Skip to main content
SpringerLink
Log in

Outcomes of Trigeminal Nerve Repair

  • Chapter
  • First Online:
Trigeminal Nerve Injuries

Abstract

This chapter describes the outcomes of trigeminal nerve repair at two European centres, one in Sheffield, UK, and the other in Copenhagen, Denmark, and compares results with those reported in the published literature. The analysis reveals that lingual nerve repair using direct reapposition by epineurial suture is a worthwhile procedure for most patients. It does not reduce the number of patients who report pain or spontaneous paraesthesia, although the level of severity of these symptoms may decline. Lingual nerve repair within 6 months of the injury may be associated with better recovery than later repair, but late repair can still result in significant neurosensory improvement. Inferior alveolar nerve decompression and neurolysis results in significant reduction in the level of dysaesthesia as well as improvement in sensation. However, as the overall level of improvement is small, and some patients do not improve at all, the procedure should only be offered to patients who are significantly affected by their symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Atkins S, Smith KG, Robinson PP et al (2006) Scarring impedes regeneration at sites of peripheral nerve repair. Neuroreport 17:1245–1249

    Article  PubMed  CAS  Google Scholar 

  2. Bagheri SC, Meyer RA, Khan HA et al (2010) Retrospective review of microsurgical repair of 222 lingual nerve injuries. J Oral Maxillofac Surg 68:715–723

    Article  PubMed  Google Scholar 

  3. Bagheri SC, Meyer RA, Cho SH et al (2012) Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect outcome. J Oral Maxillofac Surg 70:1978–1990

    Article  PubMed  Google Scholar 

  4. Blackburn CW (1990) A method of assessment in cases of lingual nerve injury. Br J Oral Maxillofac Surg 28:238–245

    Article  PubMed  CAS  Google Scholar 

  5. Blackburn CW (1992) Experiences in lingual nerve repair. Br J Oral Maxillofac Surg 30:72–77

    Article  PubMed  CAS  Google Scholar 

  6. Bongenhielm U, Robinson PP (1996) Spontaneous and mechanically evoked afferent activity originating from myelinated fibres in ferret inferior alveolar nerve neuromas. Pain 67:399–406

    Article  PubMed  CAS  Google Scholar 

  7. Bongenhielm U, Robinson PP (1998) Afferent activity from myelinated inferior alveolar nerve fibres in ferrets after constriction or section and regeneration. Pain 74:123–132

    Article  PubMed  CAS  Google Scholar 

  8. Crawley WA, Dellon AL (1992) Inferior alveolar nerve reconstruction with a polyglycolic acid bioresorbable nerve conduit. Plast Reconstr Surg 90:300–302

    PubMed  CAS  Google Scholar 

  9. Devor M, Govrin-Lippmann R (1979) Selective regeneration of sensory fibres following nerve crush injury. Exp Neurol 65:243–254

    Article  PubMed  CAS  Google Scholar 

  10. Devor M, Seltzer Z (1999) Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzak R (eds) Textbook of pain. Churchill Livingstone, London, pp 129–164

    Google Scholar 

  11. Dodson TB, Kaban LB (1997) Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature. J Oral Maxillofac Surg 55:1380–1386

    Article  PubMed  CAS  Google Scholar 

  12. Donoff RB, Guralnick W (1982) The application of microneurosurgery to oral-neurological problems. J Oral Maxillofac Surg 40:156–159

    Article  PubMed  CAS  Google Scholar 

  13. Fagin AP, Susarla SM, Donoff RB et al (2012) What factors are associated with functional sensory recovery following lingual nerve repair? J Oral Maxillofac Surg 70:2907–2915, http://dx.doi.org/10.1016/j.joms.2012.03.019

    Article  PubMed  Google Scholar 

  14. Greenwood M, Corbett IP (2005) Observations on the exploration and external neurolysis of injured inferior alveolar nerves. Int J Oral Maxillofac Surg 34:252–256

    Article  PubMed  CAS  Google Scholar 

  15. Gregg JM (1990) Studies of traumatic neuralgia in the maxillofacial region: symptom complexes and response to microsurgery. J Oral Maxillofac Surg 48:135–140

    Article  PubMed  CAS  Google Scholar 

  16. Gregg JM (1995) Surgical management of inferior alveolar nerve injuries (part II): the case for delayed management. J Oral Maxillofac Surg 53:1330–1333

    Article  PubMed  CAS  Google Scholar 

  17. Haschemi A (1981) Partial anastomosis between the lingual and mandibular nerves for restoration of sensibility in the mental area after injury to the mandibular nerve. J Maxillofac Surg 9:225–227

