Traumatic neuroma of the lower lip with intraepithelial nerve fibers

Venipuncture-related traumatic neuroma of the ulnar nerve on the dorsal of a hand: A case report

A large number of venipunctures are placed on the dorsal of the hand, and it is suitable for the majority of patients with the advantage of few complications. Here, the ulnar nerve on the dorsal was injured during peripheral intravenous catheter insertion, and a painful traumatic neuroma was discovered a week later. Through oral medication and topical lidocaine medicated plaster, the patient's pain is greatly reduced, and allowed to engage in nearly all activities. Knowledge of this complication may help with its recognition and early treatment.

Trigeminal Traumatic Neuroma: a Comprehensive Review of the Literature Based On a Rare Case

PURPOSE OF REVIEW

Traumatic neuromas in general, and trigeminal traumatic neuromas in particular, are relatively rare entities originating from a damage to a corresponding nerve or its branches. This manuscript is a comprehensive review of the literature on trigeminal traumatic neuromas based on an interesting and challenging case of bilateral intraoral lesions.

RECENT FINDINGS

The diagnosis for this patient was bilateral trigeminal traumatic neuromas. It is possible that these patients have a genetic predisposition to the development of these lesions. It is a neuropathic pain condition and may mimic dental and other trigeminal pain entities. Topical treatment with lidocaine gel, utilizing a custom-made neurosensory stent, rendered the patient significant and sustained pain relief. Trigeminal traumatic neuromas present a diagnostic challenge even to a seasoned clinician, due to the complex clinical features that may mimic other entities. Topical medications such as local anesthetics may be a good viable alternative to systemic medications to manage the pain associated with the condition. Early identification of the lesion and the associated pain helps in the succinct management of symptomatic trigeminal traumatic neuromas.

Modified bacterial cellulose tubes for regeneration of damaged peripheral nerves

INTRODUCTION

The subject of the experiment was bacterial nanocellulose, a natural polymer produced by bacteria - Gluconacetobacter xylinus. Following a specific modification process a cartilage-like material for restoration of damaged tissues may be produced. The obtained implants with excellent biocompatibility, mouldability, biophysical and chemical properties perfectly fit the needs of reconstructive surgery. The goal of the experiment was to develop and analyze cellulosic guidance channels in vivo for the reconstruction of damaged peripheral nerves.

MATERIAL AND METHODS

The experiments were conducted on Wistar rats, femoral nerve. Cellulose was produced according to a self-patented method. In the experimental group tubulization was applied, whereas in the control traditional end-to-end connection was used. Observation time was 30, 60, 90, and 180 days. Results evaluation included histological analysis and postoperative observation of motor recovery.

RESULTS

The overgrowth of connective tissue and disorganisation of neural structures was evident in 86.67% of control specimens, while for cellulosic group it was only 35% (p = 0.0022). Tubulization prevented the excessive proliferation of connective tissue and isolated from penetration with scar tissue. Autocannibalism, being probably an evidence of neurotrophic factors amassment, was observed in cellulosic group but not in the control one. Motor recovery did not differ significantly (p > 0.05). Biocompatibility of implants was affirmed by very small level of tissue response and susceptibility to vascularisation.

CONCLUSIONS

Cellulosic neurotubes effectively prevent the formation of neuromas. They are of very good biocompatibility and allow the accumulation of neurotrophic factors inside, thus facilitating the process of nerve regeneration.

Mechanism of traumatic neuroma development

We suggest that symptomatic traumatic neuromas - benign lesions of incompletely understood etiology - develop when neural fiber regeneration occurs in the presence of excessive fibrous tissue proliferation. Subsequent contraction of wound and scar myofibroblasts leads to compression of the regenerating nerve fibers and further stimulation of the overgrowth of their perineurial cells as a protective response. This chronic process leads to a slow enlargement of the proliferating mass and the typical histological picture of a traumatic neuroma, in which multiple interlacing fascicles of nerve fibers are encased in condensed fibrous tissue. To avoid the development of a traumatic neuroma, we propose that an injured or a transected nerve should be placed out of the site of potential excessive fibroproduction and/or that all external factors leading to excessive fibroproduction development be eliminated from the wound site.