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Finucane S, Dalwadi P, Mudaliar K, Hurtuk A. Trigeminal trophic syndrome: A systematic review. Am J Otolaryngol 2024; 45:104354. [PMID: 38759434 DOI: 10.1016/j.amjoto.2024.104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To systematically report and document Trigeminal Trophic Syndrome (TTS), characterize its clinical presentation, diagnostic tests performed, outline management strategies, outcomes; and highlight the role of otolaryngologists in the tissue diagnosis of this rare syndrome. DATA SOURCES PubMed/Medline, Scopus, and Cochrane databases. REVIEW METHODS PubMed/Medline, Scopus, and Cochrane databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all cases of TTS published with an English translation from inception to December 2020. RESULTS A total of 142 articles describing 214 patients with TTS were included in the analysis. There was a female predominance (62.9 %) and a median age of 57 (range 1-93) years at presentation. A trigeminal neurological insult was identified in 200 (93.5 %) cases. The most common triggers for TTS were treatment for trigeminal neuralgia (35.7 %) and cerebrovascular accident (21.6 %). Self-inflicted trauma occurred in 137 (64 %) patients. Biopsy was done in 123 (57.5 %) patients. Patient education, barrier devices, and medications to address parasthesias were the most common treatment strategies. The majority of patients (72.5 %) received multimodal therapy. Surgery was performed in 35 (22.7 %) patients. Treatment outcomes were discussed in 120 (56.1 %) patients. CONCLUSIONS TTS is a rare condition with poorly understood pathophysiology. It should be suspected in a patient with non-healing facial ulceration and altered sensation within the trigeminal nerve distribution. Biopsy of the ulcer is important to confirm the diagnosis and exclude malignancy. Treatment options include conservative and pharmacologic measures, and less frequently surgery.
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Affiliation(s)
- Sarah Finucane
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Poonam Dalwadi
- Department of Medicine, Piedmont Macon Medical Center, Macon, GA, USA
| | - Kumaran Mudaliar
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Agnes Hurtuk
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
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Đorđević Betetto L, Bajuk V. Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2023. [DOI: 10.15570/actaapa.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Minai L, Ogawa Y, Kinoshita M, Ito H, Kume M, Mitsui H, Shimada S, Kawamura T. Case of trigeminal trophic syndrome secondary to endovascular treatment for internal carotid artery aneurysm. J Dermatol 2022; 49:e212-e214. [PMID: 35212008 DOI: 10.1111/1346-8138.16336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa Minai
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Youichi Ogawa
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Manao Kinoshita
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hidemichi Ito
- Department of Neurosurgery, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Miki Kume
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Mitsui
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinji Shimada
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuyoshi Kawamura
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Ju T, Vander Does A, Yosipovitch G. Scalp dysesthesia: a neuropathic phenomenon. J Eur Acad Dermatol Venereol 2022; 36:790-796. [PMID: 35122352 DOI: 10.1111/jdv.17985] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
Scalp dysesthesia is an abnormal sensation of the scalp in the absence of cutaneous disease. It is characterized by a burning and/or itching sensation and can be related to a variety of neurogenic or psychogenic causes. This condition is extremely bothersome and is also common- especially amongst the geriatric population, in women, in patients with diabetes mellitus and patients with psychiatric history. However, despite its prevalence in many populations, there is limited data about its causes and characteristics. Given its limited cutaneous manifestations it is also easily misdiagnosed and an underrecognized cause of scalp pruritus in the dermatological community. Therefore, education on scalp dysesthesia is paramount to helping physicians identify and provide appropriate treatment for these patients. This review focuses predominately on the neurogenic causes (with a brief review of psychogenic itch) of scalp dysesthesia and the therapeutics that have been found to be effective for this condition. Neurogenic causes of scalp dysesthesia occur with damage to the central or peripheral pathways of itch sensation, resulting in modification and heightened sensitivity of nerves that result in abnormal sensations in the absence of or out of proportion to external stimuli. A comprehensive review of etiologies is provided here, ranging from lesions to the central nervous system caused by cervical spine disease, trigeminal trophic syndrome, tumor, stroke, and multiple sclerosis, to small fiber neuropathies caused by diabetes, brow lifts, keloid and burn scarring. Recently, there have also been reports of scalp dysesthesias associated with post-infectious COVID-19. Treatment options tailored towards disease severity and different causes of disease will also be discussed. By elucidating the different mechanisms and therapeutic treatments of scalp dysesthesia, we hope to provide clinicians with the tools to identify and treat this condition as well as encourage further research into its etiologies and therapeutics.
