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Trigeminal trophic syndrome
Other Resources UpToDate PubMed

Trigeminal trophic syndrome

Contributors: Deepa P. Patel MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Trigeminal trophic syndrome (TTS) is a complication of damage to the trigeminal sensory nerve or sensory nuclei resulting in self-induced excoriations of the skin on the central face. Typically, iatrogenic following therapeutic ablation of the trigeminal nerve, facial dysesthesia or hyperesthesia develops, classically involving the nasal ala. This can also occur on the upper lip, paranasal area, scalp, medial forehead, or ear. Patients may describe pain, itch, picking, or scratching sensations in the region and, as a result, manipulate or excoriate their skin.

Most cases of trigeminal trophic syndrome are a complication of neurosurgical removal of the Gasserian ganglion, which is typically performed to treat intractable trigeminal neuralgia. Additional predisposing conditions include stroke, central nervous system (CNS) tumors (ie, astrocytoma or meningioma), infections (ie, herpes simplex virus [HSV], varicella-zoster virus [VZV], or leprosy), syringobulbia, vestibular schwannoma, postencephalitic parkinsonism, and vertebrobasilar insufficiency.

Trigeminal trophic syndrome can occur weeks or years after injury to the trigeminal nerve or sensory nuclei. It occurs more commonly in elderly patients and women.

Codes

ICD10CM:
G50.0 – Trigeminal neuralgia

SNOMEDCT:
403602005 – Trigeminal trophic syndrome

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Other causes of nonhealing facial ulcers include:

Malignancy Infections Inflammatory disorders Other diagnoses on the differential include delusions of parasitosis, factitial ulcer, and substance abuse (see cocaine use disorder).

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/14/2019
Last Updated:07/25/2021
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Trigeminal trophic syndrome
Trigeminal trophic syndrome : Painful skin lesions, Superior lip, Paresthesias, Excoriations
Clinical image of Trigeminal trophic syndrome
An ulcer with overlying and surrounding hemorrhagic crust at the nostril.
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