Long span nerve allograft reduces the incidence of post-surgical and post-traumatic trigeminal neuropathic pain following mandibular resection for benign and malignant disease
John R Zuniga, DMD, MS, PhD, University of Texas Southwestern, Dallas, TX
Introduction
The objective of this study was to determine if the immediate repair of a transected trigeminal nerve during ablative mandibular surgery affected the incidence of chronic post-surgical pain (CPSP) and/or post-traumatic trigeminal neuropathic pain (PTTNp).
Materials and Methods
A multi-site, retrospective cohort of patients who underwent resection of the mandible for benign or malignant disease and either had no repair or immediate repair of the intentionally transected trigeminal nerve with a long-span nerve allograft was analyzed for the presence or absence of CPSP and PTTNp at 6 months post-surgery. The primary predictor variable was the immediate repair or no repair and the primary outcome variable was the presence or absence of CPSP and PTTNp at 6 months post-surgery.
Results
103 in the immediate repair group and 94 in the no-repair group met the inclusion and exclusion criteria. The incidence of CPSP in the immediate repair group was 3.8% and 22.3% in the no repair. The incidence of PTTNp was 0% in the immediate repair and 2.12% in the no repair group. The weighted mean CPSP/PTTNp score in the immediate repair group was 1.97±0.17 while the no-repair mean score was 1.76±0.42 which was statistically significant (p = 0.000092). Post-hoc linear regression modeling showed a statistically significant inverse relationship between the immediate repair and the incidence of CPSP/PTTNp. Age and radiation/chemotherapy had a statistically significant effect on the primary outcome variables (p=0.0015 and 0.007 respectively). Age and pathology had a statistically significant effect on the primary predictor variables (p= 0.0001). Logistic Regression modeling provided an odd ratio of 0.43.
Conclusion
Immediate repair of an intentionally transected trigeminal nerve with a long-span nerve allograft during resection of the mandible for both benign and malignant disease appears to reduce CPSP and possibly eliminate the development of PTTNp compared to avoiding nerve repair. The chance of developing chronic pain is 43 times less likely when the IAN is immediately repaired
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