Feasibility of a cross-face reconstruction of the mental nerve—A cadaveric simulation study with histomorphometric analysis

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IntroductionThe inevitable sacrifice of the inferior alveolar nerve (IAN) during oncologic resections results in substantial sensory impairment, impacting crucial functions such as speech, saliva retention, and mastication. This study investigates the feasibility of sensory restoration through cross-face reconstruction of the mental nerve via a contralateral mental nerve branch. MethodsThe cross-face reconstruction procedure was simulated in five formalin-fixed cadavers for both sides to evaluate the anatomic fundamentals and the nerve gap between the mental nerve main trunk and the transferred contralateral mental nerve branch. Furthermore, a histomorphometric analysis was performed to assess cross-sectional area and axon counts. ResultsThe mean gap distance between the main mental nerve trunk and the transferred contralateral branch was 15.3mm. End-to-end coaptation was achieved in 9 out of 10 simulations. The mean cross-sectional area was 0.996 mm2 at the main mental nerve trunk and 0.253mm2 at the coaptation site of the nerve branch. The mean donor-to-recipient axon ratio was found to be 0.3:1. ConclusionThe cadaveric simulation demonstrates the feasibility of a cross-face reconstruction of the mental nerve with only minimal gapping. Advantages of the proposed technique include the use of shorter nerve grafts, minimizing donor site morbidity and enabling fast reinnervation. This technique may offer a promising method for enhancing the quality of life for a patient group with increasing survival rates and life expectancy.