Cases Of Trigeminal Trophic Syndrome Research Articles

A rare case of trigeminal trophic syndrome with periorbital cellulitis and full-thickness upper eyelid defect in an undiagnosed patient with human immunodeficiency virus: a case report

BackgroundTrigeminal trophic syndrome is a rare cranial and facial condition caused by damage to the central or peripheral branches of the trigeminal nerve. This syndrome consists of a triad of anesthesia, paresthesia, and crescent-shaped facial ulcer involving the ala nasi and sometimes extending to the upper lip. Although previous screening for human immunodeficiency virus in some patients with trigeminal trophic syndrome was negative, we present a unique case of trigeminal trophic syndrome who tested positive for human immunodeficiency virus with eye complications.Case presentationWe present a rare case of trigeminal trophic syndrome in a 44-year-old Black African woman who tested positive for human immunodeficiency virus. She presented with a 6-week history of progressive, persistent, and painless left sided facial and scalp ulcerations that started as small skin erosion. Diagnosis of trigeminal trophic syndrome was made on clinical grounds based on the triad of anesthesia, paresthesia, and unilateral crescent-shaped ulcer in the trigeminal dermatome and her past medical history. The ulcer healed completely after counseling and pharmacological therapy, but she later developed left periorbital cellulitis and left upper eyelid full-thickness defect.ConclusionThis is by far the first documented case of trigeminal trophic syndrome with a positive human immunodeficiency virus test. Testing for human immunodeficiency virus in patients with trigeminal trophic syndrome is necessary as this can help improve clinical management and treatment outcomes. Seeking the services of specialists remotely in resource constraint settings is beneficial for managing complications associated with trigeminal trophic syndrome.

A new meaning to 'picking your nose': the first use of N-acetylcysteine to successfully treat trigeminal trophicsyndrome.

Trigeminal trophic syndrome (TTS) is a rare neurological condition characterized by self-induced injury to the face in the distribution of the trigeminal nerve. Chronic scratching or picking cause ulceration, scarring, and tissue loss. TTS typically occurs following damage to the trigeminal nerve, often from surgical procedures, trauma, or stroke. We present a case of trigeminal trophic syndrome in an elderly lady who successfully responded to oral N-acetylcysteine. An increased awareness of this rare syndrome and potential treatment options will encourage a prompt diagnosis and possibly prevent permanent disfiguration.

Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review

Trigeminal trophic syndrome (TTS) is an uncommon and relatively unknown cause of facial ulceration that occurs after damage to the trigeminal nerve. It characteristically involves non-healing facial ulceration(s) with accompanying anesthesia, paresthesia, and dysesthesia along the distribution of a trigeminal dermatome. The ulcerations are believed to be self-induced in response to paresthesia. The disease is most common in middle-aged women, manifesting as a unilateral crescent-shaped ulceration on the ala nasi, with sparing of the nasal tip. The diagnosis is clinical and mostly based on exclusion of other possible causes of facial ulcerations, with emphasis on neoplasms, infection-associated vasculitis, and factitial disorders. There are no specific histological or laboratory signs. There is no standard treatment protocol; however, a number of different successful strategies have been reported, including pharmaceutical and surgical interventions, transcutaneous nerve stimulation, and simple occlusion dressings. Due to the self-inflicted nature of this disorder, the cornerstone of management is patient education with behavioral modification. Here, we report a case of TTS following herpes zoster ophthalmicus and review the current literature on this subject.

A rare case of a folded nasolabial flap for a full-thickness alar defect due to trigeminal trophic syndrome after herpes zoster infection

A 51-year-old man was referred for a skin defect with paresthesia and decreased pain in his right ala. He had a history of herpes zoster infection 3 weeks previously. Excisional biopsy and culture showed no evidence of skin malignancy or infection. He was diagnosed with trigeminal trophic syndrome (TTS) after herpes zoster infection. A two-stage folded nasolabial flap was used to reconstruct the defect. The patient was satisfied with the cosmetic outcomes of surgery, and there was no evidence of recurrence during the follow-up. TTS, a rare skin condition that presents with paresthesia, anesthesia, and facial ulceration, occurs after trigeminal nerve injury, which can be caused by herpes zoster infection in rare cases. TTS is an often-persistent condition with a high recurrence rate, causing cosmetic problems. Some surgical methods have been attempted, but our case presents the first use of a folded nasolabial flap to treat TTS. The flap was symmetric, without any nostril collapse. It is also noteworthy that the outcome was excellent with only a skin flap that did not use a bony framework. Herein, we report a rare case of TTS that occurred after herpes zoster infection and was successfully treated with a folded nasolabial flap.

