AB191. SOH24AB_144. Direct nerve repair in paediatric facial trauma

Background: A 10-year-old boy was referred to the national maxillofacial unit following a kick from a horse to his face. This resulted in a comminuted mandibular fracture, dentoalveolar fracture to right maxilla, extensive facial laceration and transection of his right mental nerve.

Methods: Computed tomography (CT) facial bones and 3D reconstruction demonstrated the extent of the fracture. Pre operatively there was complete anaesthesia of the lower right lip and chin. Examination under anaesthesia demonstrated total transection of the mental nerve, conforming a neurotmesis injury. Direct repair of the nerve was performed by approximating the transected nerve ends and suturing of the epineurium. The fracture was reduced and fixated with miniplates and facial laceration repaired.

Results: The patient was reviewed clinically in the outpatient department at 1, 2 and 3 weeks post operatively. During this time frame, he started recognising slight touch, pressure and cold. This was then objectively proven by him being able to determine direction of touch and differentiate between sharp and blunt pressure.

Conclusions: This patient is showing signs of recovery at a very early stage of direct repair. This seems unusual. The repair was performed less than 24 hours from the injury and there was no crush injury. The wound was covered keeping it moist preventing desiccation. The nerve was repaired without any tension at all. These factors may have contributed to neurogenesis leading to this unusual result. Other possibility is the collateral innervation from the cervical plexus. However, long term follow up is necessary to conclude the final outcome.

Keywords: Maxillofacial; neurogenesis; neurotmesis; paediatric; trauma