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Joshi S, Mawdsley J, Hullah E, Ormond M, Carey B. Management of orofacial granulomatosis. Br J Hosp Med (Lond) 2023; 29:1-16. [PMID: 36989148 DOI: 10.12968/hmed.2022.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases, particularly Crohn's disease. However, subtle clinical and pathological differences justify it as a separate disease entity. Previous studies have assessed the effectiveness of interventions used in the management of orofacial granulomatosis. This article reviews the management options available. A literature search was conducted to identify studies, in English, which assessed the effect of non-pharmacological and pharmacological interventions in the treatment of orofacial granulomatosis. The interventions were categorised into dietary modification, pharmacological (topical, intralesional and systemic therapy), surgery and psychological. A combination of interventions is often required to effectively manage each patient. There is convincing evidence that diet plays a role in disease severity. In patients where dietary manipulation alone is unsuccessful, topical, intralesional and/or systemic treatment may be considered to manage the condition.
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Affiliation(s)
- Sandeep Joshi
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esther Hullah
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Ormond
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara Carey
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Wenda N, Stuhrmann NC, Messerschmid A, Märker‐Hermann E, Gosepath J. Melkersson‐Rosenthal‐syndrome ‐ A Rare Case of Laryngeal Involvement. Laryngoscope 2022; 132:2442-2444. [DOI: 10.1002/lary.30311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Nina Wenda
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | - Nicole Christina Stuhrmann
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
- Phoniatrics and Pediatric Audiology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | - Anna Messerschmid
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
| | | | - Jan Gosepath
- Department of Otolaryngology Head and Neck Surgery, Helios HSK Wiesbaden Germany
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Phillips F, Verstockt B, Sladek M, de Boer N, Katsanos K, Karmiris K, Albshesh A, Erikson C, Bergemalm D, Molnar T, Ellul P. Orofacial Granulomatosis Associated with Crohn's Disease: a Multicentre Case Series. J Crohns Colitis 2022; 16:430-435. [PMID: 34498037 DOI: 10.1093/ecco-jcc/jjab158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Orofacial granulomatosis [OFG] is a rare syndrome that may be associated with Crohn's disease [CD]. We aimed to characterise this relationship and the management options in the biologic era. METHODS This multicentre case series was supported by the European Crohn's and Colitis Organisation [ECCO], and performed as part of the Collaborative Network of Exceptionally Rare case reports [CONFER] project. Clinical data were recorded in a standardised collection form. RESULTS This report includes 28 patients with OFG associated with CD: 14 males (mean age of 32 years, ±12.4 standard deviation [SD]) and 14 females [40.3 years, ±21.0 SD]. Non-oral upper gastrointestinal tract involvement was seen in six cases and perianal disease in 11. The diagnosis of OFG was made before CD diagnosis in two patients, concurrently in eight, and after CD diagnosis in 18. The distribution of OFG involved the lips in 16 cases and buccal mucosa in 18. Pain was present in 25 cases, with impaired swallowing or speaking in six. Remission was achieved in 23 patients, notably with the use of anti-tumour necrosis factors [TNFs] in nine patients, vedolizumab in one, ustekinumab in one, and thalidomide in two. A further five cases were resistant to therapies including anti-TNFs. CONCLUSIONS OFG associated with CD may occur before, concurrently with, or after the diagnosis of CD. Perianal and upper gastrointestinal [UGI] disease are common associations and there is a significant symptom burden in many. Remission can be obtained with a variety of immunosuppressive treatments, including several biologics approved for CD.
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Affiliation(s)
- Frank Phillips
- NIHR Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals, Nottingham, UK
| | - Bram Verstockt
- University Hospitals Leuven, Gastroenterology and Hepatology, KU Leuven, Chronic Diseases, Metabolism and Ageing, TARGID-IBD unit, Leuven, Belgium
| | - Malgorzata Sladek
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Krakow, Poland
| | - Nanne de Boer
- Amsterdam UMC, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, Amsterdam, The Netherlands
| | - Konstantinos Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | | | - Ahmad Albshesh
- Department of Gastroenterology, Sheba Medical Centre, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carl Erikson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tamas Molnar
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei hospital, Msida, Malta
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4
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Gilmore R, Li Wai Suen CFD, Elliott T, De Cruz P, Srinivasan A. Using Ustekinumab to Treat Crohn's Disease-Related Orofacial Granulomatosis: Two Birds, One Stone. Inflamm Bowel Dis 2020; 26:e79-e80. [PMID: 32448910 DOI: 10.1093/ibd/izaa123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Robert Gilmore
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Christopher F D Li Wai Suen
- Department of Gastroenterology, Austin Health, Melbourne, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia
| | - Tim Elliott
- Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, Australia.,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Australia
| | - Ashish Srinivasan
- Department of Gastroenterology, Austin Health, Melbourne, Australia.,Monash University, Department of Medicine, Melbourne, Australia
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5
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Dhawan SR, Saini AG, Singhi PD. Management Strategies of Melkersson-Rosenthal Syndrome: A Review. Int J Gen Med 2020; 13:61-65. [PMID: 32161488 PMCID: PMC7049838 DOI: 10.2147/ijgm.s186315] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022] Open
Abstract
Melkerrson-Rosenthal syndrome is a rare disorder of unknown aetiology and characterized by the triad of oro-facial edema, facial nerve palsy, and furrowing of the tongue. Two or more of the above are essential for making a clinical diagnosis. The mainstay of treatment is corticosteroids. Intralesional triamcinolone acetonide may be used for the treatment of oro-facial edema. Another treatment option for oro-facial edema includes intralesional betamethasone, along with oral doxycycline. The review discusses the management strategies in Melkersson-Rosenthal syndrome.
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Affiliation(s)
- Sumeet R Dhawan
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, 133207, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pratibha D Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.,Medanta, The Medicity, Gurgaon, Haryana, India
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6
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1221] [Impact Index Per Article: 244.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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7
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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8
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Jácome-Santos H, Resende RG, Silva AMB, Cruz AF, Tanos de Lacerda SH, Mesquita RA, Tanos de Lacerda JC. Low-level laser as a complementary therapy in orofacial granulomatosis management: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e1-e5. [DOI: 10.1016/j.oooo.2019.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/03/2019] [Accepted: 02/23/2019] [Indexed: 12/20/2022]
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9
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Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000 2019; 80:61-76. [DOI: 10.1111/prd.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Esther A. Hullah
- Faculty of DentistryOral & Craniofacial SciencesKing's College London UK
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10
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Persistent Upper Lip Swelling in a Young Woman: Answer. Am J Dermatopathol 2019; 41:386-387. [PMID: 31009412 DOI: 10.1097/dad.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Orofacial granulomatosis: an unsuccessful response to weekly azithromycin pulse therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e83-e85. [DOI: 10.1016/j.oooo.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022]
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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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13
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Georgakopoulou E, Scully C. Biological agents: what they are, how they affect oral health and how they can modulate oral healthcare. Br Dent J 2017; 218:671-7. [PMID: 26114697 DOI: 10.1038/sj.bdj.2015.439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/17/2022]
Abstract
Biological agents - biologics, biologicals or biopharmaceuticals - are any medicinal product manufactured in, or extracted from, a biological source. They are often generated by DNA recombinant biotechnology and several dozen therapeutic monoclonal antibodies (mAbs) are now marketed for a variety of indications, increasingly in the management of inflammatory immune-mediated disorders, transplantation rejection and cancer treatments. Immunomodulatory mAbs are expensive, must be given by injection or infusion and can have adverse effects but are increasingly used and can be highly effective agents. This paper reviews these agents and their increasing relevance to oral science and healthcare.
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Affiliation(s)
- E Georgakopoulou
- Department of Histology and Embryology, School of Medicine, University of Athens, Greece
| | - C Scully
- 1] WHO Collaborating Centre for Oral Health-General Health Co-Director London [2] Royal College of Surgeons of Edinburgh King James IV Professor London [3] UCL Emeritus Professor, London
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14
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Mutalib M, Bezanti K, Elawad M, Kiparissi F. The role of exclusive enteral nutrition in the management of orofacial granulomatosis in children. World J Pediatr 2016; 12:421-424. [PMID: 27457793 DOI: 10.1007/s12519-016-0045-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/24/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a term used to describe a persistent, painless swelling of lips and orofacial region. It can be associated with ulceration, gingival hypertrophy and cobble stone appearance of the buccal mucosa. OFG is commonly associated with Crohn's disease and can precede the intestinal manifestation of the disease. Exclusive enteral nutrition (EEN) is a recognized treatment for induction of remission for Crohn's disease. The aim of this study was to review the use of EEN in the management of OFG in children. METHODS Retrospective review of medical records of all children diagnosed with OFG between 2007 and 2012 was conducted. Presence of comorbidities, progression to inflammatory bowel disease (IBD) and response to EEN was evaluated. RESULTS Twenty-nine children were included, mean age at diagnosis was 9 years (standard deviation 3.9) years. Ten children had isolated OFG and 19 had OFG and IBD, of which 12 presented with OFG and IBD and 7 developed IBD later. Median time to progression to IBD was 33 months (inter quartile range: 9.8-85.5). Twenty-two children completed 6 weeks of EEN, and 19 showed clinical improvement in the OFG appearance. CONCLUSION EEN appears to be an effective treatment option for children with isolated OFG or OFG and IBD.