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Affiliation(s)
- T Ju
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - A Vander Does
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - G Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
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5
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Trigeminal Trophic Syndrome: A Comprehensive Review of a Surgical Approach. J Craniofac Surg 2022; 33:1809-1812. [PMID: 35034087 DOI: 10.1097/scs.0000000000008466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Trigeminal trophic syndrome (TTS) is an exceedingly rare disease that causes facial ulceration, most commonly at the nasal ala. The overall incidence of TTS is not known, with less than 150 cases published in the literature.We searched the United States National Library of Medicine National Institutes of Health (PubMed) using the terms "Trigeminal Trophic Syndrome" and "TTS" as keywords. Publications in all languages were included if an English abstract was available. We reviewed 111 cases of TTS described in 75 publications from 1979 to 2021.Fourteen cases involved surgical reconstruction. Of these, the lesions completely healed in 7 cases (50%), recurred in 5 (36%), and were unspecified in 2 (14%). Reconstruction was completed in a 2 to 3-stage approach in 6 cases; of these, healing without recurrence was observed in 5 cases (83%). When donor tissue from the affected side was used as a basis for reconstruction, healing without recurrence was observed in 2 cases (50%). This is in comparison to the use of contralateral, sensate tissue in which there was healing without recurrence in all 3 cases (100%).The surgical management of TTS remains a topic of controversy. The rates of success remain comparable despite the use of various flap types. However, the use of contralateral, sensate flaps and a staged surgical approach appears to be effective based upon the best available evidence in the literature. Further prospective or retrospective controlled studies are necessary to make more reliable recommendations, though may be challenging given the rarity of TTS.
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Segovia González M, Martina L, García García JF, González González A, Benito Duque P. Trigeminal trophic syndrome: An unusual nasal ulceration. A case report and review of the literature. J Tissue Viability 2022; 31:369-371. [PMID: 35101334 DOI: 10.1016/j.jtv.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/03/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Affiliation(s)
- María Segovia González
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
| | - Laura Martina
- Department of Plastic and Reconstructive Surgery, Ospedale Policlinico San Martino, Genoa University, Genova, Italy.
| | | | - Alicia González González
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Pablo Benito Duque
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Jowett N, Pineda R. Corneal and Facial Sensory Neurotization in Trigeminal Anesthesia. Facial Plast Surg Clin North Am 2021; 29:459-470. [PMID: 34217450 DOI: 10.1016/j.fsc.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trigeminal anesthesia may yield blindness and facial disfigurement, secondary to neurotrophic keratopathy and trigeminal trophic syndrome. This article summarizes contemporary medical and emerging surgical approaches for the therapeutic management of this rare and devastating disease state.
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Affiliation(s)
- Nate Jowett
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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Abstract
Itch is a frequent complaint reported by the patients and is usually ascribed to dermatological causes. Central neurogenic pruritus remains an under-recognized complication with an unclear etiology previously described in the patients with stroke or with an intramedullary mass of the spinal cord. We describe a case of a nine-year-old male who developed unilateral pruritus seven days after he underwent right hemicraniectomy due to ruptured arteriovenous malformation. The patient manifested a significant improvement in pruritus after starting gabapentin. This report highlights the need for having a high index of suspicion for central neurogenic pruritus in such patients.
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Affiliation(s)
- Ankit Agarwal
- Pediatrics, Ascension Sacred Heart Hospital, Pensacola, USA
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Belinskaia DA, Belinskaia MA, Barygin OI, Vanchakova NP, Shestakova NN. Psychotropic Drugs for the Management of Chronic Pain and Itch. Pharmaceuticals (Basel) 2019; 12:ph12020099. [PMID: 31238561 PMCID: PMC6631469 DOI: 10.3390/ph12020099] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
Clinical observations have shown that patients with chronic neuropathic pain or itch exhibit symptoms of increased anxiety, depression and cognitive impairment. Such patients need corrective therapy with antidepressants, antipsychotics or anticonvulsants. It is known that some psychotropic drugs are also effective for the treatment of neuropathic pain and pruritus syndromes due to interaction with the secondary molecular targets. Our own clinical studies have identified antipruritic and/or analgesic efficacy of the following compounds: tianeptine (atypical tricyclic antidepressant), citalopram (selective serotonin reuptake inhibitor), mianserin (tetracyclic antidepressant), carbamazepine (anticonvulsant), trazodone (serotonin antagonist and reuptake inhibitor), and chlorprothixene (antipsychotic). Venlafaxine (serotonin-norepinephrine reuptake inhibitor) is known to have an analgesic effect too. The mechanism of such effect of these drugs is not fully understood. Herein we review and correlate the literature data on analgesic/antipruritic activity with pharmacological profile of these compounds.
