Secondary Nerve Reconstruction

Pain or nerve dysfunction following craniofacial trauma or surgery is often treated with medical regimes or close observation. Facial pain or dysfunction lasting longer than 6 months to 1 year can be defined as chronic facial pain. In traumatic situations, it is often the nerve foramina in the craniofacial skeleton that are areas of weakness. This often leads to nerve injury in craniofacial trauma. Dentoalveolar surgery and orthognathic surgery encompass many of the cases of injury to the inferior alveolar and lingual nerves. Appropriate surgical history and physical examination are paramount in the proper management and diagnosis of craniofacial nerve dysfunction. Surgical management is often a fine balance between managing pain and patient functional expectations. Often the goal of surgical treatment is anesthesia over dysesthesia. The techniques and principles of nerve repair are similar to those of peripheral nerve repair throughout the rest of the body. Primary tension-free nerve repair is the gold standard. There is no consensus agreement on the use of nerve grafts or conduits for secondary nerve repair in the craniofacial region. Outcomes of repair should be supplemented in a multidisciplinary fashion utilizing appropriate neuromodulating medications as well as neurosensory rehabilitation.