Miloro Michael, Ruckman Phil, Kolokythas Antonia
Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
J Oral Maxillofac Surg. 2015 Sep;73(9):1844-50. doi: 10.1016/j.joms.2015.03.018. Epub 2015 Mar 19.
Since no studies have compared direct and graft repair of the lingual nerve, we examined the subjective and objective outcomes of lingual nerve repair by direct epineurial repair and indirect graft repair, assessed the effect of other confounding variables, and compared the outcomes of autograft and allograft repairs.
All patients who had undergone microneurosurgical repair of the lingual nerve from 2000 to 2012 by 1 surgeon (M.M.) were asked to complete an online questionnaire regarding their current neurosensory status at least 2 years after nerve repair. A direct comparison was made between patients who had undergone direct epineurial repair and those who had undergone interpositional nerve graft repair. Student's t test and χ(2) test were used to determine whether a significant difference existed in the success between the 2 techniques and whether age, gender, race, delay from injury to repair, or degree of initial nerve deficit influenced the success of nerve repair.
Of the 72 patients identified, 43, who had undergone 47 nerve repairs (18 direct, 29 indirect graft repairs [4 bilateral]; 28 female and 19 male patients; mean age 28.3 years), were interviewed. The objective results of functional sensory recovery, defined by a Medical Research Council Scale grade of S3, S3+, or S4, was 89% for the graft repairs and 85% for the direct repairs (P = .01). The subjective patient satisfaction score (0 to 10 scale) was 8.9 for the graft repairs and 8.1 for the direct repairs (P = .02). The autograft and allograft repairs performed comparably, and the other variables (ie, age, gender, race, delay from injury to nerve repair, gap length, and initial Sunderland grade injury) were not found to be significant (P > .05).
Graft repair of the lingual nerve provides superior long-term (>2 years) objective and subjective outcomes compared with direct repair. This might be because of the lack of tension at the repair site, more freedom with nerve stump preparation, and the addition of neurotropic and neurotrophic factors from the donor nerve graft at the site of injury to augment neurosensory recovery.
由于尚无研究比较舌神经的直接修复和移植修复，我们研究了通过直接神经外膜修复和间接移植修复舌神经的主观和客观结果，评估了其他混杂变量的影响，并比较了自体移植和同种异体移植修复的结果。
要求2000年至2012年由1名外科医生（M.M.）进行舌神经显微神经外科修复的所有患者在神经修复至少2年后完成一份关于其当前神经感觉状态的在线问卷。对接受直接神经外膜修复的患者和接受间置神经移植修复的患者进行直接比较。采用学生t检验和χ²检验来确定这两种技术在成功率上是否存在显著差异，以及年龄、性别、种族、受伤至修复的延迟时间或初始神经缺损程度是否影响神经修复的成功率。
在确定的72例患者中，对43例（接受了47次神经修复，其中18次直接修复，29次间接移植修复[4例双侧]；28例女性和19例男性患者；平均年龄28.3岁）进行了访谈。根据医学研究理事会量表S3、S3 +或S4级定义的功能性感觉恢复的客观结果，移植修复为89%，直接修复为85%（P = 0.01）。患者主观满意度评分（0至10分），移植修复为8.9分，直接修复为8.1分（P = 0.02）。自体移植和同种异体移植修复效果相当，且未发现其他变量（即年龄、性别、种族、受伤至神经修复的延迟时间、间隙长度和初始桑德兰分级损伤）具有显著性（P > 0.05）。
与直接修复相比，舌神经移植修复提供了更好的长期（>2年）客观和主观结果。这可能是因为修复部位缺乏张力，神经残端准备更自由，以及在损伤部位来自供体神经移植的神经营养和神经营养因子增加，从而促进神经感觉恢复。
