Orofacial pain related to traumatic neuroma in a patient with multiple TMJ operations

Yasumitsu Kodama, Kenji Seo, Takafumi Hayashi, Takanori Kobayashi, Masahiro Niwano, Takahiro Koyama, Masaaki Murayama, Ritsuo Takagi
Cranio: the Journal of Craniomandibular Practice 2012, 30 (3): 183-7
The diagnosis of orofacial pain associated with temporomandibular disorders after repeated temporomandibular joint (TMJ) surgeries can be quite difficult. This case report describes a 52-year-old woman who had previously undergone five TMJ surgeries and developed divergent pain caused by a trigger point in the left preauricular area. Computed tomography and magnetic resonance imaging could not be used to identify a lesion because of metallic artifacts from a TMJ prosthesis. However, sonography indicated the location of the suspected lesion. Moreover, a neurological examination performed with local anesthesia was clinically effective in ruling out other diagnoses of orofacial pain. Ultimately, a histopathological examination of a biopsy specimen from the painful site confirmed the lesion to be a traumatic neuroma. This case report suggests the value of including traumatic neuroma in the differential diagnosis of patients with a history of previous TMJ surgery who present with orofacial pain in the region of the TMJ.

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