Trigeminal trophic syndrome (TTS) is an uncommon cause of facial ulceration caused by damage to the trigeminal nerve. The nasal ala is almost universally involved, but the cheek, temple, and frontal scalp can also be affected. It most often follows neurosurgical procedures in which the Gasserian ganglion is traumatized. Herpetic infection, cerebral vascular accidents, and intracranial neoplasms are less common causes. Patients complain of paresthesias and dysesthesias and often admit to traumatizing their face. In 2004 alone, 3 English-language articles were published focusing on TTS.1-3 This suggests that this illness may be more common than previously thought. We report a case of a woman with nasal ulceration after resection of an acoustic neuroma. A clinician who is faced with a patient with nasal ulceration should consider this diagnosis.