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Abstract
Ulcerated and inflammatory lesions of the oral mucosa are not rare. A detailed patient medical and social history including habits and abuses, as well as the duration, location, focality and presence, or lack of local and/or systemic symptoms is critical in establishing a proper diagnosis. This article discusses the clinical presentation, management, and histopathologic characteristics of a variety of ulcerative and inflammatory lesions seen in the oral cavity.
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Affiliation(s)
- Elizabeth M Philipone
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - Scott M Peters
- Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA
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2
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Shetty N, Subramanyam RV, Srikanth G, Solomon MC. Orofacial granulomatosis: A case report and a proposal of a diagnostic algorithm for oral granulomatous lesions. J Oral Maxillofac Pathol 2021; 25:346-350. [PMID: 34703131 PMCID: PMC8491324 DOI: 10.4103/0973-029x.325238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/30/2021] [Indexed: 11/05/2022] Open
Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder with multifactorial etiology and pathogenesis affecting the orofacial region which appears usually as a persistent and/or recurrent swelling that may involve one or both the lips and/or recurrent ulcers along with other orofacial features. The diagnosis of OFG is challenging and it should be ruled out from other conditions characterized by granulomatous inflammation. This article describes a case of a 30-year-old female patient with upper lip swelling as the main manifestation without any systemic involvement and we have also laid down a proposal of a diagnostic algorithm for differential diagnoses and treatment modalities for OFG which could be helpful for the clinician and dentists alike to rule out other granulomatous disorders thus in effective management of OFG.
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Affiliation(s)
- Nisha Shetty
- Department of oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R Venkata Subramanyam
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al Ahasa, Saudi Arabia
| | - Gadicherla Srikanth
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal Karnataka, India
| | - Monica Charlotte Solomon
- Department of oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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3
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Das R, Bohara S, Tripathi N, Verma L. Clinical and cytomorphological patterns of granulomatous inflammation and its correlation with Ziehl–Neelsen staining. ACTA MEDICA INTERNATIONAL 2021. [DOI: 10.4103/amit.amit_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Foreign Body Granuloma in the Tongue by a Pequi Spine. Case Rep Dent 2020; 2020:8838250. [PMID: 33224535 PMCID: PMC7671806 DOI: 10.1155/2020/8838250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
Substances considered foreign to the human organism can penetrate it due to local trauma, initially causing an acute inflammatory response against these substances, involving a neutrophilic infiltrate that, when it fails to deal with these foreign bodies, ends up generating a granulomatous inflammatory response. Granuloma formation has been associated with a variety of conditions. The correct clinical and imaging diagnoses are extremely important for the dentist to choose an appropriate therapeutic approach, aiming at the best possible treatment. This work is aimed at describing a case report of a foreign body granuloma, formed on the tongue, from the penetration of a pequi spine, in a 76-year-old patient, in whom, after an imaging diagnosis with ultrasound, surgical removal of the lesion was performed, and the piece was sent for histopathological examination, which confirmed the initial diagnostic hypothesis of a foreign body granuloma. The initial diagnosis of foreign body granulomas is challenging. For this reason, more sophisticated means of diagnosis such as tomography and magnetic resonance become important in the diagnosis, as they can show with greater clarity and reliability the nature of the lesion and its relationship with adjacent anatomical structures. In the case in question, an ultrasound examination was chosen, which was extremely important as an aid to diagnosis, considerably improving surgical planning. In addition, after surgical removal, the result of the histopathological analysis is essential to determine the definitive diagnosis, as it determines the granulomatous characteristic of the lesion.
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5
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Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis. Int J Mol Sci 2019; 20:ijms20205026. [PMID: 31614427 PMCID: PMC6834154 DOI: 10.3390/ijms20205026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022] Open
Abstract
Dysbiosis has been associated with the onset of several chronic autoimmune or inflammatory pathologies (e.g., inflammatory bowel diseases-IBD), because of its primary role in the establishment of a chronic inflammatory process leading to tissue damage. Inflammatory bowel diseases can even involve areas far away from the gut, such as the extraintestinal manifestations involving the oral cavity with the onset of aphthous-like ulcers (ALU). Studies carried out on animal models have shown that intestinal dysbiosis may be related to the development of autoimmune diseases, even if the mechanisms involved are not yet well known. The aim of this paper is to verify the hypothesis that in inflammatory bowel diseases patients, aphthous-like ulcers are the result of the concomitance of intestinal dysbiosis and other events, e.g., the microtraumas, occurring in the oral mucosa, and that ex adiuvantibus therapy with probiotics can be employed to modify the natural course of the aphthous-like ulcers.
