Traumatic neuroma of the infraorbital nerve subsequent to inferomedial orbital decompression for Graves' orbitopathy.
OBJECTIVE
To present and discuss the occurrence of a traumatic neuroma subsequent to inferomedial orbital decompression surgery in Graves' orbitopathy.


METHODS
Case report.


RESULTS
Approximately 1 month after surgery, a patient who underwent bilateral rehabilitative inferomedial orbital decompression developed a mass with clinical and radiologic characteristics compatible with a traumatic neuroma of the left infraorbital nerve. The lesion, which was thought to be the result of unnoticed nerve trauma at the time of surgical dissection of the infraorbital canal, remained stable in shape and other imaging characteristics during the 39-month follow-up period. Symptoms of trigeminal neuralgia could be only partially controlled with medical therapy (oral pregabalin 75 mg 3 times daily).


CONCLUSIONS
The second branch of the trigeminal nerve may be damaged in the course of orbital floor removal decompression for Graves' orbitopathy. This may potentially induce the formation of traumatic or amputation neuromas. Such lesions should be included in the potential complications of decompressions when counseling patients about to undergo this type of surgery, as they are difficult to treat and may cause persistent and disabling pain.
Baldeschi
Lelio
L
Orbital Center, Department of Ophthalmology, University of Amsterdam, The Netherlands. leliobaldeschi@libero.it
Saeed
Peerooz
P
Regensburg
Noortje I
NI
Zacharopoulos
Ioannis
I
Wiersinga
Wilmar M
WM
D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000209:etiology*; D019299:Decompression, Surgical / Q000009:adverse effects*; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis / Q000209:etiology*; D009882:Ophthalmic Nerve / Q000293:injuries*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed