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Yoshida K, Numata T, Sugisaki R, Ito T, Nakai T, Takagi K, Harada K, Okubo Y. Orofacial granulomatosis associated with indium allergy and apical periodontitis. J Dermatol 2024. [PMID: 38819083 DOI: 10.1111/1346-8138.17286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Kaoruko Yoshida
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Takafumi Numata
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Risa Sugisaki
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tomonobu Ito
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Takayuki Nakai
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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Kimura T, Sakata KI, Takezaki S, Asaka T, Oshima S, Yanagawa-Matsuda A, Kitagawa Y. Orofacial Granulomatosis among Pediatric Patients Well Controlled by Corticosteroid Treatment: A Rare Case Series. Case Rep Pediatr 2024; 2024:5685686. [PMID: 38712012 PMCID: PMC11073851 DOI: 10.1155/2024/5685686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Orofacial granulomatosis (OFG) is a rare disease entity characterized by nonnecrotizing granulomatous inflammation in the oral and maxillofacial regions, typically characterized by recurrent or persistent edema, primarily in the lips and occasionally in the gingiva. OFG is often associated with Crohn's disease and sarcoidosis, and an accurate diagnosis requires systemic examination of patients. Pediatric patients possess unique oral conditions where dental plaque rapidly forms, especially during tooth replacement due to tooth crowding. Moreover, controlling oral hygiene can be challenging, rendering it difficult to distinguish plaque-induced gingivitis from nonplaque-induced gingivitis. We elucidate the reports of pediatric patients who developed OFG in the lips and/or gingiva alone, which was well controlled through corticosteroid treatment. The patients demonstrated recurrent lips and/or gingival swelling with redness, which failed to improve despite oral health care and treatment with antibiotics and/or corticosteroid ointment. Incision biopsy was performed, which demonstrated granulomatous inflammation. Further systemic examination ruled out Crohn's disease and sarcoidosis and confirmed OFG diagnosis. Corticosteroid treatment orally or through gargling was administered to the patients, which provided improvement of symptoms after 1 month. As OFG may be associated with intractable diseases, monitoring the patient regularly is crucial. Pediatric patients with OFG require a collaborative approach with pediatricians and pediatric dentists to manage their oral and overall health.
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Affiliation(s)
- Taku Kimura
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Ken-Ichiro Sakata
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Shunichiro Takezaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo 060-8638, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Shohei Oshima
- Department of Dentistry for Children and Disabled Person, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Aya Yanagawa-Matsuda
- Department of Vascular Biology, Faculty and Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8648, Japan
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Lee J, Kurien L, Marciano T. Intralesional Injections of a TNF-α Inhibitor to Treat Orofacial Granulomatosis. Inflamm Bowel Dis 2024; 30:499-500. [PMID: 38243814 DOI: 10.1093/ibd/izae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Indexed: 01/22/2024]
Abstract
Lay Summary
We present the first documented case of successful treatment of orofacial granulomatosis by intralesional injections of a tumor necrosis factor α inhibitor to the lip. Our patient had rapid symptomatic improvement after 3 injections, and near resolution within 4 months of anti-tumor necrosis factor α therapy.
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Affiliation(s)
- Jasmine Lee
- Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Lisa Kurien
- Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, NY, USA
| | - Tuvia Marciano
- Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, NY, USA
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Silva Sousa P, Magalhães C, Cunha A, Castanheira A. Radiofrequency therapy as an effective treatment for granulomatous cheilitis: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:33-35. [PMID: 37598063 DOI: 10.1016/j.anorl.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Granulomatous cheilitis is a rare disorder characterized by recurrent, idiopathic, and painless lip swelling. The diagnosis is proven by histopathological examination. The unknown aetiology and poorly understood underlying mechanism contribute to the difficulty in establishing an effective treatment. This case study proposes the effectiveness of radiofrequency therapy in the management of refractory granulomatous cheilitis. CASE SUMMARY A 68-year-old patient presented with hypertrophy and swelling of the lower lip, and a biopsy revealed actinic cheilitis. The patient underwent lip shaving and an advancement mucosal flap, and definitive histologic examination confirmed the diagnosis of granulomatous cheilitis. No other signs of orofacial granulomatosis were observed, and the complementary aetiological study was negative for systemic disease. The lip swelling reappeared and persisted, which interfered with the quality of life. Hence, radiofrequency therapy was performed in the submucosal and subdermal layers of the lip, resulting in significant aesthetic and functional improvement and no further relapses after five years. DISCUSSION The management of granulomatous cheilitis is challenging. The current mainstay treatment is corticotherapy or reduction cheiloplasty in severe cases. Radiofrequency has potential as a treatment option in debilitating macrocheilia, presenting worthy long-lasting functional and aesthetical results, with minimal morbidity.
