Treatment of Trigeminal Trophic Syndrome Using Scalp Based Flap Reconstruction: Case Report

Abstract

Introduction: Trigeminal trophic syndrome (TTS) is a rare cause of ulcerative lesions in the trigeminal sensory nerve distribution secondary to repeated mechanical manipulation of the affected area. The classic lesion described in TTS is a painless ulceration on the cheek beside the ala nasi associated with trigeminal nerve dysfunction. Case presentation: 63-year-old male presented with chronic ulceration on the right frontoparietal scalp. Seven months prior to presentation, the patient developed burning pain in the V1 distribution diagnosed as shingles. As the patient’s discomfort worsened, the patient developed a 6 centimeter x 6 centimeter lesion with exposed calvarium after repeated mechanical manipulation. Management and Outcome: To make a tissue diagnosis, an excisional biopsy with bone biopsy of the exposed calvarium was performed. After excluding other diagnoses, the patient was diagnosed with TTS. A fasciocutaneous transposition flap based on the parietal branch of the superficial temporal artery with split thickness skin graft of the flap donor site was performed. In consultation with Neurology, the patient was given carbamazepine to decrease his neuropathic pain and urge to scratch. Postoperatively, the patient did not have any discomfort over the site of the flap reconstruction which healed completely. Discussion: The goal of the scalp based flap reconstruction was to design flap coverage based on a different sensory nerve distribution. Utilizing a flap from the V3/C2 distribution, the previously diseased V1 nerve distribution was avoided. Postoperatively, the patient has not disrupted the reconstruction and is pleased with the overall outcome.