A case of alveolar bone necrosis of the mandible and facial palsy following trigeminal herpes zoster infection

A case of trigeminal herpes zoster infection associated with alveolar bone necrosis of the mandible and facial palsy is reported. A 72-year-old woman was referred to our hospital by her dentist because of right-sided facial pain. Physical examination revealed vesicles on the lower-right side of the face and vesicle-like erosive lesions on the mandibular gingiva (5-1). Blood examination indicated the high levels of antibodies against varicella-zoster virus. An antiviral agent (acyclovir) was administered, and the vesicles and erosions gradually resolved. However, facial palsy (Ramsay-Hunt syndrome) and alveolar bone necrosis developed 2 weeks later, and then the right lower canine spontaneously fell out. Steroid therapy, stellate ganglion block, and local irrigation were done. Tooth extraction and removal of necrotized bone were finally carried out, and cure was obtained.