Nerve Injury and Repair Mechanisms in Maxillofacial Surgery

Nerve injury is a frequent sequela of dental and maxillofacial procedures, with the trigeminal nerve and its inferior alveolar and lingual divisions most commonly affected. Injury patterns range from transient conduction block to complete nerve transection, each carrying distinct prognostic implications. Microsurgical repair techniques, including epineurial and perineurial suturing, aim to align fascicles and restore axonal continuity. When direct suture is not feasible, grafting options such as autografts, decellularized allografts and nerve conduits are employed to bridge defects. Schwann cells and neurotrophic factors play central roles in promoting axonal regeneration, while timely intervention minimises neuroma formation and chronic neuropathic pain. Advances in diagnostic imaging and neurosensory testing have refined the assessment of sensory deficits, guiding treatment selection between conservative management—pharmacological agents for neuropathic pain—and surgical reconstruction. Emerging approaches including cross-face nerve transfers and bioengineered scaffolds promise to enhance functional recovery. Optimal outcomes depend on prompt diagnosis, precise surgical technique and multidisciplinary care, underscoring the global significance of restoring mastication, speech and facial sensation for patient quality of life.

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Nerve Injury and Repair Mechanisms in Maxillofacial Surgery publication trend

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Technical terms

Peripheral nerve injury: Damage to a nerve outside the central nervous system, classified by severity from conduction block to complete transection.

Neuropathic pain: Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.

Neurosensory testing: Clinical evaluation of sensory nerve function using quantitative (two-point discrimination, monofilament) and qualitative methods.

Decellularized allograft: Donor nerve tissue processed to remove cellular elements, preserving extracellular matrix as a scaffold for regeneration.

Nerve coaptation: Surgical alignment and suturing of severed nerve ends to facilitate directed axonal regrowth.

References

1. Post-Traumatic Trigeminal Neuropathic Pain: A Narrative Review of Understanding, Management, and Prognosis. Biomedicines (2024).
2. Comparison of Neurosensory Recovery of the Inferior Alveolar Nerve After Open and Closed Reduction for Mandibular Fractures: A Prospective Study. Cureus (2024).
3. Decellularized allografts as an alternative for reconstruction of large inferior alveolar nerve defects: a systematic review. Medicina Oral Patología Oral y Cirugia Bucal (2023).