Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
권호 표지

Surgical Anatomy of Sural Nerve for the Peripheral Nerve Regeneration in the Oral and Maxillofacial Field

구강악안면 영역의 말초신경 재생을 위한 비복신경의 외과적 해부학

  • Seo, Mi-Hyun (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Park, Jung-Min (Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Kim, Soung-Min (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kang, Ji-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Lee, Jong-Ho (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • 서미현 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 박정민 (서울대학교 치의학대학원 치학연구소) ;
  • 김성민 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 강지영 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 명훈 (서울대학교 치의학대학원 구강악안면외과학교실) ;
  • 이종호 (서울대학교 치의학대학원 구강악안면외과학교실)
  • Received : 2012.01.27
  • Accepted : 2012.03.26
  • Published : 2012.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Peripheral nerve injuries in the oral and maxillofacial regions require nerve repairs for the recovery of sensory and/or motor functions. Primary indications for the peripheral nerve grafts are injuries or continuity defects due to trauma, pathologic conditions, ablation surgery, or other diseases, that cannot regain normal functions without surgical interventions, including microneurosurgery. For the autogenous nerve graft, sural nerve and greater auricular nerve are the most common donor nerves in the oral and maxillofacial regions. The sural nerve has been widely used for this purpose, due to the ease of harvest, available nerve graft up to 30 to 40 cm in length, high fascicular density, a width of 1.5 to 3.0 mm, which is similar to that of the trigeminal nerve, and minimal branching and donor sity morbidity. Many different surgical techniques have been designed for the sural nerve harvesting, such as a single longitudinal incision, multiple stair-step incisions, use of nerve extractor or tendon stripper, and endoscopic approach. For a better understanding of the sural nerve graft and in avoiding of uneventful complications during these procedures as an oral and maxillofacial surgeon, the related surgical anatomies with their harvesting tips are summarized in this review article.