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Al-Rawi NH, Salman BM, Ortega-Pinto A. Clinical pathology conference case 2: gingival overgrowth around a badly carious first molar. Oral Surg Oral Med Oral Pathol Oral Radiol 2019. [DOI: 10.1016/j.oooo.2019.02.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Solis RN, Kuhn BT, Farwell DG. An Unusual Case of Tertiary Syphilis Behaving Like Tongue Squamous Cell Carcinoma. J Investig Med High Impact Case Rep 2018; 6:2324709618820355. [PMID: 30622992 PMCID: PMC6302270 DOI: 10.1177/2324709618820355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 12/28/2022] Open
Abstract
Syphilis may present with a myriad of oral manifestations in the primary, secondary, and tertiary stages, and may be confused with malignancy. Despite a rise in the incidence of syphilis, tertiary syphilis is exceedingly rare. Tertiary syphilis gummas usually affect the hard palate, while tongue involvement is very rare. A 55-year-old male with extensive smoking and alcohol use was referred for malignancy evaluation with an ulcerative mass creating a tongue cleft, and a positron emission tomography scan suggestive for malignancy. Biopsy results demonstrated no carcinoma but histology demonstrated granulomatous inflammation. Further laboratory results demonstrated elevated rapid plasma reagin titers with Treponema pallidum immunoglobulin G antibodies present. The patient was diagnosed with tertiary syphilis, received appropriate antibiotic therapy, and had healing of the tongue with a persistent cleft. Syphilis may mimic many disease processes. As such, it is important to include this disease in the differential of an unusual tongue lesion. An oral lesion may be the first sign of infection.
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Affiliation(s)
- Roberto N Solis
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Brooks T Kuhn
- Division of Pulmonary Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
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8
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Agarwal R, Singh M, Sharma S, Jaiswal A, Jain SL, Khurana N, Meher R. Utility of fine needle aspiration cytology to diagnose intraoral tuberculosis and other oral granulomatous lesions. Diagn Cytopathol 2018; 47:156-159. [PMID: 30548220 DOI: 10.1002/dc.24059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Tuberculosis (TB) is a common granulomatous disease leading to high morbidity and mortality worldwide. Though rare, oral tuberculosis (OTB) may manifest during the primary and/or secondary stages of the illness. We studied the manifestations and incidence of oral granulomatous lesions (OGL) and OTB diagnosed on fine needle aspiration cytology (FNAC). STUDY DESIGN In this retrospective study, we present a review of 149 cases of benign and inflammatory lesions of oral mucosa diagnosed between 2008 and 2016. RESULT Of the 280 oral FNAC performed during the 9 y study period, 149 cases were diagnosed as benign and inflammatory lesions among which 12 (4.3%) showed granulomatous lesions. Four out of 12 cases were diagnosed as OTB. One (0.011%) was a case of Primary OTB with no associated pulmonary or extrapulmonary manifestations of TB and three had associated lymphadenopathy including one with pulmonary TB. Per the clinical records, all four patients responded well to anti tubercular treatment (ATT) rendered under directly observed treatment short course (DOTS) supervision with regular visits and monitoring. CONCLUSIONS Although oral mucosal TB is a rare presentation, clinicians and pathologists need to consider it early in the differential diagnosis of primary and secondary oral mucosal lesions. Such patients should be further evaluated for pulmonary TB and tuberculous lymphadenitis.
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Affiliation(s)
- Radhika Agarwal
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Sushil Sharma
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Ankita Jaiswal
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Shyama Lata Jain
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Ravi Meher
- Department of ENT, Maulana Azad Medical College, Delhi, India
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Espinoza I, Navarrete J, Benedetto J, Borzutzky A, Roessler P, Ortega-Pinto A. Orofacial granulomatosis and diet therapy: a review of the literature and two clinical cases. An Bras Dermatol 2018; 93:80-85. [PMID: 29641703 PMCID: PMC5871368 DOI: 10.1590/abd1806-4841.20185828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/09/2016] [Indexed: 03/04/2023] Open
Abstract
Orofacial granulomatosis is a nonspecific term that contains a wide variety of
granulomatous entities, which share a clinical and histopathological
presentation. It manifests as persistent or recurrent orofacial swelling,
amongst other findings. Idiopathic orofacial granulomatosis, characterized by an
absence of systemic granulomatous disease, is a diagnosis of exclusion. The main
differential diagnosis is Crohn's disease. Its pathogenesis is unknown, however,
it seems to be immune-mediated. Patch-test sensitivity to multiple allergens is
well documented. Currently, therapeutic options consider restrictive diets,
topical, intralesional, and systemic agents. First-line therapy is currently a
matter of debate. We present a review of the value of diet therapy in this
syndrome, along with two illustrative cases.
