A novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap
A novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap
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DOI：
10.1002/hed.26896
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发表时间：
2021-10-18
影响因子：
2.9
通讯作者：
Wang, Lei
中科院分区：
文献类型：
--
作者：
Abdelrehem, Ahmed;Shi, Jingcun;Wang, Lei
本研究旨在介绍一种利用带血管化髂腹股沟神经（IIN）的带神经带血管化髂骨瓣（VIBF）重建下牙槽神经（IAN）并在下颌重建的同时保留下唇感觉的新型环状神经吻合技术。方法本研究前瞻性纳入2018年5月至2020年4月使用VIBF进行下颌骨重建的患者。受试者分为两组：(1)第一组；(2)ⅱ组（对照组）；传统VIBF。通过手术时间、术中吲哚菁绿（ICG）、下唇感觉评估（两点辨别[TPD]测试和当前感知阈值[CPT]）和流口水进行评估。结果纳入12例患者；每组6例，男7例，女5例，年龄18 ~ 57岁，平均36.75岁。所有病例均经ICG证实术中IIN灌注。I组皮瓣收获时间较II组有统计学意义（平均差异5.67 min, P = 0.0091）。在感觉恢复方面，I组差异有统计学意义（P < 0.05）。TPD结果I组手术侧和非手术侧平均9.8 +/- 6.9 mm和6.2 +/- 5.7 mm， II组感觉恢复较差，手术侧和非手术侧TPD平均24.6 +/- 6.7 mm和8.4 +/- 2.3 mm。CPT结果显示两组之间有显著差异。ⅰ组患儿流口水程度为3.16 +/- 0.75，ⅱ组患儿流口水程度为1.6 +/- 0.81，ⅰ组患儿流口水程度有显著性差异。结论采用带血管IIN的VIBF联合环神经吻合术重建下颌，可成功恢复下颌形态，保留唇部感觉。
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 (two-point 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 average of 24.6 +/- 6.7 mm and 8.4 +/- 2.3 mm on operated and non-operated sides. The CPT results showed a significant difference between both groups. In Group I, the extent of drooling was 3.16 +/- 0.75, while in Group II, the score was 1.6 +/- 0.81, revealing a significant difference favoring Group I. Conclusions Concurrent mandibular reconstruction using VIBF and loop neurorrhaphy with vascularized IIN to reconstruct IAN successfully restore lower jaw form and preserve lip sensation.