Reconstruction of the Trigeminal Nerve

Abstract

New indications for the surgical treatment of a traumatized trigeminal nerve have recently evolved (Samii 1972). Severe facial injuries may be accompanied by lesions of different branches of the trigeminal nerve, most commonly at the forehead in the area of the frontal branches or in fractures of the mandible where the inferior alveolar nerves are located. Fractures of the base of the skull or intracranial space-occupying processes may lead to a lesion of the trigeminal nerve with partial or total loss of sensation in one part of the face and paralysis of the masticatory muscles. Radical tumor extirpation of the lower jaw often requires the resection of the inferior alveolar nerv. The consequence is loss of sensation in the region of the mucosa, the lip, and the chin. Transection of the frontal nerve caused by an incised wound produces hypesthesia in the region of the forehead which is of relatively minor significance. Trigeminal neuralgia resistant to any therapy may also appear owing to the formation of a neuroma and is of greater clinical importance (Fig. 1 a). The technique of neurolysis has been successful only in rare cases. Dissection of the trigeminal nerve in this region in order to re-establish the continuity of the nerve through an end-to-end suture or a nerve graft can be performed (Fig. 1 b). As a result, not only is the pain relieved but also the restoration of sensation can be observed.