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Affiliation(s)
- Iris Espinoza
- Oral Biopsy Service at Dental School, University of Chile - Santiago, Chile
| | - Jorge Navarrete
- Dermatology Service, Clinics Hospital Dr. Manuel Quintela - University of the Republic - Montevideo, Uruguay
| | - Juana Benedetto
- Dermatology Service, Alemana de Santiago Clinic - Santiago, Chile.,Dermatology Department, University del Desarrollo - Región del Bío Bío, Chile
| | - Arturo Borzutzky
- Immunology, Allergy and Pediatric Rheumatology, Pontifical Catholic University of Chile - Santiago, Chile
| | | | - Ana Ortega-Pinto
- Department of Oral Pathology and Medicine, University of Chile - Santiago, Chile
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Laube R, Liu K, Schifter M, Yang JL, Suen MK, Leong RW. Oral and upper gastrointestinal Crohn's disease. J Gastroenterol Hepatol 2018; 33:355-364. [PMID: 28708248 DOI: 10.1111/jgh.13866] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Crohn's disease is a heterogeneous, inflammatory condition that can affect any location of the gastrointestinal tract. Proximal gastrointestinal involvement occurs in 0.5-16% of patients, and it is usually diagnosed after recognition of intestinal disease. Symptoms are often mild and nonspecific; however, upper gastrointestinal disease predicts a more severe Crohn's phenotype with a greater frequency of complications such as obstruction and perforation. Gastroscopy and biopsy is the most sensitive diagnostic investigation. There is a paucity of data examining the treatment of this condition. Management principles are similar to those for intestinal disease, commencing with topical therapy where appropriate, progressing to systemic therapy such as glucocorticoids, 5-aminosalicylic acid, immunomodulators, and biologics. Acid suppression therapy has symptomatic but no anti-inflammatory benefit for gastroduodenal and esophageal involvement. Surgical intervention with bypass, strictureplasty, or less frequently, endoscopic balloon dilation may be required for complications or failed medical therapy.
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Affiliation(s)
- Robyn Laube
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Ken Liu
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Schifter
- Department of Oral Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Dentistry, Sydney University, Sydney, New South Wales, Australia
| | - Jessica L Yang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael K Suen
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Rupert W Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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11
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Ocular, Auricular, and Oral Manifestations of Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:3269-3279. [PMID: 29064013 DOI: 10.1007/s10620-017-4781-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease (IBD) is primarily a disease of the gastrointestinal tract, though it can often affect other organ systems. These extraintestinal manifestations occur in a quarter to one-third of patients with Crohn's disease and ulcerative colitis. While musculoskeletal and dermatologic manifestations are the most common, it is also important to be cognizant of head, eye, ear, nose, and throat (HEENT) manifestations and educate IBD patients about them. Here we review the ocular manifestations in conjunction with the lesser-known but increasingly recognized ENT manifestations. Considering the lack of randomized controlled trials in treating HEENT manifestations of IBD, this review is primarily based on case reports, case series, and expert opinion with a particular focus on the newer literature supporting use of anti-TNF agents.
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12
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Afsar FS, Duran HD, Yilmaz G, Ermete M. Clinicopathological diagnosis of orofacial granulomatosis. Indian Dermatol Online J 2017; 8:32-34. [PMID: 28217469 PMCID: PMC5297267 DOI: 10.4103/2229-5178.198768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Orofacial granulomatosis is a rare chronic inflammatory disorder characterized by persistent or recurrent soft tissue swellings, oral ulceration, and other orofacial features in the absence of an identifiable granulomatous disease. We report a case of a 61-year-old woman with recurrent ulcerations and swellings in her oral mucosa. She was diagnosed as orofacial granulomatosis based upon clinicopathological correlation after exclusion of other granulomatous diseases and showed a favorable response to systemic corticosteroid treatment.
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Affiliation(s)
- Fatma Sule Afsar
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir, Turkey
| | | | - Gungor Yilmaz
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir, Turkey
| | - Murat Ermete
- Department of Pathology, Ataturk Research and Training Hospital, Izmir, Turkey
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Joshipura V, Mahantesha S, Subbaiah SK, Lakkasetty YT. A rare case of primary orofacial granulomatosis of gingiva during pregnancy. J Oral Maxillofac Pathol 2016; 19:408. [PMID: 26980981 PMCID: PMC4774306 DOI: 10.4103/0973-029x.174633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Orofacial granulomatosis (OFG) comprises a group of diseases characterized by noncaseating granulomatous inflammation affecting the soft tissues of the oral and maxillofacial region. It is important to establish the diagnosis accurately because this condition is sometimes a manifestation of many systemic conditions like Crohn's disease or sarcoidosis. The clinical outcome of OFG patients continues to be unpredictable. Current therapies remain unsatisfactory. This article reports a rare case of isolated OFG with langhans type giant cells and inflammatory infiltrate without any systemic involvement, in which the condition was a manifestation of pregnancy. The diagnostic approach to and the treatment of OFG are reviewed.
