1
|
Cecchin-Albertoni C, Pieruccioni L, Canceill T, Benetah R, Chaumont J, Guissard C, Monsarrat P, Kémoun P, Marty M. Gingival Orofacial Granulomatosis Clinical and 2D/3D Microscopy Features after Orthodontic Therapy: A Pediatric Case Report. Medicina (B Aires) 2023; 59:medicina59040673. [PMID: 37109631 PMCID: PMC10146811 DOI: 10.3390/medicina59040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Orofacial granulomatosis (OFG) represents a heterogeneous group of rare orofacial diseases. When affecting gingiva, it appears as a chronic soft tissue inflammation, sometimes combined with the enlargement and swelling of other intraoral sites, including the lips. Gingival biopsy highlights noncaseating granulomatous inflammation, similar to that observed in Crohn’s disease and sarcoidosis. At present, the etiology of OFG remains uncertain, although the involvement of the genetic background and environmental triggers, such as oral conditions or therapies (including orthodontic treatment), has been suggested. The present study reports the results of a detailed clinical and 2D/3D microscopy investigation of a case of gingival orofacial granulomatosis in an 8-year-old male patient after orthodontic therapy. Intraoral examination showed an erythematous hyperplasia of the whole gingiva with a granular appearance occurring a few weeks after the installation of a quad-helix. Peri-oral inspection revealed upper labial swelling and angular cheilitis. General investigations did not report ongoing extra-oral disturbances with the exception of a weakly positive anti-Saccharomyces cerevicae IgG auto-antibody. Two- and three-dimensional microscopic investigations confirmed the presence of gingival orofacial granulomatosis. Daily corticoid mouthwashes over a period of 3 months resulted in a slight improvement in clinical signs, despite an intermittent inflammation recurrence. This study brings new insights into the microscopic features of gingival orofacial granulomatosis, thus providing key elements to oral practitioners to ensure accurate and timely OFG diagnosis. The accurate diagnosis of OFG allows targeted management of symptoms and patient monitoring over time, along with early detection and treatment of extra-oral manifestations, such as Crohn’s disease.
Collapse
Affiliation(s)
- Chiara Cecchin-Albertoni
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Correspondence:
| | - Laetitia Pieruccioni
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Thibault Canceill
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm, Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), CEDEX 4, 31432 Toulouse, France
| | - Robin Benetah
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Jade Chaumont
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Christophe Guissard
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Paul Monsarrat
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Artificial and Natural Intelligence Toulouse Institute ANITI, 31013 Toulouse, France
| | - Philippe Kémoun
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Mathieu Marty
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- LIRDEF, Faculty of Educational Sciences, Paul Valery University, CEDEX 5, 34199 Montpellier, France
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Janšáková K, Escudier M, Tóthová Ľ, Proctor G. Salivary changes in oxidative stress related to inflammation in oral and gastrointestinal diseases. Oral Dis 2020; 27:280-289. [PMID: 32643850 DOI: 10.1111/odi.13537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/21/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The early diagnosis and monitoring of Crohn's disease (CD) and orofacial granulomatosis (OFG) might be facilitated by assaying potential disease biomarkers in saliva. Markers of oxidative stress and inflammation were assayed in salivas from patients with CD, OFG and concurrent OFG and CD (OFG + CD). SUBJECTS Unstimulated whole mouth saliva was collected from 93 subjects, and immunoglobulin A (IgA), lactoferrin (LF) and myeloperoxidase (MPO) were determined by ELISA. Markers of oxidative stress and antioxidant status were assayed spectrophotometrically. RESULTS Immunoglobulin A was significantly (p < .03) higher in experimental groups vs the control group. LF was significantly (p < .01) higher in OFG + CD compared to CTRL and CD. Ferric reducing antioxidant power was lower (p ≤ .009) in all experimental groups, and advanced glycation end products were higher (p ≤ .01) in CD and OFG + CD patients. CONCLUSION Oxidative stress is increased in saliva in CD and OFG. Although MPO, a product of inflammatory cells, was not significantly increased, the other innate immune markers, IgA and LF, which are also secreted by salivary glands, were increased. This study suggests that saliva might be utilized in monitoring CD and OFG but further longitudinal studies focused on analysing a panel of salivary markers are needed.
Collapse
Affiliation(s)
- Katarína Janšáková
- Institute of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michael Escudier
- Centre for Host Microbiome Interactions, Faculty of Dentistry & Craniofacial Sciences, King's College London, London, UK
| | - Ľubomíra Tóthová
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Gordon Proctor
- Centre for Host Microbiome Interactions, Faculty of Dentistry & Craniofacial Sciences, King's College London, London, UK
| |
Collapse
|
4
|
Skrzat A, Olczak‐Kowalczyk D, Turska‐Szybka A. Crohn's disease should be considered in children with inflammatory oral lesions. Acta Paediatr 2017; 106:199-203. [PMID: 27896868 DOI: 10.1111/apa.13686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 12/12/2022]
Abstract
This systematic review presents the oral manifestations of paediatric Crohn's disease. Our review of 28 papers published from 2000 to 2015 showed that the prevalence of oral manifestations was 10-80%. Specific symptoms included mucosal tags, swelling of the lips, cheeks and gingiva, and cobblestoning mucosa. Nonspecific symptoms included aphthous-like ulcers, angular cheilitis, lip fissuring and gingivitis. CONCLUSION The oral manifestations of Crohn's disease might precede intestinal inflammation or coincide with it. Crohn's disease should be considered in children with multiple oral manifestations and paediatric dentists, and gastroenterologists should be involved in their coordinated evaluation and follow-up.
Collapse
Affiliation(s)
- Anna Skrzat
- Students’ Scientific Group by Department of Paediatric Dentistry Medical University of Warsaw Warsaw Poland
| | | | - Anna Turska‐Szybka
- Department of Paediatric Dentistry Medical University of Warsaw Warsaw Poland
| |
Collapse
|
5
|
Hoekman DR, Roelofs JJTH, van Schuppen J, Schonenberg-Meinema D, D'Haens GR, Benninga MA. Case report of cheilitis granulomatosa and joint complaints as presentation of Crohn's disease. Clin J Gastroenterol 2016; 9:73-8. [PMID: 27017505 PMCID: PMC4829618 DOI: 10.1007/s12328-016-0641-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/17/2016] [Indexed: 12/15/2022]
Abstract
Cheilitis granulomatosa is characterized by granulomatous lip swelling. We report a case of a 13-year-old girl who presented with orofacial swelling and arthralgia, who eventually was diagnosed with Crohn’s disease, which was successfully treated with infliximab and azathioprine combination therapy. Recurrent or persistent orofacial swelling should prompt consideration of cheilitis granulomatosa, and further diagnostic evaluation to exclude the presence of Crohn’s disease seems warranted.
Collapse
Affiliation(s)
- Daniël R Hoekman
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Department of Pediatric Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|