39
Volume2 Issue4
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S
upporting
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our
P
ractice
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How toManage
ACUTEHERPESZOSTER
AFFECTINGTRIGEMINALNERVES
Point ofCare
Acuteherpeszosteraffecting trigeminalnerves
Orofacial acute herpes zoster (shingles) is an acute viral disease affect-
ing the trigeminal nerve (CNV). It is the result of reactivation of the
varicella-zoster virus (VZV) that remaineddormant in the trigem-
inal nerve root ganglion following exposure or clinicalmanifestation
of chickenpox. Reactivation could be due to immunosuppression, or it
could be age-related.
Presentation
Population
•
Individuals aged60–70years (6–7casesper 1000person-years) and
older than80years (>10casesper 1000person-years)
•
Younger patientswith immunosuppression
•
Acuteherpes zoster affectsmore than1millionpeople in theUSeach
year
•
Incidenceof zoster infection is reported tobe3–4casesper 1000per-
son-years
•
Acuteherpes zoster affects trigeminal nerves inabout 10–15%of all
zoster cases
Signs
•
Ophthalmicdivision (V1) of the trigeminal nerve ismost commonly
affected
•
Vesicles appear along thepathof dermatome (
Fig. 1
)
• Macules andpapulesprogress into vesicles andpustules that
eventuallydry, leaving a crusting appearance after 5–7days
•
Vesicles in thecorneamay lead toulceration
•
RamsayHunt syndrome,which induces facial palsy, lossof taste, buccal
ulcerationandappearanceof rash in theauditorycanal on theaffected
side; intraoralmucosal ulcerationmayalsobepart of the spectrum
withorwithout fullmanifestationof RamsayHunt syndrome
Symptoms
•
Itching, tinglingor pain sensation in the rash
•
Burningand tingling sensation (paresthesia/dysesthesia) in theaffected
sideof face, includingoral cavity
•
Sharp, shootingpain in response to light touches (allodynia)
•
Prolongedor exaggerated response topainful sensation (hyperalgesia/
hyperesthesia)
•
Odontogenicpainowing tomaxillary (V2) andmandibular (V3) nerve
division
GaryD.Klasser
DMD,CertOrofacial
Pain
Dr.Klasser is associate
professor, Louisiana
StateUniversity School of
Dentistry, department of
diagnostic sciences,New
Orleans, LA,USA.
AhadS.Ahmed
BDS,MSc
Dr. Ahmed is aPhD
candidate, faculty
of dentistry,McGill
University,OralHealth
andSocietyResearch
Division,Montreal,
Canada.
Theauthorshavenodeclared
financial interests.
Thisarticlehasbeenpeer
reviewed.
DentalEmergency
Scenario
Correction
Theoriginal article listedan incorrect dosageamount in the ‘Treatment’ section. It now reads: Valacyclovir 1000mgor 1G (orally, 3 timesdaily
for 7days).