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Affiliation(s)
- Vaibhavi Joshipura
- Department of Periodontics, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
| | - S Mahantesha
- Department of Periodontics, Faculty of Dental Science, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | | | - Yogesh T Lakkasetty
- Department of Oral and Maxillofacial Pathology, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
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Hafiz A, Mufeed A, Kandasamy G, Krishnapillai R. Uncommon inflammatory swelling of the lips: orofacial granulomatosis. BMJ Case Rep 2016; 2016:bcr-2015-211860. [PMID: 26759437 DOI: 10.1136/bcr-2015-211860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Orofacial granulomatosis (OFG) is an unusual condition associated with permanent or recurrent swelling of orofacial tissues together with oral mucosal ulceration and a variety of orofacial characteristics. The chronic inflammation inherent to OFG often displays granulomas in the subepithelial stroma. We present a case of OFG and its management. The patient responded to intralesional injections of corticosteroids.
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Affiliation(s)
- Abdul Hafiz
- MES Dental College, Perinthalmanna, Kerala, India
| | | | - Gopinath Kandasamy
- Department of Dermatology, MES Medical College, Perinthalmanna, Kerala, India
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Sung IY, Kim YM, Cho YC, Son JH. Role of gingival manifestation in diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis). J Periodontal Implant Sci 2015; 45:247-51. [PMID: 26734495 PMCID: PMC4698952 DOI: 10.5051/jpis.2015.45.6.247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022] Open
Abstract
Purpose This report describes a case of granulomatosis with polyangiitis (GPA) in which the gingival manifestation was crucial in both making an early diagnosis and possibly in deciding the approach to treatment. Methods A 57-year-old sailor presented to the Department of Dentistry at Ulsan University Hospital complaining of gingival swelling since approximately 2 months. He had orofacial granulomatous lesions and the specific gingival manifestation of strawberry gingivitis. Results The diagnosis of GPA was made on the basis of clinical symptoms and signs, and confirmed by the presence of the anti-neutrophil cytoplasmic antibody and a positive biopsy. The patient was admitted to the hospital and subsequently placed on a disease-modifying therapy regimen that included methotrexate and prednisone. Conclusions Identification of the gingival manifestation of the disease permitted an early diagnosis and prompt therapy in a disease in which time is a crucial factor. Because of its rapid progression and potentially fatal outcome, an early diagnosis of GPA is important. Therefore, dentists should be aware of the oral signs and symptoms of such systemic diseases.
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Affiliation(s)
- Iel-Yong Sung
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young-Min Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yeong-Cheol Cho
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang-Ho Son
- Department of Dentistry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Serrano TLI, Pauna HF, Hazboun IM, Dal Rio AC, Correa MEP, Nicola EMD. Foreign Body in Jugal Mucosa. Int Arch Otorhinolaryngol 2015; 19:364-6. [PMID: 26491486 PMCID: PMC4593899 DOI: 10.1055/s-0035-1547522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/26/2015] [Indexed: 11/03/2022] Open
Abstract
Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2 months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.
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Affiliation(s)
- Thiago Luís Infanger Serrano
- Department of Otolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Henrique Furlan Pauna
- Department of Otolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Igor Moreira Hazboun
- Department of Otolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ana Cristina Dal Rio
- Department of Otorhinolaringology and Multidisciplinary Laser Unit, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Ester Maria Danielli Nicola
- Department of Otolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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17
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Oral Manifestations of Crohn's Disease: A Case Report and Review of the Literature. Case Rep Dent 2015; 2015:830472. [PMID: 26240765 PMCID: PMC4512596 DOI: 10.1155/2015/830472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/16/2015] [Accepted: 06/24/2015] [Indexed: 12/16/2022] Open
Abstract
Crohn's disease (CD) is an inflammatory disorder of the gastrointestinal tract that is likely caused by an inappropriate mucosal inflammatory response to intestinal bacteria in a genetically predisposed host. The lesions of CD can involve any region of the GI tract as well as extraintestinal sites such as the skin, joints, and eyes. The most common presenting symptoms are abdominal pain and prolonged diarrhea associated with fevers, fatigue, and malaise. Delayed growth and failure to thrive may also be observed in pediatric patients. Oral manifestations of CD are known as oral CD and may precede GI involvement, thus serving as early markers of this condition. We describe a 6-year-old male who presented with oral lesions as his initial manifestation of disease and review the current literature pertaining to oral CD.
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18
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Katsanos KH, Torres J, Roda G, Brygo A, Delaporte E, Colombel JF. Review article: non-malignant oral manifestations in inflammatory bowel diseases. Aliment Pharmacol Ther 2015; 42:40-60. [PMID: 25917394 DOI: 10.1111/apt.13217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy. AIM To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases [ulcerative colitis (UC), Crohn's disease (CD)] and to critically review all relevant data. METHODS A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases (UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies. RESULTS Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one-third of patients and are usually nonspecific. CONCLUSIONS Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required.
