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Finucane S, Dalwadi P, Mudaliar K, Hurtuk A. Trigeminal trophic syndrome: A systematic review. Am J Otolaryngol 2024; 45:104354. [PMID: 38759434 DOI: 10.1016/j.amjoto.2024.104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To systematically report and document Trigeminal Trophic Syndrome (TTS), characterize its clinical presentation, diagnostic tests performed, outline management strategies, outcomes; and highlight the role of otolaryngologists in the tissue diagnosis of this rare syndrome. DATA SOURCES PubMed/Medline, Scopus, and Cochrane databases. REVIEW METHODS PubMed/Medline, Scopus, and Cochrane databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all cases of TTS published with an English translation from inception to December 2020. RESULTS A total of 142 articles describing 214 patients with TTS were included in the analysis. There was a female predominance (62.9 %) and a median age of 57 (range 1-93) years at presentation. A trigeminal neurological insult was identified in 200 (93.5 %) cases. The most common triggers for TTS were treatment for trigeminal neuralgia (35.7 %) and cerebrovascular accident (21.6 %). Self-inflicted trauma occurred in 137 (64 %) patients. Biopsy was done in 123 (57.5 %) patients. Patient education, barrier devices, and medications to address parasthesias were the most common treatment strategies. The majority of patients (72.5 %) received multimodal therapy. Surgery was performed in 35 (22.7 %) patients. Treatment outcomes were discussed in 120 (56.1 %) patients. CONCLUSIONS TTS is a rare condition with poorly understood pathophysiology. It should be suspected in a patient with non-healing facial ulceration and altered sensation within the trigeminal nerve distribution. Biopsy of the ulcer is important to confirm the diagnosis and exclude malignancy. Treatment options include conservative and pharmacologic measures, and less frequently surgery.
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Affiliation(s)
- Sarah Finucane
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Poonam Dalwadi
- Department of Medicine, Piedmont Macon Medical Center, Macon, GA, USA
| | - Kumaran Mudaliar
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Agnes Hurtuk
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
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Đorđević Betetto L, Bajuk V. Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2023. [DOI: 10.15570/actaapa.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Pleasant TK, Benvenuto A, Moyer JS. Nasal Ulceration in Trigeminal Trophic Syndrome. Facial Plast Surg Aesthet Med 2022; 24:506-508. [DOI: 10.1089/fpsam.2021.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Terrence K. Pleasant
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Jeffrey S. Moyer
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Segovia González M, Martina L, García García JF, González González A, Benito Duque P. Trigeminal trophic syndrome: An unusual nasal ulceration. A case report and review of the literature. J Tissue Viability 2022; 31:369-371. [PMID: 35101334 DOI: 10.1016/j.jtv.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/03/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Affiliation(s)
- María Segovia González
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
| | - Laura Martina
- Department of Plastic and Reconstructive Surgery, Ospedale Policlinico San Martino, Genoa University, Genova, Italy.
| | | | - Alicia González González
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Pablo Benito Duque
- Department of Plastic and Reconstructive Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Mesa-Marrero M, de Frias-Berzosa B, Hernández-Montero E, Alvarez-Roger A, Cruz-Toro P. Rhinotillexomania: A Manifestation of Psychiatric Illness. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:394-398. [PMID: 34844679 DOI: 10.1016/j.otoeng.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To increase the knowledge of rhinotillexomania, or compulsive nose picking, as a manifestation of psychiatric disease through the presentation of a case series and a review of the literature. MATERIAL We present three clinical cases with self-destructive nasal injuries as a symptom of different psychiatric diseases. RESULTS One patient presented amputation of the middle turbinate as a manifestation of an obsessive-compulsive disorder of bipolar disease. Two patients had a septal perforation. In the first patient it was the first symptom of factitious dermatitis and in the second it was during the course of schizophrenia. Only control with psychological treatment and psychotropic drugs stabilised the nasal injury. CONCLUSION Self-induced injuries are a diagnostic and treatment challenge for the ENT specialist. A knowledge of psychiatric diseases related to destructive injuries to the nose will improve the approach to patients and prevent the progression of local damage and its complications.
