Diagnosis Of Orofacial Granulomatosis Research Articles

Lip Swelling as Initial Presentation of Crohn’s Disease

A 31-year-old woman presented with a year of recurrent lower lip swelling with associated oral ulcers (Figure A). Labs were notable for an elevated C-reactive protein and hypoalbuminemia. A punch biopsy of her lower lip showed granulomatous dermatitis with lymphangiectasia, and she was given the diagnosis of orofacial granulomatosis (Figure B). Resolution of symptoms only occurred with chronic prednisone. Subsequent onset of abdominal pain, diarrhea, and bright red blood per rectum prompted a full gastrointestinal (GI) workup for possible Crohn’s disease (CD).

Interdisciplinary approach in the diagnosis and treatment of orofacial granulomatosis

Orofacial granulomatosis (OFG) is an uncommon disease and represents an idiopathic, nonnecrotizing granulomatous lesion of soft tissue in the orofacial region. Medical history is very important in the diagnosis of OFG as medical condition such as Crohn's disease can also present an extraintestinal manifestation of OFG. Exclusion of other entities such as sarcoidosis, myocardial infections, foreign body reactions, and biopsy helps establish a correct diagnosis. The term idiopathic OFG is used in cases with unknown etiology. This case report describes idiopathic OFG in a 35-year-old female patient with persistent upper lip swelling and gingival enlargement. Management with intralesional acetonide 20 mg/ml, twice week for 3 weeks and gingivectomy, resulted in significant remission without recurrence after a 6-month follow-up.

The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis.

Inflammatory bowel disease has a wide range of possible oral manifestations, many of which overlap with those seen in other conditions, including orofacial granulomatosis. The precise etiology remains unclear, as is the exact relationship between orofacial granulomatosis and Crohn's disease. Overall, there is growing evidence that orofacial granulomatosis and oral Crohn's disease are distinct clinical disorders with optimal management requiring a multidisciplinary approach with input from appropriate specialists in oral medicine, gastroenterology, allergy, dietetics, and clinical psychology. This review details the etiopathogenesis, clinical presentation, epidemiology, extra-intestinal, and oral manifestations of inflammatory bowel disease and orofacial granulomatosis. It also assesses the current role of investigations in the diagnosis of orofacial granulomatosis and critically reviews the available evidence in relation to medical and surgical interventions for the condition, and its relationship to Crohn's disease.

Orofacial Granulomatosis in an Orthodontic Patient: a Case Report

A case is presented of a 14-year-old male patient being treated with a fixed orthodontic appliance who presented with a persistent upper lip swelling. The patient was experiencing discomfort from the appliance and the appliance was debonded. A diagnosis of orofacial granulomatosis was established and the patient was managed carefully with a cinnamon- and benzoate-free diet leading to resolution of the swelling. Orofacial granulomatosis is a rare condition and its presentation, diagnosis, and management are discussed. CPD/Clinical Relevance: Orthodontists should be aware of the presentation of orofacial granulomatosis and the possible challenges associated with managing these patients.

Orofacial granulomatosis

Orofacial granulomatosis (OFG) is an uncommon chronic granulomatous condition with a multifactorial etiology and pathogenesis. Genetic, immunologic, allergic, and infectious mechanisms have been implicated. OFG is often used as a descriptor to encompass all entities with orofacial swelling and histologic evidence of noncaseating granulomas. The diagnosis of OFG should prompt evaluation for provocative factors. The cause of most cases of OFG remains obscure. The clinician must consider mycobacterial infections, deep fungal infections, sarcoidosis, rosacea, and Crohn disease (CD). In addition, OFG should be considered synonymous with previously described conditions, including granulomatous cheilitis and Miescher cheilitis, as well as Melkersson-Rosenthal syndrome and its monosymtomatic or oligosymptomatic variants. The relationship of OFG to CD is currently debated, with recent evidence suggesting the possibility of three entities: classic oral CD (established gastrointestinal CD with oral involvement), OFG with gastrointestinal involvement (OFG with subclinical or asymptomatic gastrointestinal endoscopy changes), and OFG without bowel involvement. Childhood onset, presence of certain phenotypic features, laboratory abnormalities, or gastrointestinal symptoms may indicate the need for further evaluation to assess for concurrent or future CD. Although multiple therapies have been found to be effective in small numbers of patients, treatment should be tailored to each patient.

Update on Orofacial Granulomatosis.

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.

Idiopathic orofacial granulomatosis in a young patient: A rare entity

The granular enlargement of the gingiva may be the first clinical manifestation of Orofacial granulomatosis, preceding other local or systemic manifestations. The term Idiopathic Orofacial granulomatosis (OFG) refers to conditions restricted to the oral region without any identifiable systemic granulomatous diseases. We report a case of nine year old female patient with gingival enlargement as the sole manifestation without any systemic involvement. Laboratory investigations were done to rule out tuberculosis, sarcoidosis, allergic hypersensitivity, Crohn's disease. The patient was treated by gingivectomy and there is complete remission of the lesion without any recurrence. Thus the early investigations and diagnosis of OFG can help in the prevention of future systemic complications.

Orofacial Granulomatosis - A Rare Case Report with Review of Literature

The term orofacial granulomatosis (OFG) is a descriptive term used for granulomatous disorders affecting the face and oral cavity, which can occur for a variety of reasons resulting in significant morbidity. It is characterised by persistent swelling that may involve one or both the lips and /or recurrent ulcers and a variety of other orofacial features. Medical history is very important in the diagnosis of OFG as medical condition like Crohn’s disease can also present an extra intestinal manifestation of OFG. Exclusion of other entities like sarcoidosis, mycobacterial infections, foreign body reactions and biopsy helps to establish a correct diagnosis. Herein we report a case of OFG in a 55 year old female patient with review of literature.

Orofacial Granulomatosis: Report of Two Cases with Gingival Onset

Orofacial granulomatosis is a unifying term comprising a variety of clinical conditions involving the face and the oral cavity and histologically characterized by the presence of chronic granulomatous inflammation. Lip swelling and erythema are the most frequent clinical signs. We report on the clinical-pathological features and the management of two cases of orofacial granulomatosis characterized by gingival onset, without other local and systemic manifestations. The diagnosis of orofacial granulomatosis with gingival onset is made by the exclusion of other conditions exhibiting gingival inflammation and/or enlargement. Detailed medical history, haematological investigations and gingival biopsy are fundamental for the definitive diagnosis. Though infrequent, orofacial granulomatosis with gingival involvement should be considered in the differential diagnosis of hyperplastic gingivitis of uncertain origin.

Crohn's disease manifesting in the head and neck

Crohn's disease may present to the head and neck surgeon with symptoms and signs attributed to the disease. Many clinical presentations, both specific and non-specific, have been recorded in the oral cavity, nose and larynx. Some of these clinical manifestations have been found to be consistent with Crohn's disease, but most have been attributed to Crohn's disease without histologic confirmation of the presence of non-caseating granulomas, which is pathognomonic of Crohn's disease. Lesions, when present without an associated diagnosis of Crohn's disease, should be ascribed the diagnosis of orofacial granulomatosis, until a diagnosis of intestinal Crohn's disease has been confirmed.

Monosodium glutamate-related orofacial granulomatosis: Review and case report

A case is reported in a 15-year-old white girl who had a swollen lower fa̧ce and lips; a diagnosis of orofacial granulomatosis was made. It was suspected that her condition had an allergic basis because an increase in clinical signs and symptoms was shown to be related to the food additive monosodium glutamate. Treatment with a restricted diet resulted in resolution of the facial swelling.