Trigeminal Trophic Syndrome: Presentation of a Case in Its Early Stages

Abstract

Objectives:

Be able to recognize and treat trigeminal trophic syndrome at an early stage.

Methods:

Case presentation.

Results:

The trigeminal trophic syndrome is a rare condition that arises after damage, induced or not, to the sensory part of the trigeminal root or nerve. After the nerve is damaged the patient experiences hemifacial anesthesia and paresthesias, mainly itching and burning that causes continuous touching, rubbing, and picking to relieve the perceived paresthesias. The repetitive trauma leads to an ulcer. If untreated or misdiagnosed, the ulcer may grow and cause disfigurement. In this case we presented a 43-year-old female with trigeminal neuralgia who underwent thermocoagulation of the second and third portions of the trigeminal nerve 6 months prior to her initial visit. She visited 4 other specialists before coming to us. She presented with the typical symptomatology and an ulcer of about half an inch in the left nasal vestibule. After explaining and educating the patient about the underlying causes of the ulcer (self-induced trauma) we excised the ulcer and advanced a local island flap. The patient started with carbamazepine 200 mg daily and reported reduced paresthesias. One year after the reconstruction the ulcer has not returned.

Conclusions:

Trigeminal Trophic Syndrome is a rare entity that can be encountered by otolaryngologists. The unfamiliarity with the condition leads to misdiagnosis and delay of treatment that can result in disfigurement. Treatment encompasses surgical reconstruction, medical therapy, and education of the patient.