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Affiliation(s)
| | | | | | - Andrea Alvarez-Roger
- Servicio de Otorrinolaringología, Hospital de Viladecans, Viladecans, Barcelona, Spain
| | - Paula Cruz-Toro
- Servicio de Otorrinolaringología, Hospital de Viladecans, Viladecans, Barcelona, Spain
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Evans RL, Tew JC, Yates GP, Feldman M. Factitious Disorder (Munchausen Syndrome) in Plastic Surgery: A Systematic Review of 42 Cases. Ann Plast Surg 2021; 86:e1-e6. [PMID: 32804718 DOI: 10.1097/sap.0000000000002526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification. They may deceive plastic surgeons into performing multiple unnecessary procedures. We undertook the first systematic review of FD case reports in plastic surgery. Our aims were 2-fold: (1) describe the adverse outcomes associated with these cases and (2) identify strategies for their prevention by surgeons. METHODS MEDLINE, EMBASE, and SCOPUS databases were searched. We included cases in which an adult with FD presented to a plastic surgeon. Our search returned a total of 42 eligible cases reported from North America (43%), Europe (37%), and Asia (20%). RESULTS Seventy-six percent of patients were women, and 62% worked in health care. Sixty percent had a comorbid psychiatric disorder, the most common (50%) being depression. Ninety-three percent of our sample presented with self-induced lesions. The average delay in diagnosis of FD was 54 months, with 46% of patients receiving multiple surgical procedures in this time, including debridement (36%) and skin grafts (39%). Surgical wounds were frequently exploited by patients to remain in, or return to, hospital: 50% contaminated or manipulated their wounds to prevent healing. Thirty-six percent of cases resulted in significant long-term disability (24%) or disfigurement (12%). Ten percent of patients received an amputation. Outcomes were improved when patients were confronted by surgeons, however, and 62% were willing to see a psychiatrist. Surgeons were able to support recovery in 33% of cases-for example, by using occlusive wound dressings. CONCLUSIONS Patients with FD who present to plastic surgeons are high risk: the majority require surgical intervention for severe self-injury, and many engage in harmful behaviors, such as "doctor-shopping." Early recognition of FD in plastic surgery is, therefore, crucial and may be achieved via careful examination of lesions for unusual morphology. Medical records may reveal extensive health care service use and negative investigations. Finally, plastic surgeons may play an important role in managing such patients. Management strategies include direct observation by nursing staff in the postoperative period and use of strict occlusive dressings to prevent access to surgical wounds.
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Affiliation(s)
- Rhian Louise Evans
- From the Bart's and The London School of Medicine and Dentistry, London, England
| | | | - Gregory Peter Yates
- From the Bart's and The London School of Medicine and Dentistry, London, England
| | - Marc Feldman
- Department of Psychiatry and Behavioral Medicine, University of Alabama, Tuscaloosa, AL
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Lam BC, Saboo US, Kheirkhah A. Acute neurotrophic keratitis with trigeminal trophic syndrome after craniotomy. J AAPOS 2020; 24:376-379. [PMID: 33228954 DOI: 10.1016/j.jaapos.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
We report the case of a child who, shortly after undergoing suboccipital craniotomy for resection of a medullary cavernoma, developed corneal and conjunctival epithelial breakdown of the right eye with ipsilateral facial hypoesthesia as well as erosions and crusting of the eyelids, nostril, and lips on the right side. This combination of findings likely results from acute injury to the ipsilateral trigeminal ganglion, leading to acute neurotrophic keratitis and trigeminal trophic syndrome.
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Affiliation(s)
- Brandon C Lam
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Texas
| | - Ujwala Sachin Saboo
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Texas
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, Texas.
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Mesa-Marrero M, de Frias-Berzosa B, Hernández-Montero E, Alvarez-Roger A, Cruz-Toro P. Rhinotillexomania: a manifestation of psychiatric illness. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:S0001-6519(20)30156-4. [PMID: 33087254 DOI: 10.1016/j.otorri.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To increase the knowledge of rhinotillexomania, or compulsive nose picking, as a manifestation of psychiatric disease through the presentation of a case series and a review of the literature. MATERIAL We present three clinical cases with self-destructive nasal injuries as a symptom of different psychiatric diseases. RESULTS One patient presented amputation of the middle turbinate as a manifestation of an obsessive-compulsive disorder of bipolar disease. Two patients had a septal perforation. In the first patient it was the first symptom of factitious dermatitis and in the second it was during the course of schizophrenia. Only control with psychological treatment and psychotropic drugs stabilised the nasal injury. CONCLUSION Self-induced injuries are a diagnostic and treatment challenge for the ENT specialist. A knowledge of psychiatric diseases related to destructive injuries to the nose will improve the approach to patients and prevent the progression of local damage and its complications.