Keywords

References

  1. Ziccardi VB. Microsurgical techniques for repair of the inferior alveolar and lingual nerves. Atlas Oral Maxillofac Surg Clin North Am 2011;19:79-90. https://doi.org/10.1016/j.cxom.2010.11.005
  2. Wolford LM, Rodrigues DB. Autogenous grafts/allografts/conduits for bridging peripheral trigeminal nerve gaps. Atlas Oral Maxillofac Surg Clin North Am 2011;19:91-107. https://doi.org/10.1016/j.cxom.2010.11.008
  3. Eid EM, Hegazy AM. Anatomical variations of the human sural nerve and its role in clinical and surgical procedures. Clin Anat 2011;24:237-45. https://doi.org/10.1002/ca.21068
  4. Park HD, Kwak HH, Hu KS, Han SH, Fontaine C, Kim HJ. Topographic and histologic characteristics of the sural nerve for use in nerve grafting. J Craniofac Surg 2007;18:1434-8. https://doi.org/10.1097/scs.0b013e3181534a4d
  5. Mahakkanukrauh P, Chomsung R. Anatomical variations of the sural nerve. Clin Anat 2002;15:263-6. https://doi.org/10.1002/ca.10016
  6. Konety BR. Is a nerve (graft) still a nerve by any other name? J Urol 2004;172:10-1. https://doi.org/10.1097/01.ju.0000129004.17454.5e
  7. de Moura W, Gilbert A. Surgical anatomy of the sural nerve. J Reconstr Microsurg 1984;1:31-9. https://doi.org/10.1055/s-2007-1007051
  8. Coert JH, Dellon AL. Clinical implications of the surgical anatomy of the sural nerve. Plast Reconstr Surg 1994;94:850-5. https://doi.org/10.1097/00006534-199411000-00016
  9. Minne J, Depreux R, Mestdagh H, Monier R. Topographical anatomy and connections of the sural nerve. Lille Med 1974;19:120-1.
  10. Fabre T, Montero C, Gaujard E, Gervais-Dellion F, Durandeau A. Chronic calf pain in athletes due to sural nerve entrapment. A report of 18 cases. Am J Sports Med 2000;28:679-82. https://doi.org/10.1177/03635465000280051001
  11. Amoiridis G, Schöls L, Ameridis N, Przuntek H. Motor fibers in the sural nerve of humans. Neurology 1997;49:1725-8. https://doi.org/10.1212/WNL.49.6.1725
  12. Jones RH. Repair of the trigeminal nerve: a review. Aust Dent J 2010;55:112-9. https://doi.org/10.1111/j.1834-7819.2010.01216.x
  13. Svane TJ, Wolford LM, Milam SB, Bass RK. Fascicular characteristics of the human inferior alveolar nerve. J Oral Maxillofac Surg 1986;44:431-4. https://doi.org/10.1016/S0278-2391(86)80006-4
  14. Eppley BL, Snyders RV Jr. Microanatomic analysis of the trigeminal nerve and potential nerve graft donor sites. J Oral Maxillofac Surg 1991;49:612-8. https://doi.org/10.1016/0278-2391(91)90343-K
  15. Brammer JP, Epker BN. Anatomic-histologic survey of the sural nerve: implications for inferior alveolar nerve grafting. J Oral Maxillofac Surg 1988;46:111-7. https://doi.org/10.1016/0278-2391(88)90261-3
  16. Hagan WE. "How I do it"--plastic surgery. Practical suggestions on facial plastic surgery. Microneural techniques for nerve grafting. Laryngoscope 1981;91:1759-66.
  17. Ortigüela ME, Wood MB, Cahill DR. Anatomy of the sural nerve complex. J Hand Surg Am 1987;12:1119-23. https://doi.org/10.1016/S0363-5023(87)80129-6
  18. Oberlin C. Nerve grafts. Anatomy of the donor sites. Ann Chir Main 1989;8:281-4. https://doi.org/10.1016/S0753-9053(89)80016-X
  19. Strauch B, Goldberg N, Herman CK. Sural nerve harvest: anatomy and technique. J Reconstr Microsurg 2005;21:133-6. https://doi.org/10.1055/s-2005-864847
  20. Kim ED, Seo JT. Minimally invasive technique for sural nerve harvesting: technical description and follow-up. Urology 2001;57:921-4. https://doi.org/10.1016/S0090-4295(01)00908-6
  21. Miloro M, Stoner JA. Subjective outcomes following sural nerve harvest. J Oral Maxillofac Surg 2005;63:1150-4. https://doi.org/10.1016/j.joms.2005.04.031
  22. Lee JH, Lee SY, Kim MJ, et al. Peripheral nerve repair using sural nerve graft. J Korean Assoc Maxillofac Plast Reconstr Surg 2003;25:103-13.
  23. Ehretsman RL, Novak CB, Mackinnon SE. Subjective recovery of nerve graft donor site. Ann Plast Surg 1999;43:606-12. https://doi.org/10.1097/00000637-199912000-00005
  24. Staniforth P, Fisher TR. The effects of sural nerve excision in autogenous nerve grafting. Hand 1978;10:187-90. https://doi.org/10.1016/S0072-968X(78)80012-6
  25. Aszmann OC, Muse V, Dellon AL. Evidence in support of collateral sprouting after sensory nerve resection. Ann Plast Surg 1996;37:520-5. https://doi.org/10.1097/00000637-199611000-00011
  26. Chang DW. Minimal incision technique for sural nerve graft harvest: experience with 61 patients. J Reconstr Microsurg 2002;18:671-6. https://doi.org/10.1055/s-2002-36498
  27. Yavuzer R, Yavuzer G, Ergin S, Latifoğlu O. Gait analysis: a new perspective on sural nerve graft donor site morbidity assessment. Ann Plast Surg 2002;48:449-50. https://doi.org/10.1097/00000637-200204000-00026
  28. Hadlock TA, Cheney ML. Single-incision endoscopic sural nerve harvest for cross face nerve grafting. J Reconstr Microsurg 2008;24:519-23. https://doi.org/10.1055/s-0028-1088235
  29. Korean Medical Association. English-Korean, Korean-English. Medical Terminology, 5th edition. Seoul: Korean Medical Association; 2008.