[Treatment of neurotrophic ulceration following alcohol injection of the gasserian ganglion in trigeminal neuralgia: Case report and review of the literature].
BACKGROUND
Trigeminal trophic syndrome (TTS) can occur after any injury on the fifth cranial nerve. The etiology is dominated by iatrogenic causes, especially after gasserian ganglion ablation. Middle-aged women are mostly involved and the differential diagnosis is vast.


METHODS
A 88-year old woman presented with TTS and destruction of the right nasal ala 25 years after retrogasserian alcohol injection for trigeminal neuralgia. Facing iterative failure of medical treatment, topics and neurostimulation, we performed lipofilling for the lesion. In the third month, we found a 50 % decrease in size of the lesion, as well as a complete disappearance of pruritus, thus allowing to consider reconstructive surgery.


CONCLUSIONS
Our literature review reports 28 cases of TTS subsequent to alcohol injection of the gasserian ganglion. Age of presentation ranges from 49 to 88 years, with a time of onset between trigeminal injury and TTS ranging from 2 weeks to 17 years. Recurrences are frequent. The management varies a lot according to the authors (topics, antibiotics, flaps), however the efficiency of lipofilling has not been reported yet.


CONCLUSIONS
The pathophysiology of TTS remains unknown, nevertheless the therapeutical care has to be multidisciplinary. Even though not described yet, lipofilling seems to be an interesting treatment of TTS following alcohol injection in the trigeminal ganglion.
Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France. Electronic address: katharinahufschmidt@gmail.com.
K
K
Hufschmidt
Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
J
J
Fernandez
Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
T
T
Balaguer
Service de neurochirurgie, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
D
D
Fontaine
Service de chirurgie réparatrice et plastique, CHU Pasteur 2, 30, avenue de la Voie-Romaine, 06200 Nice, France.
B
B
Chignon-Sicard
D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D012883:Skin Ulcer / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D012668:Trigeminal Ganglion / Q000473:pathology*; D014277:Trigeminal Neuralgia / Q000188:drug therapy
D000891:Anti-Infective Agents, Local; D000431:Ethanol
Alcoholization; Alcoolisation; Gasser; Lipofilling; Neurotrophic ulceration; Névralgie du trijumeau; Syndrome trophique trigéminal; Trijeminal neuralgia; Trophic Trigeminal Syndrome; Ulcération neurotrophique