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Affiliation(s)
- Margarita Mesa-Marrero
- Servicio de Otorrinolaringología, Hospital de Viladecans, Viladecans, Barcelona, España.
| | | | | | - Andrea Alvarez-Roger
- Servicio de Otorrinolaringología, Hospital de Viladecans, Viladecans, Barcelona, España
| | - Paula Cruz-Toro
- Servicio de Otorrinolaringología, Hospital de Viladecans, Viladecans, Barcelona, España
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HANÇER HS. Trigeminal Trofik Sendrom: Nazal ülserin nadir bir sebebi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.770627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Khan AU, Khachemoune A. Trigeminal trophic syndrome: an updated review. Int J Dermatol 2018; 58:530-537. [PMID: 29931799 DOI: 10.1111/ijd.14098] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/12/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Ayesha U Khan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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Hufschmidt K, Fernandez J, Balaguer T, Fontaine D, Chignon-Sicard B. [Treatment of neurotrophic ulceration following alcohol injection of the gasserian ganglion in trigeminal neuralgia: Case report and review of the literature]. ANN CHIR PLAST ESTH 2016; 62:79-86. [PMID: 27107560 DOI: 10.1016/j.anplas.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION 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. PRESENTATION OF CASE A 88-year old woman presented with TTS and destruction of the right nasal ala 25 years 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. DISCUSSION Our literature review reports 28 cases of TTS subsequent to alcohol injection of the gasserian ganglion. Age of presentation ranges from 49 to 88 years, with a time of onset between trigeminal injury and TTS ranging from 2 weeks to 17 years. 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. CONCLUSION 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.
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Affiliation(s)
- K Hufschmidt
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
| | - J Fernandez
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - T Balaguer
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - D Fontaine
- Service de neurochirurgie, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
| | - B Chignon-Sicard
- Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France
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Sawada T, Asai J, Nomiyama T, Masuda K, Takenaka H, Katoh N. Trigeminal trophic syndrome: Report of a case and review of the published work. J Dermatol 2014; 41:525-8. [DOI: 10.1111/1346-8138.12490] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Takahiro Sawada
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Jun Asai
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tomoko Nomiyama
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Koji Masuda
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Hideya Takenaka
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Norito Katoh
- Department of Dermatology; Kyoto Prefectural University of Medicine; Kyoto Japan
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Abstract
OBJECTIVES Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. METHODS We undertook a review of all published cases of facial self-mutilation (1960-2011). RESULTS We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target--seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation. CONCLUSIONS Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.
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Nasal Ulceration. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Lukšić I, Lukšić I, Šestan-Crnek S, Virag M, Macan D. Trigeminal trophic syndrome of all three nerve branches: an underrecognized complication after brain surgery. J Neurosurg 2008; 108:170-3. [DOI: 10.3171/jns/2008/108/01/0170] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors report a case of trigeminal trophic syndrome (TTS) that occurred as a complication of a neurosurgical procedure. Three years after a second surgical treatment for a meningioma of the cerebellopontine angle, this 32-year-old woman developed TTS with progressive skin ulcers on the left ala nasi and the left side of the forehead and chin. Trigeminal trophic syndrome is an extremely rare cause of facial ulceration. It occurs as a consequence of trigeminal nerve damage or impaired central sensory connections. To the authors' knowledge, this is the first report of lesions in the dermatomes of all three branches of the nerve after a neurosurgical procedure. Early recognition of this disorder is important, as treatment is difficult and often unsatisfactory. Many clinicians are not aware of this disease, thus, it may be more common than previously thought. The importance of recognizing and diagnosing TTS, as well as its treatment, are discussed.
