Traumatic neuroma and scar tissue

Deng et al. descibed a case of 29-year-old female complaining of numbness in in the region of the left lower lip and chin, based on previous iatrogenic trauma during chin augmentation with alloplastic material based on solid silicone and subsequent development of traumatic neuroma . In their case, the patient did not agree to complete removal of the tumor with the nerve and subsequent nerve transplantation, so only part of the traumatic neuroma was removed for microscopic verification of the tumor character .

This case report is of particular interest to our group, examining the mechanism of traumatic neuroma development. We previously postulated that traumatic neuroma development involves simultaneous nerve repair and defensive mechanisms (i.e. reactive proliferation of perineurial cells) in the region of concomitant wound and scar contraction . Moreover, the treatment strategy was recommended to be targeted towards disruption of the proposed “easily violable balance between nerve regeneration and damage” to obtain a long-term treatment effect . This hypothesis is in accordance with clinical findings that transposition of the nerve stump away from the future scar tissue, most effectively into venous lumen, prevent the development of traumatic neuroma .

In case of Deng et al 2 , if the neuroma development will progress in future, it might be necessary to put it away from the incisional area by transposition or bone grafting around the traumatic neuroma to prevent the ingrowth of scar tissue into neuroma proximity. However, the best resolution would be to remove the whole neuroma and graft the nerve, as proposed by authors, but again to prevent ingrowth of scar tissue into close proximity of sutured nerve stumps.

Funding

None

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Feb 8, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Traumatic neuroma and scar tissue
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