Immediate Inferior Alveolar Nerve Reconstruction with Ablative Mandibular Resection Results in Functional Sensory Recovery
Michael Miloro, MD, DMD, FACS, University of Illinois Chicago, Chicago, IL
Purpose: Ablative mandibular resection results in loss of sensation and decreased quality of life. The goal of this study is to evaluate sensory recovery of immediate inferior alveolar nerve (IAN) allograft reconstruction performed during ablative mandibular resection at one year following surgery.
Patients and Methods: A single-center retrospective cohort study included consecutive subjects who underwent mandibular resection with IAN discontinuity, and use of a nerve allograft of >40mm. The primary predictor variable is the study group vs. an historical control group of non-nerve grafted mandibular resections. Covariates include subject age, sex, specific pathology, pre- or post-surgical radiotherapy, and the presence of pre-operative paresthesia, and development of neuropathic pain. The primary outcome variable is the ability to achieve functional sensory recovery (FSR) by one year using the Medical Research Council Scale (MRCS). Statistical analysis of comparison of neurosensory outcomes over time was measured by bivariate statistics, weighted values, repeated measures ANOVA, Cox proportional hazards regression, and a McNemar test.
Results: 134 patients underwent immediate IAN reconstruction, of which 55 met the inclusion criteria. In the study group of 55 subjects, FSR was achieved in 80% of the group, compared to historical data of 70% in 30 subjects. Historical data showed recovery in 4-5 years, while our data shows 80% recovery within 1 year. The significant covariates were age (p=0.039) and pathology (p=0.048). Benign pathologic resections are 5.2 times more likely to achieve FSR (p=0.002), and all subjects < 18 years of age achieved FSR.
Conclusions: Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with 80% of subjects achieving FSR by 1 year. Immediate IAN reconstruction should be considered with mandibular resection involving the IAN.
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