Trigeminal Trophic Syndrome Research Articles

Trigeminal trophic syndrome : Late complication after herpes zoster infection with loss of ala nasi

This article presents the case of refractory facial ulcers with loss of ala nasi as arare differential diagnosis of chronic facial wounds. We diagnosed trigeminal trophic syndrome as alate complication of aherpes zoster infection. Education to avoid self-manipulation and an occlusive local therapy in combination with neuromodulating drug therapy are at the forefront of therapeutic measures. Further surgical plastic procedures can be used with restraint in therapy-resistant cases.

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

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.

Neuropathic pruritus associated with brain disorders

Various types of brain pathology may be associated with neuropathic pruritus. While the mechanisms behind neuropathic itch is not well understood, damage to the itch processing centers and circuits of the brain may lead to changes in signaling in both top-down and bottom-up pathways that results in the distortion of itch sensation. Patients with brain pathologies such as such as stroke, brain tumors, spongiform encephalopathies, multiple sclerosis, trigeminal trophic syndrome, and systemic diseases such as end-stage renal diseases and primary biliary cholangitis have reported neuropathic itch of different characteristics. Commonly involved areas of the brain that, when damaged, are associated with neuropathic itch are the primary somatosensory cortex, precuneus, hippocampus, amygdala, periaqueductal gray, thalamus, insula, nucleus accumbens, Gasserian ganglion, cerebellum, cingulate cortex, prefrontal cortex, medulla, frontotemporal, and parietal lobe. Treatments for neuropathic pain, depression and seizures, such as kappa opioids, gabapentinoids, tricyclic antidepressants, and ketamine, are commonly used to treat neuropathic pruritus and are found to be effective.

A case of trigeminal trophic syndrome responding to mirogabalin.

A case of trigeminal trophic syndrome responding to mirogabalin.

Trigeminal Trophic Syndrome: A Cause of Dysesthesia and Persistent Facial Ulceration

A woman in her 70s presented with a nonpainful, enlarging lesion on the left cheek of 6 months’ duration. She described the initial lesion as a “fever blister” that did not heal after application of triple antibiotic ointment. She reported a history of trigeminal neuralgia with nerve ablation approximately 8 years prior and admitted to frequently manipulating the lesion because of a sensation of having to blow her nose. Numbness of the affected area was present.

Тригеминальный трофический синдром

Trigeminal trophic syndrome is a rare nosological pathology form of the face. Based on the literature data and 11 own observations, the article discusses the pathogenesis, diagnosis and treatment of skin sensations, ulcerative and other cosmetic defects that occur after injury of the peripheral branches, Gasser's node, root, and the upper sensitive trigeminal nerve nucleus in the dorsolateral part of the pons Varolii upper section in the brain stem. The clinical disease manifestations are described in detail with the characteristics of the lesions, their localization, course dynamics, and mental status patterns of patients. The article presents a detailed list of pathological conditions with which trigeminal trophic syndrome should be differentiated (malignant epithelioma, mycoses, focal fibrosing alopecia, leprosy, syphilis, diabetes mellitus, cutaneous manifestations in diseases of internal organs and connective tissue (scleroderma, temporal arteritis, Wegener's granulomatosis), central and peripheral nervous system, substance abuse, psychosomatic disorders, somatopsychosis, autoaggression, Munchausen syndrome, etc.). KEYWORDS: skin ulcers, neurotrophic disorders, trigeminal trophic syndrome, deafferentation, iatrogenic complications. FOR CITATION: Belopasov V.V. Trigeminal trophic syndrome. Russian Medical Inquiry. 2020;4(9):566–572. DOI: 10.32364/2587-6821-2020- 4-9-566-572.

Trigeminal Trophic Syndrome and Neurotrophic Keratopathy following Stroke

Neurotrophic ulceration of the face and cornea are rare complications of trigeminal nerve damage. Their rarity makes them potentially underreported and misdiagnosed conditions. The neurogenic basis and self-manipulating nature of facial ulceration also require a rapid diagnosis to provide a rare syndrome-specific approach. Pain management for paresthesias and educating patients about their self-manipulating behaviors are key management strategies for successful treatment and improved outcomes under the multidisciplinary approach.

Trigeminal trophic syndrome

Clinicians should consider TTS in the differential of facial ulcerations following injury to the trigeminal pathway.

Trigeminal trophic syndrome in a C2 nerve distribution

Trigeminal trophic syndrome in a C2 nerve distribution

Midface toddler excoriation syndrome (MiTES) can be caused by autosomal recessive biallelic mutations in a gene for congenital insensitivity to pain, PRDM12.

