Cyanoacrylate glue versus suture in peripheral nerve reanastomosis Reda F. Elgazzar, BDS, MSc, PhD, a Iman Abdulmajeed, BMS, MSc, PhD, b and Mohammad Mutabbakani, BMS, MSc, PhD, c Damman, Saudi Arabia, Tanta and Alexandria, Egypt KING FAISAL UNIVERSITY Objective. To assess the effectiveness of n-butyl-2-cyanoacrylate glue compared with microsuturing technique in peripheral nerve reanastomosis in rats. Study design. Fourteen young adult white rats were used. Bilateral sciatic neurotomies were performed in 12 of them and then reanastomosed with 3 epineural microsutures in the right side (study group G1) and with n-butyl-2- cyanoacrylate glue in the left side (study group G2). On the remaining 2 rats (control group G3), sham surgery was done on both sides. Biopsies were harvested 12 weeks after surgery and examined under light microscope using Osmic acid stains. The number of nerve fibers was counted in the distal and proximal nerve segments, and the results were analyzed and compared in all groups. Results. Adequate regeneration with no anastomotic ruptures was seen 12 weeks after surgery in G1 and G2. The histomorphometric assessment showed no statistically significant difference (P = .960) in the neurotization index of G1 (89.01%) compared with G2 (88.97%). There was a significant (P = .001) reduction in the mean number of axon counts distal to the repair in G1 (271.3) and G2 (272.8) compared with that of the proximal segments of each study group (304.6 and 303, respectively, as well as to that of G3 (348.5). Conclusion. Both n-butyl-2-cyanoacrylate adhesive and 3-microsuture techniques showed comparable neurotization indices and were equally adequate to stabilize the nerve during regeneration period. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:465-72) Involvement of, and damage to, the peripheral nerves in the head and neck, including inferior alveolar, lingual, facial, and hypoglossal nerves, can occur from a num- ber of causes. These include maxillofacial trauma, involvement by neoplastic growth and dentoalveolar surgery particularly, surgical removal of the lower third molar, implant placement, and injection of local anes- thesia. Although this phenomenon is rare, the resulting sensory and motor dysfunctions are unacceptable. Re- ports suggest that, under normal conditions, spontane- ous nerve fibers’ healing can be expected within a few weeks or months. However, some cases may in fact require surgical intervention. 1-4 Several techniques of peripheral nerve repair exist, in- cluding microsuturing, gluing, 6,7 tabulation, 8 grafting 9 (al- lograft, autograft), and laser welding. 10 Although the ideal technique has yet to be developed, several principles for nerve repair are accepted. 11 These principles include: 1) The repair should limit fibrosis and inflammation, which may interfere with axon sprouting and produce misdirec- tion of the nerve fibers; 2) accurate anatomic approxi- mation of the nerve stumps should be achieved without tension or gapping to permit regenerating axons to cross a Associate Professor, Oral and Maxillofacial Surgeon, College of Dentistry, King Faisal University, Damman; and Faculty of Den- tistry, Tanta University. b Associate Professor, Department of Anatomy and General Histol- ogy, Faculty of Medicine, Alexandria University, Egypt; Department of Anatomy and General Histology, College of Medicine, King Faisal University. c Associate Professor, Chairman of the Department of Anatomy and General Histology, College of Medicine, King Faisal University. Received for publication Sep 19, 2006; returned for revision Dec 18, 2006; accepted for publication Jan 11, 2007. 1079-2104/$ - see front matter © 2007 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2007.01.019 465 Vol. 104 No. 4 October 2007 ORAL AND MAXILLOFACIAL SURGERY Editor: James R. Hupp