Case & review
The trigeminal trophic syndrome: an unusual cause of nasal ulceration

https://doi.org/10.1016/j.jaad.2004.01.038Get rights and content

Abstract

Trigeminal trophic syndrome (TTS) is an unusual complication after peripheral or central damage to the trigeminal nerve, characterized by anesthesia, paresthesias, and ala nasi ulceration. We describe a patient with classic TTS after trigeminal rhizotomy who underwent several extensive evaluations for nasal ulceration and received prolonged immunosuppressive therapy for a presumed autoimmune disorder before the correct diagnosis was made. An understanding of the predisposing factors and clinical presentation of TTS is important to ensure a timely diagnosis of this difficult-to-treat illness. Differentiation of TTS from malignancy, infection, or vasculitis is possible on the basis of clinical history, tissue biopsy, and serologic evaluation.

Section snippets

Case report

A 52-year-old woman presented with progressive ulceration of the right ala nasi. Twenty-one years previously she had cryptogenic, ipsilateral Bell's palsy, complicated by severe trigeminal neuralgia. This was managed successfully with oral carbamazepine, however, adverse effects of the drug required its discontinuation in 1997, leaving the patient with intractable pain. For this reason, the patient underwent radiofrequency trigeminal rhizotomy 4 years before presentation. Postoperatively, she

Discussion

TTS is an unusual condition after damage to the sensory root of the trigeminal nerve, with subsequent progressive ulceration in the affected dermatome. Initially described by Wallenberg,1, 2 TTS first appeared in the English-language literature 32 years later in independent publications by Loveman3 and McKenzie.4 More than 100 cases have subsequently been described.2, 5

The most common presentation of TTS follows trigeminal ablation by rhizotomy or alcohol injection into the gasserian ganglion.2

References (23)

  • I.S Cliff et al.

    Giant ulcer of the face following surgery for trigeminal neuralgia

    Arch Intern Med

    (1967)
  • Cited by (0)

    Supported by National Institutes of Health grant HL007749.

    Conflicts of interest: None identified.

    View full text