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Affiliation(s)
- Mohamed Mutalib
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Khaled Bezanti
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Mamoun Elawad
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Fevronia Kiparissi
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
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16
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Genetic Association Analysis Reveals Differences in the Contribution of NOD2 Variants to the Clinical Phenotypes of Orofacial Granulomatosis. Inflamm Bowel Dis 2016; 22:1552-8. [PMID: 27306066 PMCID: PMC4912233 DOI: 10.1097/mib.0000000000000844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare, inflammatory disorder of the mouth, in which some patients also have intestinal Crohn's disease (CD). The etiology remains largely unknown, although there is a high prevalence of atopy, and oral granulomas are also seen in other immune disorders particularly CD and sarcoidosis. We investigated whether genetic variants associated with an increased risk of CD, sarcoidosis, or atopy were also associated with susceptibility to OFG. METHODS Patients were stratified clinically as isolated oral manifestations (OFG only) or concurrent intestinal CD (OFG+CD). We genotyped 201 patients and 1023 healthy controls for risk variants in NOD2, IRGM, IL23R, ATG16L1 (CD), BTNL2 (sarcoidosis), and FLG (atopy). The coding regions of the NOD2 gene were screened for rare, potentially pathogenic variants in OFG. RESULTS A combined analysis of 3 CD-risk variants in NOD2 showed no association with any OFG subgroup. NOD2 p.L1007insC was associated with OFG+CD (P = 0.023) and IL23R p.R381Q with all OFG (P = 0.031). The sarcoidosis risk variant rs2076530 in BTNL2 was associated with all OFG (P = 0.013). We identified 7 rare missense NOD2 alleles in 8 individuals with OFG, 4 OFG-only patients and 4 patients with OFG+CD. There was a significant enrichment of NOD2 variants in the OFG+CD group compared to the OFG-only group (P = 0.008, common variants; P = 0.04, all common and rare variants). CONCLUSIONS Our findings suggest that genetic variants in NOD2 are only associated with OFG in patients with concurrent intestinal disease. A genome-wide association scan is needed to fully define the genetic architecture of OFG.
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17
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Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
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Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
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18
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Mentzer A, Goel R, Elliott T, Campbell H, Hullah E, Patel P, Challacombe S, Escudier M, Sanderson JD. Azathioprine is effective for oral involvement in Crohn's disease but not for orofacial granulomatosis alone. J Oral Pathol Med 2015; 45:312-8. [DOI: 10.1111/jop.12379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/11/2022]
Affiliation(s)
- A. Mentzer
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - R. Goel
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - T. Elliott
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - H. Campbell
- Department of Nutrition; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - E. Hullah
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - P. Patel
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - S. Challacombe
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - M. Escudier
- Department of Oral Medicine and Pathology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
| | - J. D. Sanderson
- Department of Gastroenterology; Guy's and St. Thomas' NHS Foundation Trust and King's College; London UK
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19
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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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Rangdhol RV, Madhulika N, Dany A, Jeelani S, Asokan GS. Idiopathic orofacial granulomatosis - a diagnostic and treatment challenge. J Clin Diagn Res 2014; 8:ZD07-10. [PMID: 25584331 DOI: 10.7860/jcdr/2014/10047.4961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/25/2014] [Indexed: 11/24/2022]
Abstract
Orofacial granulomatosis is an uncommon disease, usually presenting as recurrent or persistent swelling of the soft tissues, predominantly lips - termed as Cheilitis Granulomatosa. Though various aetiological factors like foreign body reactions, infections, Crohn's disease and Sarcoidosis have been implicated in the disease process. Delayed Hypersensitivity reaction with a predominant Th1-mediated immune response provide further evidence to the etiopathogenesis in Orofacial granulomatosis. The term Idiopathic Orofacial Granulomatosis is used in cases with unknown aetiology. This case report describes Idiopathic Orofacial granulomatosis in a 25-year-old male patient with persistent upper lip swelling and gingival enlargement. Management with intralesional triamcinolone acetonide 40mg, twice a week for three weeks, resulted in significant remission without recurrence after a eight month follow up.
