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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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Galohda A, Shreehari AK. Orofacial granulomatosis as a manifestation of sarcoidosis: A rare case report. J Oral Maxillofac Pathol 2023; 27:543-547. [PMID: 38033934 PMCID: PMC10683902 DOI: 10.4103/jomfp.jomfp_143_23] [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: 03/20/2023] [Revised: 05/03/2023] [Accepted: 06/19/2023] [Indexed: 12/02/2023] Open
Abstract
Orofacial granulomatosis (OFG) is an uncommon clinicopathological condition describing patients who have oral lesions characterized by persistent labial enlargement, oral ulcers and a variety of other orofacial features. Sarcoidosis is a systemic non-caseating granulomatous disorder of unknown etiology that may affect multiple organ systems. As a systemic disease, it is well documented in existing literature. However, the rarity and its often non-specific oral manifestation emphasize the need to reinforce the literature with more clinical case examples and draw additional attention to clinical features that general practitioners may encounter. In this report, a rare case is presented with definite association of sarcoidosis and orofacial granulomatosis with two years follow up after treatment. This report aims to expand the literature surrounding orofacial sarcoidosis and support oral and general health practitioners in recognizing its orofacial manifestations along with the clinical presentations that all led to a diagnosis of sarcoidosis in this case.
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Affiliation(s)
- Arpit Galohda
- Department of Periodontology, Army Dental Center (Research and Referral), Delhi Cantt, Delhi, India
| | - AK Shreehari
- Department of Periodontology, Army Dental Center (Research and Referral), Delhi Cantt, Delhi, India
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The Association between COVID-19 Related Anxiety, Stress, Depression, Temporomandibular Disorders, and Headaches from Childhood to Adulthood: A Systematic Review. Brain Sci 2023; 13:brainsci13030481. [PMID: 36979291 PMCID: PMC10046052 DOI: 10.3390/brainsci13030481] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
Objective: The coronavirus belongs to the family of Coronaviridae, which are not branched single-stranded RNA viruses. COVID-19 creates respiratory problems and infections ranging from mild to severe. The virus features mechanisms that serve to delay the cellular immune response. The host’s response is responsible for the pathological process that leads to tissue destruction. Temporomandibular disorders are manifested by painful jaw musculature and jaw joint areas, clicks, or creaks when opening or closing the mouth. All these symptoms can be disabling and occur during chewing and when the patient yawns or even speaks. The pandemic situation has exacerbated anxieties and amplified the vulnerability of individuals. Therefore, from this mechanism, how the COVID-19 pandemic may have increased the incidence of temporomandibular disorders is perceived. The purpose of this review is to evaluate whether COVID-19-related anxiety has caused an increase in temporomandibular dysfunction symptoms in adults to children. Methods: PubMed, Web of Science, Lilacs, and Scopus were systematically searched, until 30 July 2022, to identify studies presenting: the connection between COVID-19 with temporomandibular disorders. Results: From 198 papers, 4 studies were included. Literature studies have shown that the state of uncertainty and anxiety has led to an increase in the incidence of this type of disorder, although not all studies agree. Seventy-three studies were identified after viewing all four search engines; at the end of the screening phase, only four were considered that met the PECO, the planned inclusion, and the exclusion criteria. All studies showed a statistically significant correlation between temporomandibular disorders and COVID-19 with a p < 0.05. Conclusions: All studies agreed that there is an association between COVID-19 and increased incidence of temporomandibular disorders.
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Shahabinejad M, Delavarian Z, Zamani T, Fallah Toosi F. Sarcoidosis and its oral manifestations: A case report study. Clin Case Rep 2023; 11:e6923. [PMID: 36789320 PMCID: PMC9913189 DOI: 10.1002/ccr3.6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
A patient was referred to the oral medicine department with redness and swelling of the lips and cheek, and an intra-oral lesion. Biopsy and laboratory investigations suggested a diagnosis of sarcoidosis. In this study we discuss oral findings associated with sarcoidosis.
