Maxfacts

Damage affecting the cranial (head) and cervical (neck) nerves is a hugely diverse range of conditions, with many different underlying causes. Yet, these diverse neuropathy conditions have many common aspects.

Firstly, with nerve damage come signs and symptoms that can be extremely distressing.

Secondly, the spectrum of treatment modalities to deal with nerve damage is much less diverse:

• for a fair number of neuropathies, treatment and resolution of the underlying condition also addresses, and often resolves, issues arising from accompanying nerve damage;
• medical management of neuropathies, particularly underlying pathologies and dysfunctions and options to moderate pain is described on our pages discussing pain;
• surgical treatment of neuropathy is quite limited.

If abnormal sensation is a symptom after trauma to soft and/or hard tissue or surgical intervention and does not respond to non-invasive treatment after three months, surgical exploration and microscopic examination of the nerve is worthwhile. If the nerve is embedded in scar tissue, dissecting away the constricting scar tissue (neurolysis) can have astonishingly good results.

If the nerve has been partially cut, it can be microscopically repaired by direct suturing.

If it has been completely divided, then either excision of the scar at the ends of the nerve and mobilisation to reduce tension on the suture line and primary repair, or a graft using a short section of autologous (own body) nerve which has a tolerable donor site defect (for example, the sural nerve, a sensory nerve in the calf of the leg, or the greater auricular nerve from the front area of the ear) are established repair methods. Micro-surgical methods to repair nerve damage are described in more detail on the following page.

In experimental cases, using a variety of collagen tunnels to attempt to regrow axons (nerve connections) across the divided nerve endings may improve matters.

It is vital to understand that once a nerve has been structurally damaged – even by compression or constriction – a full return to previous function is unlikely. The best results come with neurolysis. Direct suturing repair of a partially cut nerve may regain 80 % function, but a 50 to 60 % return to function for a completely divided nerve or a nerve graft would be regarded as an outstanding success.

With nerve damage and neuropathy treatment, keeping expectations realistic is essential.