Tender Nasal Traumatic (TNT) Neuroma: Case Report and Review

A traumatic neuroma occurs at the injury site of a peripheral nerve; however, albeit rarely, this variant of a neuroma can involve a nerve that has not experienced penetrating trauma. A lower extremity amputation stump is the most common location of a traumatic neuroma. Traumatic neuromas may be symptomatic; tumor-associated pain can be severe and significantly affect the patient's quality of life. Several hypotheses have been postulated for the pathogenesis of neuroma-related pain, including alpha-smooth muscle actin, neural fiber structural changes, nerve growth factor, and/or sensitization of the affected nerve. In addition to prevention, non-surgical treatment (such as chemical interventions, cryotherapy, neuromodulation, pharmacologic agents, and physiotherapy) and surgical interventions (such as direct nerve repair at the time of injury or ligation of the nerve proximal to the neuroma and various potential methods to minimize subsequent irritation of the distal free end of the proximal nerve) have been used to manage neuroma-associated pain. A traumatic neuroma of the nose is rare. Indeed, it has only been described in three individuals: two women (including the Caucasian woman in this report and a Turkish woman) and one man. The benign tumor was extremely painful in both women; however, the man's lesion was non-tender. Prior trauma to the nasal site included either a laceration or elective surgery; however, the reported woman did not experience any penetrating trauma to her nose. The diagnosis was established following an excisional (for the man), incisional (for the Turkish woman), or punch (for the Caucasian woman) biopsy. Follow-up was provided for two of the patients. The man's neuroma had been completely excised, and he never developed tumor-associated tenderness. However, the pain persisted after the biopsy healed for the reported woman whose neuroma was not entirely removed. The explosive and markedly severe character of the reported patient's lesion-related tenderness prompted us to propose an acronym for this uncommon yet exquisitely painful variant of a neuroma: tender nasal traumatic (TNT) neuroma.