Trigeminal trophic syndrome: A case of maxillofacial self-mutilation

Trigeminal trophic syndrome

“…Yacoumettis et al 28 Ala nasi Ulcer Mishriki et al 31 Ala nasi Erosion Arasi et al 5 Ala nasi Erosion George et al 32 Ala nasi Ala nasi atrophy Thomas et al 33 Ala nasi Destruction of ala nasi Litschel et al 34 Ala nasi Lesion Ziccardi et al 27 Ala nasi Ulceration with peripheral inflamation Bauer 35 Ala nasi Ulcer Lyon et al 7 Ala nasi Crusting ulcer Goodnight et al 36 Ala nasi (2) Ulcer with erosion and crusting Tollefson et al 30 Ala nasi (5) Ulcer and erosion Monrad et al 4 Ala nasi, canthus Crusted ulcer and erosion Preston et al 29 Ala nasi (2), Cheek Ulcer Finlay et al 1 Ala nasi, cheek Ulcer with clean base Sadeghi et al 37 Ala nasi, cheek Expanding ulcer and inflammation Cheek, canthus Non-healing ulcer Ala nasi, cheek Ulcer and erosion Ala nasi, scalp, preauricular skin, tragus Ulcer, erosion, crusting, and serosanguinous drainage Tada et al 38 Ala nasi, forehead Deep ulceration and destruction. Spillane et al 8 Ala nasi (2), septum Ulcer and erosion Walton et al 39 Ala nasi (4), septum (2), upper lip Ulcer Owen et al 40 Ala nasi, septum Ulcer Weintraub et al 6 Ala nasi, upper lip, cheek One continuous lesion of a shallow well circumscribed ulcer with shallow bleeding base and erosion Loveman 3 Ala nasi, temple, forehead, angle of eye Carcinomatous-like ulcer and trophic ulcer Karnosh et al 41 Forehead, temple, lip, cheek, nose Well demarcated erythematous plaque Ala nasi, angle of the mouth, cheek, eyelid, chin Red patches of indurated crusted skin.…”

“…The trauma theory as well as the important cognitive and psychological component to TTS, which can strongly hinder treatment should also be addressed. 26,27 Thus, this novel surgical approach will likely have to be combined with other behavioural modification therapies to prevent recurrences, especially in cases where sensation is not restored. Similar limitations would also exist for reconstruction options with flaps.…”

Trigeminal Trophic Syndrome Mimicking Wegener's Granulomatosis

“…The clinical presentation comprises the triad of trigeminal anesthesia, altered facial sensation (paresthesia), and crescent-shaped lateral nasal ala erosion or ulcération. 2 Trigeminal anesthesia can develop after any infectious, traumatic, autoimmune, iatrogenic, degenerative, or vascular condition that damages the sensory root of the trigeminal nerve in the gasserian ganglion. Most cases of TTS occur after surgical or chemical intervention for trigeminal neuralgia.…”

“…Typically, the ulcers in TTS present in the area of sensory overlap between the first and second divisions of the nerve (ophthalmic and maxillary). 2 Although self-induced trauma is the primary cause of this syndrome, there is a proposed pathophysiological mechanism predisposing patients to the development of ulcer formation. It is hypothesized that destruction of the gasserian ganglion results in autonomie vasomotor dysfunction, as sympathetic fibers from the internal carotid plexus to the trigeminal ganglion are disrupted.…”

Common Neuropathic Itch Syndromes

“…Alternate names in the literature include trigeminal neuropathy with nasal ulcération, trigeminal neurotrophic ulcération, and trophic ulcération of the ala nasi (23). In order for TTS to develop, patients must have not only intractable neuropathic itch but also profound cutaneous deafferentation that makes the scratching painless.…”