左侧三叉神经第三支带状疱疹并发左侧下颌骨骨坏死1例

Left mandibular osteonecrosis following herpes zoster of the third branch of left trigeminal nerve:A case report

带状疱疹是由长期潜伏在脊髓后根神经节或颅脑神经节内的水痘-带状疱疹病毒重新激活和复制而引起的感染性皮肤病[1]。研究表明水痘-带状疱疹病毒被重新激活的因素包括:感冒、疲劳过度、感染、创伤、免疫功能下降等[2]。我国50岁以上人群带状疱疹的发病率为(2.9~5.8)/千人年,约有10%~15%的带状疱疹累及三叉神经,其中第一支(眼支)最常受累,而第三支(下颌支)相对较少[3-5]。

Herpes zoster of trigeminal nerve was a common skin disease caused by varicella-zoster virus infection.Simple involvement of the third branch of trigeminal nerve was rare,and so were oral complications such as pulpitis,periodontitis,spontaneous tooth loss,bone necrosis,etc.This article presented a case of herpes zoster on the third branch of the left trigeminal nerve complicated with left mandibular osteonecrosis.We reported the case of a 64-year-old man with sudden pain in the left half of the tongue 1 month ago,and then herpes on the left facial skin appeared following with acute pain.The local hospital diagnosed it as herpes zoster and treated it with external medication.A few days later,he developed gum pain in the left mandibular posterior tooth area.He was admitted to Peking University School and Hospital of Stomatology one week ago with loose and dislodged left posterior tooth accompanied by left mandibular bone surface exposure.Clinical examination showed bilateral symmetry and no obvious restriction of mouth opening.Visible herpes zoster pigmentation and scarring on the left side of the face appeared.The left mandibular posterior tooth was missing,the exposed bone surface was about 1.5 cm×0.8 cm,and the surrounding gingiva was red and swollen,painful under pressure,with no discharge of pus.The remaining teeth in the mouth were allⅢdegree loosened.Imageological examination showed irregular low-density destruction of the left mandible bone,unclear boundary,and severe resorption of alveolar bone.The patient was diagnosed as left mandibular osteonecrosis.Under general anesthesia,left mandibular lesion exploration and curettage+left mandibular partial resection+adjacent flap transfer repair were performed.The patient was re-exmained 6 months after surgery,there was no redness,swelling or other abnormality in the gums and the herpes pigmentation on the left face was significantly reduced.Unfortunately,the patient had complications of postherpetic neuralgia.This case indicate that clinicians should improve their awareness of jaw necrosis,a serious oral complication of trigeminal zoster,and provide early treatment.After the inflammation was initially controlled,surgical treatment could be considered to remove the necrotic bone,curettage the inflammatory granulation tissue,and extraction of the focal teeth to avoid further deterioration of the disease.