Maxillary Zoster and Neurotrophic Keratitis following Trigeminal Block

Herpes zoster ophthalmicus is commonly used to describe viral reactivation from the trigeminal ganglia with ocular involvement. The ophthalmic branch is the most commonly involved, whereas the maxillary and mandibular dermatomes are less commonly affected. Neurotrophic ulcer may occur secondary to intentional or inadvertent damage to the trigeminal nucleus, root, ganglion, or any segment of the ophthalmic branch of this cranial nerve. We report a case of reactivated maxillary herpes zoster combined with neurotrophic keratitis due to percutaneous 2nd and 3rd branch of trigeminal nerve block with alcohol to treat trigeminal neuralgia. A 57-year-old female came to the ophthalmology department complaining of decreased visual acuity and skin vesicle over the right lower lid and cheek. She had undergone right trigeminal nerve block for treatment of trigeminal neuralgia. Clinical examination revealed neurotrophic keratitis and maxillary herpes zoster. She was treated with oral and topical antivirals and vigorous lubrication with eye drops. Her neurotrophic keratitis showed a slow recovery. Although a few cases of herpes zoster following nerve block have been described, it would appear that a case of simultaneous maxillary herpes zoster and neurotrophic keratitis following trigeminal block has not yet been documented. It is possible that trigeminal nerve block may cause reactivation of latent virus and refractory neurotrophic keratitis.

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A Novel Case of Resolved Postherpetic Neuralgia with Subsequent Development of Trigeminal Neuralgia: A Case Report and Review of the Literature

Case Reports in Medicine ◽

10.1155/2013/398513 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Alexander Mason ◽

Kristen Ayres ◽

Sigita Burneikiene ◽

Alan T. Villavicencio ◽

E. Lee Nelson ◽

...

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Trigeminal Neuralgia ◽

Female Patient ◽

Trigeminal Nerve ◽

Postherpetic Neuralgia ◽

Subsequent Development ◽

Review Of The Literature ◽

Trigeminal Pain ◽

Ophthalmic Branch

A 72-year-old female patient is presented, who was diagnosed with herpes zoster along the left ophthalmic branch of the trigeminal nerve with associated cutaneous vesicles. The patient subsequently developed postherpetic neuralgia in the same dermatome, which, after remission, transformed into paroxysmal trigeminal pain. The two different symptom sets, with the former consistent with PHN and the later consistent with trigeminal neuralgia, were unique to our practice and the literature.

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Orofacial Herpes Zoster Infection in Dental practice: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.5310 ◽

2020 ◽

Vol 58 (231) ◽

Author(s):

Deepa Gurung ◽

Ujjwal Joshi ◽

Bikash Chaudhary

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Trigeminal Nerve ◽

Maculopapular Rash ◽

Dental Practice ◽

Herpes Zoster Infection ◽

Prodromal Symptoms ◽

Varicella Zoster ◽

Burning Pain ◽

Ophthalmic Branch

Herpes zoster infection, commonly known as Shingles, is caused by reactivation of the Varicella-Zoster virus which may have remained latent in the dorsal root ganglia. HZI is characterized by prodromal symptoms of unilateral deep aching, burning pain followed by a maculopapular rash, vesicular eruptions, ulcers, and scab formations over the affected nerve distribution. The ophthalmic branch of the trigeminal nerve is more commonly involved in HZI than maxillary and mandibular branches; in particular, the maxillary involvement is rare. This is a case report of HZI in a 65-years-old male patient involving the maxillary division of the trigeminal nerve. This case highlights the importance of early diagnosis and prompt use of antivirals in managing orofacial HZI in dental practice.

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Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e537 ◽

2013 ◽

Vol 5;16 (5;9) ◽

pp. E537-E545

Author(s):

Mark C. Kendall

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Nerve ◽

Local Anesthetic ◽

Facial Pain ◽

Case Series ◽

Pterygopalatine Fossa ◽

Atypical Facial Pain ◽

Ultrasound Guided

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions. Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic douloureux.