    Article  PubMed  CAS  Google Scholar 

  18. Hausamen JE (1981) Principles and clinical application of micronerve surgery and nerve transplantation in the maxillofacial area. Ann Plast Surg 7:428–433

    Article  PubMed  CAS  Google Scholar 

  19. Hausamen JE, Schmelzeisen R (1996) Current principles in microsurgical nerve repair. Br J Oral Maxillofac Surg 34:143–157

    Article  PubMed  CAS  Google Scholar 

  20. Hillerup S (2007) Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig 11:133–142

    Article  PubMed  Google Scholar 

  21. Hillerup S, Stoltze K (2007) Lingual nerve injury II. Observations on sensory recovery after micro-neurosurgical reconstruction. Int J Oral Maxillofac Surg 36:1139–1145

    Article  PubMed  CAS  Google Scholar 

  22. Hillerup S, Hjørting-Hansen E, Reumert T (1994) Repair of the lingual nerve after iatrogenic injury. J Oral Maxillofac Surg 52:1028–1031

    Article  PubMed  CAS  Google Scholar 

  23. Holland GR, Smith KG, Robinson PP et al (1996) A quantitative morphological study on the recovery of cat lingual nerves after transection or crushing. J Anat 188:289–297

    PubMed  Google Scholar 

  24. Holland GR, Smith KG, Robinson PP et al (1996) A quantitative morphological comparison of cat lingual nerve repair using epineurial sutures or entubulation. J Dent Res 75:942–948

    Article  PubMed  CAS  Google Scholar 

  25. Horch KW, Lisney SJW (1981) On the number and nature of regenerating myelinated axons after lesions of cutaneous nerves in the cat. J Physiol 313:275–286

    PubMed  CAS  Google Scholar 

  26. Kaban LB, Upton J (1986) Cross mental nerve graft for restoration of lip sensation after inferior alveolar nerve damage: report of a case. J Oral Maxillofac Surg 44:649–651

    Article  PubMed  CAS  Google Scholar 

  27. LaBanc JP, Gregg JM (1992) Trigeminal nerve injuries. Basic problems, historical perspectives, early successes and remaining challenges. In: LaBanc JP, Gregg JM (eds) Oral and Maxillofacial Surgery Clinics of North America: trigeminal nerve injury: diagnosis and management. W B Saunders, Philadelphia, pp 277–283

    Google Scholar 

  28. LaBanc JP, Van Boven RW (1992) Surgical management of inferior alveolar nerve injuries. In: LaBanc JP, Gregg JM (eds) Oral and Maxillofacial Surgery Clinics of North America: trigeminal nerve injury: diagnosis and management, vol 4. W B Saunders, Philadelphia, pp 425–437

    Google Scholar 

  29. Loescher AR, Robinson PP (1991) Properties of periodontal mechanoreceptors supplying the cat’s lower canine at short and long periods after reinnervation. J Physiol 444:85–97

    PubMed  CAS  Google Scholar 

  30. Mazal PR, Millesi H (2005) Neurolysis: is it beneficial or harmful? Acta Neurochir Suppl 92:3–6

    Article  PubMed  CAS  Google Scholar 

  31. Merrill RG (1964) Decompression for inferior alveolar nerve injuries. J Oral Surg Anesth Hosp Dent Serv 22:291–300

    PubMed  CAS  Google Scholar 

  32. Merrill RG (1966) Further studies in decompression for inferior alveolar nerve injury. J Oral Surg 24:233–238

    PubMed  CAS  Google Scholar 

  33. Merrill RG (1979) Prevention, treatment and prognosis for nerve injury related to the difficult impaction. Dent Clin North Am 23:471–488

    PubMed  CAS  Google Scholar 

  34. Meyer RA (1992) Applications of microneurosurgery to the repair of trigeminal nerve injuries. In: LaBanc JP, Gregg JM (eds) Oral and Maxillofacial Surgery Clinics of North America: trigeminal nerve injury: diagnosis and management. W B Saunders, Philadelphia, pp 405–416

    Google Scholar 

  35. Miloro M (1995) Surgical access for inferior alveolar nerve repair. J Oral Maxillofac Surg 53:1224–1225

    Article  PubMed  CAS  Google Scholar 

  36. Mozsary PG, Middleton RA (1984) Microsurgical reconstruction of the lingual nerve. J Oral Maxillofac Surg 42:415–420

    Article  PubMed  CAS  Google Scholar 

  37. Mozsary PG, Syers CS (1985) Microsurgical correction of the injured inferior alveolar nerve. J Oral Maxillofac Surg 43:353–358

