Editorial

Losing by a Nose: Diagnostic and Therapeutic Challenges of the Trigeminal Trophic Syndrome

Authors: David M. Aronoff, MD

Abstract

Peripheral or central damage to the trigeminal nerve is a relatively common occurrence, whether due to cerebrovascular disease, viral infections (such as varicella-zoster), idiopathic Bell palsy, or surgical ablation of the Gasserian ganglion to treat neuralgic pain.1Rarely, such injury can be complicated by the development of a triad of anesthesia, paresthesias, and crescentic ala nasi ulceration known as the trigeminal trophic syndrome (TTS).2 The distinctive nasal ulceration of the TTS is self-induced, resulting from repetitive manipulation in response to the anesthesia and/or paresthesias. It is important for healthcare practitioners to be aware of this well-described syndrome because mistaking the ulcerative lesions for either invasive infection or autoimmune disease (eg, Wegener granulomatosis) may result in inappropriate, and potentially damaging, therapy with systemic antimicrobials or immunosuppressive drugs.1,3

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References

1. Monrad SU, Terrell JE, Aronoff DM. The trigeminal trophic syndrome: an unusual cause of nasal ulceration. J Am Acad Dermatol 2004;50:949–952.
 
2. Weintraub E, Soltani K, Hekmatpanah J, et al. Trigeminal trophic syndrome. A case and review. J Am Acad Dermatol 1982;6:52–57.
 
3. Datta RV, Zeitouni NC, Zollo JD, et al. Trigeminal trophic syndrome mimicking Wegener's granulomatosis. A case report with a review of the literature. Ann Otol Rhinol Laryngol 2000;109:331–333.
 
4. Setyadi HG, Cohen PR, Schulze KE, et al. Trigeminal trophic syndrome. South Med J 2007;100:45–48.