Trophic Lesions in the Distribution of the Trigeminal Nerve

Karnosh, Louis J.; Scherb, Roger F.

doi:10.1001/jama.1940.02810510020006

Cited by 22 publications

(7 citation statements)

References 10 publications

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“…Occasionally, the exact cause remains uncertain. [3][4][5][6] The patient often develops altered sensations, such as burning or crawling, mostly in the area of sensory overlap between the ophthalmic and maxillary divisions of the trigeminal nerve. These sensations focus the patient's attention on this area and consciously or subconsciously encourage "picking" to attempt symptomatic relief.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal Trophic Syndrome: Diagnosis and Management Difficulties

Bhatti

Soggiu²,

Orlando³

2008

Plastic and Reconstructive Surgery

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T rigeminal trophic syndrome is a rare complication after peripheral or central damage to the trigeminal nerve, characterized by sensorial impairment in the trigeminal nerve territory and self-induced nasal ulceration. Conditions that can affect the trigeminal nerve include brainstem cerebrovascular disease, diabetes, tabes, syringomyelia, and postencephalopathic parkinsonism; it can also occur following the surgical management of trigeminal neuralgia. Trigeminal trophic syndrome may develop months to years after trigeminal nerve insult. Its most common presentation is a crescent-shaped ulceration within the trigeminal sensory territory. The ala nasi is the most frequently affected site.Trigeminal trophic syndrome is notoriously difficult to diagnose and manage. A clear history is of paramount importance, with exclusion of malignant, fungal, granulomatous, vasculitic, or infective causes. We present a case of ulceration of the left ala nasi after brainstem cerebrovascular accident. CASE REPORTA 52-year-old man was referred to our department for assessment of ulceration of the left ala nasi. He had suffered a cerebrovascular accident in 1999 secondary to left vertebral artery dissection resulting in brainstem infarction. Initial treatment was with warfarin, which was subsequently replaced with aspirin. Identified risk factors included hypertension and hypercholesterolemia.Residual symptoms included left arm weakness, facial numbness, and poor memory. Perception of light touch and pain over the left side of the face was significantly decreased, with an absent corneal reflex. Over the following month, itchiness of the left nostril developed, which provoked intense scratching of the ala. Over the course of 1 year, this resulted in a nonhealing ulcer affecting the left ala of his nose (Fig. 1).A dermatologist diagnosed the condition on the basis of the patient's history before referral. At this stage, the ulcerated area was treated with occlusive dressings and the patient was advised to minimize trauma to the nose. In addition, carbamazepine was commenced to reduce paresthesia. The case was referred to our department in May of 2001 for further management.Initially, the ulcer was debrided and the tissue sent for histologic analysis, which revealed hyperplastic epithelium without evidence of malignancy, infection, or vasculitis. His condition was complicated further by bleeding from the nasal vestibule over the following month. This was attributed to subconscious continuous trauma.A two-stage reconstruction of the ala was planned. In the first stage, the alar defect was corrected with a chondrocutaneous composite graft taken from the right ear, covered externally with a pedicled forehead flap based on the contralateral supratrochlear vessels and nerve. Three weeks later, the second stage was performed comprising division of the pedicle with minor readjustments of the flap (Fig. 2).The patient has been followed for over 2 years after surgery. He remains satisfied with the result and has not developed any further problems...

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Section: Discussionmentioning

confidence: 99%

Trigeminal Trophic Syndrome: Diagnosis and Management Difficulties

Bhatti

Soggiu²,

Orlando³

2008

Plastic and Reconstructive Surgery

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“…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. Angle of the jaw, scalp, skin around the ear Kavanagh et al 13 Ala nasi (2), lip and upper lip, cheek Ulceration, erythema, erosion Westerhoff et al 22 Ala nasi, upper lip, check, forhead Superficial sharply demarcated ulcers Data et al 18 Ala nasi, right cheek Ulcer with erythema Elloumi et al 15 Ala nasi (2), upper lip, eyebrow, forehead Non-healing ulcer, well demarcated edges Bhushan et al 24 Ala nasi and cheek Non-healing ulcer/erosion Dicken et al 16 Ala nasi (5), forehead (3), cheek, scalp (2), bridge of nose, chin, bridge of nose Non-healing ulcer, tissue loss and erosion Ferrara et al 42 Ala nasi, forehead and above eyebrow, cheek, chin below lower lip Well defined ulcers with bizarre outlines Munnoch et al 23 Ala nasi, lower eyelid, chin Erosive trophic ulcer Su et al 26 Ala nasi, cheek, forehead, ear, chin Superficial ulcers and destruction of ala nasi Inoue et al 19 Ala nasi, lateral canthus, lower eyelid, upper lip Deep ulcer Mclean et al 43 Ala nasi and septum Ulcer and erosion Howell RG 44 Ala nasi (3) 14 Ala nasi (3), lateral wall of nose (2) Ulcer, punched out defect Macovei et al 46 All over hemi-face (specified ala nasi and upper lip) Trophic ulceration with superficial erosion Schwertdner et al 25 Upper lip Non-healing ulcer Shea et al 20 Nose, upper lip, cheek Ulcer NOTE: Tables were compiled using refs.…”

Section: Study Lesion Location (N) Descriptionmentioning

confidence: 99%

Trigeminal trophic syndrome

Rashid

Khachemoune

2007

Acad Dermatol Venereol

136

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Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, which is believed to develop after insult to the trigeminal ganglia or other parts of the peripheral/central nervous system in the trigeminal pathway. The pathogenesis of TTS is poorly understood. Developing a better understanding of TTS will allow early recognition and improved treatment. Although the ulcers develop predominantly on the ala nasi, the literature on ulcer locations is limited. In this article, we review the epidemiologic aspects of TTS, expand on our knowledge of the anatomic location of the ulcers, and discuss current theories for its aetiology and briefly review the approaches to its management.

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“…Leprous trigeminal neu¬ ritis may result in erosion of the ala nasi, resulting in the typical "ulcération en arc" in the anesthetic trigeminal field.19 The erosive process on the skin can exist inde¬ pendently of sympathetic involvement. 3 Trophic ulcers with a morphe and localiza¬ tion very similar to those that follow op¬ erative procedures on the fifth nerve have been observed infrequently in individuals with postencephalitic parkinsonism. Postencephalitic trophic ulcers may be bilateral and oddly enough may have little or no decrease in sensory acuity.12 The interval between encephalitis and the trophic disturbance may be lengthy.…”

Section: Commentmentioning

confidence: 99%

Neurotrophic Changes in the Trigeminal Territory

Howell¹

1962

Arch Dermatol

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Trophic Lesions in the Distribution of the Trigeminal Nerve

Cited by 22 publications

References 10 publications

Trigeminal Trophic Syndrome: Diagnosis and Management Difficulties

Trigeminal Trophic Syndrome: Diagnosis and Management Difficulties

Trigeminal trophic syndrome

Neurotrophic Changes in the Trigeminal Territory

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