Herein, we report three cases diagnosed as having facial palsy concomitantly with herpes zoster in the head and neck region. Case 1 presented with Ramsay Hunt syndrome, and was concomitantly diagnosed as having herpes zoster in the neck skin innervated by the ipsilateral C3 nerve. Case 2 showed facial palsy and herpes zoster in the cheek skin innervated by the ipsilateral 2nd and 3rd branches of the trigeminal nerve. Case 3 showed facial palsy and herpes zoster in the cheek skin innervated by the contralateral 2nd branch of the trigeminal nerve. We treated all three cases using methylprednisolone and aciclovir (or valaciclovir), and both the facial palsy and herpes zoster resolved within four months.
We speculated that in cases 1 and 2, the varicella zoster virus (VZV) that was reactivated in the geniculate ganglion or the trigeminal ganglion was transmitted to other ipsilateral nerves via neural anastomosis. In case 3, we propose two possible mechanisms. The first is that VZV was reactivated in the geniculate ganglion and contralateral trigeminal ganglion simultaneously, although this patient developed neither herpes zoster in the auricle nor complained of hearing loss or vertigo. The second is that herpes simplex virus (HSV) was reactivated in the geniculate ganglion and VZV was reactivated in the contralateral trigeminal ganglion simultaneously.