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Affiliation(s)
- Daria A Belinskaia
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
| | - Mariia A Belinskaia
- International Centre for Neurotherapeutics, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Oleg I Barygin
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
| | - Nina P Vanchakova
- Department of Pedagogy and Psychology, Faculty of Postgraduate Education, First Pavlov State Medical University, L'va Tolstogo str. 6-8, St. Petersburg 197022, Russia.
| | - Natalia N Shestakova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, pr. Torez 44, St. Petersburg 194223, Russia.
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Rosen JD, Fostini AC, Yosipovitch G. Diagnosis and Management of Neuropathic Itch. Dermatol Clin 2018; 36:213-224. [DOI: 10.1016/j.det.2018.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Karadan U, Manappallil RG, Janardhanan A, Supreeth RN. Trigeminal trophic syndrome following anterior inferior cerebellar artery infarction. BMJ Case Rep 2018; 2018:bcr-2018-225278. [PMID: 29678820 DOI: 10.1136/bcr-2018-225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ummer Karadan
- Department of Neurology, Baby Memorial Hospital, Calicut, India
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Hufschmidt K, Fernandez J, Balaguer T, Fontaine D, Chignon-Sicard B. [Treatment of neurotrophic ulceration following alcohol injection of the gasserian ganglion in trigeminal neuralgia: Case report and review of the literature]. ANN CHIR PLAST ESTH 2016; 62:79-86. [PMID: 27107560 DOI: 10.1016/j.anplas.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trigeminal trophic syndrome (TTS) can occur after any injury on the fifth cranial nerve. The etiology is dominated by iatrogenic causes, especially after gasserian ganglion ablation. Middle-aged women are mostly involved and the differential diagnosis is vast. PRESENTATION OF CASE A 88-year old woman presented with TTS and destruction of the right nasal ala 25 years after retrogasserian alcohol injection for trigeminal neuralgia. Facing iterative failure of medical treatment, topics and neurostimulation, we performed lipofilling for the lesion. In the third month, we found a 50 % decrease in size of the lesion, as well as a complete disappearance of pruritus, thus allowing to consider reconstructive surgery. DISCUSSION Our literature review reports 28 cases of TTS subsequent to alcohol injection of the gasserian ganglion. Age of presentation ranges from 49 to 88 years, with a time of onset between trigeminal injury and TTS ranging from 2 weeks to 17 years. Recurrences are frequent. The management varies a lot according to the authors (topics, antibiotics, flaps), however the efficiency of lipofilling has not been reported yet. CONCLUSION The pathophysiology of TTS remains unknown, nevertheless the therapeutical care has to be multidisciplinary. Even though not described yet, lipofilling seems to be an interesting treatment of TTS following alcohol injection in the trigeminal ganglion.
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Affiliation(s)
- K Hufschmidt
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
| | - J Fernandez
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - T Balaguer
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - D Fontaine
- Service de neurochirurgie, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - B Chignon-Sicard
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
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Upshaw WN, Bilyeu CW. Carbamazepine as a Treatment for Trigeminal Trophic Syndrome: A Case Report and Literature Review. PSYCHOSOMATICS 2015. [DOI: 10.1016/j.psym.2015.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Numbness over the distribution of trigeminal nerve--trigeminal trophic syndrome or viral neuritis: a diagnostic dilemma! J Craniofac Surg 2014; 24:e432-4. [PMID: 23851893 DOI: 10.1097/scs.0b013e3182942dff] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Numbness and ulceration of the face, particularly erosion of ala of the nose, sometimes occur after sensory denervation in the territory of the divisions of the trigeminal nerve. The incidence is uncertain and usually follows surgical treatments for trigeminal neuralgia. Such condition is known as trigeminal trophic syndrome (TTS), although some authors believe it to be a special form of dermatitis artefacta. Trigeminal trophic syndrome most commonly affects adults, after iatrogenic, vascular, viral, or neoplastic damage to the trigeminal nerve. We present a rare case of TTS in a 32-year-old woman who was referred to us with progressive numbness in the right upper and lower lip region.
