Q: Dr. Eppley, I have developed a neuroma after a facelift three years ago.I first noticed it when driving and my shirt collar rubbed against it and it felt as though there was something tickling my right ear. The surgeon treated the neuroma with a steroid shot. Although the numbness and sensitivity went down it was still there. The doctor treated the neuroma two more times without improvement. The numbness extends along my lower right jaw line, upper right neck, right cheek in front of the right ear and the right ear. My surgeon told me he never had a patient with a neuroma that was not treated successfully by injecting a steroid.
I visited another facial surgeon earlier this year. He told me if he did the facial surgery he would recommend treating the neuroma at that time as another facelift. He said he would cut the neuroma off/away from the nerve. He said it might not correct the problem completely and that I might have complete numbness in some of the areas where I now I have this strange feeling in my face.
I am reluctant to have either surgeon cut me since neither has treated a neuroma before. I would appreciate your recommendation concerning my neuroma at this time.
A: Thank you for the detailed descriptions of your after facelift issues. I can make the following comments.
1) While steroids is not an unreasonable approach to an initial treatment of a neuroma, when refractory, others more definitive approaches need to be considered.
2) I have not had a patient develop a neuroma of the greater auricular nerve after a facelift but I have treated several that have.
3) The traditional treatment of a neuroma would be excision and burying the ends of the nerve into the muscle. It is possible, although less likely, that the entrapped portion of the nerve could be identified, excised and the nerve repaired by putting the two ends back together. This would be dependent on being able to find the actual location of the neuroma amidst scar tissue which is usually possible because it is so superficial and its location can be identified externally before the surgery.
4) What will happen to the sensory innervation after any of these possible neuroma treatments is unpredictable…meaning it may get better worse or there be no change. Bring three years out of the procedure makes it a different situation than when done much earlier. Similarly the impact of the neuroma repair plus or minus facelift in your tinnitus is similarly a wild card. Getting it or its exacerbation from a facelift was not a predictable event so what happens with further surgery should not be assumed.
5) Whether you treat the neuroma independent on a facelift or at the same time is personal decision and depends on your motivation for a secondary facelift.
Dr. Barry Eppley