Bilateral microneurosurgical reconstruction of inferior alveolar nerves via autogenous sural nerve transplantation.

Microneurosurgical operative techniques permit satisfactory restoration of sensation in many lesions of the inferior alveolar nerve. Therefore, restoration of the sensory deficit is becoming increasingly more important in the total functional rehabilitation of individuals with mandibular continuity defects involving transection of or permanent damage to the inferior alveolar nerve. This article reviews the case history of a young man who underwent bilateral osseous mandibular reconstruction and microneurosurgical reconstruction of his inferior alveolar nerves following severe maxillofacial trauma. A new technique for isolating the sural nerve is introduced to facilitate harvesting of the graft. Scanning electron microscopic examination of the resected proximal inferior alveolar nerve is recommended to determine the prognosis for regeneration across the proximal anastomosis and to decide whether secondary resection and reanastomosis of the distal anastomosis is indicated when anesthesia persists 9 to 12 months after initial transplantation of a long donor nerve.