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Affiliation(s)
- K H Katsanos
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Torres
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Roda
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Brygo
- Department of Stomatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - E Delaporte
- Department of Dermatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - J-F Colombel
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
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Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
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20
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Troiano G, Dioguardi M, Giannatempo G, Laino L, Testa NF, Cocchi R, De Lillo A, Lo Muzio L. Orofacial granulomatosis: clinical signs of different pathologies. Med Princ Pract 2015; 24:117-22. [PMID: 25592641 PMCID: PMC5588207 DOI: 10.1159/000369810] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
Orofacial granulomatosis (OFG) is an uncommon disease characterized by persistent or recurrent soft tissue enlargement, oral ulceration and a variety of other orofacial features. It could be an oral manifestation of a systemic disease. For a correct differential diagnosis, local and systemic conditions characterized by granulomatous inflammation should be excluded using appropriate clinical and laboratory investigations. In fact, the diagnosis of OFG may be confirmed only by histopathological identification of noncaseating granulomas. The literature from 1943 to 2014 was reviewed with emphasis on the etiology of OFG and on clinical manifestations of systemic pathologies associated with OFG. The precise cause of OFG is still unknown, although several theories have been suggested, such as infection, hereditary factors and allergy. OFG is a disease that has a wide spectrum of presentation, which may include the oral manifestation of a systemic condition such as Crohn's disease, sarcoidosis, granulomatosis with polyangiitis and Melkersson-Rosenthal syndrome.
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Affiliation(s)
- Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Mario Dioguardi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giovanni Giannatempo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Luigi Laino
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | | | - Roberto Cocchi
- Unit of Maxillofacial Surgery, Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - Alfredo De Lillo
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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21
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Granulomatous cheilitis: successful treatment of two recalcitrant cases with combination drug therapy. Case Rep Dermatol Med 2014; 2014:509262. [PMID: 25379296 PMCID: PMC4212659 DOI: 10.1155/2014/509262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/30/2014] [Indexed: 11/20/2022] Open
Abstract
Granulomatous cheilitis is a rare, idiopathic, inflammatory disorder which usually affects young adults. It is characterized by persistent, diffuse, nontender, soft-to-firm swelling of one or both lips. Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. We report two cases of granulomatous cheilitis treated with a combination of steroids, metronidazole, and minocycline with no signs of relapse at one-year follow-up.
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22
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Abstract
With new insights into the pathogenesis of specific granulomatous diseases, and with the advent of high-throughput genetic screening and availability of next-generation biological therapies, clinicians have several options at their disposal to help ensure accurate diagnosis and effective treatment. This article highlights some of the current knowledge about the more common granulomatous systemic diseases that may be encountered in clinical practice.
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Affiliation(s)
- Faizan Alawi
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Room 328B, Philadelphia, PA 19104-6002, USA.
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23
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Mignogna MD, Pollio A, Leuci S, Ruoppo E, Fortuna G. Clinical behaviour and long-term therapeutic response in orofacial granulomatosis patients treated with intralesional triamcinolone acetonide injections alone or in combination with topical pimecrolimus 1%. J Oral Pathol Med 2013; 42:73-81. [PMID: 22784292 DOI: 10.1111/j.1600-0714.2012.01186.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a relapsing inflammatory disorder of unknown aetiology and non-standardized treatment protocols. The aim of this study was to assess the clinical behaviour and long-term therapeutic response in OFG patients treated with intralesional triamcinolone acetonide (TA) injections alone or in combination with topical pimecrolimus 1%, as adjuvant, in those patients partially responders to TA. METHODS We analysed data from 19 OFG patients followed-up for 7 years. Demographic characteristics, clinical behaviour and long-term therapeutic response were investigated. RESULTS Eleven (57.9%) OFG patients treated with intralesional TA injections therapy reached first complete clinical remission in a mean time of 10 ± 2.2 (95% CI, 8.5-11.5) weeks, while eight (42.1%) patients, partially responders to intralesional TA injections, were treated with TA injections plus topical pimecrolimus 1%, as adjuvant, achieving complete clinical remission in a mean time of 29.8 ± 7.8 (95% CI, 23.2-36.3) weeks. Relapses occurred in four TA responder patients with a disease-free time of 35.8 ± 8.7 (95% CI, 21.9-46.4) weeks and in five patients treated with TA and topical pimecrolimus 1% with a disease-free time of 55.8 ± 18.5 (95% CI, 32.8-78.8) weeks. Patients were followed-up for a mean time of 56.3 ± 18.2 (95% CI, 47.6-65.1) months. At last control, all 19 patients were in complete clinical remission. CONCLUSION These preliminary data suggest that intralesional TA injections still represent a mainstay in the treatment of OFG. It is unclear the role of topical pimecrolimus, as adjuvant, in leading OFG patients, partly responders to intralesional TA injections, to a complete clinical remission.