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Affiliation(s)
- Mehdi Shahabinejad
- Oral and Maxillofacial Diseases Research CenterMashhad University of Medical SciencesMashhadIran,Oral and Maxillofacial Pathology DepartmentMashhad University of Medical SciencesMashhadIran
| | - Zahra Delavarian
- Oral and Maxillofacial Diseases Research CenterMashhad University of Medical SciencesMashhadIran,Oral and Maxillofacial Medicine, Oral and Maxillofacial Diseases Research CenterMashhad University of Medical SciencesMashhadIran
| | - Toktam Zamani
- Oral and Maxillofacial MedicineMashhad University of Medical SciencesMashhadIran
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Lafuente-Ibáñez de Mendoza I, Vigarios E, Herbault-Barres B, Alberdi-Navarro J, Sibaud V, Maret D, Aguirre-Urizar JM. Non-infectious granulomatous disorders of the upper lip: clinicopathological analysis of 11 patients. BMC Oral Health 2022; 22:173. [PMID: 35545768 PMCID: PMC9097340 DOI: 10.1186/s12903-022-02189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Non-infectious granulomatous disorders of the upper lip represent a special chapter of oral and maxillofacial pathology. In this work we report a case-series of this process, to analyse its main clinicopathological features and find differential data that allow us improve its diagnosis and understand its pathogenesis. Methods We present 11 cases of non-infectious granulomatous disorders of the upper lip, 8 women and 3 men with an age range of 29–84 years, who have been attended at the Oral Medicine Department of the IUCT (France) and the Oral Medicine Unit of the UPV/EHU (Spain). All clinicopathological data were collected in a specific protocol. Results We recognized 4 different subtypes of non-infectious granulomatous disorders of the upper lip: (1) associated with Crohn’s disease (1 case), (2) associated with foreign body (2 cases), (3) associated with gingivitis lichenoid-like (4 cases), (4) idiopathic (4 cases). Conclusions Clinicopathological differences were identified between these subtypes. A good differential diagnosis is necessary in all cases to rule out the presence of local or systemic etiopathogenic factors.
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Affiliation(s)
- Irene Lafuente-Ibáñez de Mendoza
- Oral Medicine and Pathology Unit, Department of Stomatology II, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940, Leioa, Spain.
| | - Emmanuelle Vigarios
- Department of Oral Medicine, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Béatrice Herbault-Barres
- Department of Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Javier Alberdi-Navarro
- Oral Medicine and Pathology Unit, Department of Stomatology II, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940, Leioa, Spain
| | - Vincent Sibaud
- Department of Dermatology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Delphine Maret
- Faculté de Chirurgie Dentaire, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - José Manuel Aguirre-Urizar
- Oral Medicine and Pathology Unit, Department of Stomatology II, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940, Leioa, Spain
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Casper J, Mohammad-Khani S, Schmidt JJ, Kielstein JT, Lenarz T, Haller H, Wagner AD. Melkersson-Rosenthal syndrome in the context of sarcoidosis: a case report. J Med Case Rep 2021; 15:488. [PMID: 34602094 PMCID: PMC8489098 DOI: 10.1186/s13256-021-03044-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Melkersson–Rosenthal syndrome is a rare disease characterized by the triad of recurrent orofacial swelling with facial paralysis and fissured dorsal tongue. Histologically, noncaseating granulomatous inflammation occurs that confirms the diagnosis. Overlaps between granulomatous diseases such as sarcoidosis and Crohn’s disease are described. Systemic corticosteroid therapy is the treatment of choice for acute attacks.
Case presentation We here present a case of a 59-year-old White woman suffering from Melkersson–Rosenthal syndrome with a past history of sarcoidosis on therapy with leflunomide in combination with low-dose tacrolimus successfully treated with the anti-leprosy drug clofazimine after failure of systemic steroid therapy. Conclusions We propose clofazimine as an alternative treatment in steroid-refractory cases.
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Affiliation(s)
- J Casper
- Department of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - S Mohammad-Khani
- Department of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - J J Schmidt
- Department of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - J T Kielstein
- Department of Nephrology, Städtisches Klinikum Braunschweig, Freisestraße 9-10, 38118, Brunswick, Germany
| | - T Lenarz
- Department of Otolaryngology (ENT), Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - H Haller
- Department of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - Annette D Wagner
- Department of Nephrology and Hypertension, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany.
