Orofacial Lesions Research Articles

Orofacial tuberculosis: Clinical manifestations, diagnosis and management.

Orofacial tuberculosis (TB) is an uncommon form of extrapulmonary TB and is nonspecific in its clinical presentation. It can be misdiagnosed especially when oral lesions are present before systemic symptoms become apparent. Doctors especially attending dentist who generally is the first among clinicians to come across such pathological entity should be aware of the orofacial lesions of TB and consider them in the differential diagnosis of suspicious oral lesions to ensure early diagnosis of TB and its treatment. In this review, we have discussed in detail the clinical presentation of various forms of orofacial TB, diagnosis, and management of patients. Also, an update is provided about recent anti-TB drug development.

Knowledge of Nairobi East District Community Health Workers concerning HIV-related orofacial lesions and other common oral lesions

BackgroundHuman immunodeficiency virus (HIV) related orofacial lesions (HROLs) impact negatively on the health of patients and could be managed at primary healthcare (PHC) level. Community health workers (CHWs) are crucial in optimal patient management through patient identification, education and early referral for professional care. The study objective was to assess knowledge of Nairobi East district CHWs regarding HROLs and other common oral diseases.MethodsOf the total population of CHWs, 815 [94.5%] completed a 56-item questionnaire covering 5 topics: general dental knowledge, knowledge about HROLs, past encounters with HROLs, current care at community level, opinions regarding oral health problems; and items concerning background characteristics and past training activities. Confirmatory factor analysis revealed Cronbach’s alpha coefficient values of 0.45, 0.59, 0.79, 0.50 and 0.09 respectively. The first four topics were confirmed as domains. Mean minimum score was 0 and mean maximum score was 1 for each variable. However, for ‘past encounters with HROLs, the minimum score was 0 and maximum score was 5.ResultsCHWs had moderate knowledge about general oral health (mean = 0.47) and HROLs (mean = 0.43). None had been formally trained in oral health aspects. Although they had high opinions regarding their role in identifying, educating and referring patients with HROLs (mean = 0.80) to the health facilities, they actually rarely referred such patients.ConclusionsCHWs need training for building competence in promoting oral health among general and HIV patients in their communities and in early identification and management of non-HIV oral lesions.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1066) contains supplementary material, which is available to authorized users.

Oral mucosal lesions and immune status in HIV-infected Indian children.

Pediatric HIV is growing at an alarming rate in developing countries. Due to their compromised immune status, children infected with HIV are prone to a number of opportunistic infections. Oral manifestations are the first signs of the disease in many of them. To assess the oral mucosal status of Indian children with HIV, based on their CD4 cell counts. Two hundred and twenty one HIV infected children aged 6-18 years from various HIV centers, were divided into three groups, based on their CD4 cell counts; Group 1: ≥500, Group 2: 201-499 and Group 3: ≤200 cells. The children in each group were further considered as 'prior to antiretroviral treatment (ART)' and 'on ART'. Oral mucosal examination was done based on presumptive criteria given by Ramos-Gomez for diagnosis of oro-facial lesions commonly associated with HIV infection in children. Data obtained was subjected to statistical analysis. Angular cheilitis and pseudomembranous candidiasis were the frequently seen oral lesions. Children with CD4 cell count ≥500 had significantly fewer oral lesions each. A high percentage of HIV-infected children were affected with oral mucosal lesions. There was a significant association between immune status and frequency of oral lesions.

Orofacial viral infections--an update for clinicians.

Orofacial viral infections may be less common but appear in different clinical forms. Often these infections get initially treated by antibiotics which obviously will have limited or no effect. The authors review the current concepts of orofacial viral infections, causative agents, their classification and clinical manifestations and a basis for treatment. Most viral infections do not require any specific treatment except in patients who are immunosuppressed or immunodeficient. Appropriate diagnosis and timely management of orofacial viral lesions are important irrespective of whether it is localized or a manifestation of a systemic infection.

Treatment of a Crohn's disease–related cutaneous facial lesion with topical tacrolimus

We report a case of an orofacial lesion in Crohn's disease successfully treated with tacrolimus ointment. A 22-year-old woman with Crohn's disease presented with a discharging lesion on the right side of her face. Intraorally, there was a resultant loss of the sulcal depth. She reported a 1-year history of variable right-sided facial swelling for which she had undergone extraoral incision and drainage, resulting in localized paresthesia and nonhealing of the incision site. Following exclusion tests, a treatment of twice-daily extraoral application of tacrolimus 0.1% ointment was commenced. Upon review, the lesion had reduced in size, with minimal discharge. Further improvement over 12months of tacrolimus use resulted in a satisfactory cosmetic result as well as resolution of the intraoral features and reestablishment of the full sulcal depth. This case illustrates the successful use of topical tacrolimus to treat a cutaneous manifestation of Crohn's disease.

