Bagheri Shahrokh C, Meyer Roger A, Khan Husain Ali, Steed Martin B
Department of Oral and Maxillofacial Surgery, Northside Hospital, and Atlanta Oral and Facial Surgery, Atlanta, GA 30339, USA.
J Oral Maxillofac Surg. 2009 Sep;67(9):1791-9. doi: 10.1016/j.joms.2009.04.115.
Injuries to the peripheral branches of the trigeminal nerve from maxillofacial trauma can have distressing sensory or functional sequelae. The present study reports the results of trigeminal microneurosurgical repair in a series of patients with maxillofacial trauma.
A retrospective chart review was completed of all patients who had undergone microneurosurgical repair of peripheral trigeminal nerve injuries caused by maxillofacial trauma and who had been treated by one of us (R.A.M.) from March 1986 through December 2005. A physical examination, including standardized neurosensory testing, was completed on each patient preoperatively. All patients were followed up periodically after surgery for at least 1 year with neurosensory testing repeated at each visit. Sensory recovery was evaluated using the guidelines established by the Medical Research Council. The following data were collected and analyzed: patient age, gender, nerve injured, etiology (location of fracture), chief sensory complaint (ie, numbness or pain, or both), interval from injury to surgical intervention, intraoperative findings, surgical procedure, and neurosensory status at the final evaluation.
A total of 42 patients (25 males and 17 females) with average age of 37.1 years (range 11 to 61) and a follow-up of at least 12 months were included in the study. The most commonly injured/repaired nerve was the inferior alveolar nerve caused by mandibular angle fracture (n = 21), followed by the mental nerve due to mandibular parasymphysis fracture (n = 12), the infraorbital nerve from zygomaticomaxillary complex fracture (n = 7), and lingual nerve and long buccal nerve from mandibular body fracture (n = 1 each). In 17 patients, the chief sensory complaint was numbness, and 25 patients complained of pain with or without mention of numbness. The average interval from nerve injury to repair was 12.5 months (range 2 to 24). The most common intraoperative finding was a compression injury (n = 19), followed by partial nerve severance (n = 9). The most frequent surgical procedure was external decompression/internal neurolysis (n = 20). Ten injured nerves required reconstruction of a discontinuity defect with an autogenous nerve graft (donor sural or great auricular nerve), all of which were associated with mandibular angle or parasymphysis fractures. After a minimum of 1 year of follow-up, neurosensory testing demonstrated that 6 nerves (14%) showed no sign of recovery, 23 nerves (55%) had regained "useful sensory function," and 13 nerves (31%) showed full recovery as described by the Medical Research Council scale.
Microsurgical repair of peripheral branches of the trigeminal nerve injured by maxillofacial trauma produced significant improvement or complete recovery in 36 (86%) of 42 patients. These results compare favorably with the microsurgical repair of peripheral trigeminal nerve injuries resulting from other causes.
颌面部创伤导致的三叉神经周围分支损伤可产生令人苦恼的感觉或功能后遗症。本研究报告了一系列颌面部创伤患者三叉神经显微神经外科修复的结果。
对1986年3月至2005年12月期间由我们其中一人（R.A.M.）治疗的、接受了因颌面部创伤导致的周围三叉神经损伤显微神经外科修复的所有患者进行了回顾性病历审查。术前对每位患者进行了体格检查，包括标准化的神经感觉测试。所有患者术后定期随访至少1年，每次随访时重复进行神经感觉测试。使用医学研究理事会制定的指南评估感觉恢复情况。收集并分析了以下数据：患者年龄、性别、损伤神经、病因（骨折部位）、主要感觉主诉（即麻木或疼痛，或两者皆有）、从损伤到手术干预的间隔时间、术中发现、手术操作以及最终评估时的神经感觉状态。
本研究纳入了42例患者（25例男性和17例女性），平均年龄37.1岁（范围11至61岁），随访至少12个月。最常受伤/修复的神经是下颌角骨折导致的下牙槽神经（n = 21），其次是下颌骨正中联合骨折导致的颏神经（n = 12）、颧上颌复合体骨折导致的眶下神经（n = 7）以及下颌体骨折导致的舌神经和颊长神经（各n = 1）。17例患者的主要感觉主诉是麻木，25例患者主诉疼痛，伴有或不伴有麻木。从神经损伤到修复的平均间隔时间为12.5个月（范围2至24个月）。最常见的术中发现是压迫性损伤（n = 19），其次是部分神经离断（n = 9）。最常进行的手术操作是外部减压/内部神经松解术（n = 20）。10条损伤神经需要用自体神经移植物（供体腓肠神经或耳大神经）重建连续性缺损，所有这些均与下颌角或正中联合骨折相关。经过至少1年的随访，神经感觉测试表明，6条神经（14%）没有恢复迹象，23条神经（55%）恢复了“有用的感觉功能”，13条神经（31%）按照医学研究理事会的标准显示完全恢复。
颌面部创伤所致三叉神经周围分支的显微外科修复使42例患者中的36例（86%）有显著改善或完全恢复。这些结果与其他原因导致的周围三叉神经损伤的显微外科修复相比具有优势。