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Chatterjee D, Bhattacharjee R, Saikia UN. Non-Infectious Granulomatous Dermatoses: A Pathologist's Perspective. Indian Dermatol Online J 2021; 12:515-528. [PMID: 34430454 PMCID: PMC8354400 DOI: 10.4103/idoj.idoj_662_20] [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: 08/22/2020] [Revised: 10/14/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Granulomatous dermatitis (GD) is one of the commonest tissue reaction patterns encountered in dermatopathology practice. Granulomatous inflammation in the skin can be seen in a wide range of conditions, thus, granulomatous dermatitis always poses significant challenge even to the astute dermatologists and dermatopathologists. Broadly, granulomatous dermatitis is divided into two groups-infectious and non-infectious, the prevalence of both highly variable and show overlapping pathology. However, there are subtle histological clues, which when combined with clinical features, help to narrow down the differential diagnosis. Thus, a good Clinicopathological correlation (CPC) along with histochemical stains, culture and ancillary techniques including molecular studies are required for arriving at a definite diagnosis. In this review, we shall discuss the histological clues to diagnose non-infectious granulomatous dermatitis (NIGD) and their differential diagnoses.
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Affiliation(s)
- Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajsmita Bhattacharjee
- Department of Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Galdiero MR, Maio F, Arcoleo F, Boni E, Bonzano L, Brussino L, Cancian M, Cremonte L, Del Giacco SR, De Paulis A, Detoraki A, Firinu D, Lamacchia D, Loffredo S, Nettis E, Parente R, Parronchi P, Pellacani G, Petraroli A, Rolla G, Senter R, Triggiani M, Vitiello G, Spadaro G, Bova M. Orofacial granulomatosis: Clinical and therapeutic features in an Italian cohort and review of the literature. Allergy 2021; 76:2189-2200. [PMID: 33641182 DOI: 10.1111/all.14799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data. METHODS A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG. RESULTS Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response. CONCLUSIONS OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management.
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Affiliation(s)
- Maria R. Galdiero
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Filomena Maio
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia‐CervelloUnità Operativa Complessa di Patologia Clinica Palermo Italy
| | - Elisa Boni
- Laboratorio Unico Metropolitano Maggiore Hospital AUSL Bologna Italy
| | - Laura Bonzano
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | - Mauro Cancian
- Department of Medicine University of Padova Padova Italy
| | - Luigi Cremonte
- Allergy Unit San Giacomo HospitalNovi Ligure Alessandria Italy
| | - Stefano R. Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | | | - Stefania Loffredo
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation School of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology University of Salerno Salerno Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giovanni Pellacani
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | | | - Massimo Triggiani
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Maria Bova
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
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Abstract
The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.
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Affiliation(s)
- Corinne Légeret
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
| | - Raoul Furlano
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
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10
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Pathological and Immunohistochemical Characteristics of Granuloma and Lymphatics in Cheilitis Granulomatosa. Am J Dermatopathol 2021; 44:83-91. [PMID: 33878045 DOI: 10.1097/dad.0000000000001952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cheilitis granulomatosa (CG) is an idiopathic, rare, and chronic granulomatous disorder involving the lips. We characterized the pathological and immunohistopathological findings of these granulomas and their relationship with the lymphatic vessels. Pathologically confirmed cases of primary CG from 2001 to 2016 were collected. Cases of inflammatory cheilitis without the presence of granuloma were included in the control group. Demographic data, clinical presentation, response to therapy, and pathological differences were compared. Periodic acid-Schiff and acid-fast stains excluded patients having infections. CD68, CD163, and D2-40 stains demonstrated features of granuloma, macrophage polarization, and the relationship between granuloma and lymphatic vessels. Thirteen patients diagnosed with CG were enrolled. Thirteen people were enrolled in the control group. The granulomas were either mononuclear or sarcoidal. They were predominantly positive for CD68 but negative for CD163. Perilymphatic granulomas were found in all patients. Intralymphatic histiocytosis and lymphatic dilatation were more commonly observed in patients diagnosed with CG than those in controls (54% vs. 15%, P = 0.03 and 92% vs. 23%, P < 0.01). TH1 immune response due to CD68+ M1 macrophages results in CG. Perilymphatic aggregation of macrophages and intralymphatic histiocytosis were important pathological clues for diagnosis.
