Dn 10S00pjouna 001-018 Cau S076 Herpes Zoster with Postherpetic Neuralgia involving the Left Maxillary and Mandibular Branch of Trigeminal Nerve Supa SP Chute, Zags H Al Pubised 2017 Meine was alo presen On exainaon, ster of vscls wer preset in tele mide and lowe third of he face along vith cenvcalnphadenpaiy ad ree of kn thus folorngthedematonal ue Fig 1) taal examination eveded clusters of salow ulcers on theese of theupper bua mucosa which were shout 35 mmm nse th exthemetus and regular bores an issue as es een. Salo es unteay on et paltal muzasa wee also preset (Fig. 2). The ft manus pstr eth ppeated nama tht ay dental crpsodontl patoagy ut enderess was etd on percussion ith tet #4546, Basedon he history of fetes unlatntense burning pan ed redness nthe side of he face along wi he cet pani te et mandibular tet, and lo te presenoe of vss along th cous of he mary and mancibuar civ of tga nee twas provisional cagosed as ft malay nd mana ison of ‘igminal nee. The ferent dagoses included wee anginaroc edema aut cry erpion and enthema rufifome, pemphigus nd pemphigoid. mestigatonncfed Tzack smear n which there were numerous lymphocytes, mutnuclsed int ce, wthinanuclearinusion bodes, Dierenttin oF KZ andhepes ‘simple infection was confimed by polymerase cain reaction (PCR). These was elevation inthe levels of imanoglbn (and gt anodes against V2. Vatcela zoster vu I lerel ws 239 pm and V2VIg6 level was gate than 155 ml, which was sugestie of ante infeto of HZ, Patent was teated with alt valarylorthrce daly fr 15 ay nds tte gebapertnonce daly or 15 dant 0.9% acyonr ream ‘topical for five times a day. The atin was reviewed afer 15 days, showed healing of allhe vesicles long with seating bt persistence ani the deat suo bythe tected nerve was sugestie of PAN (Figs 3 and 4) Patent was then thised to conte tablet gabapentin or note 15 dys folowing which he pan subsite in month Callan Figs 14 and: ror picture showing ict vesicles and etnesson hele side of face‘Tabi: Domatomes atected by HZ Dermafome acted ‘reo afecea along the nerve dsrbution Opiitainic branch of CNV Lesions invling the ronal egion, upper eyed, conjunctiva lacrimal gland, anterior par of Maxillary branch of CN V Mandibular branch of CN V Fecial nerve (vl) Facial nerve with vestbulocochlear rere (vl) Vi with VIX. X. and ¥ cranial ewe Glossopharyngeal (NX) and vagal nerve OX) Arnold nerve wich isthe cervical branch ofthe vagus nerve the scalp, invement of ciliary gangen causes Argl-Raberson up. Theimvohement f resol ranch causes lesion in the Bp ad ide ofthe nes cled “Hutchinson s sig! Lesion inving midl thd of he face lover eyed upper eye side fhe nose, ucper lip, rasopharms,ontum. eto and irc efectng malay ach, busca mucos, ula, and osiar area Lesions inh loner ofthe fae, lower ip. tempor enon endinteoralyimvling anton partafthe ongue foo ofthe meth, and buccal mucus membrane FRemsay Hur syrome type | causes herpetic lesions in he oral cviy or extemal ear combined win fail pals. his con accompanied by neurological disturbances Ramsay Hur syndrome type Il causing fc palsy, hesing loss, vetigo and tints with characterise vesicle on external ear meatus Ramsay Hur syrereme Il assritet with Frank-Hochwart syndrome (payreur ranials rmenienfori) Rash onthe alae, posterior tngue, epigtis. ons ils, and ocasionaly extemal ear vesicles Zoster meringencephalts Table 1: Dermatomes affected by HZ Fine 28 and Re iniraneal lion shnwina ohistr of vasieas on he lf ei ofthe eel ant lations Figs 24 and B Intraoral lesion showing cluster of vesicles onthe lf side ofthe buccal and palatal mucosaFias 3A and B: Three months postoverative extraoralvictures showina healina with scarrina