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Affiliation(s)
- Michele D Mignogna
- Oral Medicine Unit, Department of Odontostomatological and Maxillofacial Sciences, Federico II University of Naples, Naples, Italy.
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24
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Rana AP. Orofacial granulomatosis: A case report with review of literature. J Indian Soc Periodontol 2013; 16:469-74. [PMID: 23162350 PMCID: PMC3498725 DOI: 10.4103/0972-124x.100934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 03/12/2012] [Indexed: 01/19/2023] Open
Abstract
Orofacial granulomatosis (OFG) encompasses conditions characterized by non-necrotizing granulomatous inflammation of the oral and maxillofacial region that present clinically as labial enlargement, perioral and/or mucosal swelling, oral ulcerations, and gingivitis. The unifying term “OFG” has been introduced to integrate the spectrum of various disorders, including Melkersson-Rosenthal syndrome and granulomatous cheilitis (which is sometimes considered to be a monosymptomatic form of Melkersson-Rosenthal syndrome), and has been shown to be associated with Crohn's disease, sarcoidosis, and infectious diseases such as tuberculosis. Although various etiological agents such as food substances, food additives, dental materials, and various microbiological agents have been implicated in the disease process, its precise pathogenesis is yet to be elucidated. Delayed type of hypersensitivity reaction appears to play a significant role, although the exact antigen inducing the immunological reaction varies in individual patients. However, evidence for the role of genetic predisposition to the disease is sparse. The underlying immunological mechanism appears to show some similarities between OFG and Crohn's disease, emphasizing the need for more comparative studies of the two entities. The aim of this article is to report a case of OFG, along with a detailed literature review of the facts and variations associated with its nomenclature, clinical presentation, and etiology. It also projects the challenges that a professional has to face in the diagnosis and treatment planning of such cases.
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Affiliation(s)
- Abha Parag Rana
- Department of Periodontology, M. P. Dental College, Vadodara, Gujarat, India
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25
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Zbar AP, Ben-Horin S, Beer-Gabel M, Eliakim R. Oral Crohn's disease: is it a separable disease from orofacial granulomatosis? A review. J Crohns Colitis 2012; 6:135-42. [PMID: 22325167 DOI: 10.1016/j.crohns.2011.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 07/05/2011] [Indexed: 02/08/2023]
Abstract
Symptomatic oral Crohn's disease is comparatively rare. The relationship between orofacial granulomatosis, (where there is granulomatous inflammation and ulceration of the mouth in the absence of gastrointestinal disease) and true oral Crohn's disease is discussed along with the plethora of clinical oral disease presentations associated with both disorders and the differential diagnosis of oral ulceration in patients presenting to a gastroenterological clinic. Specific oral syndromes are outlined including the association between oral manifestations in Crohn's disease and the pattern of intestinal disease and their relationship to other recorded extraintestinal manifestations. The histological and immunological features of oral biopsies are considered as well as the principles of management of symptomatic oral disease. At present, it is suggested that both orofacial granulomatosis and oral Crohn's disease appear to be distinct clinical disorders.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Aviv, Israel.
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26
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Abstract
Orofacial granulomatosis is an uncommon disorder, but has been increasingly recognized in the past decade. It causes significant morbidity in the patient including oral ulcerations, enlargement of soft tissues which are often persistent and painful. This necessitates early medical intervention. We report one such case of a female patient who presented with a persistent upper lip enlargement. She had visited multiple general dental practitioners and general physicians but was undiagnosed. Ultrasonography proved an adjunctive tool in diagnosis. She was treated with a combination of topical and intra-lesional steroids. A 1-year follow-up did not show any evidence of recurrence.
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27
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Braz-Silva PH, Magalhães MHCG, Hofman V, Ortega KL, Ilie MI, Odin G, Vielh P, Hofman P. Usefulness of oral cytopathology in the diagnosis of infectious diseases. Cytopathology 2010; 21:285-99. [PMID: 20629682 DOI: 10.1111/j.1365-2303.2010.00779.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, the incidence of oral opportunistic infections has increased, partly due to the widespread implementation of organ and bone marrow transplantation and the increase in the prevalence of human immunodeficiency virus (HIV) infection. Cytology can be used as a rapid, inexpensive and simple routine procedure in diagnosing infectious diseases of the mouth. Moreover, ancillary methods can be applied to cytological samples, increasing the specificity and sensitivity for the diagnosis of infectious diseases. This review describes the cytopathological features of the main viral, fungal, bacterial and parasitic infections of the mouth. Cytological techniques of specimen collection, identification of infectious agents by cytomorphological approaches and ancillary methods, and diagnostic pitfalls will be discussed.