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11
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Santonocito S, Polizzi A, De Pasquale R, Ronsivalle V, Lo Giudice A, Isola G. Analysis of the Efficacy of Two Treatment Protocols for Patients with Symptomatic Oral Lichen Planus: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E56. [PMID: 33374791 PMCID: PMC7794703 DOI: 10.3390/ijerph18010056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Oral lichen planus (OLP) is a chronic, inflammatory, immune-mediated disease, which can alter the quality of life of patients. The aim of this randomized clinical trial was to compare the therapeutic efficacy of clobetasol oral gel 0.05% versus an anti-inflammatory in oral solution (mouthwash) in the management of patients suffering from symptomatic OLP. The secondary objective was to analyze which one of the two treatments induced a greater risk of developing side effects. Forty patients were assigned (20 patients for group), through a randomized design, to receive clobetasol gel 0.05% or an anti-inflammatory mouthwash, which contains calcium hydroxide, hyaluronic acid, umbelliferone and oligomeric pro-anthocyanidins) for three months. At baseline (T0) and after 3 months (T1), patients underwent dental and dermatological examinations to assess their symptoms (Numerical Pain Scale (NRS) score) and signs (Thongprasom score). Data were calculated using T-test for the dependent variable, Wilcoxon test and Mann-Whitney u test. Both clobetasol and anti-inflammatory resulted in a statistically significant reduction of signs, (p < 0.001 and p = 0.02, respectively) and symptoms (p < 0.001 for clobetasol and p = 0.02 for anti-inflammatory). In conclusion, the results evidenced that, compared to clobetasol, the anti-inflammatory was less effective in determining the reduction of signs and symptom in OLP patients.
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Affiliation(s)
- Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Rocco De Pasquale
- Department of General Surgery and Surgical-Medical Specialties, Unit of Dermatology, University of Catania, 95124 Catania, Italy;
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, Unit of Oral Pathology, School of Dentistry, University of Catania, 95124 Catania, Italy; (S.S.); (A.P.); (V.R.); (A.L.G.)
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Wang S, Wang H, Shi X, Wu F, Lv L, Hu M, Sun W, Wu L, Zhou H. A case of Melkersson-Rosenthal syndrome with endocrine disorders: Extraordinary efficiency of hydroxychloroquine and mechanism hypothesis. Eur J Neurol 2020; 28:928-933. [PMID: 33270950 DOI: 10.1111/ene.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disease. In addition to the traditional clinical triad, there is also a diversity of clinical signs, and it may be related to other systemic diseases. METHODS In the present study, we report a case of MRS with endocrine disorders that exhibits extraordinary therapeutic efficiency by using hydroxychloroquine (HCQ), explore whether there is an internal connection between MRS and endocrine disorders, and discuss the mechanism of the therapeutic efficiency of using HCQ. The hypothesis proposed for the first time is that MRS may essentially be a systemic granulomatous disease. RESULTS The physical examination revealed orofacial swelling and fissured tongue. The histopathologic examination showed epithelioid granulomas. Combined with the other examination, this case was diagnosed as incomplete MRS. HCQ and local drugs were introduced. The patient achieved clinical recovery and psychological cure by the 18-week follow-up, and the 1-year follow-up found no reactivation of MRS. Moreover, the levels of cortisol and adrenocorticotropic were within normal ranges. CONCLUSIONS After the drug therapy was targeted at granuloma, not only did all of the symptoms related to MRS disappear, but the endocrine system also returned to normal. It is speculated that the endocrine disorder in this patient may be related to MRS. We further propose the first-time hypothesis that MRS may essentially be a systemic granulomatous disease. It provides a new medication method with high-level efficiency.
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Affiliation(s)
- Shimeng Wang
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Hongmei Wang
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Mianyang Stomatological Hospital, Mianyang, China
| | - Xueke Shi
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Fanglong Wu
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Ling Lv
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Mingjia Hu
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Wanxin Sun
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Lanyan Wu
- Department of Oral Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hongmei Zhou
- State Key Laboratory of Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
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Granulomatose orofaciale : une série de 10 cas. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Porrini M, Garagiola U, Rossi M, Bosotti M, Marino S, Giannì AB, Runza L, Spadari F. Photobiomodulation and Miescher's cheilitis granulomatosa: case report. Maxillofac Plast Reconstr Surg 2020; 42:35. [PMID: 33102396 PMCID: PMC7575664 DOI: 10.1186/s40902-020-00279-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Miescher's cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip. Case presentation The patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T 1-T 12). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T 10-T 12 was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T 7). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period. Conclusions Our experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.
