J Korean Assoc Oral Maxillofac Surg.  2012 Jun;38(3):177-183. 10.5125/jkaoms.2012.38.3.177.

Alveolar bone necrosis and spontaneous tooth exfoliation associated with trigeminal herpes zoster: a report of three cases

• Kim NK
• Kim BC
• Nam JW
• Kim HJ

• KMID: 2043848
• DOI: http://doi.org/10.5125/jkaoms.2012.38.3.177

Abstract

Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus, an infection most commonly affecting the thoracolumbar trunk. Herpes Zoster Infection (HZI) may affect the cranial nerves, most frequently the trigeminal. HZI of the trigeminal nerve distribution network manifests as multiple, painful vesicular eruptions of the skin and mucosa which are innervated by the infected nerves. Oral vesicles usually appear after the skin manifestations. The vesicles rupture and coalesce, leaving mucosal erosions without subsequent scarring in most cases. The worst complication of HZI is post-herpetic neuralgia; other complications include facial scarring, motor nerve palsy and optic neuropathy. Osteonecrosis with spontaneous exfoliation of the teeth is an uncommon complication associated with HZI of the trigeminal nerve. We report several cases of osteomyelitis appearing on the mandible, caused by HZI, and triggering osteonecrosis or spontaneous tooth exfoliation.

Keyword

Human herpesvirus 3; Herpes zoster; Osteonecrosis; Tooth exfoliation

MeSH Terms

Cicatrix
Cranial Nerves
Herpes Zoster
Herpesvirus 3, Human
Mandible
Mucous Membrane
Necrosis
Optic Nerve Diseases
Osteomyelitis
Osteonecrosis
Paralysis
Rupture
Skin
Skin Manifestations
Tooth
Tooth Exfoliation
Trigeminal Nerve

Figure

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  Fig. 1 Case 1. Skin lesions of herpes zoster (healing phase); clusters on the skin on the lower side of the face (V3 area) were observed.

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  Fig. 2 Case 1. Necrotic bone was exposed on the mandible, right.

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  Fig. 3 Case 1. Preoperative radiographic findings. A. Large sequestrum was seen on the right mandible, and it was definitely distinguished from the surrounding bone on the orthopantograph. B. Mandibular computed tomography (CT) axial view; large sequestrum can be seen on the right mandible. C. Mandibular CT axial view; exfoliated socket can be seen on #33, 34, 35.

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  Fig. 4 Case 1. Post-operative radiographic findings post-operative day 8; the necrotic bone and multiple hopeless teeth were removed, and normal healing was noted.

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  Fig. 5 Case 2. Skin lesions of herpes zoster; erythematous swelling and ulcer with post-inflammatory hyperpigmentation. A. Skin lesion can be seen on the chin, right. B. Skin lesion can be seen on the preauricular area, right.

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  Fig. 6 Case 2. Necrotic bone was exposed, spontaneous teeth exfoliation on #43, 44, 45.

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  Fig. 7 Case 2. Radiographic findings; diffuse radiolucent lesion and extraction sockets area seen on the mandible, right. A. Orthopantograph. B. Mandibular computed tomography (CT) view: coronal. C. Mandibular CT view: axial.

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  Fig. 8 Case 2. Soft tissue covering previous lesion.

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  Fig. 9 Case 3. Lesions of herpes zoster (active phase). A. Extraoral view; diffuse erythematous plaques and vesicles were seen on the upper side of the face (V2 area) with tenderness. B. Intraoral view; multiple mucosal vesicles and ulcer formation observed on the maxilla, left.

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  Fig. 10 Case 3. Lesions of herpes zoster (healing phase). A. Extraoral view; clusters on the skin on the upper side of the face (V2 area) were seen. B. Intraoral view; normal healing state on mucosal lesion. No visible scar formation.

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