Traumatic Neuromas of the Oral Cavity

What Are Traumatic Neuromas of the Oral Cavity?

Traumatic neuromas in the oral cavity are either surgically induced or as a result of trauma that can give the patient moderate to severe oral pain, numbness, burning sensation, or discomfort. Traumatic neuroma in the oral cavity is primarily a benign lesion in response to oral trauma or injury. However, it most often would also result from a reaction to a previous surgical procedure within the oral cavity.

Traumatic neuromas may be caused in response to minor injuries when the oral host immunity gives a state of the altered inflammatory immune response to undesirable traumatic or surgical stimuli such as anesthetic failure or incorrect technique, or iatrogenic errors during dental procedures. In the oral cavity, the traumatic neuromas most commonly occur in the locations of the lips, tongue, or gingiva.

What Are the Clinical Features of Oral Traumatic Neuromas?

Clinically, these traumatic neuromas may be present in the oral mucosa as a small, firm nodule that may be painful or may cause some discomfort. These lesions might be accidental finding to the dentist or may be presented as nodular lesions with or without pain. The clinical manifestations or symptoms are usually spontaneous and would be triggered post the traumatic impact on the specific oral site. However, most case reports suggest that traumatic neuromas are painless. Per case reports and dental research, the most common oral region is the mental foramen area (the premolar region). This area would be most commonly affected by this condition owing to either traumatic tooth extraction or considerable trauma from an ill-fitting prosthesis or denture. Some patients suffering from neuromas may also complain of post-operative numbness, which may occur along the nerve distribution. When the nerve that is usually distal to the affected or impacted site is involved, the feeling of numbness is expected in the patient.

Other oral locations include the tongue, the lower lip region, etc. Intraosseous lesions are also common and may be observed radiographically as radiolucent defects on routine oral radiographic imaging like OPG (orthopantomogram) and IOPA (intraoral periapical radiography).

Current research also indicates that there may be many unusual cellular entities clinicopathologically in association with traumatic neuroma that would co-occur within the oral cavity, such as :

• Granular cell tumors of the oral cavity or the submandibular salivary gland.

• Certain intralesional glandular or submucosal alveolar lesions in association with neuromas.

• Sometimes even the residual or minor salivary gland ducts may be affected when a traumatic neuroma involves the glands.

What Are the Microscopic Features of Oral Traumatic Neuromas?

On microscopic examination, these lesional cells are a constitution of proliferated nerve fascicles. These nerve bundles are usually embedded in a matrix of collagen. The histopathologic examination shows that the cell arrangements are haphazard, comprising numerous small nerve bundles. These bundles contain axons, Schwann cells, perineurial cells, etc., while fibrosis is present in the surrounding areas without any other reactive changes, like myofibroblastic cell proliferation.

What Are the Systemic Manifestations of Oral Traumatic Neuromas?

Research also shows that it is not uncommon for a traumatic oral neuroma to stimulate oral or orofacial pain in the patient. Limited case records also show that oral cavity neuromas may be responsible for further causing conditions like atypical facial pain or trigeminal neuralgia. Oral neuromas may also be associated with the MEN2B syndrome (multiple endocrine neoplasias 2B) and may need systemic and endocrine management by the physician.

How To Differentiate Neurofibroma From Traumatic Fibroma?

The dentist should always distinguish a traumatic neuroma from a neurofibroma which may pose a confusing challenge to the physician. In contrast to neuromas, neurofibromas are always usually deep-rooted lesions and do not particularly have a site-specific predilection in the oral cavity or mucosa. Neurofibromas are persistently growing, or expansile oral lesions and hence need to be distinguished based on clinical features from traumatic neuromas.

What Are the Treatment Strategies For Oral Traumatic Neuromas?

Treatment for a traumatic neuroma includes timely oral diagnosis and management, mainly through complete surgical excision with preservation of vital anatomic structures. Complete excision is the most recommended mainstay treatment for removing traumatic neuromas of the oral cavity by the oral and maxillofacial surgeon.

The excisions may also include small portions of the proximal nerve bundles to prevent further recurrence of the lesion. Most such lesions do not recur, although some patients may report recurring lesions at the same site again with persistent pain or discomfort.

Conclusion

To conclude, traumatic neuromas should be investigated for possible oral and systemic links and should be distinguished from similar appearing lesions like neurofibromas. Timely management helps the patient be relieved of oral pain or discomfort, and excision of these lesions renders a good prognosis.