How to Choose and Use the CBCT

The emergence of Cone Beam Computed Tomography(CBCT) in the late 1990s represented an innovative advancement in the field of dental and maxillofacial radiology because it greatly reduced the radiation exposure to patients and offered 3D images easily. The 3D information generated by this technique brings the potential of improved diagnosis and treatment planning for a wide range of clinical applications in dentistry. The use of CBCT includes diagnosis and surgical assessment of the orofacial hard tissue lesions, dental implant treatment planning and postoperative evaluation, TMJ assessment, diagnosis of craniofacial fracture, orthodontics, endodontics, and so on. All CBCT examinations should be justified on an individualized needs. The clinical benefits to the patient for each CBCT scan must outweigh the potential risks associated with exposure to ionizing radiation. CBCT scans should be taken with initially obtained medical and dental histories of patients and a close clinical examination. CBCT should be considered as an imaging alternative of other conventional radiography in cases where the anatomical structures of interest may not be seen. The smallest possible field of view(FOV) and the lowest setting of tube current and scan time should be chosen, and the entire images scanned should be interpreted by a qualified expert.

Submental cutaneous sinus tract of mandibular second molar origin

To report a case in which a submental cutaneous sinus tract resulted from apical periodontitis associated with a mandibular second molar. A 53-year-old man presented with a chronic cutaneous sinus tract in the submental region, which had previously been misdiagnosed as a thyroglossal fistula. The origin of the sinus tract was shown by sinus tract angiography to be the left mandibular second molar (tooth 37), which had apical periodontitis. The sinus tract healed after extraction of the tooth and partial excision of the lesion from an extraoral approach. Histological examination confirmed that the tract was lined with granulation tissue and not with epithelial tissue. A submental sinus tract drainage pathway was observed. Prompt dental evaluation, especially of all mandibular teeth, should be considered when assessing cases of submental cutaneous sinus tracts. An odontogenic origin should be part of the differential diagnosis for orofacial skin lesions. Cutaneous sinus tracts of mandibular molar origin are complex and thus a comprehensive examination should be stressed. It is necessary to examine all mandibular teeth in cases of odontogenic submental cutaneous sinus tracts. Sinus tract angiography can be used to identify the sinus tract pathway and to confirm the associated teeth. The treatment of an odontogenic cutaneous sinus tract requires the elimination of the source of infection.

Evaluation of the orofacial lesions in treated leprosy patients

Background:Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases.Aim:To evaluate the incidence of orofacial lesions in treated leprosy patients.Materials and Methods:Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated.Results:On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%).Conclusion:Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae.

Clinic-pathological Study and Comparative Analysis of Orofacial Lesions in a Brazilian Population of Children and Adolescents

Objective: To describe the sample of Maxillofacial Complex (MFC) Lesions observed in a Brazilian service diagnostic reference for such lesions, and comparatively analyse observed data across the national and international literature. Material and Methods: A literature review of survey of MFC Lesions in Children and Adolescentes was performed. The keywords used were “Oral, Pathology” and “Child”, and 18 articles were selected. Then, we surveyed the biopsy archives of the Department of Pathology and Legal Medicine and the Oral Pathology Laboratory of the Federal University of Ceara recorded from 1994 to 2010. The inclusion criterion was patients whose age fell within the range of 0-16 years old. Results: From a total of 4,775 histological results, 499 (10.4%) were selected. Most lesions were diagnosed in female patients, and the prevalence increased with age. Benign lesions represented 90.4% of those reported; some patients had mucocele and inflammatory lesions, and malignant lesions accounted for 1.8% of all lesions reported. These data, compared to the selected articles, showed little similarity between populations at the international level. Conclusion: the evaluated population had significant differences compared to the articles reviewed. The international level of distribution has little influence on this prevalence, which indicates the necessity for performing more local surveys to establish reliable epidemiological profiles.

Orofacial Lesions in Infants Managed by Nasoalveolar Molding Appliances

This retrospective clinical study documented common orofacial lesions in infants with cleft lip and palate (CL/P), who were managed using a nasoalveolar molding appliance (NAMA).

