Refined Approach to Preservation of the Inferior Alveolar Nerve during Resection and Primary Reconstruction of the Mandible

Abstract

Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior to the mandibular canal. This technique was used by some authors to preserve continuity of the IAN during resection of the mandible in patients with benign tumors. The described techniques are traumatic, time-consuming, and not precise. We propose a new refined technique of preservation of IAN with use of a guide to approach mandibular canal, cutting guides with a slot for a relocated IAN, and a new approach to positioning of the fixating screws. We assessed the effectiveness of this new technique with use of an electro-odontometer. In 21 cases, we demonstrated a refined approach to preservation of the IAN. In 7 patients (33%), the IAN was preserved on one side and in 14 patients (67%), on both sides. Sensation in the lower lip was restored in 18 patients (86%). These patients generally recovered sensation within 22 days postoperatively. This proposed technique makes preservation of IAN easier, faster, less traumatic, and more predictable. In this article, we describe criteria for the patients with cancer of oral mucosa to be admitted for this procedure. Restored sensation in the lower lip of the patients who have undergone resection of the mandible significantly improves their quality of life.

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

“…Of the included articles, three are prospective cohort studies ( 5 - 7 ), one is a retrospective cohort study ( 8 ), one is a retrospective analysis ( 9 ), three are case series ( 2 , 10 , 11 ), four are case reports ( 12 - 15 ), and one is a technical note ( 4 ). The articles included a total of 127 patients, all of whom underwent mandibular resective therapies.…”

“…The inferior alveolar nerve (IAN) is one of the branches of the mandibular division of the trigeminal nerve ( 1 ). It runs inside the mandibular canal and innervates the mandibular teeth, chin, lower lip, mucosa, and gingiva up to the lower second premolar ( 2 ). Lesions in the IAN are a clinical problem that have been documented in surgical procedures such as extraction of the lower third molars, mandibular fractures, orthognathic surgery, placement of dental implants, and mandibular resections due to benign and malignant tumors ( 1 , 3 ).…”

“…This condition significantly affects the quality of life of patients who experience it, producing alterations in speech, taste, mastication, oral hygiene, and lip competence, the latter of which is involved in the retention and swallowing of food ( 3 ). In addition, injury to this nerve can cause chronic neuropathic pain ( 5 ), adverse psychological effects, and decreased quality of life in patients ( 2 ). The complications described above could be avoided through maneuvers that preserve the IAN ( 4 ).…”

Mandibular canal vs. inferior alveolar canal: Evidence‐based terminology analysis

“…The articles that were included in the IAC/IANC group were excluded from this group. The most recent, consecutive 50 articles containing “mandibular canal” but neither “inferior alveolar canal” nor “inferior alveolar nerve canal” were included (defined as the MC group) (Abd Fattah, Hariri, Nambiar, Abu Bakar, & Abdul Rahman, 2019; Al‐Shayyab, Qabba'ah, Alsoleihat, & Baqain, 2019; Alves, Dias, Mansa, & Machado, 2020; Arias et al, 2019; Bosykh, Turkina, Franco, Franco, & Makeeva, 2019; Bozkurt & Görürgöz, 2019; Burian et al, 2019; Cârstocea, Săndulescu, Hostiuc, & Rusu, 2020; M. H. Chen et al, 2019; Costa et al, 2019; Esposito et al, 2019; Felice et al, 2019; Felice, Barausse, Pistilli, Ippolito, & Esposito, 2019; Fistarol, De Stavola, Fincato, & Bressan, 2019; Freire, Nascimento, Vasconcelos, Freitas, & Haiter‐Neto, 2019; Friedrich, Matschke, & Wilczak, 2019; Iwanaga et al, 2020, 2020; Iwanaga, Wong, Kikuta, & Tubbs, 2019; Kalabalik & Aytuğar, 2019; Koç, Eroğlu, & Bilgili, 2019; Komal, Bedi, Wadhwani, Aurora, & Chauhan, 2020; K. C. Lee, Yoon, Philipone, & Peters, 2019; Liye et al, 2019; Matsuda, Yoshimura, & Sano, 2019; Matzen, Petersen, Schropp, & Wenzel, 2019; Matzen, Villefrance, Nørholt, Bak, & Wenzel, 2020; Munhoz, Arita, Nishimura, & Watanabe, 2019; Na et al, 2019; Ngeow & Chai, 2020a, 2020b; Nicol, Loncle, Pasquet, & Vacher, 2019; Okumuş & Dumlu, 2019; Oliveira et al, 2019; Ozdede, 2020; Pedersen, Matzen, Hermann, & Nørholt, 2019; Predoiu, Rusu, & Chiriţă, 2019; Puciło, Lipski, Sroczyk‐Jaszczyńska, Puciło, & Nowicka, 2020; Raju et al, 2019; Sahl, Alqahtani, Alqahtani, & Gallez, 2018; Satir, 2019; Sholapurkar & Davies, 2019; Sinha et al, 2019; Sun et al, 2019; Tereshchuk & Sukharev, 2019; Uğur Ay...…”

Tissue-Engineered Bone Implants for the Replacement of Jawbone Defects. Literature Review

“…For example, for mandibular reconstruction, the peroneal autograft on microvascular anastomosis is most often used. Its advantages are a long vascular stem, vessel diameter, suitable length and thickness of the bone, the possibility of performing reconstruction over a long distance, the possibility of including a muscle or skin component with a flap, stable bone structure that allows intraosseous implantation and further orthopedic prosthesis, minimal resorption [Tereshchuk et al, 2018].…”