tests and 3 different surveys (Direct Path, Numerical Rating Scale, Word Choice) were collected before surgery and at 3, 6, and 12 months after surgery. Safety data were recorded. RESULTS: Twenty-six patients participated in this study. Three patients served as positive controls (no nerve repair). Five in the repair group and 1 in the positive control group were lost to follow-up. Data during a 1-year period were collected on 18 patients (7 male and 11 female; mean age, 26.4 yr; range, 10 to 64 yr). The mean length of the PNA was 62.7 mm (range, 45 to 70 mm). Seventeen of 18 patients had S4 sensory scores preoperatively and the postoperative score was S4 at 3 months in 3, at 6 months in 3, and at 1 year in 12. Scores for positive control patients never exceeded S2. Numerical rating scales and word choices were not statistically different from presurgical scores at 6 and 12 months. There were no adverse events. CONCLUSIONS: The PNA is safe and effective when immediately inserted with resection and reconstruction of the mandible: 90% of patients achieved functional sensory recovery and reported similar sensations to preoperative subjective values.
PURPOSE: This study determined whether immediate reconstruction of the inferior alveolar nerve with a long (>4.5 cm) processed nerve allograft (PNA) in conjunction with simultaneous ablation and reconstruction of the mandible would be effective in safely restoring subjective sensation and achieving functional sensory recovery. MATERIALS AND METHODS:Patients (5 to 70 yr old) requiring resection of the unilateral or bilateral mandible for benign pathology were included. The graft had to be longer than 4.5 cm. Results of sensory nerve tests and 3 different surveys (Direct Path, Numerical Rating Scale, Word Choice) were collected before surgery and at 3, 6, and 12 months after surgery. Safety data were recorded. RESULTS: Twenty-six patients participated in this study. Three patients served as positive controls (no nerve repair). Five in the repair group and 1 in the positive control group were lost to follow-up. Data during a 1-year period were collected on 18 patients (7 male and 11 female; mean age, 26.4 yr; range, 10 to 64 yr). The mean length of the PNA was 62.7 mm (range, 45 to 70 mm). Seventeen of 18 patients had S4 sensory scores preoperatively and the postoperative score was S4 at 3 months in 3, at 6 months in 3, and at 1 year in 12. Scores for positive control patients never exceeded S2. Numerical rating scales and word choices were not statistically different from presurgical scores at 6 and 12 months. There were no adverse events. CONCLUSIONS: The PNA is safe and effective when immediately inserted with resection and reconstruction of the mandible: 90% of patients achieved functional sensory recovery and reported similar sensations to preoperative subjective values.
Authors: Bauback Safa; Sonu Jain; Mihir J Desai; Jeffrey A Greenberg; Timothy R Niacaris; Jason A Nydick; Fraser J Leversedge; David M Megee; Jozef Zoldos; Brian D Rinker; Desirae M McKee; Brendan J MacKay; John V Ingari; Leon J Nesti; Mickey Cho; Ian Lee Valerio; Dennis S Kao; Yasser El-Sheikh; Renata V Weber; Jaimie T Shores; Joseph F Styron; Wesley P Thayer; Wojciech H Przylecki; Harry A Hoyen; Gregory M Buncke Journal: Microsurgery Date: 2020-02-26 Impact factor: 2.425