Reconstruction of peripheral trigeminal nerve of the mandible in pediatric patients using long-span nerve allografts
Michael Miloro, MD, DMD, FACS, University of Illinois at Chicago, Chicago, IL; Northwestern Memorial Hospital, Chicago, IL and John R Zuniga, DMD, MS, PhD, University of Texas Southwestern, Dallas, TX
Purpose: Mandibular resection for benign pathology may require removal of bone, teeth, soft tissue, and inferior alveolar nerve (IAN). This study was designed to determine if immediate IAN allograft reconstruction in conjunction with mandibular resection and primary reconstruction can provide functional sensory recovery (FSR) in the pediatric age group.
Methods: Inclusion of pediatric subjects (age 8 -18) requiring mandibular resection for benign pathology resulting in discontinuity of the IAN, with a nerve allograft length of 45-70 mm. MRSC sensory testing was performed before and at 3, 6, and 12 months postsurgically. A positive control group consisted of pediatric subjects who had mandibular resection with IAN discontinuity without nerve reconstruction.
Results: Twenty subjects comprised the study group (nerve allograft) and 12 patients served as a positive control group (no nerve allograft). Data was available on 18 study, and 12 positive control, subjects. The study group had 7 males and 11 females, mean age 14.6 years (range 10-18); the positive control group had 6 males and 6 females, mean age 14.75 years (range 8-18). Specific pathology included ameloblastoma (60% in study group, 66% in positive control), central ossifying fibroma or variant (20% of study and 16% of positive control), and myxoma (15% of study and 16% of positive control). Mean allograft length was 63.75mm (range 45-70mm), with diameter of 2-4 mm. S4 values were present pre-surgically in all study and positive controls. In the study group, FSR (S3, S3+, S4) was achieved in 68.4% at 3 months, 88.2% at 6 months, and 100% at 12 months. In the positive control group no subject achieved FSR, with 83.3% anesthetic at 3 months with maximum of S2 in 33.3% at 12 months. There were no adverse events or pathologic recurrences during the study period.
Conclusions: Long-span nerve allografts are effective in restoring sensation to the lip and chin in dramatic fashion with 100% reaching FSR, while no subjects without nerve reconstruction achieved FSR. The data indicate that pediatric patients recover FSR sooner, and to a greater magnitude, than adults, based upon published data. IAN reconstruction for ablative mandibular resection in pediatric patients should be performed in the immediate reconstructive phase of treatment.
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