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Pendharkar NC, Kirby JS. JAAD Grand Rounds quiz. Nasal ulceration after facial laceration. J Am Acad Dermatol 2012; 67:325-7. [PMID: 22794812 DOI: 10.1016/j.jaad.2010.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 10/25/2010] [Accepted: 11/20/2010] [Indexed: 10/28/2022]
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Willis M, Shockley WW, Mobley SR. Treatment options in trigeminal trophic syndrome: a multi-institutional case series. Laryngoscope 2011; 121:712-6. [PMID: 21433016 DOI: 10.1002/lary.21421] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Trigeminal trophic syndrome (TTS) is an uncommon medical condition that may be encountered by otolaryngologists and facial plastic surgeons. TTS begins with damage to the trigeminal nerve or its central sensory connections, causing anesthesia in a dermatomal distribution. With repeated scratching and manipulation, an ulceration occurs, often in the alar region. In this multi-institutional report, we summarize a small series of patients with TTS. Treatment options are discussed along with a review of the relevant literature. Although rare, it is important that practicing otolaryngologists be familiar with the classic signs and symptoms of this condition in order to avoid delays in diagnosis and treatment.
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Affiliation(s)
- Mark Willis
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kurien AM, Damian DL, Moloney FJ. Trigeminal trophic syndrome treated with thermoplastic occlusion. Australas J Dermatol 2011; 52:e1-4. [DOI: 10.1111/j.1440-0960.2009.00613.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pedicelli C, Paradisi A, Fazio M, Angelo C, Fazio R, Paradisi M. Trigeminal neurotrophic ulceration in Wallenberg's syndrome. Int J Dermatol 2009; 48:443-5. [PMID: 19335439 DOI: 10.1111/j.1365-4632.2009.03920.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Farahani RMZ, Marsee DK, Baden LR, Woo SB, Treister NS. Trigeminal trophic syndrome with features of oral CMV disease. ACTA ACUST UNITED AC 2008; 106:e15-8. [DOI: 10.1016/j.tripleo.2008.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/27/2008] [Accepted: 05/04/2008] [Indexed: 10/21/2022]
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Fruhauf J, Schaider H, Massone C, Kerl H, Mullegger RR. Carbamazepine as the only effective treatment in a 52-year-old man with trigeminal trophic syndrome. Mayo Clin Proc 2008; 83:502-4. [PMID: 18380997 DOI: 10.4065/83.4.502] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Trigeminal trophic syndrome is a rare condition resulting from self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The syndrome consists of a classic triad of anesthesia, paresthesias, and secondary persistent or recurrent facial ulcerations. The most common causes include destruction of the trigeminal ganglion, rhizotomy, and stroke. We describe a patient who developed the syndrome as a sequel to brainstem infarction and trigeminal neuropathy. Whereas a-lipoic acid and gabapentin were ineffective, a remarkable benefit was achieved by administering carbamazepine (200 mg 3 times a day), which influences both neuropathic and behavioral factors in this rare syndrome. Our experience with the presented case, together with the scarce information in the literature, indicates that carbamazepine should be the first treatment option for trigeminal trophic syndrome.
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Affiliation(s)
- Julia Fruhauf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.
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22
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Lukšić I, Lukšić I, Šestan-Crnek S, Virag M, Macan D. Trigeminal trophic syndrome of all three nerve branches: an underrecognized complication after brain surgery. J Neurosurg 2008; 108:170-3. [DOI: 10.3171/jns/2008/108/01/0170] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors report a case of trigeminal trophic syndrome (TTS) that occurred as a complication of a neurosurgical procedure. Three years after a second surgical treatment for a meningioma of the cerebellopontine angle, this 32-year-old woman developed TTS with progressive skin ulcers on the left ala nasi and the left side of the forehead and chin. Trigeminal trophic syndrome is an extremely rare cause of facial ulceration. It occurs as a consequence of trigeminal nerve damage or impaired central sensory connections. To the authors' knowledge, this is the first report of lesions in the dermatomes of all three branches of the nerve after a neurosurgical procedure. Early recognition of this disorder is important, as treatment is difficult and often unsatisfactory. Many clinicians are not aware of this disease, thus, it may be more common than previously thought. The importance of recognizing and diagnosing TTS, as well as its treatment, are discussed.
