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Immediate Inferior Alveolar Nerve Reconstruction with Ablative Mandibular Resection Results in Functional Sensory Recovery
Michael Miloro, MD, DMD, FACS1; Nicholas Callahan, MPH, DMD, MD2; Michael R Markiewicz, MD, DDS, MPH, FACS3; Antonia Kolokythas, DDS, MSc, MSed, FACS4; Sarah L Moles, DMD2
1University of Illinois at Chicago, Chicago, IL; 2University of Illinois, Chicago, IL; 3University of Buffalo, Buffalo, IL; 4University of Rochester, Rochester, NY

Purpose: Ablative mandibular resection results in loss of sensation and decreased quality of life. The purpose of this study is to evaluate neurosensory recovery after immediate inferior alveolar nerve (IAN) nerve allograft reconstruction performed during ablative mandibular resection.
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. A positive control group of non-grafted subjects utilized published historical data. The primary predictor variable was the ability to achieve functional sensory recovery (FSR) using the Medical Research Council Scale (MRCS), and secondary variables included sex, specific pathology, comorbidities, pre- or post-surgical radiotherapy, pre-existing paresthesia, graft length, method of repair, time to FSR, specific bony reconstruction, postsurgical complications, development of neuropathic pain, and quality of life assessment (OHIP-14). Comparisons were made to historical data. Statistical analysis of comparison of neurosensory outcomes over time was measured by weighted values, and repeated measures ANOVA, and McNemar test.
Results: A total of 102 subjects underwent 120 immediate nerve allografts (71 male, 49 female; mean age 47.1 (range 12-83) for ablative defects involving the IAN > 4 cm. 50 allografts in 46 patients were included with 6 month postoperative neurosensory testing. 51% of the subjects were male with an average age of 45 (range 12-78), 8 allografts were completed in patients ? 18 years old. At 30 subjects (59%) showed FSR with an MRCS > S3. 13 subjects (25%) had documented presurgical neurosensory deficits with 7 (54%) obtaining FSR postoperatively. 21 subjects (41%) underwent additional surgery, of which 12 (57%) obtained FSR. 7 subjects ? 18 years old obtained FSR at 6 months. At 1 year recall, 44 IAN allografts were included. 24 subjects (71%) showed FSR. 12 subjects (35%) had documented presurgical neurosensory deficits with 6 (50%) obtaining FSR. 14 subjects (41%) underwent additional surgery, of which 8 (57%) obtained FSR. 100% of patients ? 18 years old obtained FSR at 1 year.
Conclusions: Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with 59% reaching FSR by 6 months and 71% reaching FSR by 1 year when compared with non-grafted historical data. Immediate IAN nerve reconstruction should be considered with mandibular ablative defects involving the IAN.


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