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Affiliation(s)
- Ivica Lukšić
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
| | - Ivana Lukšić
- 2Department of Clinical Microbiology and Hospital Infection, University Hospital Dubrava, Zagreb, Croatia
| | - Sandra Šestan-Crnek
- 2Department of Clinical Microbiology and Hospital Infection, University Hospital Dubrava, Zagreb, Croatia
| | - Mihajlo Virag
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
| | - Darko Macan
- 1Department of Maxillofacial and Oral Surgery, University Hospital Dubrava, Medical School and School of Dental Medicine, University of Zagreb; and
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Abstract
Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, which is believed to develop after insult to the trigeminal ganglia or other parts of the peripheral/central nervous system in the trigeminal pathway. The pathogenesis of TTS is poorly understood. Developing a better understanding of TTS will allow early recognition and improved treatment. Although the ulcers develop predominantly on the ala nasi, the literature on ulcer locations is limited. In this article, we review the epidemiologic aspects of TTS, expand on our knowledge of the anatomic location of the ulcers, and discuss current theories for its aetiology and briefly review the approaches to its management.
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Affiliation(s)
- R M Rashid
- Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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18
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Setyadi HG, Cohen PR, Schulze KE, Mason SH, Martinelli PT, Alford EL, Taffet GE, Nelson BR. Trigeminal trophic syndrome. South Med J 2007; 100:43-8. [PMID: 17269524 DOI: 10.1097/01.smj.0000253020.74133.7e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ulceration of the nose may be inadvertently induced by the patient. Although trigeminal trophic syndrome is an uncommon cause of chronic ulcers, healthcare providers should consider the possibility of this disorder when encountering a patient with nasal ulcerations. Trigeminal trophic syndrome most commonly occurs in older women following therapy for trigeminal neuralgia. The ulcers usually involve the nasal ala and paranasal areas. The clinical vignette of a man with a self-induced nasal ulcer secondary to trigeminal trophic syndrome, which was initially suspected to be skin cancer, is presented. Since nasal ulcerations can be secondary to other conditions, a lesional biopsy should be performed to exclude other diagnoses when trigeminal trophic syndrome is entertained. In addition to trigeminal trophic syndrome, the differential diagnosis of conditions that can cause nasal ulcers include factitial disorders with self-induced ulcerations (such as dermatitis artifacta and neurotic excoriations), granulomatous conditions, infectious diseases, malignancy, and pyoderma gangrenosum. Treatment of trigeminal trophic syndrome requires prevention of digital manipulation of the lesion-either by occluding contact with the ulcer, initiating psychotropic medication, or both. Psychiatric and/or pharmacologic intervention should be considered to reduce or resolve further habitual self-inflicted injury before surgical intervention.
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Preston PW, Orpin SD, Tucker WFG, Zaki I. Successful use of a thermoplastic dressing in two cases of the trigeminal trophic syndrome. Clin Exp Dermatol 2006; 31:525-7. [PMID: 16716154 DOI: 10.1111/j.1365-2230.2006.02125.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of trigeminal trophic syndrome is challenging and often unsatisfactory, particularly in patients with cognitive impairment. We report the novel use of a thermoplastic dressing in two patients with trigeminal trophic syndrome. Use of the dressing resulted in successful healing of ulceration in both patients, which has been maintained in the short term, representing a simple and economical therapeutic option in the management of this difficult condition.
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Affiliation(s)
- P W Preston
- Department of Dermatology, Solihull Hospital, Heart of England NHS Trust, Birmingham, UK.
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Racette AJ, Moore A, Brown S, Racette A. Recognizing trigeminal trophic syndrome. J Am Acad Dermatol 2006; 55:359-61. [PMID: 16844535 DOI: 10.1016/j.jaad.2005.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 09/29/2005] [Accepted: 10/14/2005] [Indexed: 11/23/2022]
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Tollefson TT, Kriet JD. Complex nasal defects: structure and internal lining. Facial Plast Surg Clin North Am 2005; 13:333-43, vii. [PMID: 15817411 DOI: 10.1016/j.fsc.2004.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The development of nasal reconstruction concepts such as the three-layered (lining, structure, and covering) repair has led to remarkable esthetic and functional improvements. The authors present a variety of techniques for providing nasal structure and internal lining and discuss the application of these methods to specific nasal defects.
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Affiliation(s)
- Travis T Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, 2521 Stockton Boulevard, Sacramento, CA 95817, USA
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