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• Transcanal labyrinthectomy is frequently unsuccessful in controlling vertigo due to intractable Meniere's disease. It may in fact make the condition worse due to the formation of a traumatic neuroma. The translabyrinthine vestibular nerve section is more reliable, but the morbidity is greater. Therefore, the transcanal procedure is usually recommended as the initial procedure, but the patient is warned that a second more extensive procedure may be necessary to control dizziness. ( Arch Otolaryngol 105:654-655, 1979)

The use of articular branch of the dorsal sensory ulnar nerve as a nerve graft is discussed. A case of traumatic neuroma of the dorsal ulnar nerve which was treated by this method is presented.

✓ A simple and effective method of eliminating pain as a result of amputation and traumatic neuroma is described. Following excision of the neuroma, intramedullary long-bone implantation of the proximal nerve is performed. This technique has been used in five patients and there has been no recurrence of pain.

A case is presented which demonstrates the need for a complete history as well as thorough clinical examination when evaluating symptoms in an area where endodontic therapy has been previously performed.

A traumatic neuroma of the intestine arising at the site of a previous ileocolic anastomosis is reported. Barium enema examination showed an extramucosal mass in a patient who presented with abdominal pain, rectal bleeding, and anemia. Although rare, traumatic neuroma should be included in the differential diagnosis of an intestinal mass occurring after intestinal surgery.

In 1974, 252 infants with birth weights < 1501 g were referred to our neonatal intensive care unit. Arterial blood gases were monitored frequently to avoid the complications of hypo- and hyperoxia. Umbilical catheters were removed after 4 to 5 days; further arterial sampling was obtained preferentially from the right brachial artery. Eighty-nine percent (146/167) of the survivors have been examined prospectively to the age of 18 months post-term. Evidence of peripheral median nerve damage with mild to moderate impairment of the pincer grasp was found in 18 infants (12%). All had visually obvious scarring in the antecubital fossa secondary to arterial punctures. The right median nerve alone was affected in 13 cases; bilateral damage occurred in 5. The incidence of this lesion varied directly with the frequency of peripheral arterial punctures and indirectly with birth weight. An examination of autopsy tissue blocks of the antecubital fossa taken from 6 similarly treated infants revealed 4 with varying degrees of hemorrhage dissecting tissue planes. The most severe lesion demonstrated repeated extensive bleeding, muscle necrosis and a traumatic neuroma. A well defined pincer grasp is expected to be present by 12 months post-term; by 18 months post-term all peripheral regeneration of damaged nerve fibers should be completed. These results suggest that brachial arterial punctures may be associated with median nerve damage in the pre-term infant.

The temporal bone histopathology in a patient who suffered repeated head trauma and a longitudinal temporal bone fracture shows unusual features associated with the facial nerve. In the distal meatal segment, a type of traumatic neuroma was found with disorganized nerve bundles and distinct areas of Schwann's cell proliferation but lacking fibrosis. Periosteal new bone formation in the labyrinthine segment narrows the fallopian canal and protrudes into the nerve, which completely fills the canal. The tympanic and mastoid segments of the nerve show severe degeneration of nerve fibers and an increase in connective tissue between fascicles. An attempted facial nerve decompression did not reach the area of primary pathology in the labyrinthine and meatal segments of the nerve, which could have been exposed by the transtemporal supralabyrinthine approach.

Palisaded encapsulated neuromas (PFN) are uncommon benign neural neoplasms of the skin, first described by Reed, Fine and Meltzer (1972). Sixty consecutive cases of PEN were reviewed. Clinically these asymptomatic lesions appeared as shiny, dome-shaped, flesh- coloured, firm, 2–6 mm papules that were present for a few months to several years. Only twice was the correct diagnosis made, the usual clinical impression being basal cell carcinoma or melanocytic naevus. All lesions were solitary, most occurring on the central face, nose or lips, of middle-aged individuals of both sexes. Less than 10% occurred outside the facial area. By light microscopy, well-demarcated single or multiple nodules composed of fascicles of spindle cells were seen in the dermis. No mast cells were present and there were no areas resembling Antoni type B tissue. By electron microscopy (EM) the tumour consists of interlacing bundles of Schwann cells admixed with many non-myelinated C fibres. Only a few axons are myelinated. PEN should be included in the differential diagnosis of fiesh-coloured papules on the face. These are true neuromas that are distinctive pathologically and can be easily differentiated from neurilemmomas and neurofibromas. They most closely resemble traumatic neuromas but lack fibrosis surrounding the nerve bundles. They also are similar to neuromas in the multiple mucosal neuromata syndrome (Williams & Pollock, 1966; Reed et al., 1972). We speculate that minor injury to facial skin damages small peripheral nerve fascicles leading to proliferation of axons in a fashion similar to traumatic neuroma formation. As the lesion matures many of the small bundles of nerve regress, leaving either single or multiple lobules of axonal and Schwannian proliferation to produce the true neuroma seen on EM.