The Inferior Alveolar Nerve: To Graft or Not to Graft in Ablative Mandibular Resection?

Publication date: Available online 14 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Maryam Akbari, Michael Miloro

Purpose

To determine contemporary surgical decision-making processes regarding the use of a nerve graft with ablative mandibular resection, and to identify utilization barriers amongst head and neck surgeons.

Materials and Methods

An online electronic survey was distributed to head and neck surgeons and oral and maxillofacial surgery (OMS) residency program directors (n=249) using REDCap, that queried practice patterns and subjective opinions regarding inferior alveolar nerve (IAN) grafting at the time of mandibular resection.

Results

There was a response rate of 37%, and only 10.6% of respondents perform IAN reconstruction always (60% usually/sometimes, 28.8% rarely/never) with ablative benign mandibular resection, while only 1.1% perform IAN grafting always (10-20% usually/sometimes, 89% rarely/never) in ablative malignant mandibular resection. Among the 93 participants, the most significant utilization barriers were lack of evidence for improving quality of life, potential impact of radiation on nerve healing, and lack of efficacy for restoration of neurosensory function.

Conclusions

Despite evidence-based literature demonstrating the efficacy of immediate IAN grafting with ablative benign mandibular resection, most head and neck surgeons do not perform this procedure routinely in benign or malignant mandibular pathology. Future research should focus not only on the achievement of functional sensory recovery, but also on the impact of IAN grafting on improved quality of life indicators in both benign and malignant mandibular disease, with and without adjunctive chemo-radiation therapy.

http://bit.ly/2RStJ0I