Severe destruction of the right ala of the nose - a case report

Introduction The neurotrophic ulcer of the trigeminal nerve represents a rare exclusion diagnosis in clinical everyday life. Based on the present case we report on the diagnosis and management of neurotrophic ulceration.

Anamnesis A 54-year-old female patient presented with a progressive destruction of the right nasal wing. About 15 years ago, a neurosurgical resection of a trigeminal neurinoma was performed retroauricularly on the right with subsequent stereotactic radiation.

Diagnosis The ENT examination revealed an asymmetrically destroyed right nasal wing. Tumor growth was excluded on MRI of the facial soft tissues. Colleagues of the Neurology department confirmed a lesion of the right trigeminal nerve. A sample was taken in the wound area.

Results The pathological and microbiological results of the biopsy revealed a chronic inflammation without any evidence of malignancy or vasculitis. The laboratory chemical parameters including rheumatological, microbiological and virological parameters were all inconspicuous.

In summary of the results an acute inflammatory, a rheumatological as well as a malignant process could be excluded. Due to the chronic foreign body sensation and the subjective rhinorrhea, the patient permanently and forcefully manipulates the lateral nasal tissue. Due to the damage of the trigeminal nerve, accompanied by paraesthesia, these pronounced manipulations are hardly perceptible, which led to the destruction of the tissue.

Summary The Trigeminus Trophic Syndrome is a rare disorder after damage to sensitive roots of the trigeminal nerve. Causal therapy does not exist. For this reason, protective measures of the injured area recommended. Abstaining from manipulation by the patient is essential for stopping the progress of deformities.

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Publication History

Article published online:
07 August 2020