Traitement de l’ulcération neurotrophique après alcoolisation du ganglion de Gasser dans l’atteinte du nerf trijumeau : cas clinique et revue de la littérature

Abstract

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. A 88-year old woman presented with TTS and destruction of the right nasal ala 25years 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. Our literature review reports 28cases of TTS subsequent to alcohol injection of the gasserian ganglion. Age of presentation ranges from 49to 88years, with a time of onset between trigeminal injury and TTS ranging from 2weeks to 17years. 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. 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.