American Society for Peripheral Nerve

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Immediate Allograft Outcomes of Long Span Defects of the Inferior Alveolar Nerve
David Salomon, DDS; Michael R Markiewicz, MD, DDS, MPH; Michael Miloro, MD, DMD, FACS; University of Illinois at Chicago, Chicago, IL

Statement of the Problem: Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but must also address restoration of neurosensory function. The goal of this study is to determine the outcomes of immediate reconstruction of long span defects (?50 mm) of the inferior alveolar nerve (IAN) following ablative mandibular resection using allogeneic nerve grafts.

Materials and Methods: A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps ?50 mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center. The demographic and clinical data was collected for each patient and analyzed using clinical neurosensory testing, and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery, and subjective perception was recorded using a Visual Analog Scale.

Methods of Data Analysis: The subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. Demographic and clinical data examined including patient age, gender, pathology, length of nerve allograft, and follow up period.

Results: Of 20 nerve repairs, 11 subjects met the inclusion criteria. The average age was 36.5 years (range: 18 to 61 years) and 81.8% were male subjects. All IAN defects resulted from resection of mandibular pathology (10 benign, 1 malignant lesion). 10 of the 11 IAN defects were reconstructed with a 70 mm nerve allograft, while one nerve defect was reconstructed with a 50 mm graft. Mean follow up time was 14.0 months (range: 6 to 27.5 months). Mean VAS reported was 3.6 (range: 0 to 7). 54.5% of subjects displayed return of some superficial pain and tactile sensation without over-response (S3), with 27.3% displaying good stimulation localization (S3+).

Outcome Data: The results of the MRCS exam were the primary outcome variable from which functional sensory recovery (S3, S3+, S4) was determined. Additionally, the VAS of patient-perceived neurosensory recovery was assessed.

Conclusions: Immediate reconstruction of the IAN with allogeneic nerve grafting of long span defects (?5 cm) is a viable and predictable option to achieve useful functional sensory recovery.

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