Efficacy of Acellular Nerve Allografts in Trigeminal Nerve Reconstruction.
OBJECTIVE
During trigeminal nerve repair, a gap is sometimes encountered that prevents the tension-free apposition of nerve endings. The use of a processed acellular nerve allograft is a novel technique that shows promise in overcoming this problem. The goal of the present study was to support the slowly evolving body of evidence that acellular processed nerve allografts (Avance; Axogen, Alachua, FL) are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve.


METHODS
The study design consisted of a retrospective review of the medical records of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries from July 2008 to August 2014. Sixteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (V.Z.). Serial neurosensory testing was performed by 1 clinician (V.Z.) in a standardized fashion. The primary outcome variable was the interval to functional sensory recovery as defined by the Medical Research Council Scale.


RESULTS
The participants ranged in age from 16 to 62 years (mean 32). Of the 16 patients, 12 were female (75%) and 4 were male (25%), and 3 were smokers (18.75%) and 13 were nonsmokers (81.25%). One half of the patients (n = 8; 50%) underwent surgery on the inferior alveolar nerve, and 8 (50%) underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal (n = 9; 56.25%) Of the 16 patients, 15 (93.75%) achieved functional sensory recovery during the study period.


CONCLUSIONS
The results of the present study support the hypothesis that processed nerve allografts are effective in reconstructing small (<2-cm) trigeminal nerve defects.
Chief Resident, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine of New Jersey, Newark, NJ. Electronic address: Andrew.yampolsky@jefferson.edu.
Andrew
A
Yampolsky
Professor and Chair, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine New Jersey, Newark, NJ.
Vincent
V
Ziccardi
Attending Surgeon, Good Samaritan Medical Center, Department of Oral and Maxillofacial Surgery, Chestnut Hill, MA.
Sung-Kiang
SK
Chuang
D000293:Adolescent; D000328:Adult; D064591:Allografts; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D061221:Trigeminal Nerve Injuries / Q000601:surgery*; D055815:Young Adult