Advances in peripheral and maxillofacial nerve reconstruction: a narrative review

Background and Objective: Peripheral nerve injuries (PNIs), including those affecting the oral and maxillofacial region, frequently result from trauma, tumor resection, or iatrogenic causes, leading to substantial functional impairment and reduced quality of life. Established surgical strategies—such as end-to-end neurorrhaphy, autografts, allografts, nerve transfer, and nerve guidance conduits—remain the mainstay of treatment. In addition, several adjunctive and emerging approaches—electrical stimulation, exosome-based therapies, and bioengineered conduits, are in rapid development, with many still at the preclinical stage. Since no former review has integrated repair strategies for peripheral and maxillofacial nerve injuries within a single framework, we combined them and aiming to find points for reference to support clinical decision-making.

Methods: The literature search was performed on PubMed, Embase, and Medline databases using a combined search strategy of MeSH terms and free-text keywords for both peripheral and maxillofacial nerve injuries, limited to studies published from January 10, 2020 to February 12, 2026. Priority was given to clinical trials and systematic reviews. Studies were excluded if they were non-human, non-English, incomplete clinical trials, or not available. Additional relevant studies on emerging technologies (e.g., stem cells, exosomes, additive manufacturing) were identified through supplementary searches and citation chasing.

Key Content and Findings: This review summarizes common peripheral nerve repair strategies, including end-to-end neurorrhaphy, autografts, allografts, nerve transfer, nerve guidance conduits, and adjunctive methods such as electrical stimulation. Their respective advantages, disadvantages, and clinical status are presented in a concise table for easy reference. For maxillofacial applications, specific techniques for facial nerve and inferior alveolar nerve repair are discussed, with emphasis on anatomical considerations and clinical outcome data derived from systematic reviews and randomized controlled trials.

Conclusions: For both maxillofacial and other peripheral nerves surgeries, less invasive, relatively conservative approaches such as end-to-end anastomosis and neurolysis should be prioritized, and repair should ideally be completed within the six-month golden window for facial nerve surgeries. Electrical stimulation is an effective adjunct, yet its optimal parameters still depend on the expertise of experienced clinicians. When nerve transfer is required, a donor-to recipient ratio greater than 0.7:1 is generally recommended. For Bell’s palsy, corticosteroid therapy is effective but it has little use in limb nerve repair.