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Affiliation(s)
- Massimo Porrini
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Umberto Garagiola
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Margherita Rossi
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Moreno Bosotti
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Sonia Marino
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Aldo Bruno Giannì
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
| | - Letterio Runza
- Division of Pathology, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, Milan, Italy
| | - Francesco Spadari
- Department of Biomedical, Surgical and Dental Sciences-Maxillo-Facial and Odontostomatology Unit-Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, University of Milan, via della Commenda 10, Milan, Italy
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Brown R, Farquharson A, Cherry-Peppers G, Lawrence L, Grant-Mills D. <p>A Case of Cheilitis Granulomatosa/Orofacial Granulomatosis</p>. Clin Cosmet Investig Dent 2020; 12:219-224. [PMID: 32606993 PMCID: PMC7320889 DOI: 10.2147/ccide.s254899] [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: 04/02/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
A case of a 19-year-old female patient is presented to a private practice dental clinician with swelling of the lower lip and inflammation of the anterior dorsal tongue. The patient presented with moderate oral pain as well as abdominal pain. The lesions were biopsied and noted for a granulomatous histopathologic appearance. The patient reported a history of using cinnamon as a flavoring agent. The lesions resolved within two weeks after the biopsy procedures and topical steroid therapy. The lesions were diagnosed as cheilitis granulomatosa/orofacial granulomatosis. The patient has remained lesion free as of the three-year follow-up. Etiologic, diagnostic and therapeutic issues related to this relatively rare condition of cheilitis granulomatosa/orofacial granulomatosis are discussed.
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Affiliation(s)
- Ronald Brown
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
- Correspondence: Ronald Brown Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, 600 W Street, NW, Washington, DC20059, USATel +1 202-806-0020 Email
| | - Andre Farquharson
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
| | - Gail Cherry-Peppers
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Leslie Lawrence
- Department of Pediatric Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Donna Grant-Mills
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
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16
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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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Dioguardi M, Crincoli V, Laino L, Alovisi M, Sovereto D, Mastrangelo F, Lo Russo L, Lo Muzio L. The Role of Periodontitis and Periodontal Bacteria in the Onset and Progression of Alzheimer's Disease: A Systematic Review. J Clin Med 2020; 9:E495. [PMID: 32054121 PMCID: PMC7074205 DOI: 10.3390/jcm9020495] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 12/28/2022] Open
Abstract
The evidence of a connection between the peripheral inflammatory processes and neurodegenerative diseases of the central nervous system is becoming more apparent. This review of the related literature highlights the most recent clinical, epidemiological, and in vitro studies trying to investigate possible connections between periodontal bacteria and the onset and progression of Alzheimer's disease. This review was conducted by searching databases such as PubMed and Scopus using keywords or combinations such as Alzheimer's Disease AND periodontal or dementia AND periodontitis OR periodontal. After eliminating overlaps and screening the articles not related to these issues, we identified 1088 records and proceeded to the selection of articles for an evaluation of the associative assumptions. The hypothesis suggested by the authors and confirmed by the literature is that the bacterial load and the inflammatory process linked to periodontal disease can intensify inflammation at the level of the central nervous system, favoring the occurrence of the disease. The analysis of the literature highlights how periodontal disease can directly contribute to the peripheral inflammatory environment by the introduction of periodontal or indirect pathogenic bacteria and proinflammatory cytokines locally produced at the periodontal level following bacterial colonization of periodontal defects.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (D.S.); (F.M.); (L.L.R.)
| | - Vito Crincoli
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Division of Complex Operating Unit of Dentistry, “Aldo Moro” University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy;
| | - Mario Alovisi
- Department of Surgical Sciences, Dental School, University of Turin, 10126 Turin, Italy
| | - Diego Sovereto
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (D.S.); (F.M.); (L.L.R.)
| | - Filiberto Mastrangelo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (D.S.); (F.M.); (L.L.R.)
| | - Lucio Lo Russo
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (D.S.); (F.M.); (L.L.R.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy; (D.S.); (F.M.); (L.L.R.)
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18
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Müller S. Non-infectious Granulomatous Lesions of the Orofacial Region. Head Neck Pathol 2019; 13:449-456. [PMID: 30627963 PMCID: PMC6684712 DOI: 10.1007/s12105-018-00997-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Abstract
Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.
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Affiliation(s)
- Susan Müller
- Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA, 30033, USA.
