口腔帶狀皰疹病毒感染 病例報告 - aoms.org.tw

1 - 231 - Taiwan J Oral Maxillofac Surg22: 231-236, September 2011 varicella-zoster virus (VZV) ( Hodgkin's disease, lymphocytic leukemia ) 1 10% (post-herpetic neuralgia) 6 42 97 1 ( ) V1 V2 Tzanck smear - 232 -Taiwan J Oral Maxillofac Surg ( ) ( )

2 Tzanck smear (VZV, R't V1 & V2) 37 C CRP ( mg/dl) (8,110/ L) tetracycline ointment (BID) acyclovir (Zovirax, 250 mg, 2vial, Q8H) mefenamic acid (Ponstan, 500 mg, 1#, QID) gabapentin (Neurontin, 300 mg, 1#, BID) vitamin B12 C amitriptyline (Trynol, 10 mg, 1#) ( ) varicella-zoster virus (VZV) 1 15% V1 V2 V3 2 Tzanck smear3 multinucleated giant cells 4 5 4 (post-herpetic neuralgia, PHN)

3 6 1999 Tidwell 1 2002 Fristad 7 2004 Arikawa 2 herpes zoster 44 (acyclovir) 72 - 233 - A, B. V1 V2 C. D. canine space A B C D - 234 -Taiwan J Oral Maxillofac Surg acyclovir (Zovirax) valaciclovir (Valtrex)

4 72 VZV tetracycline ointment NSAIDs mefenamic acid (Ponstan) gabapentin (Neurontin) carbamazepam (Tegretol) Capsaicin (substance P inhibitor) vitamin B12 C - 235 - 1,000ml Herpes zoster 1. Tidwell E, Hutson B, Burkhart N, et al. Herpes zoster of the trigeminal nerve third branch: a case report and review of the literature.

5 Int Endodontic J 1999; 32: Arikawa J, Mizushima J, Higaki Y, et al. Mandibular alveolar bone necrosis after trigeminal herpes zoster. Int J Dermatol 2004; 43: Oranje AP, Folkers E. The Tzanck smear: Old, but still of inestimable value. Pediatr Dematol 1988; 5: Strommen GL, Pucino F, Tight RR, et al. Human infection with herpes zoster: etiology, pathophysiology, diagnosis, clinical course and treatment. P harmacotherapy 1988; 8: Barratt AP, Katelaris CH, Morris JG, et al. Zoster sine herpete of the trigeminal nerve. Oral Surg Oral Med Oral pathol Oral Radiol Endod 1993; 75: Nurmikko T, Bowsher D. Somatosensory findings in postherapetic neuralgia.

6 J Neurol Neurosurg Psychiatry 1990; 53: Fristad I, Bardsen A, Knudsen GC, et al. Prodromal herpes zoster a diagnostic challenge in endodontics. Int Endod J 2002; 35: 236 -Taiwan J Oral Maxillofac Surg Oral Herpes Zoster Infection Case ReportChia-Tuo Lee, Jeffery Wu, Hung-Cheng LinDepartment of Oral and Maxillofacial Surgery, Cathay General Hospital, Taipei, TaiwanAbstractThis 42 years old male visited at Emergency Service due to the swelling over the right side infraorbital area and the upper lip after endodontic treatment of the right first molar at local dental clinic. Under examination, moderate swelling over the vestibular area of the right upper canine and multiple vesicles and ulcers over the right palate were noted.

7 Panoramic x-rays showed no evidence of the odontogenic infection. The patient felt fullness and pain over the vestibular area, so we performed incision and drainage at canine space to decrease pressure, and prescribed antibiotics and analgesics at Emergency Service. He found the improvement of the symptoms and signs two days after first-aid, but skin rash existed over the 1st and 2nd branch of the fifth cranial nerve. We referred the patient to dermatology, Tzanck smear proved herpes zoster infection, and arranged admission. The symptom disappeared nearly one week after admission. Symptoms except parathesia were cured. Toothache, oral mucous vesicles and ulcers, skin rash and necrosis of jaw bone are clinical signs of herpes zoster infection.

8 The symptoms of herpes zoster infection over oral cavity may be easily confused with the common odontogenic infection by the oral surgeon. We present this rare case for differential diagnosis with another odontogenic infection condition to prevent from delaying words: herpes zoster : April 15, 2011 Accepted: August 5, 2011 Reprint requests to: Dr. Hung-Cheng Lin, Department of Oral and Maxillofacial Surgery, Cathay General Hospital, Taipei, Taiwa