American Society for Peripheral Nerve

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Painful Neuroma after Cosmetic Surgery: Diagnosis and Treatment
Giorgio Pietramaggiori, MD, PhD; Wassim Raffoul, MD ; Saja Scherer, MD
Plastic Surgery Department, University Hospital of Lausanne, Switzerland, Lausanne, Switzerland

Introduction :Temporary numbess or loss of feeling are quite common and often transient complications after aesthetic surgery. Chronic neuropatic pain occurs rarely and can become a serious challenge for both the surgeon and the patient. We here report three cases of painful neuromas after cosmetic surgery.

Methods: From a review of the patients of our peripheral nerve clinic, we selected three with painful neuromas after aesthetic surgery (one after upper blepharoplasty and two after breast augmentation). All patients were referred to us by their pain doctors. We here describe the common findings in the history and management.

Results: Patients developed pain soon after surgery. The patients consulted back their surgeon several times for persisting pain (daily from 6/10 to 8/10) without any sign of healing problems. Despite attempts to control the pain with several strategies ranging from ergotherapy (desensitization), scar massage, anti-inflammatory drugs and anti-pain drugs, pain could not be controlled several months after the operation. Two of four patients agreed in accepting psychiatric support with no improvement. They reported dramatic deterioration of quality of life. Patients were then referred to our clinic where we found tinel sign close to the scars and an ultrasound guided lidocaine test resulted in complete resolution of pain (0/10). Patients were taken to the operation room where we found a neuroma of the zygomatico-temporal branch of the trigeminal nerve (ZTBTG, post superior blepharoplasty) and two intercostal neuromas (post breast augmentation). Neuromas were excised and the proximal end of the nerve was buried in muscle. After ZTBTG surgery the patient reported more than 50% improvement in pain (decreased intensity and frequency) while after intercostal neuromas surgery complete remission of pain was reported.

Conclusion: Neuroma of the zygomatico-temporal branch after upper blepharoplasty has not been reported in the literature to date and we believe that chronic neuropatic pain after cosmetic surgery may be under reported due to difficulties in diagnosis. Postoperative severe pain that does not respond to conventional therapy should be investigated as a potential neuroma and treated accordingly.

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