Considerations in nerve repair.

BUMC PROCEEDINGS 2003;16:152–156 Some nerve injuries require repair in order to regain sensory or motor function. Although this article focuses primarily on trigeminal nerve (TN) injuries and repairs, the facts presented may apply to any peripheral nerve repair. The primary indications for nerve repair or grafting are 1) an injury or continuity defect in a nerve, as a result of trauma, pathology, surgery, or disease, that cannot regain normal function without surgical intervention and 2) loss of normal neurologic function, resulting in anesthesia, paresthesia, dysesthesia, or paralysis, that cannot be corrected by nonsurgical treatment. In some nerve injuries (e.g., neurapraxia), the nerve regains sensory or motor function unless irreversible compression, neuroma (axonotmesis), or transection (neurotmesis) occurs. In more severe injuries, there may be significant loss of nerve substance (continuity defect), or a section of nerve may need to be removed to expose normal nerve tissue in preparation for nerve repair. Thus, nerve repair and nerve grafting procedures may be required to provide continuity between the proximal and distal portions of the nerve. The 3 major branches of the TN that can be involved in injuries are the inferior alveolar nerve (IAN), lingual nerve (LN), and infraorbital nerve (ION). The most common types of injury to the IAN and LN are iatrogenic, related to removal of impacted teeth (Figure 1), orthognathic surgery (jaw repositioning), periodontics (gum surgery), endodontics (root canal procedures), dental implants, curettage of intrabony lesions, partial Considerations in nerve repair