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Affiliation(s)
- R Vishwanath Rangdhol
- Professor and Head, Department of Oral Medicine and Radiology, Indira Gandhi Institute of Dental Science , Pondicherry, India
| | - N Madhulika
- Graduate Student, Department of Oral Medicine and Radiology, Indira Gandhi Institute of Dental Science , Pondicherry, India
| | - A Dany
- Reader, Department of Oral Medicine and Radiology, Sri Aurobindo Institute of Medical Sciences , Indore, India
| | - S Jeelani
- Reader, Department of Oral Medicine and Radiology, Indira Gandhi Institute of Dental Science , Pondicherry, India
| | - G S Asokan
- Associate Professor, Department of Oral Medicine and Radiology, Tagore Dental College and Hospital , Chennai, India
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21
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Eustace K, Clowry J, Kirby B, Lally A. Thalidomide in the treatment of refractory orofacial granulomatosis. Br J Dermatol 2014; 171:423-5. [DOI: 10.1111/bjd.12944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. Eustace
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - J. Clowry
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - B. Kirby
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - A. Lally
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
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22
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Georgakopoulou EA, Scully C. Orofacial adverse effects of biological agents. ACTA ACUST UNITED AC 2014; 6:252-60. [PMID: 24850782 DOI: 10.1111/jicd.12102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/20/2014] [Indexed: 01/15/2023]
Abstract
Biological agents (BA) are increasingly used effectively in the treatment of a range of disorders, but to date, their application in diseases affecting the orofacial region has been fairly limited. Several orofacial adverse effects related to BA have been recently reported. However, the evidence for such adverse reactions is not always strong, and some of the adverse effects of BA have only been reported in case reports or case series. Most reactions to BA reported thus far have been in association with antitumor necrosis factor-α agents, which is not surprising, as these are the most widely-used BA. In the present study, the orofacial adverse effects are reported with various BA in order to sensitize clinicians to the possibilities. In addition, we briefly summarize the mode of action and indications of these BA. As the use and range of BA increases, the number and diversity of adverse effects might well increase. Despite the adverse effects of biological agents, these may often be less serious than the adverse effects of the more traditional immunosuppressive agents.
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Affiliation(s)
- Eleni A Georgakopoulou
- Department of Histology and Embryology, National and Kapodistrian University of Athens, Athens, Greece
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23
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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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24
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Campbell HE, Escudier MP, Milligan P, Challacombe SJ, Sanderson JD, Lomer MCE. Development of a low phenolic acid diet for the management of orofacial granulomatosis. J Hum Nutr Diet 2013; 26:527-37. [PMID: 23574355 DOI: 10.1111/jhn.12046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy. METHODS A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values. RESULTS The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713]. CONCLUSIONS A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.
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Affiliation(s)
- H E Campbell
- Diabetes and Nutritional Sciences Division, King's College London (KCL), London, UK; Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust (GSTFT), London, UK
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25
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Khadir K, Hali F, Tirhazouine I, Zamiati S, Laraqui A, Lakhdar H, Benchikhi H. [Granulomatous macrocheilitis: 19 cases]. Ann Dermatol Venereol 2013; 140:56-8. [PMID: 23328362 DOI: 10.1016/j.annder.2012.10.597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 09/03/2012] [Accepted: 10/31/2012] [Indexed: 11/16/2022]
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26
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Campbell H, Escudier MP, Brostoff J, Patel P, Milligan P, Challacombe SJ, Sanderson JD, Lomer MCE. Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach? J Oral Pathol Med 2013; 42:517-22. [DOI: 10.1111/jop.12041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- H. Campbell
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust (GSTFT); London UK
- National Institute for Health Research (NIHR) Comprehensive Biomedical Research Centre at GSTFT and KCL; London UK
| | | | - J. Brostoff
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
| | - P. Patel
- Department of Gastroenterology; GSTFT; London UK
| | - P. Milligan
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
| | | | - J. D. Sanderson
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Gastroenterology; GSTFT; London UK
| | - M. C. E. Lomer
- Diabetes and Nutritional Sciences Division; King's College London (KCL); London UK
- Department of Nutrition and Dietetics; Guy's and St Thomas' NHS Foundation Trust (GSTFT); London UK
- Department of Gastroenterology; GSTFT; London UK
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27
