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Does Immediate Inferior Alveolar Nerve Allograft Reconstruction Result in Functional Sensory Recovery in Pediatric Patients?

  • Michael Miloro
    Correspondence
    Address correspondence and reprint requests to Dr Miloro: Department of Oral and Maxillofacial Surgery, University of Illinois, 801 S Paulina St, Room 110, Chicago, IL 60611
    Affiliations
    Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois, Chicago, IL
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  • John R. Zuniga
    Affiliations
    Robert V. Walker DDS Chair in Oral and Maxillofacial Surgery and Professor, Departments of Surgery and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
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      Purpose

      Ablative mandibular resection may result in neurosensory loss and decreased quality-of-life, yet nerve reconstruction is not performed routinely for various reasons, including increased operative time. This study aimed to determine whether immediate inferior alveolar nerve (IAN) allograft reconstruction provides functional sensory recovery (FSR) in the pediatric age group.

      Patients and Methods

      This multicenter retrospective cohort study included pediatric patients who underwent mandibular resection with IAN discontinuity and a nerve allograft greater than 45 mm. A positive control group also was included, comprising pediatric patients who underwent mandibular resection without nerve reconstruction. The primary predictor variable was the use of a nerve allograft; a secondary variable was the time to achieve FSR using the Medical Research Council Scale. Comparisons were made to historical adult data. Statistical analysis of the comparison of neurosensory outcomes over time was measured by weighted values, repeated-measures analysis of variance, and the McNemar test.

      Results

      The study group consisted of 32 patients, 18 in the graft group and 14 in the non-graft group, without significant differences in age, gender, or nerve gap length. By 1 year, FSR was achieved in 100% in the study group and 0% in the control group (P < .00001). The median time to FSR was 75 days in the study group and 110 days in the historical adult study group. In comparison to historical adult data, there was a significant difference at 1 year, with adults at 87% FSR (P = .01562).

      Conclusions

      Long-span nerve allografts were effective in restoring sensation to the lip and chin in pediatric patients, with 100% reaching FSR, whereas no patients without nerve reconstruction achieved FSR. Pediatric patients recovered to a higher level of FSR than adults at 1 year. Immediate IAN reconstruction in pediatric patients should be considered strongly when the mandible requires resection with sacrifice of the IAN.
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