Intraoperative Nerve Protection
Ryles Tube
Nerve Sleeve
A near zero cost 360° nerve shield repurposed from a sterile nasogastric tube protecting the IAN during mandibular osteotomy.
★ Technical Note under review — JOMS · 6 month follow up: intact IAN function
Operative Illustration Panels — Ryles Tube Nerve Sleeve Technique for IAN Protection
The Problem
Inferior alveolar nerve (IAN) injury during mandibular osteotomy causes transient neurosensory deficits in up to 37% of cases. Piezoelectric systems reduce this risk but are unaffordable in resource limited settings. Conventional vessel loops provide protection on one surface only.
The Solution
A sterile Ryles nasogastric tube, universally stocked at near zero cost, slit longitudinally and placed as a 360° circumferential nerve shield sleeve. Formalised into a reproducible protocol with a French size selection table matched to published IAN canal diameters. Applied intraoperatively: fully intact IAN sensory function at 6 month review.
Biodesign Stage Progress
| Code | Stage | Status | What Was Done |
|---|---|---|---|
| 1.2 | Needs Exploration | ✓ Complete | IAN injury risk during osteotomy identified as high stakes unmet need in resource limited centres |
| 1.3 | Need Statement | ✓ Complete | Surgeons need a low cost, reliable, 360° nerve protection method during IAN transposition |
| 2.2 | Existing Solutions | ✓ Complete | Benchmarked against vessel loops and piezoelectric systems; key gaps identified |
| 3.1 | Ideation | ✓ Complete | Conceived Ryles tube as circumferential nerve sleeve, repurposing stocked theatre consumable |
| 3.2 | Concept Selection | ✓ Complete | French size selection protocol developed; failure modes identified and mitigated |
| 4.5 | Prototyping | ✓ Complete | Technique applied intraoperatively: 6 month follow up confirms intact IAN function |
| 4.6 | Concept Testing | ✓ Complete | Clinical outcome validated; reproducible protocol with sizing table documented |
| 5.1 | IP Strategy | ► Active | Patent landscape review pending; manuscript under review at JOMS |
| 5+ | Implementation | ○ Pending | Multicentre prospective study, regulatory classification, and adoption strategy to be developed |