Yampolsky Andrew, Ziccardi Vincent, Chuang Sung-Kiang
Chief Resident, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine of New Jersey, Newark, NJ.
Professor and Chair, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine New Jersey, Newark, NJ.
J Oral Maxillofac Surg. 2017 Oct;75(10):2230-2234. doi: 10.1016/j.joms.2017.02.015. Epub 2017 Feb 27.
During trigeminal nerve repair, a gap is sometimes encountered that prevents the tension-free apposition of nerve endings. The use of a processed acellular nerve allograft is a novel technique that shows promise in overcoming this problem. The goal of the present study was to support the slowly evolving body of evidence that acellular processed nerve allografts (Avance; Axogen, Alachua, FL) are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve.
The study design consisted of a retrospective review of the medical records of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries from July 2008 to August 2014. Sixteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (V.Z.). Serial neurosensory testing was performed by 1 clinician (V.Z.) in a standardized fashion. The primary outcome variable was the interval to functional sensory recovery as defined by the Medical Research Council Scale.
The participants ranged in age from 16 to 62 years (mean 32). Of the 16 patients, 12 were female (75%) and 4 were male (25%), and 3 were smokers (18.75%) and 13 were nonsmokers (81.25%). One half of the patients (n = 8; 50%) underwent surgery on the inferior alveolar nerve, and 8 (50%) underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal (n = 9; 56.25%) Of the 16 patients, 15 (93.75%) achieved functional sensory recovery during the study period.
The results of the present study support the hypothesis that processed nerve allografts are effective in reconstructing small (<2-cm) trigeminal nerve defects.
在三叉神经修复过程中，有时会遇到间隙，这会阻碍神经末梢的无张力对接。使用经过处理的脱细胞神经同种异体移植物是一种新技术，有望解决这一问题。本研究的目的是支持逐渐积累的证据，即脱细胞处理的神经同种异体移植物（Avance；Axogen公司，阿拉楚阿，佛罗里达州）是自体神经移植和使用导管修复三叉神经缺损的可行替代方法。
本研究设计为回顾性分析2008年7月至2014年8月转诊至罗格斯牙医学院治疗三叉神经损伤患者的病历。16例患者符合本研究的纳入标准。所有患者均使用经过处理的神经同种异体移植物进行神经移植。所有手术均由同一位外科医生（V.Z.）进行。由1名临床医生（V.Z.）以标准化方式进行系列神经感觉测试。主要结局变量是根据医学研究委员会量表定义的功能感觉恢复间隔。
参与者年龄在16至62岁之间（平均32岁）。16例患者中，12例为女性（75%），4例为男性（25%），3例为吸烟者（18.75%），13例为非吸烟者（81.25%）。一半患者（n = 8；50%）接受了下牙槽神经手术，8例（50%）接受了舌神经手术。最常见的损伤机制是拔除阻生第三磨牙（n = 9；56.25%）。16例患者中，15例（93.75%）在研究期间实现了功能感觉恢复。
本研究结果支持以下假设，即经过处理的神经同种异体移植物在重建小（<2 cm）三叉神经缺损方面是有效的。
