Sensory Outcomes After Reconstruction of Lingual and Inferior Alveolar Nerve Discontinuities Using Processed Nerve Allograft—A Case Series

• Published in: Journal of oral and maxillofacial surgery Vol. 73; no. 4; pp. 734 - 744
• Main Author: Zuniga, John R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Allografts - transplantation; Child; Female; Follow-Up Studies; Humans; Lingual Nerve - surgery; Lingual Nerve Injuries - surgery; Male; Mandibular Nerve - surgery; Microsurgery - methods; Middle Aged; Pain Threshold - physiology; Peripheral Nerves - transplantation; Reconstructive Surgical Procedures - methods; Retrospective Studies; Safety; Sensation - physiology; Sensory Thresholds - physiology; Surgery; Tissue Scaffolds; Touch - physiology; Treatment Outcome; Trigeminal Nerve Injuries - surgery; Young Adult
• ISSN: 0278-2391; 1531-5053; 1531-5053
• DOI: 10.1016/j.joms.2014.10.030

The present study describes the results of using a processed nerve allograft, Avance Nerve Graft, as an extracellular matrix scaffold for the reconstruction of lingual nerve (LN) and inferior alveolar nerve (IAN) discontinuities. A retrospective analysis of the neurosensory outcomes for 26 subjects with 28 LN and IAN discontinuities reconstructed with a processed nerve allograft was conducted to determine the treatment effectiveness and safety. Sensory assessments were conducted preoperatively and 3, 6, and 12 months after surgical reconstruction. The outcomes population, those with at least 6 months of postoperative follow-up, included 21 subjects with 23 nerve defects. The neurosensory assessments included brush stroke directional sensation, static 2-point discrimination, contact detection, pressure pain threshold, and pressure pain tolerance. Using the clinical neurosensory testing scale, sensory impairment scores were assigned preoperatively and at each follow-up appointment. Improvement was defined as a score of normal, mild, or moderate. The neurosensory outcomes from LNs and IANs that had been microsurgically repaired with a processed nerve allograft were promising. Of those with nerve discontinuities treated, 87% had improved neurosensory scores with no reported adverse experiences. Similar levels of improvement, 87% for the LNs and 88% for the IANs, were achieved for both nerve types. Also, 100% sensory improvement was achieved in injuries repaired within 90 days of the injury compared with 77% sensory improvement in injuries repaired after 90 days. These results suggest that processed nerve allografts are an acceptable treatment option for reconstructing trigeminal nerve discontinuities. Additional studies will focus on reviewing the outcomes of additional cases.