    Article  PubMed  CAS  Google Scholar 

  38. Pitta MC, Wolford LM, Mehra P et al (2001) Use of Goretex tubing as a conduit for inferior alveolar and lingual nerve repair: experience with 6 cases. J Oral Maxillofac Surg 59:493–496

    Article  PubMed  CAS  Google Scholar 

  39. Pogrel MA, Kaban LB (1993) Injuries to the inferior alveolar and lingual nerves. J Can Dent Assoc 21:50–54

    CAS  Google Scholar 

  40. Pogrel MA, Maghen A (2001) The use of autologous vein grafts for inferior alveolar and lingual nerve reconstruction. J Oral Maxillofac Surg 59:985–988

    Article  PubMed  CAS  Google Scholar 

  41. Pogrel MA, McDonald AR, Kaban LB (1998) Gore-Tex tubing as a conduit for repair of lingual and inferior alveolar nerve continuity defects: a preliminary report. J Oral Maxillofac Surg 56:319–321

    Article  PubMed  CAS  Google Scholar 

  42. Rath EM (2002) Skeletal muscle autograft for repair of human inferior alveolar nerve: a case report. J Oral Maxillofac Surg 60:330–334

    Article  PubMed  Google Scholar 

  43. Riediger D, Ehrenfeld M, Cornelius CP (1989) Micronerve surgery on the inferior alveolar and lingual nerve with special consideration for nerve replacement. In: Riediger D, Ehrenfeld M (eds) Microsurgical tissue transplantation. Quintessence Publishing Co, San Francisco, pp 189–194

    Google Scholar 

  44. Robinson PP (1981) The reinnervation of teeth, mucous membrane and skin following inferior alveolar nerve section in the cat. Brain Res 220:241–253

    Article  PubMed  CAS  Google Scholar 

  45. Robinson PP (1989) The reinnervation of the tongue and salivary glands after lingual nerve injuries in cats. Brain Res 483:259–271

    Article  PubMed  CAS  Google Scholar 

  46. Robinson PP (1992) The effect of injury on the properties of afferent fibres in the lingual nerve. Br J Oral Maxillofac Surg 30:39–45

    Article  PubMed  CAS  Google Scholar 

  47. Robinson PP (2011) Characteristics of patients referred to a UK trigeminal nerve injury service. Oral Surg 4:8–14

    Article  Google Scholar 

  48. Robinson PP, Smith KG (1996) A study on the efficacy of late lingual nerve repair. Br J Oral Maxillofac Surg 34:96–103

    Article  PubMed  CAS  Google Scholar 

  49. Robinson PP, Smith KG, Johnson FP et al (1992) Equipment and methods for simple sensory testing. Br J Oral Maxillofac Surg 30:387–389

    Article  PubMed  CAS  Google Scholar 

  50. Robinson PP, Loescher AR, Smith KG (2000) A prospective, quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg 38:255–263

    Article  PubMed  CAS  Google Scholar 

  51. Robinson PP, Boissonade FM, Loescher AR et al (2004) Peripheral mechanisms for the initiation of pain following trigeminal nerve injuries. J Orofac Pain 18:287–292

    PubMed  Google Scholar 

  52. Robinson PP, Loescher AR, Yates JM et al (2004) Current management of damage to the inferior ­alveolar and lingual nerves as a result of removal of third molars. Br J Oral Maxillofac Surg 42:285–292

    Article  PubMed  Google Scholar 

  53. Robinson PP, Yates JM, Smith KG (2008) A prospective, quantitative study on the clinical outcome of inferior alveolar nerve decompression and neurolysis. Oral Surg 1:35–44

    Article  Google Scholar 

  54. Rutner TW, Ziccardi VB, Janal MN (2005) Long-term outcome assessment for lingual nerve microsurgery. J Oral Maxillofac Surg 63:1145–1149

    Article  PubMed  Google Scholar 

  55. Smith KG, Robinson PP (1995) An experimental study of lingual nerve repair using epineurial suture or entubulation. Br J Oral Maxillofac Surg 33:211–219

    Article  PubMed  CAS  Google Scholar 

  56. Smith KG, Robinson PP (1995) The reinnervation of the tongue and salivary glands after two methods of lingual nerve repair in the cat. Arch Oral Biol 40:373–383

    Article  PubMed  CAS  Google Scholar 

  57. Smith KG, Robinson PP (1995) Lingual nerve defect repair by three methods. J Oral Maxillofac Surg 53:1052–1062

    Article  PubMed  CAS  Google Scholar 

  58. Smith KG, Robinson PP (1995) The reinnervation of the tongue and salivary glands after lingual nerve repair by stretch, sural nerve graft or frozen muscle graft. J Dent Res 74:1850–1860