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Howell JL, Bussell RM, Hegarty AM, Zaitoun H. Service evaluation of patients with orofacial granulomatosis and patients with oral Crohn's disease attending a paediatric oral medicine clinic. Eur Arch Paediatr Dent 2012; 13:191-6. [PMID: 22883358 DOI: 10.1007/bf03262869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM Presenting features associated with orofacial granulomatosis (OFG) and oral Crohn's disease (OCD) are varied, making successful diagnosis and management difficult. The aim of this service evaluation was to establish a profile of patients with these conditions attending a paediatric oral medicine clinic and to determine their overall satisfaction with the care received. STUDY DESIGN A retrospective case note analysis to establish the patient profile and a postal patient satisfaction questionnaire for service evaluation. METHODS All patients with OFG and OCD who had attended the joint paediatric dentistry/oral medicine clinic at Charles Clifford Dental Hospital, Sheffield in the previous 14 years were included in the study. Hospital case notes were retrospectively reviewed and patient demographics, clinical features, investigations, diagnosis, treatment and outcomes of treatment were recorded. An anonymous patient satisfaction questionnaire using the Healthcare Satisfaction Generic Module of the Paediatric Quality of Life Inventory (PedsQLTM) was distributed to all patients by mail. RESULTS A total of 24 patients (13 females and 11 males) were identified. Median age at presentation was 11 years (SD± 3.79, range 2-15). Fifteen patients (63%) were diagnosed with OCD, and 9 (37%) with OFG. Overall, the most common orofacial feature was oral ulceration (75%) followed by lip/facial swelling (71%), angular cheilitis (67%) and mucosal cobblestoning (67%). Differences in presentation were seen between the two conditions with oral ulceration (87%) and mucosal cobblestoning (80%) being the most frequently observed features of OCD and lip swelling (78%) and angular cheilitis (67%) being the most common features of OFG. 58% of patients reported relief of symptoms through treatment. Thirteen patient satisfaction questionnaires were completed (54%). 85% (n=11) felt the overall care received in the clinic was 'excellent'. CONCLUSIONS This service evaluation highlights the variety of presenting features of OFG and OCD. Despite only a moderate response to treatment, patient satisfaction with the service was high, emphasising the importance of good communication when managing children with chronic, debilitating conditions.
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Affiliation(s)
- J L Howell
- Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield, UK
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28
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Merigo E, Fornaini C, Manfredi M, Meleti M, Alberici F, Corcione L, Buzio C, Rocca JP, Ferri T, Vescovi P. Orofacial granulomatosis treated with low-level laser therapy: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e25-9. [DOI: 10.1016/j.oooo.2011.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 11/11/2011] [Accepted: 12/16/2011] [Indexed: 11/30/2022]
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30
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Orofacial granulomatosis: clinical study of 20 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e12-7. [DOI: 10.1016/j.oooo.2011.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/14/2011] [Accepted: 10/21/2011] [Indexed: 01/20/2023]
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31
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O’Neill ID, Scully C. Biologics in oral medicine: principles of use and practical considerations. Oral Dis 2012; 18:525-36. [DOI: 10.1111/j.1601-0825.2012.01919.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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O’Neill ID, Scully C. Biologics in oral medicine: oral Crohn’s disease and orofacial granulomatosis. Oral Dis 2012; 18:633-8. [DOI: 10.1111/j.1601-0825.2012.01918.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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33
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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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34
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Campbell HE, Escudier MP, Patel P, Challacombe SJ, Sanderson JD, Lomer MCE. Review article: cinnamon- and benzoate-free diet as a primary treatment for orofacial granulomatosis. Aliment Pharmacol Ther 2011; 34:687-701. [PMID: 21815899 DOI: 10.1111/j.1365-2036.2011.04792.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Orofacial granulomatosis is a rare chronic granulomatous inflammatory disease of the lips, face and mouth. The aetiology remains unclear but may involve an allergic component. Improvements have been reported with cinnamon- and benzoate-free diets. AIMS To explore the prevalence of compound and food sensitivity and examine the dietary treatments used in orofacial granulomatosis. METHODS A comprehensive literature search was carried out and relevant studies from January 1933 to January 2010 were identified using the electronic database search engines; AGRIS 1991-2008, AMED 1985-2008, British Nursing and Index archive 1985-2008, EMBASE 1980-2008, evidence based medicine review databases (e.g. Cochrane DSR), International Pharmaceutical and Medline 1950-2008. RESULTS Common sensitivities identified, predominantly through patch testing, were to benzoic acid (36%) food additives (33%), perfumes and flavourings (28%), cinnamaldehyde (27%), cinnamon (17%), benzoates (17%) and chocolate (11%). The cinnamon- and benzoate-free diet has been shown to provide benefit in 54-78% of patients with 23% requiring no adjunctive therapies. A negative or positive patch test result to cinnamaldehyde, and benzoates did not predict dietary outcome. The most concentrated source of benzoate exposure is from food preservatives. Use of liquid enteral formulas can offer a further dietary therapy, particularly in children with orofacial granulomatosis. CONCLUSION Management of orofacial granulomatosis is challenging but cinnamon- and benzoate-free diets appear to have a definite role to play.
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Affiliation(s)
- H E Campbell
- Diabetes and Nutritional Sciences Division, King's College London-KCL, London, UK
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