Nerve Grafting in Head and Neck Reconstruction

Area of Science:

• Reconstructive Surgery
• Neuroscience
• Biomaterials

Background:

• Head and neck ablative surgery, particularly of the mandible, often necessitates nerve reconstruction.
• Functional sensory recovery (FSR) is crucial for patient quality of life after such procedures.
• Processed nerve allografts (PNA) represent a significant advancement in nerve repair technology.

Purpose of the Study:

• To evaluate the efficacy of long-span (>5 cm) processed nerve allografts (PNA) for functional sensory recovery (FSR) in mandible reconstruction.
• To compare FSR outcomes between pediatric and adult patients undergoing immediate nerve reconstruction.
• To assess the safety and predictability of PNA in head and neck reconstructive surgery.

Main Methods:

• Review of recently published prospective and retrospective multisite controlled cohort studies.
• Analysis of immediate nerve reconstruction outcomes using >5 cm PNA allografts for the inferior alveolar nerve.
• Inclusion of both adult and pediatric patient populations.

Main Results:

• High percentages of FSR were observed in both adult (89%) and pediatric (100%) patients within 1 year.
• Pediatric patients achieved FSR earlier than adult patients.
• Control groups (non-allograft repair) did not achieve FSR, reaching only S2 sensory levels; no neuropathic pain was reported with immediate PNA repair.

Conclusions:

• Long-span (>5 cm) PNA effectively provide FSR in pediatric and the majority of adult patients requiring mandible reconstruction.
• Immediate PNA nerve repair is a safe and predictable method for restoring nerve function.
• PNA should be considered for patients undergoing ablative surgery of the mandible to improve functional outcomes.