Fujita Shigeyuki, Tojyo Itaru, Yamada Masai, Go Yoshihiko, Matsumoto Takashi, Kiga Norifumi
Professor, Department of Oral and Maxillofacial Surgery Wakayama Medical University, Wakayama City, Japan.
Associate Professor, Department of Oral and Maxillofacial Surgery Wakayama Medical University, Wakayama City, Japan.
J Oral Maxillofac Surg. 2014 Jul;72(7):1433.e1-7. doi: 10.1016/j.joms.2014.03.018. Epub 2014 Apr 1.
The object of this study was to assess the effects of an inside-out vein graft as a cuff after direct suture on human lingual nerve regeneration and recovery after iatrogenic lingual nerve injury.
Ten patients with unilateral lingual nerve anesthesia as a complication of iatrogenic injury after third molar extraction underwent microneurosurgical procedures for the injured lingual nerve under general anesthesia. The patients were randomized into 2 groups. In group A, after removing the neuromas and peripheral scars surrounding the torn nerves, the 2 nerve ends were sutured without tension. In group B, after the same procedure, including the same suturing procedure, an inside-out vein graft was placed as a cuff after the direct suture. Each group was followed at least once every 6 months for 1 year after the procedure. Postoperative outcomes were evaluated using the Pogrel criteria, the Sunderland grade, and the British Medical Research Council Scale (MRCS).
There were no particular differences between groups A and B at 6 and 12 months after the operation. However, based on the MRCS criteria, there was a clearly better result in group B than in group A at 6 and 12 months after the operation, and the recovery of gustatory sensation tended to be better in group B than in group A 1 year after the operation.
This inside-out vein graft as a cuff after direct suturing may facilitate faster lingual nerve regeneration than the traditional direct suture approach. The inside-out vein graft as a cuff may provide the advantages of preventing axonal escape at the suture lines, minimizing nerve entrapment, and preventing neuroma formation in the space between the sutured nerves.
本研究的目的是评估外翻静脉移植作为袖套在直接缝合后对医源性舌神经损伤后人类舌神经再生和恢复的影响。
10例因拔除第三磨牙后医源性损伤并发单侧舌神经麻醉的患者在全身麻醉下接受了受损舌神经的显微神经外科手术。患者被随机分为2组。A组在切除撕裂神经周围的神经瘤和周围瘢痕后，将2个神经断端无张力缝合。B组在进行相同手术（包括相同的缝合步骤）后，直接缝合后放置外翻静脉移植作为袖套。术后每组至少每6个月随访1年。使用波格雷尔标准、桑德兰分级和英国医学研究委员会量表（MRCS）评估术后结果。
术后6个月和12个月时，A组和B组之间没有特别差异。然而，根据MRCS标准，术后6个月和12个月时，B组的结果明显优于A组，并且术后1年时，B组味觉感觉的恢复倾向于比A组更好。
这种外翻静脉移植作为直接缝合后的袖套可能比传统的直接缝合方法更有利于舌神经更快地再生。外翻静脉移植作为袖套可能具有防止轴突在缝合线处逃逸、使神经受压最小化以及防止缝合神经之间的间隙中形成神经瘤的优点。
