The use of autogenous vein grafts for inferior alveolar and lingual nerve reconstruction

Purpose: This study evaluated whether an autogenous vein graft forms a sati sfactory conduit for nerve regeneration. Patients and Methods: Fifteen patients received a total of 16 autogenous ve in grafts to repair continuity defects of the inferior alveolar (6) and lin gual nerves (10) nerves. All were treated between 4 and 10 months after inj ury. At surgery, the postresection defects ranged from 2 to 14 nun. All lin gual nerves were repaired with saphenous vein grafts from an intraoral appr oach and all inferior alveolar nerves were repaired with facial vein grafts inserted from an extraoral approach. Results: Lingual nerve repair in 3 cases where the gap between the nerve en ds was 5 mm or less resulted in some return of sensation. In 7 cases where the gap was between 5 and 14 mm, there was no return of sensation. In the 6 inferior alveolar nerve repairs there was some return of sensation in all cases and there was good return of sensation in 3 cases. One patient redeve loped dysesthesia in the inferior alveolar nerve and subsequently had a neu rectomy. Histologic material was available from this case. Conclusions: It appears that a vein graft can form a physiologic conduit fo r nerve regeneration. The results are more successful with shorter gaps, wh ich indicates that, in some respects, the vein acts like a barrier membrane . The increased success rate in the inferior alveolar nerve repair may be b ecause the vein remains straight and patent in the inferior alveolar canal. The lack of success with a long lingual nerve gap repair may be because th e vein is collapsed or kinked by movement of the tongue, which may inhibit neural regeneration. Therefore, vein grafts should not be used for long lin gual nerve continuity defects. (C) 2001 American Association of Oral and Ma xillofacial Surgeons.