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Affiliation(s)
- Ivica Lukšić
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
| | - Ivana Lukšić
- 2Department of Clinical Microbiology and Hospital Infection, University Hospital Dubrava, Zagreb, Croatia
| | - Sandra Šestan-Crnek
- 2Department of Clinical Microbiology and Hospital Infection, University Hospital Dubrava, Zagreb, Croatia
| | - Mihajlo Virag
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
| | - Darko Macan
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
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Abstract
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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Affiliation(s)
- R M Rashid
- Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Setyadi HG, Cohen PR, Schulze KE, Mason SH, Martinelli PT, Alford EL, Taffet GE, Nelson BR. Trigeminal trophic syndrome. South Med J 2007; 100:43-8. [PMID: 17269524 DOI: 10.1097/01.smj.0000253020.74133.7e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ulceration of the nose may be inadvertently induced by the patient. Although trigeminal trophic syndrome is an uncommon cause of chronic ulcers, healthcare providers should consider the possibility of this disorder when encountering a patient with nasal ulcerations. Trigeminal trophic syndrome most commonly occurs in older women following therapy for trigeminal neuralgia. The ulcers usually involve the nasal ala and paranasal areas. The clinical vignette of a man with a self-induced nasal ulcer secondary to trigeminal trophic syndrome, which was initially suspected to be skin cancer, is presented. Since nasal ulcerations can be secondary to other conditions, a lesional biopsy should be performed to exclude other diagnoses when trigeminal trophic syndrome is entertained. In addition to trigeminal trophic syndrome, the differential diagnosis of conditions that can cause nasal ulcers include factitial disorders with self-induced ulcerations (such as dermatitis artifacta and neurotic excoriations), granulomatous conditions, infectious diseases, malignancy, and pyoderma gangrenosum. Treatment of trigeminal trophic syndrome requires prevention of digital manipulation of the lesion-either by occluding contact with the ulcer, initiating psychotropic medication, or both. Psychiatric and/or pharmacologic intervention should be considered to reduce or resolve further habitual self-inflicted injury before surgical intervention.
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Preston PW, Orpin SD, Tucker WFG, Zaki I. Successful use of a thermoplastic dressing in two cases of the trigeminal trophic syndrome. Clin Exp Dermatol 2006; 31:525-7. [PMID: 16716154 DOI: 10.1111/j.1365-2230.2006.02125.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of trigeminal trophic syndrome is challenging and often unsatisfactory, particularly in patients with cognitive impairment. We report the novel use of a thermoplastic dressing in two patients with trigeminal trophic syndrome. Use of the dressing resulted in successful healing of ulceration in both patients, which has been maintained in the short term, representing a simple and economical therapeutic option in the management of this difficult condition.
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Affiliation(s)
- P W Preston
- Department of Dermatology, Solihull Hospital, Heart of England NHS Trust, Birmingham, UK.
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Racette AJ, Moore A, Brown S, Racette A. Recognizing trigeminal trophic syndrome. J Am Acad Dermatol 2006; 55:359-61. [PMID: 16844535 DOI: 10.1016/j.jaad.2005.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 09/29/2005] [Accepted: 10/14/2005] [Indexed: 11/23/2022]
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Patel GK, Motley RJ. Nocturnal sedation in a child with facial ulceration. Int Wound J 2006; 3:145-6. [PMID: 17007345 PMCID: PMC7951766 DOI: 10.1111/j.1742-4801.2006.00188.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Mostly, herpes zoster affects adults and therefore childhood presentation can represent a diagnostic challenge. Childhood herpes zoster, when it occurs, can also be associated with peripheral nerve complications, as illustrated by this case. A 3-year-old child who had herpes zoster developed a nasolabial scar resulting in a shallow non-healing ulcer from being repeatedly picked. Healing was only achieved after nocturnal sedation, with chloral hydrate.
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Affiliation(s)
- Girish K Patel
- Welsh Institute of Dermatology, University Hospital of Wales, Heath Park, Cardiff, UK.
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Affiliation(s)
- Robert Slater
- Delaware County Memorial Hospital, Drexel Hill, PA, USA.
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Hinrichs R, Weber L, Scharffetter-Kochanek K. [Chronic ulceration of one side of the face]. Hautarzt 2005; 57:455-7. [PMID: 16044271 DOI: 10.1007/s00105-005-0997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R Hinrichs
- Universitätsklinik für Dermatologie und Allergologie, Ulm.