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Affiliation(s)
- P Silva Sousa
- Otorhinolaryngology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal.
| | - C Magalhães
- Otorhinolaryngology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - A Cunha
- Otorhinolaryngology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal; Otorhinolaryngology Department, Hospital das Forças Armadas, Porto, Portugal
| | - A Castanheira
- Otorhinolaryngology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
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Magerl M, Sala‐Cunill A, Weber‐Chrysochoou C, Trainotti S, Mormile I, Spadaro G. Could it be hereditary angioedema?-Perspectives from different medical specialties. Clin Transl Allergy 2023; 13:e12297. [PMID: 37746796 PMCID: PMC10509412 DOI: 10.1002/clt2.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease, with patients often suffering with associated symptoms for many years before receiving a correct diagnosis. The symptoms greatly impact a patient's quality of life (QoL) and include excruciating abdominal pain and angioedema of the skin and submucosa. Angioedema of the larynx represents a significant mortality risk in undiagnosed patients, and a large proportion of patients with HAE receive incorrect diagnoses and undergo unnecessary surgery. HAE-specific treatments can control and prevent acute life-threatening episodes, in addition to improving QoL, emphasizing the value of early diagnosis for patients. Diagnostic delay may be due to a lack of HAE awareness by healthcare professionals and the similarity of HAE symptoms with those of more common conditions, complicating differential diagnosis. The multifaceted nature of the condition may result in visits to one of many different medical settings, for example: the Emergency Room, pediatrics, general practice, otolaryngology, gastroenterology, and dermatology. Therefore, it is crucial that physicians in multiple healthcare specialties are aware of the disease to ensure that patients with HAE receive a timely diagnosis. Using patient cases from various medical specialties, this review highlights the necessity for cross-specialty awareness of HAE and outlines the essential information for the various healthcare professionals that may encounter a patient with HAE symptoms, in order to effectively treat and/or diagnose HAE.
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Affiliation(s)
- Markus Magerl
- Institute of Allergology IFACharité – Universitätsmedizin BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Anna Sala‐Cunill
- Allergy SectionInternal Medicine DepartmentHospital Universitari Vall d’HebronBarcelonaSpain
| | | | - Susanne Trainotti
- Department of OtorhinolaryngologyKlinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Ilaria Mormile
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI)University of Naples Federico IINaplesItaly
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI)University of Naples Federico IINaplesItaly
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Cecchin-Albertoni C, Pieruccioni L, Canceill T, Benetah R, Chaumont J, Guissard C, Monsarrat P, Kémoun P, Marty M. Gingival Orofacial Granulomatosis Clinical and 2D/3D Microscopy Features after Orthodontic Therapy: A Pediatric Case Report. Medicina (B Aires) 2023; 59:medicina59040673. [PMID: 37109631 PMCID: PMC10146811 DOI: 10.3390/medicina59040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Orofacial granulomatosis (OFG) represents a heterogeneous group of rare orofacial diseases. When affecting gingiva, it appears as a chronic soft tissue inflammation, sometimes combined with the enlargement and swelling of other intraoral sites, including the lips. Gingival biopsy highlights noncaseating granulomatous inflammation, similar to that observed in Crohn’s disease and sarcoidosis. At present, the etiology of OFG remains uncertain, although the involvement of the genetic background and environmental triggers, such as oral conditions or therapies (including orthodontic treatment), has been suggested. The present study reports the results of a detailed clinical and 2D/3D microscopy investigation of a case of gingival orofacial granulomatosis in an 8-year-old male patient after orthodontic therapy. Intraoral examination showed an erythematous hyperplasia of the whole gingiva with a granular appearance occurring a few weeks after the installation of a quad-helix. Peri-oral inspection revealed upper labial swelling and angular cheilitis. General investigations did not report ongoing extra-oral disturbances with the exception of a weakly positive anti-Saccharomyces cerevicae IgG auto-antibody. Two- and three-dimensional microscopic investigations confirmed the presence of gingival orofacial granulomatosis. Daily corticoid mouthwashes over a period of 3 months resulted in a slight improvement in clinical signs, despite an intermittent inflammation recurrence. This study brings new insights into the microscopic features of gingival orofacial granulomatosis, thus providing key elements to oral practitioners to ensure accurate and timely OFG diagnosis. The accurate diagnosis of OFG allows targeted management of symptoms and patient monitoring over time, along with early detection and treatment of extra-oral manifestations, such as Crohn’s disease.
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Affiliation(s)
- Chiara Cecchin-Albertoni
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Correspondence:
| | - Laetitia Pieruccioni
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Thibault Canceill
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm, Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), CEDEX 4, 31432 Toulouse, France
| | - Robin Benetah
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Jade Chaumont
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Christophe Guissard
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Paul Monsarrat
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Artificial and Natural Intelligence Toulouse Institute ANITI, 31013 Toulouse, France
| | - Philippe Kémoun
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Mathieu Marty
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- LIRDEF, Faculty of Educational Sciences, Paul Valery University, CEDEX 5, 34199 Montpellier, France
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Courtney A, Holmes Z, Sharma S, Brand R. Orofacial granulomatosis: Challenges in diagnosis and treatment. J Paediatr Child Health 2023; 59:159-161. [PMID: 36036750 DOI: 10.1111/jpc.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Ashling Courtney
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Zack Holmes
- Dermatology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Surabhi Sharma
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roland Brand
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Stoevesandt J, Keita DU, Goebeler M. Disease‐related burden and long‐term outcome in orofacial granulomatosis: observations from a large single‐centre cohort. Clin Exp Dermatol 2022; 47:1169-1173. [DOI: 10.1111/ced.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Johanna Stoevesandt
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg Würzburg Germany
| | - Dyamilatou U. Keita
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg Würzburg Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg Würzburg Germany
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