Trigeminal Trophic Syndrome: A Comprehensive Review of a Surgical Approach.

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 orretrospective controlled studies are necessary to make more reliable recommendations, though may be challenging given the rarity of TTS.

Postherpetic Trigeminal Trophic Syndrome: A Case Report

Trigeminal trophic syndrome (TTS) is a rare condition characterized by anesthesia, paresthesia, and facial ulceration involving the trigeminal dermatome secondary to self-manipulation of the skin after a peripheral or central injury to the trigeminal nerve or its branches. Differential diagnosis of TTS includes conditions presenting with chronic facial ulceration, such as various infectious diseases, malignancy, vasculitis, pyoderma gangrenosum and dermatitis artefacta. We report a case of postherpetic TTS and highlight the importance of early diagnosis and prompt treatment of this condition, which may commonly be misdiagnosed.

Trigeminal trophic syndrome in a child – An unusual case report from Syria

The trigeminal trophic syndrome (TTS) is a rare form of cutaneous ulceration characterized by anesthesia, paresthesia and a secondary persistent facial ulceration. It is uncommon in children. However, we report an unusual case of TTS in a 5- year-old child with Moebius syndrome ,extending over the right nostril and then the other nostril was infected. The diagnosis of TTS was based on clinical history, tissue biopsy and serologic evaluation. The ulcer was treated with multiple antibiotics with no improvement. We describe this case because of very few pediatric cases of TTS published in the past , and to increase the awareness of this syndrome among dermatologists.

A case of trigeminal trophic syndrome responding to mirogabalin.

A case of trigeminal trophic syndrome responding to mirogabalin.

Trigeminal trophic syndrome

A 26-year-old woman developed a well-circumscribed, bleeding ulcer at the right nasolabial area 28 months after the recurrence of a posterior fossa meningioma. To our knowledge, this is the first reported case of trigeminal trophic syndrome following an intracranial meningioma. Clinical data from sixty-three cases of trigeminal trophic syndrome in the English literature are reviewed, and etiologic factors are discussed. (J AM ACAD DERMATOL 6:52-57, 1982.)

Carbamazepine as a Treatment for Trigeminal Trophic Syndrome: A Case Report and Literature Review

Trigeminal trophic syndrome (TTS) is a rare condition that results from damage to the central or peripheral branches of the trigeminal nerve. Themost common causes cited in the literature are trigeminal nerve ablation or transaction of the gasserian ganglion (as treatment of trigeminal neuralgia), stroke (specifically the Wallenberg lateral medullary syndrome), acoustic neuromas, postencephalitis, vertebrobasilar insufficiency, astrocytoma, syringobulbia, herpes zoster, and trauma. The first cases of TTS were published independently byWallenberg andLoveman in 1933. TTS is a clinical diagnosis that is characterized by paresthesia and nasal ulcerations, which are caused by repetitive scratching of the skin, in the distribution of the damaged trigeminal nerve. The time of onset varies significantly, ranging from months to decades. It is believed that patients pick or rub at the skin to relieve the irritation caused by the paresthesias, often described as a burning, itching, or crawling sensation. Decreased sensation often accompanies the paresthesias, allowing for severe disfigurement to occur with repetitive manipulation of the area. The repetitive scratching and manipulation results in painless, unilateral, crescent-shaped ulcers that classically involve the nasal ala.

A rare case of trigeminal trophic syndrome with an extensive scalp, forehead, and upper eyelid ulceration in a patient with undiagnosed Alzheimer disease

Trigeminal Trophic Syndrome (TTS) is a rare presentation of facial ulceration, which is characterized by the triad of anesthesia, paraesthesia, and damage of trigeminal sensory branches. We report a unique case of TTS as an extensive forehead and scalp ulceration in a patient with undiagnosed Alzheimer disease. Treatment options for trigeminal trophic syndrome are limited and disappointing especially in older patients with dementia. Family education and behavioral modification therapies may be well tolerated option in this population.

