Providing Microsurgical Repair of Trigeminal-Facial Nerve Injuries

The trigeminal nerve and its branches (click on image to enlarge).

The trigeminal nerve — the fifth cranial nerve — is a complex nerve responsible for sensation in the face and motor functions such as biting and chewing.

The trigeminal nerve is the largest of the cranial nerves that emerge directly from the brain, in contrast to spinal nerves.

The several branches of the trigeminal nerve supply sensation to the upper face, midface, upper lip, jaw and palate, lower face, lower lip, and tongue.

These trigeminal nerve branches can be injured by facial trauma, local anesthesia, or surgical procedures, and lose their function. Complete sensory recovery from such injuries seldom occurs spontaneously.

Peripheral trigeminal nerve injuries can result in permanent sensory dysfunction, such as decreased or lost sensation, painful sensation, or a combination of both.

This sensory dysfunction in the face and/or mouth often interferes with performance of activities of daily living, and may adversely affect the lives of afflicted patients.

In selected patients, microsurgical repair of trigeminal nerve injuries can be helpful in achieving functional sensory recovery and in improving quality of life.

Dr. David K. Lam

Few surgeons are trained or provide this surgery. But at Stony Brook Medicine, we have David K. Lam, MD, DDS, PhD, professor of surgery and chief of oral and maxillofacial surgery.

Here, Dr. Lam regularly performs this very complex microsurgical repair procedure, which can potentially restore lost feeling in the face and mouth.

Dr. Lam treats patients who endure trigeminal nerve injuries from trauma, head and neck cancer surgery, oral and maxillofacial surgery, and dental procedures (usually following implants or wisdom teeth removal).

"Advances in microsurgical techniques and materials," says Dr. Lam, "have improved our ability to manage these injures, and have also expanded the applications of micro-neurosurgery, resulting in excellent success rates."

The patient with a trigeminal nerve injury may experience a variety of distressing sensations, such as numbness, tingling, burning, or hypersensitivity of the affected area.

Sensations like these due to trigeminal nerve injuries may interfere with normal speaking, chewing, drinking, eating, shaving, or kissing. Their impact on quality of life is often very negative.

When these sensations persist for months following the initial nerve injury, the chance the injury won't resolve by itself is high. That's why early evaluation by a specialist for management and treatment is indicated.

Initial care of trigeminal nerve injuries involves close monitoring of symptoms and neurosensory testing.

The best time to treat a trigeminal nerve injury with surgical repair is controversial but is ideally within three months of the initial injury. This time frame is associated with the highest rate of success.

The specialized microsurgical techniques used by Dr. Lam improve the healing of nerves, thus providing a better chance for recovery of sensation.

Ideally, patients or their doctors will identify the symptoms of trigeminal nerve injuries early, and will address the injuries that don't resolve by themselves, in order to prevent irreversible damage.

The microsurgical repair of trigeminal nerve injuries, in Dr. Lam's hands, usually takes 3-4 hours with the patient under general anesthesia. Usually no overnight hospitalization is required.

The procedure is usually performed through the mouth, so there is no visible scar.

Recovery from the procedure generally takes 7-10 days, at which time patients can return to their normal activities.