Oral and Maxillofacial Surgery

Microsurgical Repair Principles

• Timing: Primary repair (immediate) vs secondary repair (delayed)
• Tension-free approximation: Essential for successful repair
• Precise fascicular alignment: Critical for functional recovery
• Microsurgical technique: 8-0 to 10-0 non-absorbable sutures

Epineural Suturing

• Indication: Pure sensory nerves (like inferior alveolar nerve)
• Technique: Sutures placed through epineurium only
• Advantages:
  • Simpler technique
  • Less surgical trauma
  • Shorter operative time
  • Adequate for sensory function
• Suture material: 8-0 or 9-0 nylon or polypropylene
• Number of sutures: 2-4 sutures typically sufficient

Perineural/Group Fascicular Suturing

• Indication: Mixed motor/sensory nerves
• Technique: Individual fascicles or fascicular groups sutured separately
• Advantages:
  • More precise fascicular alignment
  • Better functional outcomes for motor nerves
  • Reduced cross-innervation
• Disadvantages:
  • More complex technique
  • Longer operative time
  • Greater surgical trauma
• Requirements: High magnification, specialized training

Fascicular Suturing

• Indication: Large mixed nerves with identifiable fascicles
• Technique: Individual fascicle-to-fascicle repair
• Use: Primarily for major peripheral nerves outside oral cavity