Odontogenic Herpes Zoster Infection: A Case Report and Review

Abstract

Herpes zoster is a commonly encountered entity of which all clinicians should be aware. The diagnosis is most often considered and made based on a characteristic vesicular rash that presents in a unilateral dermatomal distribution and is usually accompanied by a painful neuritis. Not uncommonly, the pain presents a few days before the rash becomes evident and may even occur without the rash appearing. When this happens patients may be subject to further diagnostic testing seeking alternative diagnoses, as herpes zoster is known to mimic a variety of other non-cutaneous organ system entities. Although the thoracic and lumbar dermatomes are the affected most frequently, in approximately one-fifth of cases the cranial nerves are involved either singularly or in combination. Trigeminal nerve zoster is of particular concern as it poses a risk of developing into zoster ophthalmicus with subsequent keratitis and uveitis resulting in permanent vision impairment. Involvement of the second (maxillary) and third (mandibular) branches of this 5th cranial nerve are less common and may present with signs and symptoms of a primary dental process. The infrequency and unfamiliarity of herpes zoster odontogenic manifestations can lead to unnecessary investigation and treatment. Apropos such a case we review the epidemiology, pathophysiology, signs, and symptoms of odontogenic herpes zoster.