    Article  PubMed  CAS  Google Scholar 

  59. Smith KG, Robinson PP (1995) An experimental study on the recovery of the lingual nerve after injury with or without repair. Int J Oral Maxillofac Surg 24:372–379

    Article  PubMed  CAS  Google Scholar 

  60. Smith KG, Robinson PP (1995) The effect of delayed nerve repair on the properties of regenerated afferent fibres in the chorda tympani. Brain Res 691:142–152

    Article  PubMed  CAS  Google Scholar 

  61. Smith KG, Yates JM, Robinson PP (1998) The use of neurotrophic factors to enhance lingual nerve repair. Br J Oral Maxillofac Surg 36:228

    Article  Google Scholar 

  62. Strauss ER, Ziccardi VB, Janal MN (2006) Outcome assessment of inferior alveolar nerve microsurgery: a retrospective review. J Oral Maxillofac Surg 64:1767–1770

    Article  PubMed  Google Scholar 

  63. Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain Res 74:491–516

    CAS  Google Scholar 

  64. Susarla SM, Lam NP, Donoff RB et al (2005) A comparison of patient satisfaction and objective assessment of neurosensory function after trigeminal nerve repair. J Oral Maxillofac Surg 63:1138–1144

    Article  PubMed  Google Scholar 

  65. Susarla SM, Kaban LB, Donoff RB et al (2007) Does early repair of lingual nerve injuries improve functional sensory recovery? J Oral Maxillofac Surg 65:1070–1076

    Article  PubMed  Google Scholar 

  66. Susarla SM, Kaban LB, Donoff RB et al (2007) Functional sensory recovery after trigeminal nerve repair. J Oral Maxillofac Surg 65:60–65

    Article  PubMed  Google Scholar 

  67. Tall JM, Stuess SL, Cruce WL et al (2001) Gender and the behavioral manifestations of neuropathic pain. Pharmacol Biochem Behav 68:99–104

    Article  PubMed  CAS  Google Scholar 

  68. Torrance N, Smith BH, Bennett MI et al (2006) The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain 7:281–289

    Article  PubMed  Google Scholar 

  69. Yates JM, Smith KG, Robinson PP (2000) Ectopic neural activity from myelinated afferent fibres in the lingual nerve of the ferret following three types of injury. Brain Res 874:37–47

    Article  PubMed  CAS  Google Scholar 

  70. Ziccardi VB, Rivera L, Gomes J (2009) Comparison of lingual and inferior alveolar nerve microsurgery outcomes. Quintessence Int 40:295–301

    PubMed  Google Scholar 

  71. Zuniga JR, Chen N, Miller IJ (1994) Effects of chorda-lingual injury and repair on human taste. Chem Senses 19:657–665

    Article  PubMed  CAS  Google Scholar 

  72. Zuniga JR, Chen N, Phillips CL (1997) Chemosensory and somatosensory regeneration after lingual nerve repair in humans. J Oral Maxillofac Surg 55:2–13

    Article  PubMed  CAS  Google Scholar 

  73. Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF (1998) The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 56:2–8

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Oral & Maxillofacial Medicine and Surgery, University of Sheffield, School of Clinical Dentistry, Claremont Crescent, Sheffield, S10 2TA, UK

    Peter P. Robinson BDS, FDSRCS, PhD, DSc, F.Med.Sci & Keith G. Smith BDS, FDSRCS, PhD

  2. Department of Oral and Maxillofacial Surgery, University of Copenhagen Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark

    Søren Hillerup PhD, Dr.Odont

  3. Institute of Odontology, Panum Instituttet, University of Copenhagen, Norre Alle 20, 2200, Copenhagen, Denmark

    Søren Hillerup PhD, Dr.Odont

Authors
  1. Peter P. Robinson BDS, FDSRCS, PhD, DSc, F.Med.Sci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keith G. Smith BDS, FDSRCS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Søren Hillerup PhD, Dr.Odont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter P. Robinson BDS, FDSRCS, PhD, DSc, F.Med.Sci .

Editor information

Editors and Affiliations

  1. , Oral and Maxillofacial Surgery, University of Illinois, S. Paulina St. MC 835 801, Chicago, 60612, Illinois, USA

    Michael Miloro

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Robinson, P.P., Smith, K.G., Hillerup, S. (2013). Outcomes of Trigeminal Nerve Repair. In: Miloro, M. (eds) Trigeminal Nerve Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35539-4_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35539-4_19

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35538-7

  • Online ISBN: 978-3-642-35539-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation