Poster Print Size: This poster template is 44” high by 44” wide. It can be used to print any poster with a 1:1 aspect ratio.

Placeholders: The various elements included in this poster are ones we often see in medical, research, and scientific posters. Feel free to edit, move, add, and delete items, or change the layout to suit your needs. Always check with your conference organizer for specific requirements.

Image Quality: You can place digital photos or logo art in your poster file by selecting the Insert, Picture command, or by using standard copy & paste. For best results, all graphic elements should be at least 150-200 pixels per inch in their final printed size. For instance, a 1600 x 1200 pixel photo will usually look fine up to 8“-10” wide on your printed poster.

To preview the print quality of images, select a magnification of 100% when previewing your poster. This will give you a good idea of what it will look like in print. If you are laying out a large poster and using half-scale dimensions, be sure to preview your graphics at 200% to see them at their final printed size.

Please note that graphics from websites (such as the logo on your hospital's or university's home page) will only be 72dpi and not suitable for printing.

[This sidebar area does not print.]

Change Color Theme: This template is designed to use the built-in color themes in the newer versions of PowerPoint.

To change the color theme, select the Design tab, then select the Colors drop-down list.

The default color theme for this template is “Office”, so you can always return to that after trying some of the alternatives.

Printing Your Poster: Once your poster file is ready, visit www.genigraphics.com to order a high-quality, affordable poster print. Every order receives a free design review and we can deliver as fast as next business day within the US and Canada.

Genigraphics® has been producing output from PowerPoint® longer than anyone in the industry; dating back to when we helped Microsoft® design the PowerPoint® software.

US and Canada: 1-800-790-4001

Email: info@genigraphics.com

[This sidebar area does not print.]

Trigeminal Trophic Syndrome. Presentation of a Case in its Early Stages

Jose Schimelmitz-Idi, Daniel Bross-Soriano, Carlos Valle-Aguilar American British Cowdray Campus Santa Fe. Mexico D.F.

INTRODUCTION DISCUSSION

CASE PRESENTATION

Figure 2. Resection and flap.

Figure 1. Ulcer in nasal vestibule.

ABSTRACT

CONCLUSIONS

REFERENCES

CONTACT

REPLACE THIS BOX WITH YOUR

ORGANIZATION’S HIGH RESOLUTION

LOGO

The Trigeminal Trophic Syndrome is a rare condition that arises after damage, induced or not to the sensory part of the trigeminal root or nerve. After the nerve is damaged the patient experiences hemifacial anesthesia and paresthesias, mainly itching and burning that causes continuous touching, rubbing and picking to relieve the perceived paresthesias. The repetitive trauma leads to an ulcer. If untreated or misdiagnosed the ulcer may grow and cause disfigurement. We presented the case of a 43 year old women with the diagnosis of Trigeminal Trophic Syndrome.

A 43 year old female presented to the office with a nasal ulcer in her left nasal vestibule. (fig 1) She had a history of left trigeminal neuralgia and 6 months prior to her visit she underwent thermocoagulation of the left V2 and V3. 2 weeks after surgery she started experiencing an intense itching and a burning sensation inside and around her left nostril. She has been treated with mupirocin ointment without any results. After ruling out malignancy, vasculitis and infection we confirmed the diagnosis of Trigeminal Trophic Syndrome. Treatment included resection of the ulcer and an island flap to cover the defect (fig 2,3), carbamazepine to reduce the paresthesias and most important education of the patient to make her realize that the ulcer was self inflicted. Histologically the report was of a chronic ulcer with minimal inflammatory infiltrate. One year after repair there is no recurrence (fig 4). The patient is still taking carbamazepine on and off. The paresthesias are still there although less intense. She reminds herself everyday not to touch rub or pick her face.

The Trigeminal Trophic Syndrome is a rare entity that can be encountered by otolaryngologists. The unfamiliarity with the condition leads to misdiagnosis and delay of treatment that can result in disfigurement. Treatment encompasses surgical reconstruction, medical therapy and education of the patient.

The Trigeminal Trophic Syndrome is a rare condition characterized by anesthesia, paresthesia and self provoked nasal ulceration. The syndrome arises after damage, induced or not, to the sensory part of the trigeminal root or nerve most commonly after treatment of trigeminal neuralgia, but it can also appear after stroke, neoplasia, viral infection, and trauma among others. After the nerve is damaged the patient experiences hemifacial anesthesia and paresthesias, mainly itching and burning that causes continuous touching, rubbing and picking to relieve the perceived paresthesias. The repetitive trauma leads to an ulcer. If untreated or misdiagnosed the ulcer may grow and cause disfigurement.

1. Monrad SU, Terrell JE, Aronoff. The trigeminal trophic syndrome: An unusual case of nasal ulceration. J Am Academ Dermatology. June 2004. 949-952

2. Loveman AB an unusual dermatosis following section of the fifth cranial nerve. Arch Dermatol Syph 1933;28:369-375

3. McKenzie KG. Observations on the results of the operative treatment of trigeminal neuralgia. Can Med Assos J 1933;29:492-496

4. Willis M, Shockley WW, Mobley SR. Treatment options in trigeminal trophic syndrome: A multi-institutional case series. Laryngoscope, 121:712-716, 2011

5. Curtis AR, Oaklander AL, Johnson A, Yosipovitch G. Trigeminal trophic syndrome from stroke:an under-recognized central neuropathic itch syndrome. Am J Clin Dermatol. 2012 Apr 1;13(2)125-128

6. Arasi R, Mckay M, Grist WJ. Trigeminal Trophic Syndrome. Laryngoscope 1988 Dec;98(12):1330-3

7. Bhushan M, Parry EJ, Telfer NR. Trigeminal trophic syndrome: successful treatment with carbamazepine. Br J Dermatol 1999;141:758-759

8. Fruhauf J, Schaider H, Massone C, Kerl H, Mullegger RR. Carbamazepine as the only effective treatment in a 52 year old man with trigeminal trophic syndrome. Mayo Clin Proc. 2008 Apr;83(4):502-4

Jose Schimelmitz-idi Hospital ABC Campus Santa Fe Mexico, D.F. joseschimelmitz@gmail.com

Figure 3. Resection and island flap.

Figure 4. One year after repair.

The Trigeminal Trophic Syndrome is a rare condition characterized by the triad of facial anesthesia, facial paresthesia and ulcerations of the nose adopting a crescentic shape. It was first described by Wallenberg in 1901 (1) and subsequently by Loveman (2,4) and Mckenzie (3,4) The clinical presentation is that of a patient that presents with unilateral facial anesthesia,unilateral facial paresthesias and unilateral facial ulcers most commonly after surgical treatment for trigeminal neuralgia(4) or suffered a stroke (5), neoplasia, trauma or viral infection (1). The patient refers a burning and itching sensation that leads to repetitive touching rubbing and picking of the affected area that provokes tissue loss and formation of an ulcer. Most commonly the patient is unaware that the ulcers are self inflicted. The differential diagnosis for a non healing facial ulcer includes basal cell carcinoma, squamous cell carcinoma, syphilis, leprosy, fungal, mycobacterial or parasitic infections, Wegener´s granulomatosis and T-cell lymphoma. Once the diagnosis is made the treatment is multidisciplinary and encompasses patient education making the patient aware that the lesions are self inflicted, surgical treatment for repair of the defects and medical treatment such as carbamazepine (7,8))to relieve the paresthesias. Other medical treatments have been used with mixed results such as Vitamin B, Diazepam, amitriptyline, chlorpromazine, acyclovir and injected triamcinolone (4).