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Sensory Outcomes Following Simultaneous Nerve Allograft and Mandibular Reconstruction for Benign Pathology
John randall Zuniga, DMD; MS, PhD1; John Peter Smith, MD2; Fayette Williams, DDS, MD2; Daniel Petrisor, DDS, MD3
1University of Texas, Dallas, TX, 2Fort Worth, TX, 3Oregon Health Sciences University, Portland, OR
Patients (age 5 -70) requiring resection of the unilateral or bilateral mandible for benign pathology which would include the continuity loss of the IAN were included. The length of the nerve allograft must be between 45 to 70 mm. Sensory nerve tests and three different surveys (Direct Path, Numerical rating scale, Word Choice) were collected before and at 3, 6 , and 12 months. Safety data were recorded.
Twenty-three patients were consented to this study. There were 2 patients with bilateral repairs and 3 patients who served as positive control since no nerve repair was performed. Three patients in the repair group and 1 patient in the positive control group were lost to follow up. Data over a 1 year time was collected on 17 patients. There were 7 males and 10 females, mean age were 26.4 years, range 10 to 64. The confirmed pathology of the mandible was ameloblastoma (n=11), central ossifying fibroma (n=4), myxoma (n=1), and sclerosing osteomyelitis (n=1). The mean length of the nerve defect was 59.75mm, range 45 to 70mm. The mean length of the nerve allograft was 62.7mm, range 45 to 70mm. The diameter was 2-3mm for each. Sixteen of 17 had S4 sensory scores preoperatively and the postoperative score was S4 at 3 months in 3, in 10 at 6 months, and in 12 patients at 12 months. The positive control patients reached S2 at 12 months. Numerical rating scales and word choices were not significantly different from presurgical scores at 6 and 12 months but remained significantly elevated in direct path scores (unusual feeling in face and left over food in cheek). There were no adverse events or recurrences of pathology at these postoperative times.
Nerve allografts were found to be safe and effective in restoring both subjective and objective reports of sensation to the lip and chin in dramatic fashion with 94% reaching useful and functional sensory recovery and >80% reporting similar sensations to preoperative subjective values.
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