Unilateral Orofacial Manifestations of Maxillary Trigeminal Herpes Zoster Associated with Orbital Cellulitis in an Immunocompetent Patient: A Case Report and Literature Review

Background Herpes zoster results from the reactivation of latent varicella-zoster virus and commonly affects sensory nerves. Involvement of the maxillary division of the trigeminal nerve with concomitant oral manifestations is uncommon and may pose a diagnostic challenge for oral healthcare professionals. Case Presentation We report the case of a 56-year-old immunocompetent man with no significant medical history who presented with severe unilateral oral pain associated with a burning sensation. Clinical examination revealed extensive ulceronecrotic cutaneous lesions involving the left hemiface and painful ulcerative lesions of the left palatal mucosa, both respecting the midline and corresponding to the maxillary (V2) dermatome. Laboratory investigations showed an inflammatory syndrome with elevated C-reactive protein levels. Cervicofacial computed tomography demonstrated left orbital cellulitis, soft-tissue infiltration, cervicofacial collections, and bilateral cervical lymphadenopathy with central necrosis. The diagnosis of herpes zoster involving the maxillary branch of the trigeminal nerve was established based on the characteristic clinical and radiological findings. Conclusion This case highlights the importance of recognizing the characteristic unilateral distribution of oral and facial lesions in trigeminal herpes zoster. Early diagnosis is essential for appropriate management and prevention of potential complications.