Side-to-End Trigeminal to Trigeminal Fascicular Neurorrhaphy to Restore Lingual Sensibility: A New Technique

Injuries to the lingual nerve can result from a variety of oral and maxillofacial surgical procedures. The anatomical proximity of lingual nerve puts it at risk during procedures on adjacent structures. The most common surgical procedure associated with iatrogenic lingual nerve lesions is extraction of third molars. However, lingual nerve injury has also been reported after mandibular sagittal split osteotomies, mandibular fractures, submandibular salivary gland excision, sialolith, dental implant placement, laryngoscopy, and general dental therapy, such as local anesthesia injection.[1] [2] Lingual nerve can also be involved in oncologic resection in the head and neck district. The tongue is an important and sensitive anatomical structure that serves a range of vital functions such as mastication, phonation, and deglutition.[3] Patients with loss of lingual nerve function are affected by serious discomfort complaining recurrent tongue bite lesions, unilateral numbness, neurogenic paresthesia, or dysesthesia, difficulty with pronunciation and chewing, loss of gustatory function in the lesion side. Some patients may even suffer from episodic or constant neuralgic pain, known as allodynia. Depending on the nature and extent of the injury, some lingual nerve lesions have the potential for functional regeneration.[4] [5] In the majority of cases, direct neurorraphy still remains the surgical option of choice. Nevertheless, oncologic resections for treating oral or lingual cancers often require the sacrifice of lingual nerve making direct neurorraphy impossible.

Nowadays, the advancement in microsurgery and, moreover, the introduction of supramicrosurgery, have made surgical restoration of lingual nerve lesions effective.[6] [7] Gennaro et al[8] describe a new supramicrosurgical procedure to restore lingual sensibility.

• References

• 1 Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB. Retrospective review of microsurgical repair of 222 lingual nerve injuries. J Oral Maxillofac Surg 2010; 68 (4) 715-723
• 2 Bagheri SC, Meyer RA, Khan HA, Wallace J, Steed MB. Microsurgical repair of the peripheral trigeminal nerve after mandibular sagittal split ramus osteotomy. J Oral Maxillofac Surg 2010; 68 (11) 2770-2782
• 3 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (4) 491-516
• 4 Zuniga JR, Chen N, Phillips CL. Chemosensory and somatosensory regeneration after lingual nerve repair in humans. J Oral Maxillofac Surg 1997; 55 (1) 2-13 , discussion 13–14
• 5 Fagin AP, Susarla SM, Donoff RB, Kaban LB, Dodson TB. What factors are associated with functional sensory recovery following lingual nerve repair?. J Oral Maxillofac Surg 2012; 70 (12) 2907-2915
• 6 Koshima I, Narushima M, Mihara M, Uchida G, Nakagawa M. Cross-face nerve transfer for established trigeminal branch II palsy. Ann Plast Surg 2009; 63 (6) 621-623
• 7 Koshima I, Narushima M, Mihara M, Uchida G, Nakagawa M. Fascicular turnover flap for nerve gaps. J Plast Reconstr Aesthet Surg 2010; 63 (6) 1008-1014
• 8 Gennaro P, Gabriele G, Della Monaca M, Facchini A, Mitro V. Mandibular nerve fascicular cross-face for sensitive recovery after mandibulectomy: a new technique. J Plast Surg Hand Surg 2013; 47 (3) 228-231
• 9 Truini A, Barbanti P, Galeotti F, Leandri M, Cruccu G. Trigeminal sensory pathway function in patients with SUNCT. Clin Neurophysiol 2006; 117 (8) 1821-1825