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Schwerdtner O, Damaskos T, Kage A, Weitzel-Kage D, Klein M. Autologous epidermal cells can induce wound closure of neurotrophic ulceration caused by trigeminal trophic syndrome. Int J Oral Maxillofac Surg 2005; 34:443-5. [PMID: 16053858 DOI: 10.1016/j.ijom.2004.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2004] [Indexed: 11/25/2022]
Abstract
Trigeminal trophic syndrome is an extremely rare complication following surgical ablation of the trigeminal nerve or after alcohol injection or thermocoagulation of the Gasserian ganglion. These lesions show a poor healing tendency and sometimes persist for years. The therapeutic results of local wound care with ointments and wound dressings are often unsatisfactory, and those of plastic surgery are variable. In the case presented, the skin area affected by neurotrophic ulceration is successfully treated with autologous cultivated epidermal cells. This form of tissue engineering is already a clinically established procedure for treating burns and chronic wounds. The results show for the first time that transplantation of in vitro cultivated epidermal cells can induce tissue regeneration and may be an effective tool in the treatment of neurotrophic ulcerations in the facial region.
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Affiliation(s)
- O Schwerdtner
- Department for Oral and Maxillofacial Surgery, Plastic Surgery, Surgical Robotics and Navigation, Campus Virchow Clinic, Charité, Humboldt-University of Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
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31
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Monrad SU, Terrell JE, Aronoff DM. The trigeminal trophic syndrome: an unusual cause of nasal ulceration. J Am Acad Dermatol 2004; 50:949-52. [PMID: 15153901 DOI: 10.1016/j.jaad.2004.01.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Seetha U Monrad
- Department of Internal Medicine, University of Michigan Health Systems, Ann Arbor, Michigan, USA
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Abstract
Trigeminal trophic ulceration is a rare clinical entity after an injury to the sensitive root of the trigeminal nerve, mostly due to therapy for trigeminal neuralgia. Other rare causes are Wallenberg's syndrome or a history of removal of acoustic neuroma. After weeks to years, a slowly progressive ulceration develops due to autonomic dysfunction and the patient manipulation because of serious chronic paresthesia. Finally, in many cases, a significant defect of the nasal arch develops. In spite of typical clinical signs and location, diagnosis is made late in most cases. Reviewing the literature, two cases are presented and diagnostic problems and difficulties of the most effective therapeutic approach are discussed.
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Affiliation(s)
- M Koch
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Friedrich-Alexander-Universität, Erlangen-Nürnberg.
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Sadeghi P, Papay FA, Vidimos AT. Trigeminal Trophic Syndrome-Report of Four Cases and Review of the Literature. Dermatol Surg 2004; 30:807-12; discussion 812. [PMID: 15099331 DOI: 10.1111/j.1524-4725.2004.30220.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trigeminal trophic syndrome is a unilateral, frequently crescent-shaped neurotrophic ulceration of the face occurring after injury to the trigeminal nerve. The appearance of the ulcers resembles other disease entities such as granulomatous disease, neoplasm, vasculitis, infection, and factitial dermatitis. OBJECTIVES The objectives of this study are to increase awareness of this disorder and to emphasize the importance of eliciting a thorough neurologic history when evaluating facial ulcerations. METHODS Four cases are reported and, using MEDLINE, the English and non-English literature from 1982 to 2002 is reviewed. RESULTS Including this report, there have been 60 cases of trigeminal trophic syndrome reported from 1982 to 2002. The age at presentation ranged from 14 months to 93 years. Time of onset from injury to the trigeminal ganglion or its branches and the development of the ulcers ranged from 2 weeks to 30 years. One-third of the patients had undergone trigeminal nerve ablation for the treatment of trigeminal neuralgia and another third had a history of stroke. Other causes included craniotomy, head trauma, herpes infection. CONCLUSION The majority of cases of trigeminal trophic syndrome are associated with a history of stroke or trigeminal nerve ablation. Successful surgical outcome can be achieved if the underlying neurologic pathology is addressed before the reconstructive procedure.
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Affiliation(s)
- Parrish Sadeghi
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Affiliation(s)
- C C Lyon
- Dermatology Centre, Hope Hospital, Stott Lane, Salford M6 8HD, UK.
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