Herpes Zoster V2 — MFDS Part 1 MCQ

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ModerateOral MedicineHerpes Zoster V2MFDS Part 1

A 72-year-old patient develops severe burning pain over the left midface. Three days later, grouped vesicles appear over the left cheek, side of the nose and upper lip, accompanied by unilateral ulceration of the left hard palate. The lesions do not cross the midline. What is the most likely diagnosis?

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Correct answer: D — Herpes zoster involving the maxillary division of the trigeminal nerve

The diagnosis is herpes zoster involving the maxillary division (V2) of the trigeminal nerve. The decisive features are severe prodromal neuropathic pain followed by grouped vesicles and ulcers confined to one side of the V2 territory, including the cheek, upper lip and ipsilateral hard palate, without crossing the midline. It represents reactivation of latent varicella-zoster virus in a sensory ganglion. Primary herpetic gingivostomatitis causes more diffuse oral ulceration and generalised gingivitis rather than a unilateral dermatome. Erythema multiforme typically produces widespread target lesions and prominent, often bilateral, mucosal erosions. Pemphigus vulgaris causes persistent flaccid bullae and erosions without dermatomal restriction or a painful prodrome. Aphthous stomatitis produces discrete ulcers, not a preceding unilateral vesicular eruption. Post-herpetic neuralgia is an important complication, particularly in older adults.

Reference: Kim IH, Mupparapu A, Yablonski JN, Mupparapu M. A Patient with Herpes Zoster of the Maxillary Division of Trigeminal Nerve Presents for Oral Evaluation and Toothache. Dental Clinics of North America. 2023;67(4):687–690. https://www.nhs.uk/conditions/shingles/