Novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap

Abstract

Background: This study aimed to introduce a novel loop neurorrhaphy technique using an innervated vascularized iliac bone flap (VIBF) with vascularized ilioinguinal nerve (IIN) to reconstruct the inferior alveolar nerve (IAN) and preserve lower lip sensation simultaneously with mandibular reconstruction.Methods: This study prospectively included patients who underwent mandibular reconstruction using VIBF from May 2018 to April 2020. Subjects were allocated into two groups: (1) Group I; innervated VIBF with loop neurorrhaphy (IIN doubly anastomosed with IAN and mental nerve), (2) Group II (control); conventional VIBF. Evaluation was done with operative time, intraoperative indocyanine green (ICG), lower lip sensory assessment (twopoint discrimination [TPD] test and current perception threshold [CPT]), and drooling.Results: Twelve patients were included; 6 in each group, (7 males and 5 females), age ranging from 18 to 57 years (average: 36.75 years). In all cases, intraoperative perfusion of IIN was confirmed by ICG. Group I showed a statistically significant more flap harvesting time compared with group II (mean difference, 5.67 min; P = 0.0091). There was a significant difference in sensory recovery favoring group I (P < 0.05). The TPD results in group I showed an average of 9.8 ± 6.9 mm and 6.2 ± 5.7 mm on operated and non-operated sides, while Group II showed a poor sensory recovery, and the TPD showed an Ahmed Abdelrehem and Jingcun Shi share the work as first co-authors.

Planning of physiotherapeutic procedure in patients after mandible reconstruction taking into account donor site: a literature review

“… Author and year Disease P Donor site Evaluation of the function of the jaw and/or mouth and/or the speech apparatus and/or esophagus Evaluation of the global function related to the donor site 31. Abdelrehem et al [ 42 ] AB, OM, malignant tumor of jaw, KCOT n = 12 age 18–57 Innervated vascularizediliac bone No speech disorders in some patients, accidental bites on the lip, salivation 0–3.17 on a scale No restrictions in everyday activities 32. Devireddy et al [ 26 ] OF, AB, KCOT n = 7 age 13–63 Nonvascular fibula graft No restrictions, deviation in one of the directions or no large changes in the jaw movement, no restrictions on tongue mobility, limited opening or improvement of the mouth opening 3.5–4.2 cm No foot drooping 33.…”

“…They concerned both the craniofacial area and donor sites. These included sensory disturbances in the lips and graft area, or pain in the oral cavity [ 15 – 17 , 20 , 34 , 42 ]. Some patients also experienced neuropathic pain or local pain in the limb, as well as sense weakness in the donor site area or complete loss of sense along the peroneal nerve [ 14 , 20 , 40 , 41 , 43 – 46 ].…”

Identification of Functional Modules and Key Pathways Associated with Innervation in Graft Bone—CGRP Regulates the Differentiation of Bone Marrow Mesenchymal Stem Cells via p38 MAPK and Wnt6/β-Catenin

“…Traditional approaches for repairing maxillofacial bone defects using nonvascularized free bone grafts often result in significant bone resorption and surgical failures, even when the grafts are adequately vascularized. However, our research team has observed that restoration of neural innervation in the transplanted bone can effectively maintain bone mass and preserve the original strength of the graft [ 12 , 16 ]. While autologous bone grafting remains the current gold standard, emerging neovascularized tissue-engineered bone technology offers promising prospects.…”

Frontiers of Hydroxyapatite Composites in Bionic Bone Tissue Engineering

“…Retrospective and prospective clinical studies have shown that simultaneous innervated bone grafting can significantly reduce osteoporosis and effectively maintain lower lip sensation. It also suggests that nerves are important in bone homeostasis [ 182 , 183 ]. In recent years, studies in the field of tissue engineering have found that in addition to vascularization, neurogenesis may also be important in promoting the formation of bone [ 167 , 184 , 185 ].…”