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19
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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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20
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Feugueur G, Konstantinou MP, Croze J, Laurencin S, Cousty S. Management of orofacial granulomatosis: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Orofacial granulomatosis is characterized by recurrent swelling affecting the lips, cheeks, and tongue. The rarity of this pathology and the lack of consensus in therapeutic management make the reporting of this clinical case relevant. Observation: A 48-year-old man consulted for labial and gingival orofacial granulomatosis. The treatment consisted of 40 mg/L injections of triamcinolone acetonide once weekly for 3 weeks. The symptoms improved after 1 week of treatment. Comments: The usual treatment for this condition targets the inflammation caused by the lesion. Corticosteroids (clobetasol, triamcinolone acetonide, prednisolone), monoclonal antibodies (infliximab, adalimumab), or TNF-α inhibitors are commonly used. Symptom recurrenceis frequently observed after treatment with corticosteroids. Biotherapies are often used as a second-line treatment. Conclusion: Orofacial granulomatosis symptoms are rare and difficult to diagnose due to its varying manifestations. Common treatments target one of the steps of the inflammatory response. The detection of specific cellular markers is a way to enable a more precise etiological diagnosis and allows for a more targeted therapy.
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Abstract
OBJECTIVES Orofacial granulomatosis (OFG) is a chronic inflammatory condition affecting the orofacial area. Its connection to Crohn disease (CD) is debated. Our aim was to describe a cohort of pediatric patients with OFG in detail, study the long-term behavior of OFG, and evaluate factors predicting CD in patients with OFG. METHODS We invited patients diagnosed with OFG at 2 university hospitals, Finland for a follow-up appointment. Patients (n = 29) were examined by a dentist and an otorhinolaryngologist using a structural schema. Orofacial findings were also recorded using digital photographing. Patients filled in questionnaires about general health and special diets. Patients' nutrition was evaluated from food records. The findings were compared between patients with OFG only and OFG with CD. RESULTS Patients with CD had more findings in the orofacial area (total score for orofacial findings median 11) compared to patients with OFG only (total score median 7.5). There was no statistically significant difference in the type of lesions between these groups, except the upper lip was more often affected in patients with CD (n = 11) than in patients with OFG only (n = 0). Most of the patients had normal otorhinolaryngological findings. All patients with elevated anti-Saccharomyces cerevisiae antibody A levels had CD (n = 6) and they presented with more orofacial findings (total score) than patients with normal levels of anti-S cerevisiae antibody A (P = 0.0311). CONCLUSIONS Long-term follow-up of pediatric-onset patients with OFG shows good prognosis. Patients with OFG do not seem to have otorhinolaryngological comorbidity. Anti-S cerevisiae antibody A may serve as a factor to indicate the possible presence of underlying CD in patients with OFG, but further studies are requested.
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22
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Zhang W, Wang J, Yu X, Wang W. Orofacial granulomatosis: A case report of three cases may be caused by apical periodontitis. Medicine (Baltimore) 2017; 96:e8102. [PMID: 28953630 PMCID: PMC5626273 DOI: 10.1097/md.0000000000008102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Orofacial granulomatosis (OFG) is a rare disease characterized by noncaseating granulomatous inflammation. The most common clinical presentation is persistent swelling of the soft tissues in the oral and maxillofacial regions. The precise cause of OFG is unknown. Corticosteroids are the first-line and best treatment, but there is lack of uniform treatment prescription and standard. It is important to identify the pathogen in order to improve treatment specificity. PATIENT CONCERNS Three patients presented with recurring lip swelling and cobblestone formation on buccal mucosa, complained of toothache or dental caries for many years. They had very similar and characteristic clinical signs, especially the corresponding location with infected teeth, which suffered from apical periodontitis. DIAGNOSES The three patients were all diagnosed with typical clinical signs and non-caseating epithelioid cell granulomas histologically. INTERVENTIONS The teeth with apical periodontitis were extracted or treated and corticosteroids were prescribed locally or/and systematically. OUTCOMES A complete resolution of lip swelling and cobblestone formation were shown after treatment. LESSONS This is the first report to highlight that apical periodontitis may intrigue the pathogenesis of OFG, which suggested that dental infection may be the direct and initial etiology of OFG. Removal of infected teeth should be performed as soon as possible in order to reduce the dosage of corticosteroids and occcurence rate of OFG.
