Trigeminal trophic syndrome with features of oral CMV disease

Trigeminal trophic syndrome (TTS) is an exceedingly rare complication following injury to the trigeminal ganglion, characterized by painless ulcerations, which has only rarely been reported with intraoral features. We present a patient with multiple intraoral ulcerations of the right buccal and alveolar mucosa that had previously been treated with nerve ablation therapy for trigeminal neuralgia. Positive immunohistochemistry staining of a biopsy specimen for cytomegalovirus suggested a viral etiology; however, lesions persisted despite antiviral therapy, and immunohistochemistry was negative on follow-up biopsy. Diagnosis of TTS is one of exclusion as it can mimic many other conditions, and should be considered in patients with unilateral painless ulcerations with a history of trigeminal nerve damage.