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Affiliation(s)
- P H Braz-Silva
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, University of Nice Sophia Antipolis, Nice, France
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28
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Al Johani KA, Moles DR, Hodgson TA, Porter SR, Fedele S. Orofacial granulomatosis: clinical features and long-term outcome of therapy. J Am Acad Dermatol 2010; 62:611-20. [PMID: 20137827 DOI: 10.1016/j.jaad.2009.03.051] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 03/11/2009] [Accepted: 03/16/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a chronic inflammatory disorder characterized by persistent or recurrent soft tissue enlargement, oral ulceration, and a variety of other orofacial features. There remain few detailed reports of the clinical features and long-term response to therapy of substantial groups of patients with OFG. OBJECTIVE The aim of this study was to determine retrospectively the clinical, hematologic, and histopathological features of a large case series of patients with OFG. In addition the long-term response to therapy was examined. METHODS Clinically relevant data of 49 patients with OFG who attended a single oral medicine unit in the United Kingdom were retrospectively examined. The analyzed parameters included diagnostic features, clinical manifestations, and outcomes and adverse side effects of therapy. RESULTS Labial swelling was the most common presenting clinical feature at diagnosis (75.5%), followed by intraoral mucosal features other than ulceration such as cobblestoning and gingival enlargement (73.5%). Mucosal ulceration was observed in 36.7% of patients whereas extraoral facial manifestations such as cutaneous erythema and swelling were present in 40.8% of patients. Of the 45 patients who required treatment, 24 (53.3%) were treated with topical corticosteroids/immunosuppressants only, whereas 21 (46.7%) received a combined therapy (topical plus systemic corticosteroids/immunosuppressants and/or intralesional corticosteroids). The long-term outcome analysis showed complete/partial resolution of tissue swelling and oral ulceration in 78.8% and 70% of patients, respectively. LIMITATIONS The main limitation of the current study was its retrospective design and methodology including differences in reporting clinical features and outcome. CONCLUSIONS OFG can show multiple facial and mucosal clinical features. Long-term treatment with topical and/or combined therapy is needed in the majority of patients. Response to therapy is highly variable even though in the long-term complete/partial disease resolution can be obtained in the majority of patients. Mucosal ulceration tends to be more recalcitrant than orofacial swelling. Adverse side effects of therapy are rare.
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Affiliation(s)
- Khalid A Al Johani
- Oral Medicine, University College London Eastman Dental Institute and University College London Hospital Eastman Dental Hospital, London, UK.
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29
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Miziara ID, Costa KC, Mahmoud A, Weber R, Wilhelmsen NSW, Imamura R. Laryngeal manifestations in atypical recurrent aphthous stomatitis. Braz J Otorhinolaryngol 2009; 75:660-4. [PMID: 19893932 PMCID: PMC9442197 DOI: 10.1016/s1808-8694(15)30514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 10/12/2008] [Indexed: 11/28/2022] Open
Abstract
Recurrent aphthoid stomatitis is characteristically observed in children and adolescents in the form of painful relapsing ulcers in the oral mucosa unaccompanied by evidences of systemic disease. The ulcers appear every one or two weeks for at least one entire year. Some patients suspected for recurrent aphthoid stomatitis develop lesions in atypical sites - mainly in the larynx - concurrently to the ones found in the oral mucosa. Aim this study aims to describe a series of recurrent aphthoid stomatitis patients with atypical laryngeal injuries. Study design: this is a case series study. Materials and method patients diagnosed with recurrent aphthoid stomatitis with oral mucosa ulcers and laryngeal symptoms without altered lab test results and no evidence of systemic disease underwent fibroscopic examination, oral and laryngeal biopsies, followed by specimen evaluation by direct immunofluorescence. Results all six patients in this series had acute and chronic inflammatory processes according to pathology studies and negative direct immunofluorescence test results. Conclusion laryngeal involvement in recurrent aphthoid stomatitis is rare. Therefore, during diagnostic examination thorough clinical history and meticulous physical examination accompanied by fibroscopic examination are necessary. When atypical lesions are found, biopsies for histological evaluation and direct immunofluorescence tests are required.
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Affiliation(s)
- Ivan Dieb Miziara
- São Paulo University Medical School. Stomatology Service, ENT Division, São Paulo University Hospital
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30
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Sethuraman G, Ramesh V, Ramam M, Sharma VK. Skin Tuberculosis in Children: Learning from India. Dermatol Clin 2008; 26:285-94, vii. [PMID: 18346559 DOI: 10.1016/j.det.2007.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi 110029, India.
