The Trigeminal Nerve is the largest cranial nerve (CN V) and allows you to have sensation in your face. There are three branches and the one that gets the most attention is the third branch (Cranial Nerve V, 3rdBranch – CN V3). This nerve allows you to feel your lip, chin, teeth, gums, cheek, and tongue. It also has a role in taste. Loss of sensation may interfere with speaking, eating, drinking, tooth brushing, shaving, and smiling. It has the potential to impact nearly every social interaction that most people take for granted.

Despite the best of care practices, trigeminal nerve injuries are a known risk of oral surgical treatments. Injuries occur and in some cases are unavoidable. Recovery occurs in most, but not all Northern Virginia patients. Injury to nerves can also occur during trauma or resection of cancer.

Nerve Injuries can be classified, and recovery can be predicted. Depending on the injury and classification, nerve sensation can recover in days to weeks. In more severe classifications the recovery can be months and in some instances not at all.

The FIRST and most important step is to have Dr. Gocke performs a patient interview, physical exam, and a neurosensory testing exam to determine the classification or grade of injury.

A TIMELY referral and exam is crucial to success when microsurgery is required. If you have had numbness or pain that are not improving or getting worse for 30 days or more, then please schedule to see Dr. Gocke. Again, time is the most important factor affecting outcomes of trigeminal nerve injuries. Surgical intervention target dates should be within 90 days of the injury – odds of surgical improvement decrease by about 5.8% per month delay.


  • Spontaneous recovery occurs in SOME but not all Northern Virginia patients
  • Deficit >1 monthindicates high-grade injury with uncertain recovery
  • Nerves in soft tissue (Lingual Nerve, LN) have LOWER recovery rates than those in boney canals (Inferior Alveolar Nerve, IAN) (LN and IAN are branches of the trigeminal nerve)
  • Patients anesthetic at 3 months usually do not achieve recovery without microsurgery
  • Documentation with nerve testing and classification is mandatory
  • Timely referral for microsurgery provides the best chance for recovery

from HealthGrades.com
“We found Dr. Gocke to be excellent in treating my son, both on an emergency call to the ER and and then again when removing my son’s wisdom teeth. His treatments, manner, and staff are all first-rate.”

Why refer to a MICROSURGEON?

  • Serial examinations by the same experienced surgeon
  • Trial of medications, if indicated
  • Prompt microsurgery, if indicated
  • The best option for Northern Virginia patients to regain neurosensory function and quality of life

At Virginia Oral, Facial and Implant Surgery, our doctors are highly trained and qualified to treat facial injuries and facial trauma – specifically related to sensory nerve damage and the trigeminal nerve. Because Dr. Gocke believes it is important to stay on top of the latest technologies available to surgeons, they have recently invested in new technology, Avance® Nerve Graft, which is specifically designed to perform the precise task of restoring sensory nerves in the face.

Facial Sensation

The 5th cranial nerve is the only nerve in the face that provides facial sensations such as perception of touch, identification of sense origination, pain, and temperature. Within this one nerve, resides three branches. Each one of these branches provides sensation to a different area of the face – one in the forehead, one in the central area of the face, and one in the lower area of the face. If you have suffered trauma or injury to your face and have lost facial sensation asa result, then Dr. Gocke may be able to restore your facial sensation with the new Avance® Nerve Graft technology.

Avance® Nerve Graft

Avance® Nerve Graft is an off-the-shelf processed human nerve tissue, which is used to bridge two severed nerve endings and restore sensory nerves in Northern Virginia patients who have experienced trauma or injury. This new technology provides oral and maxillofacial surgeons the opportunity to offer their patients a better solution to their sensory nerve damage through a proprietary cleansing process. This cleansing process clears away cellular and noncellular debris from the nerve endings, and the tissue graft that is usedprotects the ECM (extracellular matrix) in the process. Avance® Nerve Graft can provide the ability to:

  • Reconnect nerve endings that have been severed using three-dimensional scaffolding,
  • Isolate and cleanse the ECM that, when healed, becomes the patient’s owntissue,
  • Avoid donor nerve surgery, and
  • Provide reconnection between nerve endings that have gaps in varying lengths and diameters.

AxoGuard® Nerve Connector

For Northern Virginia patients who have sensory nerve damage that is due to severed nerves that are separated by 5mm or less, Dr. Gocke has the ability touse the AxoGuard® Nerve Connector. This porcine submucosa (a type of thin layer of tissue) ECM connector gives patients’ bodies the ability to repair the nerve through its own natural healing process. The AxoGuard® Connector draws nerve endings back together while relieving tension, provides added strength to the connection site, and aids in the repair process as a whole.

The AxoGuard® Nerve Connector has several key advantages:

  • Protects the patient’s original structure of the ECM
  • Decreases the number of sutures needed
  • Reduces tension on the nerve endings
  • Provides a strong and reliable connection
  • Reduces the chances of nerve incompatibility

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AxoGuard® Nerve Protector

For patients of Virginia Oral, Facial and Implant Surgery in Northern Virginia who have a more substantial gap between damaged nerve endings, the AxoGuard® Nerve Protector is the solution to provide restoration of facial sensation. This porcine ECM is a surgical implant, rather than a coaptation aid, and is used to protect a patient’s injured nerves, reinforce the reconstruction of the nerve, while also isolating the nerve allowing protection from surrounding tissues. These benefits allow the patient’s owncells to be incorporated into the ECM and develop similar tissue to the nerve epineurium.
AxoGuard® Nerve Protector can:

  • Protect injured nerves up to 40mm
  • Decrease the risk of entrapment in compressed nerves
  • Provide protection topartially severed nerves
  • Strengthen a coaptation area

AxoGuard® Nerve Protector allows for nerve gliding, is strong and flexible, and protects the patient’s original structure of the ECM.

Virginal Oral, Facial and Implant Surgery Can Help

Sensory nerve damage is more common in America than you may think. More than 1.4 million people suffer nerve trauma each year, and of those, almost 900,000 need surgical attention. With today’s advances in microsurgery, and with the help of AxoGen’s® new technology, Dr. Gocke is able to avoid the traditional surgical methods of using donor nerves from his Northern Virginia patients, and instead can offer them a more precise treatment that provides better results, fewer complications, and an easier healing process.

If you are suffering from damaged nerves, reach out to Virginia Oral, Facial and Implant Surgery today to find out more about AxoGen® and Avance® Nerve Graft technology. You can reach our office in the Northern Virginia area by calling (703) 388-2805 to find out more about microsurgical nerve repair surgery!