Dental amputation neuromas

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.

Extraosseous and intraosseous oral traumatic neuromas and their association with tooth extraction

Tooth extraction has been suggested as the most common etiologic factor in the development of oral traumatic neuroma, but intraosseous lesions are stated to be rare. The clinicopathologic features of 45 oral traumatic neuromas are reviewed. Fifteen cases were painful. Inflammatory infiltrate was present in 53% of the painful cases in contrast to only 17% of asymptomatic neuromas, and was the only light microscopic feature significantly related to the incidence of pain. Eleven of 45 cases were found in an intraosseous location. Four of 45 reviewed neuromas were associated with extractions. All 4 cases were painful and 2 of them were in an intraosseous location. Only 3 of the 15 painful cases and 2 of the remaining asymptomatic 30 cases had a tentative clinical diagnosis of traumatic neuroma before removal.

Traumatic neuroma following sagittal mandibular osteotomy

A case of painful traumatic neuroma, arising from the inferior alveolar nerve after sagittal osteotomy of the mandible with demonstrable radiological change, is reported. The co-existence of temporomandibular joint (TMJ) pain-dysfunction syndrome and a painful traumatic neuroma had posed diagnostic problems. Some modifications of the surgical technique are discussed with a view to minimizing damage to the inferior alveolar nerve during sagittal osteotomy of the mandible. The aetiology, clinical features, diagnosis and treatment of traumatic neuromas are reviewed.

Traumatic neuroma following sagittal split mandibular osteotomy

A 23-year-old female patient had a sagittal split mandibular osteotomy performed to correct prognathism. Two years after surgery she developed pain in the distribution of the right inferior dental and mental nerves. The area was investigated surgically and a traumatic neuroma was excised.

Neuro-histological reactions following tooth extractions

The neuro-histological reactions after tooth extraction were investigated in the extraction alveolus, the mandibular nerve and the trigeminal ganglion. In the ganglion, nerve cell bodies showing signs of retrograde reaction (chromatolysis and nuclear displacement) were seen 12 h after extraction. Maximal number of reacting cells were registered in the first postoperative week. Three weeks after extraction the number of reacting cells were at a normal low level. In the mandibular nerve no signs of axon degeneration could be demonstrated. In the alveolus, initial traumatic axon degeneration was followed by regeneration 2 days after extraction. Within the first postoperative week the alveolus was filled with connective tissue, in which many long thin axons were seen. Cancellous bone then filled the alveolus; the axons were thereby gathered - concentrated - into fascicles in the central part, with a direction towards the limbus. However, this was only passed by very few axons. Four months after extraction signs of axon degeneration were seen, and 2 months later the myelin sheaths also displayed degenerative signs. Ten months after extraction a minor area of connective tissue with a content of few axons and vessels was found at the bottom of the former alveolus. The histological appearance was of a small traumatic neuroma.

Neural tumors of the oral cavity. A review of the spectrum of benign and malignant oral tumors of the oral cavity and jaws

The clinical and histologic features of benign and malignant neural tumors of the oral cavity and jaws are reviewed. Some rarer histologic variants are mentioned. Particular attention is paid to the two syndromes involving neural tumors of the oral cavity, namely, neurofibromatosis and multiple endocrine neoplasia III. A previously unreported case of the latter is presented.

Painful traumatic neuromas in the oral cavity

Traumatic neuromas in facial pain are characterized by a history of surgery at time of onset and by pain of an atypical neuralgic or nonneuralgic type with a stinging, burning, or paresthetic character. Pressure on the suspected area provokes pain, and localized analgesia relieves the pain. In six cases out of seven diagnosed clinically according to these criteria, excision biopsy revealed traumatic neuroma. One week postoperatively all patients were improved. One to 3 years later four patients out of six were still satisfactorily improved. In cases of painful oral traumatic neuromas where conservative measures have failed, a single excision then seems justified.