Professor and Head, Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL.
Associate Professor, Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL.
J Oral Maxillofac Surg. 2024 Jan;82(1):126-133. doi: 10.1016/j.joms.2023.09.025. Epub 2023 Oct 5.
Ablative mandibular resection with sacrifice of the inferior alveolar nerve (IAN) results in loss of sensation and decreased quality of life.
The purpose of this study is to evaluate functional sensory recovery (FSR) of immediate IAN allograft reconstruction performed during ablative mandibular resection at 1 year following surgery.
STUDY DESIGN, SETTING, SAMPLE: This is a single-center retrospective cohort study that included consecutive subjects who underwent mandibular resection with IAN discontinuity and used a nerve allograft of ≥40 mm.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable is the use of an immediate nerve allograft in mandibular reconstruction.
MAIN OUTCOME VARIABLE(S): The main outcome variable is FSR at 1 year using the Medical Research Council Scale.
Covariates include subject age, sex, specific pathology, nerve gap length, and development of neuropathic pain.
Statistical analysis of comparison of neurosensory outcomes was measured by bivariate statistics, weighted values, repeated measures, analysis of variance, and McNemar test.
The study sample was composed of 164 subjects, of whom 55 (33.5%) underwent nerve allograft reconstruction and 30 (18.3%) did not have nerve reconstruction. Seventy-nine subjects (48.2%) did not meet the inclusion criteria. In the entire nerve allograft group of 55 subjects, FSR was achieved in 80% at 1 year; however, in benign disease alone, 31 of 33 (94%) achieved FSR at 1 year. In the nonallograft group (all benign disease), only 2 of 30 (7%) achieved FSR at 1 year. The significant covariates were age and pathology. Benign pathologic resections were 5.2 times more likely to achieve FSR than malignancies, and all subjects ≤ 18 years of age achieved FSR. After adjusting for age, sex, pathology, nerve gap length, nerve allograft was significantly associated with achieving FSR at 1 year (adjusted odds ratio = 5.52, 95% confidence interval = (1.03, 29.51), P value = .045 < .05).
Immediate long-span IAN allograft reconstruction is effective in restoration of sensation with an overall 80% of subjects achieving FSR at 1 year, while benign disease resulted in 94% FSR at 1 year. Immediate IAN reconstruction should be considered with mandibular resection involving the IAN, especially for children and benign disease.
下颌骨切除术伴下牙槽神经（IAN）牺牲会导致感觉丧失和生活质量下降。
本研究旨在评估在接受下颌骨切除术后 1 年内，即刻 IAN 同种异体移植重建术对感觉功能的恢复（FSR）。
研究设计、地点、样本：这是一项单中心回顾性队列研究，纳入了连续接受 IAN 连续性中断的下颌骨切除术且使用了≥40mm 神经同种异体移植物的受试者。
预测因子/暴露/独立变量：主要预测变量是下颌骨重建中使用即刻神经同种异体移植物。
主要结局变量是使用 Medical Research Council 量表在 1 年内的 FSR。
协变量包括受试者年龄、性别、具体病理、神经间隙长度和神经痛的发展。
采用双变量统计、加权值、重复测量、方差分析和 McNemar 检验对神经感觉结果的比较进行统计分析。
研究样本由 164 名受试者组成，其中 55 名（33.5%）接受了神经同种异体移植重建，30 名（18.3%）未进行神经重建。79 名受试者（48.2%）不符合纳入标准。在 55 名接受神经同种异体移植的受试者中，80%在 1 年内实现了 FSR；然而，在单纯良性疾病中，33 名中的 31 名（94%）在 1 年内实现了 FSR。在非同种异体移植组（均为良性疾病），只有 30 名中的 2 名（7%）在 1 年内实现了 FSR。有意义的协变量是年龄和病理学。良性病理切除比恶性肿瘤更有可能实现 FSR，所有≤18 岁的受试者都实现了 FSR。在调整年龄、性别、病理学、神经间隙长度后，神经同种异体移植与 1 年内实现 FSR 显著相关（调整优势比=5.52，95%置信区间=（1.03，29.51），P 值=0.045<.05）。
即刻长段 IAN 同种异体移植重建可有效恢复感觉，总体有 80%的受试者在 1 年内实现 FSR，而良性疾病在 1 年内实现 FSR 的比例为 94%。对于涉及 IAN 的下颌骨切除术，应考虑即刻 IAN 重建，特别是对于儿童和良性疾病。
