11.0: Thursday, March 17, 2005

Trigeminal Trophic Syndrome: Case Report and Review of the Literature

Bharat Shah, MD and Robert D. Wallace.

Purpose: Case report and review of clinical presentation and treatment of trigeminal trophic syndrome. Methods: Chart review. Trigeminal trophic syndrome (TTS) is a rare, progressive, destructive process of the face associated with iatrogenic, vascular, or viral insult to the trigeminal nerve. A severe iatrogenic case of TTS is presented, as well as a review of the literature and treatment options. A 50 year old Caucasian female presented with an eight year history of progressive ulceration of the nasal ala and septum. She had a history of post-traumatic trigeminal neuralgia treated by trigeminal nerve rhizotomy one year prior to the onset of symptoms. Workup for herpetic, mycobacterial, and viral infection were negative. The patient underwent multiple debridements of necrotic soft tissue and alar reconstruction with melolabial flaps and cartilage grafts. The ulceration continued to progress with a resultant defect encompassing the ipsilateral forehead, cornea, nasal tip and sidewall, septum, and upper lip. Conclusions: Trigeminal trophic syndrome is difficult to diagnose and treat, and factitious disorder must be excluded. Opthalmalogic involvement is common and may be severe. Surgical reconstruction may be complicated by recurrent or progressive ulceration. Nonsurgical treatments and nasal prosthetics may be beneficial.