di Luca Alessandro, Ralli Massimo, Hemied Sara, de Vincentiis Marco, di Luca Natale Mario
Institute of Public Health, Section of Legal Medicine, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.
SAGE Open Med Case Rep. 2017 Jul 27;5:2050313X17723548. doi: 10.1177/2050313X17723548. eCollection 2017.
Trigeminal trophic syndrome is a rare complication of peripheral or central damage to the trigeminal nerve characterized by anesthesia, paresthesia and a secondary persistent facial ulceration.
We describe the case of a 40-year-old woman with previous history of Le Fort I osteotomy for a class III malocclusion who developed trigeminal trophic syndrome. Atypically, the cutaneous symptoms appeared bilaterally and 8 years after surgery.
Differential diagnosis was based on clinical history, tissue biopsy and serologic evaluation. Atypical findings could be linked to the surgical burdens of Le Fort I osteotomy, a procedure characterized by a bilateral incision on the maxillofacial bones with a reasonable probability of causing a bilateral injury of the peripheral branches of the trigeminal nerve.
Although the long delay between trigeminal trophic syndrome onset and surgery and the absence of adequate medical evidence cannot confirm a link with previous surgery in this case, the increasing number of maxillofacial surgery cases suggests that this complication may be more frequent in the next decades, and thus, involved specialists should be aware of this condition as a possible complication of maxillofacial surgery procedures.
三叉神经营养综合征是三叉神经外周或中枢损伤的一种罕见并发症，其特征为感觉缺失、感觉异常以及继发性持续性面部溃疡。
我们描述了一例40岁女性病例，该患者既往因III类错牙合畸形接受过勒福I型截骨术，之后患上了三叉神经营养综合征。非典型的是，皮肤症状在双侧出现，且在手术后8年出现。
鉴别诊断基于临床病史、组织活检和血清学评估。非典型表现可能与勒福I型截骨术的手术负担有关，该手术的特点是在颌面骨上进行双侧切口，有合理的可能性导致三叉神经外周分支的双侧损伤。
尽管在该病例中，三叉神经营养综合征发病与手术之间存在较长时间间隔，且缺乏充分的医学证据无法证实与既往手术有关联，但颌面外科手术病例数量的增加表明，在未来几十年这种并发症可能会更频繁出现，因此，相关专科医生应意识到这种情况是颌面外科手术可能出现的并发症。
