McVeigh Katherine A, Adams Morag, Harrad Richard, Ford Rebecca
a Bristol Eye Hospital , Bristol , England, UK.
Orbit. 2018 Feb;37(1):32-35. doi: 10.1080/01676830.2017.1353117. Epub 2017 Aug 16.
Trigeminal trophic syndrome (TTS) is a condition whereby persistent facial ulceration presents consequent to central or peripheral insult to the trigeminal nerve. Lesions are created by repetitive self-inflicted manipulation and trauma of dysaesthetic skin within the trigeminal dermatome. We discuss four cases with aetiologies varied from presumed microvascular compromise to resection of cerebral meningioma, cerebrovascular accident, and herpes zoster ophthalmicus. We discuss the management of the under-recognised associated periocular skin ulcerations that result from physical manipulation of dysesthic skin and prove to be persistent and challenging to treat. Patient education and counselling are crucial in understanding and preventing the detrimental effect of physical manipulation of the skin. Occlusive dressings can reduce recurrent trauma. Topical lubricants, antibiotics, or autologous serum may be needed in cases with corneal involvement or exposure. Surgical interventions may be used, but frequently fail if the underlying neurological pathology and skin manipulation has not been adequately addressed. TTS should be suspected in persistent or recurrent facial ulceration with concomitant anaesthesia and paraesthesia in the trigeminal distribution, with alar nasi involvement being a key feature.
三叉神经营养综合征（TTS）是一种因三叉神经受到中枢或外周损伤而导致持续性面部溃疡的病症。病变是由三叉神经分布区内感觉异常皮肤的反复自我损伤性操作和创伤造成的。我们讨论了4例病因各异的病例，从推测的微血管受损到脑膜瘤切除、脑血管意外和眼部带状疱疹。我们讨论了因对感觉异常皮肤进行物理操作而导致的未被充分认识的相关眼周皮肤溃疡的处理，这些溃疡被证明持续存在且治疗具有挑战性。患者教育和咨询对于理解和预防皮肤物理操作的有害影响至关重要。封闭敷料可减少反复创伤。在角膜受累或暴露的情况下，可能需要局部使用润滑剂、抗生素或自体血清。可能会采用手术干预，但如果潜在的神经病理学和皮肤操作问题未得到充分解决，手术往往会失败。对于伴有三叉神经分布区麻醉和感觉异常的持续性或复发性面部溃疡，应怀疑为TTS，鼻翼受累是一个关键特征。
