Herpes zoster with oro-facial involvement - Report of a case and detailed review of literature

Herpes zoster or shingles is a recurrence of varicella zoster virus that entered the cutaneous nerve endings during an earlier episode of chicken pox, travelled to the dorsal root ganglia, and remained in a latent form. Nerves most commonly involved are C3, T5, L1, L2 and first division of trigeminal nerve. The condition is characterized by occurrence of multiple, painful, unilateral vesicles and ulceration which shows a typical single dermatome involvement. The infection usually affects elderly individuals, and if present in the younger age group, a suspicion should be raised about the immune-compromised status such as HIV. Many patients report to the dental clinic with the complications of herpes zoster, with trigeminal nerve involved in about 15% cases and most commonly the ophthalmic division. Diagnosing these complications of herpes zoster could pose a challenge to an oral physician due to their varied presentation ranging from post herpetic neuralgia, external root resorption, osteonecrosis and tooth exfoliation. This paper reports a case of herpes zoster with unilateral vesicles over the left side of upper and middle 1/3rd of face along the trigeminal nerve tract, with intraoral involvement of buccal mucosa and palate on the same side.