Midface toddler excoriation syndrome (MiTES) is a condition recently reported in three unrelated children. Habitual scratching from the first year of life inflicted deep, chronic, scarring wounds around the nose and eyes. One child had a mild neurological deficit but there was no other evidence of insensitivity to pain. Bilateral distribution and localization to the midface distinguish MiTES from other causes of self-inflicted skin damage such as trigeminal trophic syndrome. An earlier study of five siblings from a consanguineous Irish family, with lesions corresponding to MiTES plus other sensory deficits, showed homozygous mutations in a gene for hereditary sensory and autonomic neuropathy type VIII (HSAN8), PRDM12. To study further cases of MiTES, including analysis of PRDM12. We describe five further children, from four families, with facial lesions typical of MiTES, in whom mutation analysis of PRDM12 was carried out. Homozygous or compound heterozygous pathogenic expansions of the PRDM12 polyalanine tract were found in four of five affected individuals, in three families. Our finding of autosomal recessive mutations in PRDM12 in four of five patients with MiTES extends the phenotypic spectrum of PRDM12 mutations, which usually cause HSAN8, characterized by mutilating self-inflicted wounds of the extremities, lips and tongue. By contrast, MiTES shows severe midfacial lesions with little if any evidence of generalized pain insensitivity. The condition is probably genetically heterogeneous, and other congenital insensitivity to pain and HSAN genes such as SCN11A may be implicated. This new understanding of the nature of MiTES, which can masquerade as factitious disease, will facilitate appropriate management.

Atypical variant of trigeminal trophic syndrome successfully treated with pregabalin: a case report series.

Atypical variant of trigeminal trophic syndrome successfully treated with pregabalin: a case report series.

Trigeminal trophic syndrome: an updated review.

Trigeminal trophic syndrome (TTS) is a rare disease process that is thought to occur after insult to the trigeminal nerve. The earliest descriptions of this condition were provided in the early 20th century, yet it remains relatively unknown, with approximately 200 cases since described. Most commonly seen in older women, TTS characteristically involves persistent facial ulceration with loss of sensation and paresthesia along the distribution of the trigeminal dermatome. Ulceration often occurs in the alar region, following self-manipulation in response to paresthesias. Time of onset of TTS after trigeminal insult may vary from weeks to decades, and emergence of ulceration may be associated with psychiatric disorders. Diagnosis is clinical and made by exclusion of similarly presenting conditions. Histology is nonspecific yet necessary to exclude other causes of facial ulceration. Although there is not yet a standard management strategy, a number of successful approaches have been reported including pharmaceutical and surgical interventions, installation of a protector, and transcutaneous nerve stimulation. However, because of the self-inflicted manifestations of this disorder, behavioral modifications remain of the utmost importance. This review serves to address the history, epidemiology, pathogenesis, clinical presentation, histology, diagnosis, differential diagnosis, and management options for TTS.

Teaching NeuroImages: Facial ulceration in stroke

A 50-year-old woman with a history of lateral medullary stroke 3 years ago presented with a 7-month history of persistent itch with constant picking and a nonhealing ulcer on the left side of her face (figure). Examination revealed anesthesia over the V2 distribution of the trigeminal nerve. Trigeminal trophic syndrome is a rare cause of chronic facial ulceration first described by Wallenberg.1 It results from damage to the trigeminal ganglion or nerve. Causes include trigeminal nerve ablation, stroke, tumors, herpes, and leprosy.2 The ulceration results from self-mutilation due to facial anesthesia and paresthesias.

Zespół troficzny nerwu trójdzielnego związany z neuralgią po przebytym półpaścu – opis rzadkiego przypadku i przegląd piśmiennictwa

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Kaul P, Mushtaq S, Kalsotra P. Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature. Dermatology Review/Przegląd Dermatologiczny. 2018;105(4):542-547. doi:10.5114/dr.2018.78075. APA Kaul, P., Mushtaq, S., & Kalsotra, P. (2018). Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature. Dermatology Review/Przegląd Dermatologiczny, 105(4), 542-547. https://doi.org/10.5114/dr.2018.78075 Chicago Kaul, Pallvi, Sabha Mushtaq, and Parmod Kalsotra. 2018. "Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature". Dermatology Review/Przegląd Dermatologiczny 105 (4): 542-547. doi:10.5114/dr.2018.78075. Harvard Kaul, P., Mushtaq, S., and Kalsotra, P. (2018). Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature. Dermatology Review/Przegląd Dermatologiczny, 105(4), pp.542-547. https://doi.org/10.5114/dr.2018.78075 MLA Kaul, Pallvi et al. "Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature." Dermatology Review/Przegląd Dermatologiczny, vol. 105, no. 4, 2018, pp. 542-547. doi:10.5114/dr.2018.78075. Vancouver Kaul P, Mushtaq S, Kalsotra P. Trigeminal trophic syndrome associated with post-herpetic neuralgia – report of a rare case with review of literature. Dermatology Review/Przegląd Dermatologiczny. 2018;105(4):542-547. doi:10.5114/dr.2018.78075.

Trigeminal trophic syndrome: An unusual cause of scalp ulceration

Trigeminal trophic syndrome: An unusual cause of scalp ulceration

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.)

Trigeminal trophic syndrome: A case report of an underdiagnosed cause of facial chronic ulcer

Trigeminal trophic syndrome: A case report of an underdiagnosed cause of facial chronic ulcer

Trigeminal Trophic Syndrome: An Unusual Cause of Nasal Ulceration

Trigeminal Trophic Syndrome: An Unusual Cause of Nasal Ulceration

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

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.

Two cases of ophthalmic trigeminal trophic syndrome

Two cases of ophthalmic trigeminal trophic syndrome