Trigeminal trophic syndrome

Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, consequent to damage to the trigeminal nerve or its central sensory connections. We reporta case of TTS in a 48-year-old woman with Bell's palsy following herpes zoster infection. The patient was treated and counseled. There hasnot been any recurrence for 1 year and the patient is being followed-up. The diagnosis of TTS should be suspected when there is unilateral facial ulceration, especially involving the ala nasi associated with sensory impairment.

Numbness Over the Distribution of Trigeminal Nerve—Trigeminal Trophic Syndrome or Viral Neuritis

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.

Trigeminal trophic syndrome: Improvement with trolamine/sodium alginate–containing topical emulsion

To the Editor: Trigeminal trophic syndrome (TTS) is a rare presentation of recurrent unilateral facial ulceration after damage to the sensory root of the trigeminal nerve.1,2 Crescentic erosions of the nasal alae are characteristic, though lesions may occur anywhere along the dermatome. Paresthesia and painful dysesthesia prompts excoriation and ulceration. Therapy is challenging and often disappointing. We present a case of TTS that improved rapidly with trolamine/sodium alginate–containing topical emulsion.

Trigeminal trophic syndrome of all three nerve branches: an underrecognized complication after brain surgery

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.

Trigeminal trophic syndrome: A report of two cases with review of literature

Trigeminal trophic syndrome, a rare cause of facial ulceration, is the consequence of damage to the trigeminal nerve or its central sensory connections. We report two cases of trigeminal trophic syndrome, complications of cerebral vascular accidents. A 65-year-old woman complained of numerous and progressive ulcers of the right side of her face of 2 month's duration. A 67-year-old woman presented with an ulcer of the ala nasi of 10 week's duration. This syndrome most commonly occurs in women with an average age of 57 years. About 100 cases are reported in the literature. The diagnosis is made on clinical grounds, and is suggested when loss of sensation occurs in association with unilateral facial ulceration, especially involving the ala nasi. Once the ulcers appear, they are extremely persistent.

Trigeminal Trophic Syndrome

Seven cases of trigeminal trophic syndrome are reported. In this rare condition, neurotrophic ulcers occur on the face, especially in the ala nasi area in a dermatome of the trigeminal nerve that has been rendered anesthetic, usually as a complication of trigeminal ablation by surgical means or injection for treatment of trigeminal neuralgia. The period from time of trigeminal nerve injury to onset of the ulcer varies from weeks to several years, with a mean of 1 to 2 years. Self-induced trauma is believed to produce the tissue destruction. Once the ulcers appear, they are extremely persistent.

Trigeminal trophic syndrome: A report of two cases and review

[Editorial Comment: Trigeminal trophic syndrome is a rare condition occurring in patients with trigeminal anesthesia. The most common cause is trigeminal rhizotomy for neuralgia. The absence of protective sensory feedback allows trauma to proceed to severe ulceration without pain. It is important that the otolaryngologist be aware of this rare syndrome.) Trigeminal trophic syndrome (TTS),‘-’ trigeminal neuropathy with nasal ulceration,8~g trigeminal neurotrophic ulceration,“*l’ trophic ulceration of the ala nasi,l’ and ulceration in arc13 are terms that describe a distinctive facial ulceration following sensory impairment of the trigeminal nerve. This uncommon clinical entity was first described by Loveman in 1933,14 and independently by McKenzie15 2 months later. Since then, numerous investigators have described similar cases of nasal erosion or chronic facial ulceration following sensory impairment in the trigeminal area. In 1982 Weintraub reviewed 63 cases of TTS and found that 46% occurred after trigeminal rhizotomy and 29% after alcohol injection of the gasserian ganglion. Less frequent causes included vertebrobasilar insufficiency (9%), acoustic neuroma (5%), postencephalitic parkinsonism (5%), syringobulbia (2%), and unknown (5%).’ Two women who demonstrated this lesion are described.

Trigerninal trophic syndrome: A case and review

A 26-year-old woman developed a well-circumscribed, bleeding ulcer at the right nasolabial area 28 months after the recurrence of a posterior fossa meningioma. To our knowledge, this is the first reported case of trigeminal trophic syndrome following an intracranial meningioma. Clinical data from sixty-three cases of trigeminal trophic syndrome in the English literature are reviewed, and etiologic factors are discussed.