Sensory Restoration of Trigeminal Nerve Territories V2 and V3 Using Nerve Transfers: A Systematic Review.

Introduction: Sensory function in the V2 and V3 territories of the trigeminal nerve is critical for facial sensation and quality of life. Injuries to these branches often result in significant sensory deficits, impairing daily activities. Nerve transfer techniques offer potential solutions for restoring lost sensation for patients with loss of proximal nerve stump, central pathway damage, or in the presence of large nerve gaps. However, they remain underutilized in clinical practice. Objective: This systematic review assesses the feasibility and effectiveness of nerve transfer techniques for sensory reconstruction of the V2 and V3 territories. Methods: A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted. Studies reporting sensory reconstruction outcomes, such as 2-point discrimination (2PD) or directional brush stroke detection, were included. Articles published from 2009 to 2024 were reviewed, alongside relevant references outside this timeframe providing important clinical insights. Ten studies meeting the inclusion criteria were analyzed, and their quality was assessed using PRISMA guidelines. Results: Sixteen patients (mean age: 32.1 years) and 24 repairs were identified. Trigeminal nerve injuries resulted from surgical complications (31.2%), trauma (25%), and oncological resections (18%) in most cases. Sixty-six percent of cases underwent cross-facial nerve grafts (CFNG), while the remaining repairs were reconstructed using regional nerve transfers. Recovery times varied, with a mean follow-up of 20.6 months. All patients achieved significant improvement in facial sensation and symptoms. Conclusion: CFNGs and nerve transfers are effective for restoring sensation in V2 and V3 territories, with promising recovery rates. Larger studies with extended follow-ups are needed to refine and validate these techniques.