A diffuse traumatic neuroma in the palate: a case report

Abstract

BackgroundA traumatic neuroma is not a true neoplasm but a reactive proliferation of neural tissue that commonly occurs after the transection or damage of a nerve bundle. Traumatic neuromas are rare in the oral region and usually occur as a solitary nodule of the mental foramen, lower lip, or tongue. This is the first report of a diffuse traumatic neuroma of the palate.Case presentationA 30-year-old Japanese man was referred to our clinic complaining of painful swelling of the left side of his palate. The swelling was diffuse and his pain increased with palpation of his palate. He had no noteworthy medical or family history, and was not aware of any history of trauma or inflammation in his head or neck area. We administered antibiotics and non-steroidal anti-inflammatory drugs because we suspected that his symptoms were the result of inflammation caused by an infection. However, his symptoms did not change. An incisional biopsy was performed, and histopathologic examination indicated that the lesion was a traumatic neuroma. Under general anesthesia the lesion was resected with a 5-mm margin using an electric scalpel because of the diffuse expansion and indistinct borders of the mass. Some tumor cells were observed within the surgical margins of the resected specimen, but there has been no recurrence of either the pain or mass in the 3 years since the surgery.ConclusionsThe location and diffuse nature of this traumatic neuroma are both very rare. While we were initially unsure about the diagnosis and treatment of this mass, the treatment outcome has been good. However, a postoperative recurrence can occur at any time following the excision of a traumatic neuroma, and close long-term follow-up will continue.

Sağ mental forameni içeren travmatik nöroma

“…Cahn in 1939 reported the first traumatic neuroma occurring in the mental foramen. Usual intraoral sites are the mental foramen as was in this case, lower lip and tongue; with some rare reports in the palate 4,5 . These lesions occur at any age, but are frequently diagnosed in young and middle-aged females.…”

The Paramedian Forehead Flap: A Retrospective Clinical Model for Understanding the Connection Between Supraorbital and Supratrochlear Nerve Pathology and Headaches

“…While incidence of painful neuromas in the upper and lower extremities ranges from 4% to 26%, neuroma incidence rates in the head and face are largely unknown, described only as case reports. [29][30][31][32][33] In a retrospective analysis, Wolvetang et al identified 598 patients who underwent primary neuroma surgery, finding that secondary operations were performed for 7.8% of patients, with excision alone or excision with implantation into bone and muscle having higher rates of secondary surgeries compared to excision and direct neurorrhaphy with or without a nerve graft. 32 These data can be taken into consideration when approaching potential neuroma formation from PMFF and SON manipulation, and excision as a form of treatment.…”

“…[29][30][31][32][33] In a retrospective analysis, Wolvetang et al identified 598 patients who underwent primary neuroma surgery, finding that secondary operations were performed for 7.8% of patients, with excision alone or excision with implantation into bone and muscle having higher rates of secondary surgeries compared to excision and direct neurorrhaphy with or without a nerve graft. 32 These data can be taken into consideration when approaching potential neuroma formation from PMFF and SON manipulation, and excision as a form of treatment. Furthermore, future assessment of the PMFF study population for neuroma formation and resection could provide a new understanding of neuroma incidence and pathophysiology after surgery, particularly when compared to the extremities.…”

Neuroma mentoniano traumático. Reporte de caso clínico

“…Según Eguchi y cols. mencionan que existen NTs con límites difusos que impiden su resección quirúrgica respetando la vaina nerviosa; por lo que puede resultar en un daño neurológico severo, como un área de hipoestesia y parálisis nerviosa 3 , o como en nuestro caso anestesia debido a la imposibilidad anatómica de ser resecado de forma simple y conservadora como lo refieren Sayan y cols. y Chau y cols.…”

“…Si estos elementos regeneradores encuentran tejido cicatricial o no pueden restablecer la inervación, entonces puede desarrollarse una masa tumoral en el lugar de la lesión 1 . Dentro de las patologías que se asemejan a los neuromas traumáticos (NTs), encontramos al neuroma mucoso, neurofibroma, neuroma en empalizada y el hamartoma neurovascular 3 .…”