Herpes Zoster Infection Involving the Mandibular Division of the Trigeminal Nerve: A Case Report with Review of Complications

Abstract

Herpes Zoster Virus (HZV) is a neurotropic virus that, upon reactivation, causes a characteristic unilateral dermatomal eruption not crossing the midline, limited to the area supplied by the affected nerve. The condition, known as Shingles or Herpes Zoster (HZ), has increasing incidence with immunosenescence, particularly in individuals above the age of 50 years, HIV-infected individuals, patients with malignancies, or those on protracted corticosteroid therapy. Involvement of the mandibular division of the Trigeminal nerve, though rare (1.7–2%), produces a distinctive constellation of unilateral intraoral vesicles, odontalgia, and cutaneous eruptions on the affected side. Serious complications associated with mandibular zoster include post-herpetic neuralgia, osteonecrosis of the jaw, tooth exfoliation due to vasculitis, Bell's Palsy, and Ramsay–Hunt syndrome. Here we report a case of a 50-year-old female presenting with painful rashes and vesicles on the left side of the face and left half of the oral cavity, diagnosed with Herpes Zoster infection involving the mandibular division of the left Trigeminal Nerve via Tzanck test. She was treated with Acyclovir and followed up with no complications. This report discusses the incidence, clinical manifestations, rare complications including vascular and neurological sequelae, diagnosis, treatment, and prevention of Herpes Zoster infection with mandibular involvement.