Biglioli Federico, Lozza Alessandro, Colletti Giacomo, Allevi Fabiana
Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan.
Service of Neurophysiopathology-National Neurological Institute C. Mondino, Pavia, Italy.
J Craniofac Surg. 2018 Nov;29(8):e740-e744. doi: 10.1097/SCS.0000000000004663.
Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery.Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex.All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN.All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery.All patients feeling pain preoperatively experienced complete relief of algic symptoms.The early microsurgical approach is the most suitable choice for the treatment of LN injuries.
舌神经（LN）损伤是口腔外科手术最严重的后果之一。及时进行神经显微外科重建可缓解大部分此类症状，实现满意的功能恢复。2006年1月至2015年5月期间，35例部分或完全性LN损伤患者接受了手术。所有患者术前均接受临床和神经学评估，评估舌触觉和疼痛感觉阈值以及咬肌抑制反射。所有患者均接受了探查手术，对于完全性损伤，对远、近端残端进行直接显微神经缝合，对于不完全性损伤，则切除创伤性神经瘤并对损伤神经的远、近端残端进行显微神经缝合。由于切断LN下颌下支可实现远端残端的游离，因此一直避免进行神经移植。除1例患者外，所有患者的舌感觉均有良好恢复，无论是临床还是电生理方面均未完全恢复：观察到咬肌抑制反射抑制成分SP1和SP2的兴奋性恢复，潜伏期常延长，但与功能恢复一致。所有术前感到疼痛的患者疼痛症状均完全缓解。早期显微外科手术方法是治疗LN损伤的最合适选择。