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31
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Antunes KB, Miranda ÁM, Carvalho SRDS, Azevedo ALDR, Tatakis DN, Pires FR. Sarcoidosis Presenting as Gingival Erosion in a Patient Under Long-Term Clinical Control. J Periodontol 2008; 79:556-61. [DOI: 10.1902/jop.2008.070139] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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Al Johani K, Moles DR, Hodgson T, Porter SR, Fedele S. Onset and progression of clinical manifestations of orofacial granulomatosis. Oral Dis 2008; 15:214-9. [PMID: 19222765 DOI: 10.1111/j.1601-0825.2009.01512.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND There remain few studies describing in detail the early occurrence and long-term progression of clinical manifestations of orofacial granulomatosis (OFG) in a substantial number of patients. OBJECTIVES The aim of this study was to determine the early and late clinical manifestations of a large case series of patients with OFG. PATIENTS/METHODS Clinically relevant data of 49 patients with OFG who attended an Oral Medicine unit in the UK were examined retrospectively. The analyzed parameters included occurrence and typology of initial manifestations at onset and with respect to long-term follow-up. RESULTS Five major patterns of disease onset were observed. Recurrent facial swelling with/without intra-oral manifestations was the single most common presentation at onset followed by intra-oral ulcers, and other intra-oral and neurological manifestations. The majority of patients later developed a spectrum of additional features. CONCLUSIONS OFG results in multiple manifestations at different time points. The disease onset is characterized by manifestations other than facial swelling in about half of affected individuals. However, patients can develop cosmetically unacceptable lip/facial swelling at a later stage. Nearly all affected individuals ultimately develop lip/facial swelling while about half of all patients develop oral ulceration.
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Affiliation(s)
- K Al Johani
- Oral Medicine, UCL Eastman Dental Institute, London, UK.
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33
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Shams MG, Motamedi MHK, Azizi T. Orofacial granulomatosis of the lower lip and cheek: report of a case. ACTA ACUST UNITED AC 2007; 104:e42-4. [PMID: 17703966 DOI: 10.1016/j.tripleo.2007.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 05/11/2007] [Accepted: 05/11/2007] [Indexed: 11/29/2022]
Abstract
Orofacial granulomatosis (OFG) is a granulomatous disease of the orofacial region. This clinicopathological entity describes patients with oral lesions characterized by persistent and/or recurrent labial enlargement, ulcers, and a variety of other orofacial features, which on biopsy have lymphedema and noncaseating granulomas. The cause is idiopathic but appears to represent an abnormal immune reaction. This may be a manifestation of Crohn's disease (CD) since some patients with oral lesions develop typical bowel symptoms of CD in ensuing months to years; tooth-associated infections, sarcoidosis, food or contact allergies, and viruses have also been implicated in causing OFG. Clinical features of OFG are highly variable and sometimes so insidious that signs and symptoms are frequently not severe enough to cause alarm. The lips are most commonly involved and demonstrate a nontender, persistent swelling. Because of the relatively nonspecific clinical findings associated with granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for clinicians. We report a case of OFG of the lower lip and cheek and describe its management to add to the current body of literature on the subject.
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Affiliation(s)
- Mohammad Ghasem Shams
- Department of OMS and Trauma Research Center, Baqiyatallah Medical Center, Baqiyatallah Medical Sciences University, Tehran, Iran
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34
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Vidal M, Delevaux I, André M, Marroun I, Gavet F, Voinchet H, Palat S, Kintossou R, Gilain L, Aumaître O. Tuberculose disséminée révélée par une localisation linguale. Rev Med Interne 2007; 28:124-6. [PMID: 17157966 DOI: 10.1016/j.revmed.2006.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 11/07/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.
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Affiliation(s)
- M Vidal
- Service de médecine interne, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 01, France.
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35
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Gaugel D, Klein A, Plinkert PK. [Ulcerative gingivostomatitis and peridontitis]. HNO 2006; 54:157-65. [PMID: 16496194 DOI: 10.1007/s00106-006-1382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many systemic diseases have oral and/or pharyngeal manifestations. Mucosal lesions in the upper aerodigestive tract may be caused by granulomatous inflammations, and infectious, autoimmune and neoplastic diseases before they appear systemically or otherwise. ENT specialists can play a decisive role in identifying patients with pathological mucosal changes and transfer them to dermatology, hematology, gastroenterology or maxillofacial surgery in order to assure the best possible treatment. This article presents the case of an elderly female patient with a history of necrotising severe stomatitis that turned out to be a rare B-cell lymphoma. In the second part of the article, we present a number of common and rare diseases that may be encountered in ENT practice with an overview of clinical manifestations and current diagnostic modalities.
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Affiliation(s)
- D Gaugel
- Universitäts-Hals-Nasen-Ohren-Klinik, Heidelberg, Germany.
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