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Trigeminal Trophic Syndrome: An Unusual Cause of Nasal Ulceration
Acta Otorrinolaringol Esp. 2017;68(3):188---189
www.elsevier.es/otorrino
IMAGES IN OTORHINOLARYNGOLOGY
Trigeminal Trophic Syndrome: An Unusual Cause of Nasal Ulceration夽 Síndrome trófico trigeminal: causa infrecuente de ulceración nasal Carlos Morales-Raya,a Esther García-González,b Lidia Maro˜ nas-Jiméneza,∗ a b
Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain Servicio de Otorrinolaringología, Hospital Universitario 12 de Octubre, Madrid, Spain
A male aged 65 with left acoustic neuroma who had undergone surgery 10 years previously. From then onwards, he had been in complete remission and with no other relevant history. He went to the doctor for a painless nasal ulcer which had progressively increased over the last month. Physical examination revealed a major loss of violet-ruby edged substance in the left nasal ala associated with thermoalgesic hyposensitivity in the trigeminal ipsilateral region (Figs. 1 and 2). All microbiologic studies tested negative
Figure 2
Figure 1
夽 Please cite this article as: Morales-Raya C, García-González E, Maro˜ nas-Jiménez L. Síndrome trófico trigeminal: causa infrecuente de ulceración nasal. Acta Otorrinolaringol Esp. 2017;68:188---189. ∗ Corresponding author. E-mail address: [email protected] (L. Maro˜ nas-Jiménez).
and the cutaneous biopsy only revealed non-specific inflammatory changes. Local care measures, together with the application of topical emollients were administered and the disappearance of the perilesional erythema was observed when the patient came for a follow-up check-up the following month. Trigeminal trophic syndrome is a rare cause of facial ulceration which appears as a consequence fifth cranial nerve injuries. The standard triad of anaesthesia, paresthesias and nasal ulceration which typically respect the tip, is key for its clinical identification within the spectrum of differential diagnosis of mid-line destructive disease.
2173-5735/© 2016 Elsevier Espa˜ na, S.L.U. and Sociedad Espa˜ nola de Otorrinolaringolog´ıa y Cirug´ıa de Cabeza y Cuello. All rights reserved.
Trigeminal trophic syndrome Treating this condition constitutes a genuine therapeutic challenge and should be essentially aimed at the prevention of repeated trauma to the region, by the patient. The use of a protective prosthesis and the administration of gabapentin, amitriptyline, pimozide or vitamin B, and the
189 performing of several procedures such as transcutaneous electrical nerve stimulation, cervical sympathectomy or surgical coverage of the defect lead to variable and often poor outcomes.
www.elsevier.es/otorrino
IMAGES IN OTORHINOLARYNGOLOGY
Trigeminal Trophic Syndrome: An Unusual Cause of Nasal Ulceration夽 Síndrome trófico trigeminal: causa infrecuente de ulceración nasal Carlos Morales-Raya,a Esther García-González,b Lidia Maro˜ nas-Jiméneza,∗ a b
Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain Servicio de Otorrinolaringología, Hospital Universitario 12 de Octubre, Madrid, Spain
A male aged 65 with left acoustic neuroma who had undergone surgery 10 years previously. From then onwards, he had been in complete remission and with no other relevant history. He went to the doctor for a painless nasal ulcer which had progressively increased over the last month. Physical examination revealed a major loss of violet-ruby edged substance in the left nasal ala associated with thermoalgesic hyposensitivity in the trigeminal ipsilateral region (Figs. 1 and 2). All microbiologic studies tested negative
Figure 2
Figure 1
夽 Please cite this article as: Morales-Raya C, García-González E, Maro˜ nas-Jiménez L. Síndrome trófico trigeminal: causa infrecuente de ulceración nasal. Acta Otorrinolaringol Esp. 2017;68:188---189. ∗ Corresponding author. E-mail address: [email protected] (L. Maro˜ nas-Jiménez).
and the cutaneous biopsy only revealed non-specific inflammatory changes. Local care measures, together with the application of topical emollients were administered and the disappearance of the perilesional erythema was observed when the patient came for a follow-up check-up the following month. Trigeminal trophic syndrome is a rare cause of facial ulceration which appears as a consequence fifth cranial nerve injuries. The standard triad of anaesthesia, paresthesias and nasal ulceration which typically respect the tip, is key for its clinical identification within the spectrum of differential diagnosis of mid-line destructive disease.
2173-5735/© 2016 Elsevier Espa˜ na, S.L.U. and Sociedad Espa˜ nola de Otorrinolaringolog´ıa y Cirug´ıa de Cabeza y Cuello. All rights reserved.
Trigeminal trophic syndrome Treating this condition constitutes a genuine therapeutic challenge and should be essentially aimed at the prevention of repeated trauma to the region, by the patient. The use of a protective prosthesis and the administration of gabapentin, amitriptyline, pimozide or vitamin B, and the
189 performing of several procedures such as transcutaneous electrical nerve stimulation, cervical sympathectomy or surgical coverage of the defect lead to variable and often poor outcomes.