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Affiliation(s)
- Wenyi Zhang
- Department of Periodontology and Oral Mucosal Diseases
| | - Jia Wang
- Department of Restorative Dentistry and Endodontics
| | - Xixi Yu
- The Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Wanchun Wang
- Department of Periodontology and Oral Mucosal Diseases
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23
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Beaumont J, Chesterman J, Kellett M, Durey K. Gingival overgrowth: Part 1: aetiology and clinical diagnosis. Br Dent J 2017; 222:85-91. [DOI: 10.1038/sj.bdj.2017.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/30/2022]
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24
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Holl-Ulrich K, Rose C. [Non-infectious granulomatous inflammation: Focus on the lungs and skin]. DER PATHOLOGE 2017; 37:172-82. [PMID: 26670175 DOI: 10.1007/s00292-015-0119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whereas a granulomatous reaction represents a physiologically useful immune defense mechanism against many infections, in autoimmune diseases granuloma formation and the concomitant inflammatory mechanisms may provoke a potentially organ-threatening reaction. Morphologically, several defined sub-types of granuloma have long been known, e.g. foreign body granuloma, tuberculous granuloma,sarcoid, pseudosarcoid, rheumatoid and rheumatic fever granulomas. However, in practice, assigning granulomas to a certain etiology from a biopsy or resection specimen can be a challenging diagnostic process. This article gives a practically oriented overview of the clinically most relevant non-infectious granulomatous diseases. The etiology, epidemiology, clinical correlation and morphology of granulomatous diseases are discussed, focussing on the lungs and skin.
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Affiliation(s)
- K Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. .,Gemeinschaftspraxis für Pathologie am Lademannbogen, Hamburg, Deutschland.
| | - C Rose
- Dermatopathologie Lübeck, Lübeck, Deutschland
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25
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Abstract
Orofacial granulomatosis (OFG) is a condition manifesting clinically with chronic swelling of the mouth and/or face, notably with swelling of the lips and oral mucosa, a full-thickness, erythematous gingivitis and mucosal ulceration of various clinical types. Some patients may also present with neurological findings, for example facial palsy. Biopsy of affected tissue shows lymphoedema, with or without granulomatous inflammation. The oral lesions in OFG are histologically indistinguishable from the oral lesions in Crohn's disease (CD) and other systemic granulomatous disorders. It is a condition which may respond to the exclusion of certain food-related chemicals from the diet in up to 60% of patients and, as such, is distinct from gastrointestinal CD. CD is a relapsing systemic inflammatory disease which predominantly affects the gut, and patients suffering from this disease frequently present with abdominal pain, fever and altered bowel habit. A proportion of patients with clinical OFG (without other systemic disease) may have asymptomatic gastrointestinal involvement or go on to develop gut CD suggesting an association between the two diseases. It is estimated that 1% of CD sufferers may have a diagnosis of OFG, but the majority of patients in specialist OFG clinics do not have gut symptoms.
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Affiliation(s)
- Esther A Hullah
- Guy's and St Thomas' NHS Foundation Trust, Department of Oral Medicine, London, UK
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26
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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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Handra-Luca A, Haddar D, Morin AS. Nasopalpebral Schwannomas and Human Immunodeficiency Virus Infection. Med Princ Pract 2016; 25:96-8. [PMID: 26436768 PMCID: PMC5588322 DOI: 10.1159/000441455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of a schwannoma of nasopalpebral location, occurring in a human immunodeficiency virus (HIV)-positive patient. CLINICAL PRESENTATION AND INTERVENTION A 55-year-old man presented with a nasopalpebral painless tumefaction, pneumopathy and HIV-related immunodepression after stopping combination antiretroviral therapy. Magnetic resonance imaging showed subcutaneous masses, with contrast enhancement of the left nose pyramid, internal cantus and inferior palpebral area, suspicious of Kaposi sarcoma. The resected specimen showed schwannoma histology, with tumor cells expressing S100 protein and WT1. CONCLUSION The features of a rare case of facial schwannoma of nasopalpebral location in an HIV-positive patient are reported. The diagnosis may be difficult before microscopic examination, with imaging features suggesting a Kaposi sarcoma.
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Affiliation(s)
- Adriana Handra-Luca
- Service d'Anatomie Pathologique, Assistance Publique - Hopitaux de Paris (AP-HP), Université Paris Nord Sorbonne Cité, Bobigny, France
- *Adriana Handra-Luca, MD, PhD, Service d’Anatomie Pathologique, AP-HP GHU Avicenne, Université Paris Nord Sorbonne Cité, 125, rue de Stalingrad, FR–93009 Bobigny (France), E-Mail
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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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