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Reparatur- und Rekonstruktionsverfahren der Nn. lingualis und alveolaris inferior

Teil 2: operative Prinzipien, Zeitwahl, Outcome und Indikationsstellung

Repair and reconstruction of the lingual and inferior alveolar nerve

Part 2: operative principles, timing, outcome and indications

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Zusammenfassung

Läsionen des N. lingualis oder N. alveolaris inferior, die keine Aussicht auf eine Spontanregeneration und Wiederherstellung der sensiblen Restitution besitzen, kommen im Rahmen von Tumorresektionen, Traumen und akzidentell bei dentoalveolären oder orthognath-chirurgischen Eingriffen vor. Bei geschlossenen Nervenverletzungen ist die klinische Differenzierung einer irreversiblen Läsion und somit die Indikationsstellung zur operativen Reparatur oder Rekonstruktion nur durch Verlaufsbeobachtung möglich. Ein frühzeitiges Timing bis zur Wiederherstellungsoperation gilt als kritisch für die funktionelle neurosensorische Restitution. Der Frage, welche Größenordnung dem optimalen Zeitfenster zugemessen werden sollte, wird in einer Literaturübersicht des letzten Jahrzehnts nachgegangen. Nach Darstellung der heute verfügbaren mikroneuralen Operationstechniken werden unter Berücksichtigung der derzeitigen Datenlage Überlegungen und Wege zur Entscheidungsfindung sowie zur Operationsindikationsstellung in verschiedenen Verletzungsszenarien vorgestellt.

Abstract

Injuries of the lingual nerve (LN) or the inferior alveolar nerve (IAN) which do not have the potential for spontaneous regeneration and sensory restitution are the typical sequelae of oral cancer resection, traumatic avulsion and accidental injuries resulting from dentoalveolar or orthognathic surgical procedures. In closed injuries the irreversible nature of a lesion and the necessity to operate can be revealed only expectantly by clinical assessment of neurosensory function during a regular follow-up. A short term microneural intervention is regarded crucial for functional sensory recovery. The appropriate time slot for surgery however continues to be a controversial topic and is figured out on findings from the recent literature. After an introductory review of currently available microneural surgical techniques some thoughts and road maps for decision making as well as up to date indications for surgery related to different injury scenarios are addressed with respect to the latest data.

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Interessenkonflikt. C.P. Cornelius gibt an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Ludwig-Maximilians-Universität München – Campus Innenstadt, Lindwurmstr. 2a, 80337, München, Deutschland

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Cornelius, C. Reparatur- und Rekonstruktionsverfahren der Nn. lingualis und alveolaris inferior. MKG-Chirurg 6, 184–204 (2013). https://doi.org/10.1007/s12285-012-0334-7

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