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Long-term Outcome of Trigeminal Nerve Block with Alcohol for the Treatment of Trigeminal Neuralgia

The Korean Journal of Pain ◽

10.3344/kjp.2006.19.1.45 ◽

2006 ◽

Vol 19 (1) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Kyung Ream Han ◽

Chan Kim ◽

Do Wan Kim ◽

Oi Gyeong Cho ◽

Hye Won Cho

Keyword(s):

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Nerve ◽

Term Outcome ◽

Long Term Outcome

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Postherpetic Neuralgia and Trigeminal Neuralgia

Pain Research and Treatment ◽

10.1155/2017/1681765 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

L. Feller ◽

R. A. G. Khammissa ◽

J. Fourie ◽

M. Bouckaert ◽

J. Lemmer

Keyword(s):

Herpes Zoster ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Postherpetic Neuralgia ◽

Early Stage ◽

Antiviral Agents ◽

Short Review ◽

Vascular Compression ◽

Varicella Zoster ◽

Classical Trigeminal Neuralgia

Postherpetic neuralgia (PHN) is an unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons and which can induce psychosocial dysfunction and can negatively impact on quality of life. Preventive options for PHN include vaccination of high-risk persons against HZ, early use of antiviral agents, and robust management of pain during the early stage of acute herpes zoster. If it does occur, PHN may persist for months or even years after resolution of the HZ mucocutaneous eruptions, and treatment is often only partially effective. Classical trigeminal neuralgia is a severe orofacial neuropathic pain condition characterized by unilateral, brief but recurrent, lancinating paroxysmal pain confined to the distribution of one or more of the branches of the trigeminal nerve. It may be idiopathic or causally associated with vascular compression of the trigeminal nerve root. The anticonvulsive agents, carbamazepine or oxcarbazepine, constitute the first-line treatment. Microvascular decompression or ablative procedures should be considered when pharmacotherapy is ineffective or intolerable. The aim of this short review is briefly to discuss the etiopathogenesis, clinical features, and treatment of PHN and classical trigeminal neuralgia.

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(389) Treatment of refractory trigeminal neuralgia caused by head and neck radiation with ultrasound guided trigeminal nerve block

Journal of Pain ◽

10.1016/j.jpain.2016.01.366 ◽

2016 ◽

Vol 17 (4) ◽

pp. S72 ◽

Cited By ~ 1

Author(s):

A. Ebrahimi ◽

A. Nader ◽

M. Kendall

Keyword(s):

Trigeminal Neuralgia ◽

Head And Neck ◽

Nerve Block ◽

Trigeminal Nerve ◽

Ultrasound Guided ◽

Head And Neck Radiation

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LOCAL ANESTHETIC SPREAD TO THE CONTRALATERAL TRIGEMINAL GANGLION

Pain Management Case Reports ◽

10.36076/pmcr.2019/3/59 ◽

2019 ◽

pp. 59-62

Author(s):

Kim T. Nguyen

Keyword(s):

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Ganglion ◽

Trigeminal Nerve ◽

Local Anesthetic ◽

Local Anesthetics ◽

Ultrasound Guidance ◽

Pterygopalatine Fossa ◽

Patient Reported ◽

Key Words Trigeminal Neuralgia

Chronic neuropathic pain syndromes can severely affect a person’s quality of life. Trigeminal neuralgia is among these syndromes and involves the mandibular branch of the fifth cranial trigeminal nerve. Patients typically present with facial pain described as electrical and shock-like in nature, exacerbated by movements of the jaw such as talking and chewing. Many patients are unable to achieve adequate relief with medical management and therefore require interventions such as injections of local anesthetics, steroids, or glycerol. One method of injection uses ultrasound guidance for local anesthetic injection in the pterygopalatine fossa affecting the trigeminal ganglion. A 64-year-old woman with a history of trigeminal neuralgia presented for a trigeminal nerve block on her right side via ultrasound guidance. Following the injection, she experienced the desired effect of numbness on her right side in the distribution of the trigeminal nerve. In addition, the patient reported feeling the same effects on her left side despite no injection being done on that side. We describe a unique case in which local anesthetics spread through the pterygopalatine fossa and across the midline, affecting the contralateral trigeminal ganglion. Patients should be monitored for hemodynamic changes following this injection. Key words: Trigeminal neuralgia, trigeminal nerve block, pterygopalatine fossa, regional block, trigeminal ganglion

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Diplopia following Extraoral Maxillary Nerve Blockade for Trigeminal Neuralgia

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0038-1665546 ◽

2018 ◽

Vol 05 (03) ◽

pp. 193-194

Author(s):

Siddharth Chavali ◽

Girija P. Rath ◽

Parmod K. Bithal

Keyword(s):

Trigeminal Neuralgia ◽

Nerve Block ◽

Trigeminal Nerve ◽

Nerve Stimulation ◽

Abducens Nerve ◽

Injection Technique ◽

Nerve Blockade ◽

Maxillary Nerve ◽

Management Protocol ◽

Tip Position

AbstractWe report a case of diplopia due to reversible abducens nerve block associated with extraoral maxillary blockade of the trigeminal nerve. This complication occurs despite precautions such as aspiration and confirmation of needle tip position with nerve stimulation. Knowledge of this condition and its potential cause should alert the physician to the importance of appropriate injection technique and an understanding of the management protocol.

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