title: Mandibular osteonecrosis and Ramsay Hunt syndrome following a case of herpes zoster.
abstract: Varicella zoster virus (VZV) is the agent that causes chicken pox, a common childhood infection that characteristically presents as vesicular rashes affecting the trunk and head. After the primary infection has resolved, VZV lies dormant in the spinal dorsal root ganglia or extramedullary cranial nerve ganglia until reactivation results in herpes zoster (shingles). The sensory nerves of the trunk, as in classic shingles, and the fifth cranial nerve, as in trigeminal zoster, are the most frequently affected. Shingles is an acute viral infection characterized by the appearance of painful unilateral vesicular rash usually restricted to a dermatomal distribution of a sensory nerve. The rash of shingles is usually preceded by pain and paresthesia. A rare, severe complication of the reactivation of VZV in the geniculate ganglion of the facial nerve is Ramsay Hunt syndrome (RHS). RHS is characterized by otalgia, vesicles in the auditory canal, and ipsilateral facial paralysis. An even rarer complication of VZV infection includes post-zoster osteonecrosis. This report documents a case of severe mandibular osteonecrosis and RHS after an outbreak of herpes zoster and treatment strategies.
authors.affiliation: Former Resident, Department of Oral and Maxillofacial Surgery, Denver Health Medical Center, Denver, CO.
authors.forename: Travis
authors.initials: T
authors.lastname: Rudd
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Denver Health Medical Center, Denver, CO. Electronic address: bchai001@yahoo.com.
authors.forename: Bryan Y
authors.initials: BY
authors.lastname: Chai
authors.affiliation: Attending Physician, Department of Plastic Surgery, Denver Health Medical Center, Denver, CO.
authors.forename: Raffi
authors.initials: R
authors.lastname: Gurunluoglu
authors.affiliation: Attending Physician, Department of Oral and Maxillofacial Surgery, Denver Health Medical Center, Denver, CO.
authors.forename: Mark
authors.initials: M
authors.lastname: Glasgow
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000821:virology; D016697:Herpes Zoster Oticus / Q000821:virology*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery / Q000821:virology*; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery / Q000821:virology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014080:Tooth Exfoliation / Q000821:virology; D014081:Tooth Extraction / Q000379:methods
chemical_list: D000998:Antiviral Agents