Changing Perspectives: Why ENT Surgeons Should Consider Nerve Reconstruction

As ENT specialists, our mission should be treating patients, eliminating disease, and restoring our patients to their fullest selves whenever possible. In my years performing complex head and neck surgeries, I have seen that the procedure itself is only the beginning of a patient’s journey toward recovery. Many who reconstruct the mandible as part of cancer treatment and tumor removal often don’t prioritize the severed nerves, leading to a less full life for patients post-op, as they struggle with sensation loss.

We should consider our patients as more than just cases. They are people whose lives will be forever impacted by nerve loss, who will have lifelong issues with eating, speaking, and expressing themselves. As I have developed my practice, nerve reconstruction has become the standard as I seek to better equip my patients to face a more normal future. This procedure is far from the regular for my ENT peers, but it offers a chance for patients to recover nerve sensation, dignity, and quality of life in their recovery. For those who want to truly fulfill their mission to improve patients’ lives, this technique deserves a place in our standard of care.

Moving Beyond the Status Quo

Historically, our focus has been straightforward: Remove the malignancy, stabilize the bony scaffold, cover the tissue defect, and reduce potential complications. While this approach effectively achieves the core medical objective, it overlooks a critical aspect of recovery: a patient’s ability to return to everyday life with minimal impairment. Sensory loss following mandibular surgery leaves many patients with ongoing challenges, from drooling to difficulties in speaking, eating, and facial expression. In my early years of practice, I didn’t pay much attention to these issues; we were taught to accept numbness as an inevitable side effect of surgery.

Over time, patients began to express dissatisfaction with the numbness in their faces. Many described the constant “thick” feeling as similar to dental anesthesia—an unending state of disconnectedness from parts of their faces. For some, this was not just bothersome but deeply troubling, affecting social interactions and daily life. These interactions led me to investigate nerve reconstruction and eventually integrate it into my practice. Listening to patients goes hand in hand with seeing beyond the case and understanding more deeply the concerns of life beyond tumor removal.

Scientific Backing and Patient Benefits: Why It Matters

Nerve reconstruction in mandibular surgeries isn’t simply an add-on. Studies have shown that more than 80% of patients treated with a nerve allograft report sensory improvement and no adverse reaction. When we use nerve allografts to bridge the gap and reconnect affected sensory nerves, we allow the body’s natural regenerative processes to restore nerve function gradually. Patients report an incremental return of sensation, sometimes within the first few months after surgery. This restoration often continues for years, with patients regaining the ability to sense touch and temperature, while also enjoying a feeling of facial normalcy.

The benefits go beyond the physical sensation. Witnessing a patient’s smile when they finally become aware of both sides of their face is heartening. One of my patients, who regained tongue sensation after a lingual nerve reconstruction, shared how he could eat with greater ease and less self-consciousness. Though sometimes dismissed as secondary, such improvements are central to quality of life.

Overcoming Barriers: Efficiency and Team Approach

For some surgeons, the additional time required for nerve reconstruction is a barrier. In my practice, I’ve worked to reduce this impact by refining efficiencies within the surgical team. Our approach includes preparing the nerve for reconstruction during the ablative phase, ensuring a seamless transition from tumor removal to reconstructive efforts. This collaborative approach has allowed the team to streamline surgeries without compromising patient outcomes.

Surgeons can also benefit from a unified team capable of ablative and reconstructive work. For practices without this structure, I recommend coordinating closely between ablative and reconstructive teams. Having the ablative team prepare the nerve in advance can make a significant difference in surgical flow and the team’s overall comfort with the procedure. The additional microsurgical training required for nerve reconstruction may seem daunting, but with repetition and support, these skills become as natural as any other aspect of head and neck surgery.

An Ethical Responsibility to Restore, Not Just Repair

Surgeons have a responsibility not only to cure but to consider our patients’ long-term well-being. Some may view nerve reconstruction as an unnecessary extension of an already demanding procedure. I urge my colleagues to see it differently. When patients leave our care with intact sensation, they do so with a greater sense of completeness and dignity, less burdened by reminders of their disease.

Adopting nerve reconstruction is an investment in our patients’ futures and a commitment to our principles of patient-centered care. We must continue advancing our practices to serve our patients fully rather than stopping at what is most efficient.

A Call to Action for the ENT Community

Nerve reconstruction may still be unfamiliar to some, yet its benefits are tangible. ENT surgeons should explore the technique, read the research, and consider the profound differences it makes for patients. By prioritizing disease eradication and functional restoration, we position ourselves as true advocates for patient-centered care in head and neck surgery.

Incorporating nerve reconstruction need not disrupt our workflow or overburden our schedules. Through team efficiency and preparation, we can seamlessly integrate this life-altering step into our surgeries. As more consider making nerve repair and sensory restoration a standard part of mandibular reconstruction, our field will continue to evolve toward a more holistic approach to patient care. Let us extend our responsibility beyond the operating table.

Dr. Villaret is an otolaryngologist specializing in comprehensive adult and pediatric ENT care, head and neck cancer, and thyroid surgery, servicing the Charlotte, N.C., area. He is board certified by and is a member of the American Board of Otolaryngology.