mandible resection procedures

Reconstructing and repairing the inferior alveolar nerve (IAN) at the time of mandibular resection is more likely to help patients achieve full functional outcomes, including restoring sensation.1-3 Timing matters, because patients with persistent neurosensory disturbances after IAN damage have consistently reported disturbances to everyday life related to their injuries.3-5

reconstruction after tumor removal

Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. Connector-Assisted Repair® with Avance Nerve Graft® has demonstrated meaningful recovery rates† of 89% (n=18) when used for IAN repair.6

remember the following:

  • According to AAOMS ParCar guidelines, consideration should be given toward neural reconstruction following ablative jaw procedures that result in nerve continuity defects, using interposition autogenous or allogeneic nerve grafting.7
  • When a nerve gap is created upon tumor excision, Avance Nerve Graft can be used to bridge a gap up to 7 cm with Connector-Assisted Repair.8
  • A Connector-Assisted Repair at the proximal and distal coaptations using a semi-translucent, porcine, small intestine submucosa (SIS) Axoguard Nerve Connector may enable easier coaptation, reduce tension and improve fascicular alignment.8-10
  • The construct can be wrapped with an Axoguard Nerve Protector® to provide a physical barrier between the nerve and the surrounding bone, hardware and tissue.
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publications

Full Axogen clinical bibliography

A case-and-control, multisite, positive controlled, prospective study of the safety and effectiveness of Immediate Inferior alveolar nerve processed nerve allograft reconstruction with ablation of the mandible for benign pathology

Sensory outcomes after reconstruction of lingual and inferior alveolar nerve discontinuities using processed nerve allograft—a case series

Does immediate inferior alveolar nerve allograft reconstruction result in functional sensory recovery in pediatric patients?

resources

Reimbursement guide and coding assistance

IAN reconstruction in a segmental mandible resection via mandibular foramen access

IAN reconstruction in a segmental mandible resection via buccal decortication access

IAN reconstruction brochure

IAN quality of life

solutions

avance nerve graft Avance Nerve Graft®

Axoguard® Nerve Connector Axoguard Nerve Connector®

Axoguard HA+ Nerve Protector™

Axoguard® Nerve Protector Axoguard Nerve Protector®

See sizing and IFU on solution pages

more procedures

trauma

iatrogenic trigeminal

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references

†Defined as Medical Research Council Scale of S3/M3 or greater.

  1. Ducic I, et al. Reconstructive options for inferior alveolar and lingual nerve injuries after dental and oral surgery. Ann Plast Surg. 2019;82(6):653-660.
  2. Salomon D, et al. Outcomes of immediate allograft reconstruction of long span defects of the inferior alveolar nerve. J Oral Maxillofac Surg. 2016;0278-2391/16/30251-8.
  3. Leung YY, et al. Trigeminal neurosensory deficit and patient reported outcome measures: the effect on life satisfaction and depression symptoms. PLoS One. 2013;8(8):e72891.
  4. Cakir M, et al. Effects of inferior alveolar nerve neurosensory deficits on quality of life. Niger J Clin Pract. 2018;21:206-211.
  5. Patel N, et al. Quality of life following injury to the inferior dental or lingual nerve—a crosssectional mixed-methods study. Oral Surg. 2018;11:(1)9-16.
  6. Zuniga J, et al. A case-and-control, multisite, positive controlled, prospective study of the safety and effectiveness of immediate inferior alveolar nerve processed nerve allograft reconstruction with ablation of the mandible for benign pathology. J Oral Maxillofac Surg. 2017;75(12):2669-2681.
  7. American Association of Oral and Maxillofacial Surgeons (AAOMS). Parameters of care: AAOMS clinical practice guidelines for oral and maxillofacial surgery (AAOMS ParCare). 6th ed. 2017:e207.
  8. Jewell E, et al. Nerve de-tensioning effects of conduits: A quantitative cadaveric analysis comparing conduit-assisted and direct digital nerve repairs. Poster presented at: American Association for Hand Surgery Annual Meeting; January 17-21, 2023; Miami, FL.
  9. Hanwright PJ, et al. The effects of a porcine extracellular matrix nerve wrap as an adjunct to primary epineurial repair. J Hand Surg Am. 2021;46(9):813.e1-813.e8. doi:10.1016/j.jhsa.2020.11.023
  10. Ducic I, et al. Refinements of nerve repair with connector-assisted coaptation. Microsurgery. 2017;37(3):256-263. doi:10.1002/micr.30151