End-to-Side Cross-Face Nerve Graft for Mental Nerve Reconstruction after Segmental Mandibulectomy

The traditional technique for mental nerve reconstruction after segmental mandibulectomy is to bridge the gap between the proximal end of the inferior alveolar nerve (IAN) and the mental nerve stump, which often presents significant challenges. In cases of the proximal IAN stump being close to the skull base or inside the remaining mandible body and ramus, approaching the proximal end of the IAN can be challenging. To overcome the limitation, a novel technique of cross-face mental nerve reinnervation with end-to-side coaptation to the contralateral mental nerve has been developed. This procedure involves preparing the recipient site before mandibulectomy, harvesting a donor nerve, preparing the contralateral mental nerve for end-to-side neurorrhaphy, and performing cross-face reinnervation after flap inset. The technique uses end-to-side coaptation to connect the nerve graft to the contralateral mental nerve. This new technique overcomes challenges posed by traditional methods, offering advantages such as shorter nerve grafts, easier coaptation due to superficial nerve position, and reduced risk of interference with second-stage dental surgery. Initial outcomes have been promising, with all patients showing sensation recovery above S3 and no significant interference with contralateral mental nerve function. This innovative approach provides a solution for patients undergoing segmental mandibulectomy and has potential applications in restoring sensation lost due to various causes. It opens new possibilities for nerve rehabilitation and warrants further investigation through larger clinical trials to validate its efficacy and explore its potential in other nerve repair scenarios.