Functional Sensory Recovery After Trigeminal Nerve Repair

Abstract Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

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Outcomes of surgical repair of a single digital nerve in adults

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419846761 ◽

2019 ◽

Vol 44 (6) ◽

pp. 560-565 ◽

Cited By ~ 2

Author(s):

Abhilash Jain ◽

Rebecca Dunlop ◽

Tim Hems ◽

Jin Bo Tang

Keyword(s):

Surgical Repair ◽

Nerve Repair ◽

Hand Dominance ◽

Digital Nerve ◽

Current Standard ◽

Recent Systematic Review ◽

Standard Management ◽

Nerve Recovery ◽

Sensory Recovery ◽

Improved Function

Current standard management of a cut digital nerve is end-to-end microsurgical nerve coaptation where possible. A recent systematic review of adult digital nerve injuries that were either repaired or left unrepaired showed that the evidence for good nerve recovery or improved function following nerve repair is poor. In the 30 studies included, only 24% of repaired nerves regained sensory recovery close to or equivalent to estimated pre-injury levels. Neuroma rates were the same in those nerves repaired (4.6%) and those not repaired (5%). Questions under debate include proper assessment methods of outcomes, decision making for repair or no repair to different fingers or the thumb, levels of injury, age, and hand dominance. This review summarizes the major evidence available and debates the surgical dogma that surrounds this injury.

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Facial Sensory Restoration After Trigeminal Sensory Rhizotomy by Collateral Sprouting From the Occipital Nerves

Neurosurgery ◽

10.1093/neuros/nyz306 ◽

2019 ◽

Vol 86 (5) ◽

pp. E436-E441 ◽

Cited By ~ 1

Author(s):

Lindsey Freeman ◽

Osmond C Wu ◽

Jennifer Sweet ◽

Mark Cohen ◽

Gabriel A Smith ◽

...

Keyword(s):

Trigeminal Nerve ◽

Spinal Nerve ◽

Sensory Function ◽

Spinal Nerves ◽

Collateral Sprouting ◽

Late Failure ◽

Upper Cervical ◽

Sensory Recovery ◽

Cranial Nerve Injury ◽

Occipital Nerve Block

Abstract BACKGROUND AND IMPORTANCE Lesioning procedures are effective for trigeminal neuralgia (TN), but late pain recurrence associated with sensory recovery is common. We report a case of recurrence of type 1A TN and recovery of facial sensory function after trigeminal rhizotomy associated with collateral sprouting from upper cervical spinal nerves. CLINICAL PRESENTATION A 41-yr-old woman presented 2 yr after open left trigeminal sensory rhizotomy for TN with pain-free anesthesia in the entire left trigeminal nerve distribution. Over 18 mo, she developed gradual recovery of facial sensation migrating anteromedially from the occipital region, eventually extending to the midpupillary line across the distribution of all trigeminal nerve branches. She reported recurrence of her triggered lancinating TN pain isolated to the area of recovered sensation with no pain in anesthetic areas. Nerve ultrasound demonstrated enlargement of ipsilateral greater and lesser occipital nerves, and occipital nerve block restored facial anesthesia and resolved her pain, indicating that recovered facial sensation was provided exclusively by the upper cervical spinal nerves. She underwent C2/C3 ganglionectomy, and ganglia were observed to be hypertrophic. Postoperatively, trigeminal anesthesia was restored with complete resolution of pain that persisted at 12-mo follow-up. CONCLUSION This is the first documented case of a spinal nerve innervating a cranial dermatome by collateral sprouting after cranial nerve injury. The fact that typical TN pain can occur even when sensation is mediated by spinal nerves suggests that the disorder can be centrally mediated and late failure after lesioning procedures may result from maladaptive reinnervation.

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Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

Plastic Surgery International ◽

10.1155/2013/704589 ◽

2013 ◽

Vol 2013 ◽

pp. 1-17 ◽

Cited By ~ 23

Author(s):

Felix J. Paprottka ◽

Petra Wolf ◽

Yves Harder ◽

Yasmin Kern ◽

Philipp M. Paprottka ◽

...

Keyword(s):

Meta Analysis ◽

Nerve Repair ◽

Donor Site ◽

Surgical Techniques ◽

Graft Material ◽

Digital Nerve ◽

Nerve Reconstruction ◽

Level Of Evidence ◽

Sensory Recovery ◽

End To End

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.

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FINGERTIP REPLANTATIONS: IMPORTANCE OF VENOUS ANASTOMOSIS AND THE CLINICAL RESULTS

Hand Surgery ◽

10.1142/s0218810409004177 ◽

2009 ◽

Vol 14 (01) ◽

pp. 1-6 ◽

Cited By ~ 26

Author(s):

Takaaki Hasuo ◽

Genzaburo Nishi ◽

Daiji Tsuchiya ◽

Takanobu Otsuka

Keyword(s):

Survival Rate ◽

Nerve Repair ◽

Venous Drainage ◽

Clinical Results ◽

High Survival ◽

Venous Anastomosis ◽

Nail Deformity ◽

Sensory Recovery ◽

Distal Interphalangeal ◽

Protective Sensation

Overall survival rate for 143 digits with complete amputation of the distal phalanx was 78%. Replanted digits that underwent venous anastomosis showed a very high survival rate of 93%. Loss of the distal interphalangeal joint function in subzone IV was significantly inferior to that in subzones II and III. Protective sensation was achieved in 96% of replanted digits. Sensory recovery in the absence of nerve repair was significantly worse for avulsion injury than for crush injury. Nail deformity tended to be increased for replanted digits in subzone III or with crush-type injury. Successful venous anastomosis appears to offer the best way to promote survival of replanted digits. If venous anastomosis is infeasible, a replanted digit can survive with any methods for venous drainage in subzones II and III, but does not survive in subzone IV. To minimise nail deformity, repair of the germinal matrix is necessary.

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