Traumatic neuroma
| Traumatic neuroma | |
|---|---|
| Other names | Amputation neuroma or Pseudoneuroma[1] |
 | |
| Specialty | Neurology |
A traumatic neuroma is a type of neuroma which results from trauma to a nerve, usually during a surgical procedure. The most common oral locations are on the tongue and near the mental foramen of the mouth.[2] They are relatively rare on the head and neck.[3]
Pathophysiology
An essential step in the formation of a traumatic neuroma is injury to the perineurium. The perineum directs the growth of axons by acting as a surface that the axons cannot go through. If the perineurium is compromised, the axons may escape into the extraperineural space and arborize in an unregulated fashion.[4]
Prevention
Many surgeries have nerve injury as an unavoidable consequence such as limb amputation, nerve resections, or radical prostatectomy. Consequently, surgical techniques to reduce accidental nerve injury (nerve sparing techniques)[5][6] and reduce the likelihood to develop traumatic neuromas[7] have been researched. Targeted muscle reinnervation (TMR) is a promising technique used clinically that has significantly improved various benchmarks of quality of life such as pain free patients, residual limb pain, phantom limb pain, opioid use, and ambulation.[8] TMR involves the transfer of proximal nerve stumps to nearby muscle and was originally developed to improve prosthetic control. A newer, related technique is taking a muscle graft and moving it to the divided end of the peripheral nerve, called a regenerative peripheral nerve interface (RPNI). RPNI also significantly reduces the incidence of neuroma formation for amputation.[9]
See also
References
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
- ^ Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
- ^ Lee EJ, Calcaterra TC, Zuckerbraun L (1998). "Traumatic neuromas of the head and neck". Ear, Nose, & Throat Journal. 77 (8): 670–4, 676. doi:10.1177/014556139807700816. PMID 9745184. S2CID 11599827.
- ^ Zabaglo M, Dreyer MA. Neuroma. [Updated 2022 Nov 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549838/#
- ^ Michl U, Tennstedt P, Feldmeier L, Mandel P, Oh SJ, Ahyai S, Budäus L, Chun FKH, Haese A, Heinzer H, Salomon G, Schlomm T, Steuber T, Huland H, Graefen M, Tilki D. Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy. Eur Urol. 2016 Apr;69(4):584-589. doi:10.1016/j.eururo.2015.07.037 Epub 2015 Aug 12. PMID 26277303.
- ^ Tavukçu HH, Aytac O, Atug F. Nerve-sparing techniques and results in robot-assisted radical prostatectomy. Investig Clin Urol. 2016 Dec;57(Suppl 2):S172-S184. doi:10.4111/icu.2016.57.S2.S172 Epub 2016 Dec 8. PMID 27995221; PMCID: PMC5161020.
- ^ Scott BB, Winograd JM, Redmond RW. Surgical Approaches for Prevention of Neuroma at Time of Peripheral Nerve Injury. Front Surg. 2022 Jun 27;9:819608. doi:10.3389/fsurg.2022.819608 PMID 35832494; PMCID: PMC9271873.
- ^ Chang BL, Mondshine J, Attinger CE, Kleiber GM. Targeted Muscle Reinnervation Improves Pain and Ambulation Outcomes in Highly Comorbid Amputees. Plast Reconstr Surg. 2021 Aug 1;148(2):376-386. doi:10.1097/PRS.0000000000008153 PMID 34398088.
- ^ Kubiak CA, Kemp SWP, Cederna PS, Kung TA. Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain. Plast Reconstr Surg. 2019 Sep;144(3):421e-430e. doi:10.1097/PRS.0000000000005922 PMID 31461024.
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