Herpes Zoster Mandibularis: Dilemma of Diagnosis - A Case Report.

Abstract

Background: Herpes zoster infection involving the mandibular branch of the trigeminal nerve is rare. It can present with severe pre-eruptive pain along the distribution of the nerve involved. As presented by the patient in this study, this lesion may be mistaken for other painful conditions, leading to misdiagnosis and maltreatment. Post-herpetic neuralgia is the most common and important complication of herpes zoster infection. It is often refractory to treatment and can profoundly affect the patient's quality of life.   Objective: To report an unusual and rare case of herpes zoster mandibularis and the diagnostic dilemma experienced in the management.   Case Report: A 60-year-old female presented with severe intractable pain from the left side of the tongue and floor of the mouth, rashes of the lower lip and cheek, and ulcerations of the oral cavity. After a period of diagnostic puzzle due to confusing presentations, a diagnosis of herpes zoster infection involving the mandibular branch of the trigeminal nerve complicated with postherpetic neuralgia was finally made and the patient was treated accordingly. The peculiarity, management, and treatment outcome of the case are discussed.   Conclusion: Herpes zoster mandibularis as seen in this case can present with clinical features that are confusing and can lead to misdiagnosis and inappropriate treatment. This study aims to raise awareness of the clinical presentation of this rare entity among clinicians in medical and dental practices. It is also advisable to seek dental and orofacial evaluation for patients with a similar presentation from specialists in Oral Medicine and Maxillofacial Surgery.