Nerve Grafting in Head and Neck Reconstruction

In head and neck reconstructive surgery, especially of the mandible, the long-span processed nerve allograft (PNA) is a technological advancement that provides improved quality of life for patients who require ablative surgery by allowing for functional sensory recovery (FSR) in the majority of patients treated with immediate reconstruction. Recently published clinical prospective and retrospective multisite controlled cohort studies of immediate nerve reconstruction at the time of ablative surgery, including pediatric patient populations, were reviewed for valid and predictable outcomes of FSR following the reconstruction of the inferior alveolar nerve using > 5-cm PNA allografts. Both adult and pediatric patients demonstrate high percentages of FSR within 1 year. Pediatric patients demonstrate robust recovery with 100% reaching FSR within 1 year, whereas 89% of adults achieved FSR during the same time span; the pediatric patient population reached FSR earlier when compared with adults. Control, nonallograft nerve repair patients never achieved FSR, reaching only S2 levels in both adults and pediatric groups. There were no adverse events; in fact, no patients demonstrated the occurrence of neuropathic pain when the nerve repair was performed immediately in contrast to delayed repair states. Long-span (> 5-cm) nerve allografts provide FSR in pediatric patients and the majority of adult patients and should be used in patients who require ablation of the mandible for head and neck reconstruction.