Trigeminal trophic syndrome: recognising a pattern

Trigeminal trophic syndrome (TTS) is an unusual presentation of painless facial ulceration with associated facial anaesthesia and paraesthesia. The syndrome stems from injury to branches of the trigeminal nerve. TTS can also be triggered by conditions such as ischaemic strokes and herpes zoster virus. The altered superficial sensation to the skin causes irritation along the distribution of the trigeminal nerve, usually described as burning and tingling. This sensation leads to repetitive scratching and rubbing over the affected area. Self-manipulation injuries then progress into an erosive ulcer, typically around the cheek, face and lateral nasal ala. We present the cases of two patients with erosive lateral nasal ulcers and a history of ipsilateral vestibular schwannoma repair. In both cases, symptoms resolved following diagnosis and treatment for TTS. We also provide a literature review of the condition, including a summary of the most recently published case reports.