Necrosis of the Intranasal Structures and Soft Palate as a Result of Heroin Snorting: A Case Series

ABSTRACT Background: The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012. Cases: The cases concern 17 males and 7 females (median age 29.5 (range: 24–42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5–10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved. Discussion: The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.

Self-inflicted injury as a potential trigger for carcinoma of lip - a case report

To report a case of an elderly patient with an unstable mental condition, presenting with the carcinoma of lip due to repeated toothpick injury. Self-induced lesions of the face and mouth may be a manifestation of unusual or aggressive oral habits or an emotional disorder. The deliberate creation of orofacial lesions, is an indication of underlying psychiatric disease. Betel quid chewing is the major risk factor for oral cancer. It conditions the oral mucosa towards the development of cancer. Repeated trauma by self mutilation on such a conditioned mucosa can lead to the development of cancer. A male patient aged 85 years reported the complaint of a growth on the left side of the lower lip. Trauma followed by self inflicted injury had predisposed to the formation of cancer. Diagnosis of self inflicted lesions are challenging as the histories of these lesions tend to be vague and misleading. Our knowledge in this particular pathology is limited mainly because of diagnostic difficulties and lack of solid statistical data.

Cystic lymphoid hyperplasia: an orofacial lesion strongly associated with HIV and AIDS

Cystic lymphoid hyperplasia (CLH) frequently affects the parotid gland in human immunodeficiency virus (HIV)-infected patients. This clinicopathological study, comprising 167 cases, aims to define the clinical-pathological parameters of CLH in order to elucidate the aetiopathogenesis. This retrospective study of 167 archival cases of CLH recorded patients' age, race and gender, and the nature, site and symptoms of CLH. A total of 109 cases were reviewed histologically and analyzed for HIV-1 p24 antigen immunopositivity using standard procedures. CLH of the parotid gland showed a male predominance, whereas submandibular gland (P = 0.27) and bilateral parotid involvement favoured females (2:1). CLH occurred at a younger mean age in females than males in the parotid gland (P = 0.0035) and in the submandibular gland (P = 0.0032). Intra-lymph nodal origin was favoured, with 76.1% of cases occurring within entrapped salivary gland remnants. P24 staining revealed ~90% sensitivity in HIV-associated CLH. CLH should be used preferentially to describe parotid enlargement in HIV-infected patients. This study strongly supports the hypothesis that CLH develops following ductal ectasia of entrapped salivary gland inclusions arising within lymph nodes. CLH should be classified as an orofacial lesion associated strongly with HIV and AIDS.

A Community-Based Oral Health Promotion Model for HIV Patients in Nairobi, East District in Kenya: A Study Protocol

General HIV-related orofacial lesions, most commonly oropharyngeal candidiasis, have a typical clinical appearance and can be recognised by members of the community. Although affected patients often experience pain leading to compromised eating and swallowing, barriers such as social stigma and lack of knowledge regarding available services may prevent them from seeking early care. Educating the community about these lesions through community health workers (CHWs) who are democratically elected community members may encourage individuals affected to seek early oral healthcare in the health facilities. A health facility (HF) is a health centre mainly run by clinical officers (CO), i.e. personnel with a 3-year medical training, and nurses. This study aims to evaluate the effect of a CHW training programme on: i) their knowledge and recognition of HIV-related oral-facial lesions at a community level; and ii) referral of affected patients from the community to the HFs.Design and MethodsAll 800 CHWs in 2 administrative divisions of Nairobi East District (test group n=400; control group n=400) will be selected. The test group will receive training. CHWs in both groups will be assessed at 4 time points: −3, 0, +3 and +6 months with reference to the training on: i) their knowledge of HIV-related orofacial lesions (using a written questionnaire); and ii) their performance in referring affected patients to the HFs (using clinical data).Expected ImpactEarly recognition of HIV-related orofacial lesions at a community level will prompt community members to seek early oral care, leading to early HIV testing and counselling regarding failure of antiretroviral therapy, while treatment outcomes are still favourable.

Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre

The aim of this study was to evaluate the relative frequencies, types and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary centre. The records of the Departments of Oral-Dental Surgery and Pathology of a tertiary hospital in Nigeria were reviewed and analyzed for patients with oro-facial lesions during a seven year period (January, 2001 - December, 2007). The main outcome measures were patients' age and sex, histology assessment, tissue type and location. A total of 102 (51.3%) benign lesions, 59 (29.6%) malignant lesions and 38 (19.1%) inflammatory/reactive lesions were seen. The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%) and pleomorphic adenoma (13.7%). The malignant lesions were mainly well differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprised mainly of chronic osteomyelitis (15.8%) and non-specific chronic inflammatory lesions; giant cell granulomas, granulation tissues which constituted 10.5% each. [corrected] There were 104 (52.3%) males and 95 (47.7%) females giving a male: female ratio of 1.1:1. The mean age of the patients was 36.1(SD ± 18.9) years with a range of 1 to 85 years. Most tissue specimens were soft tissues (61.3%), while bone specimen accounted for 15.6% of all specimens analysed. There were 62 (31.2%) mandibular lesions, 24 (12.1%) palatal lesions and 15 (7.5%) parotid lesions, while maxillary antral lesions were the least, constituting only 0.5% of all lesions studied. [corrected]. The range of diagnosed lesions from our study was diverse, though our results do not represent the actual prevalence of orofacial lesions within the general population, but simply reflect the frequency of histologically diagnosed lesions at a health center in North-East Nigeria. This survey has shown that most oro-facial lesions studied were benign neoplasms and that most of these neoplasms were from the mandible.

Pain scores of odontogenic orofacial lesions in a tertiary Hospital in sub Saharan West Africa.

Aim & objective To determine the correlation of three main pain measuring scales used as diagnostic aid to orofacial lesion of odontogenic origin. Methodology A six month cross sectional survey utilizing interviewer administered questionnaire targeted at attendees of Dental outpatient clinic of University College Hospital, Nigeria (UCH), a tertiary hospital. Results Mean age for odontogenic pain was 35.68 ± 16.44; male to female ratio was 1: 1.24. Pain was more severe but statistically insignificant among females (p = 0.85), however, there was significant difference in the mean pain intensity between diagnostic categories of odontogenic lesion (p = 0.00).The commonest odontogenic lesion category was caries related (54.3% of all orofacial and 58.9% of odontogenic lesions respectively). There was positive correlation between the three pain measuring scales (Visual Analogue Scale (VAS),Number of verbs chosen(NWC) M r = 0.838 & r = 0.599 respectively). However the three diagnostic scales failed to distinguish between specific odontogenic lesions when the mean pain scores were very close. Conclusion Pain measuring scales should only be used as aid to diagnosis and not for definitive diagnosis.

Concordance between Clinical and Histopathological Diagnoses at Komfo Anokye Teaching Hospital Oral and Maxillofacial Unit

Background: Accurate diagnosis of orofacial tumours is important as this determines the treatment options as well as the eventual treatment outcome. Agreement between clinical and histopathological diagnosis becomes important in this regard. Aims: The aim was to determine the level of agreement between clinical and histopathology diagnosis of orofacial lesions. Method: This is a retrospective study of all histopathology reports seen at KATH maxillofacial unit. Thedata collected included, clinical diagnosis and histological diagnosis. Results: A total of 567 histopathology reports were evaluated. The percentage of agreement between clinical and histopathological diagnosis was 62.8%. Conclusion: The agreement between clinical and histopathological diagnosis was high. However clinicians cannot rely on only the clinical diagnosis in managing patients.

Orofacial Cysts at Komfo Anokye Teaching Hospital, Ghana

Background: Information about orofacial cysts from African populations is scarce and there are only a few studies available regarding the prevalence of these lesions in the West African sub-region. The purpose of the present study is to determine the distribution and prevalence of all histologically diagnosed orofacial cysts in Kumasi, Ghana. Aim: To determine prevalence, sex, age and anatomic distribution of orofacial cyst seen at the oral and maxillofacial unit in Komfo Anokye Teaching hospital (KATH). Method: This is a retrospective study, which examined histologically diagnosed lesions including orofacial cysts. The study duration was from 1999 to 2010 September inclusive. Results: There were 37 odontogenic cysts constuting 6.5%, of all orofacial lesions. There were 18 non-odontogenic cysts i.e. 3.1% of all lesions diagnosed during the study period. The odontogenic cysts comprised 19 (51.4%) developmental cysts and 18 (48.6%) inflammatory cysts. Male-to-female ratio for the orofacial cysts was 1:1 and the mean age was 36.7 years. Conclusion: There is low prevalence of the odontogenic cysts, which is consistent with findings from other African studies. Although radicular cysts accounted for the majority of orofacial cysts in this study, the prevalence of radicular cysts is low compared to reports from developed countries.

Oro-facial tumours and tumour-like lesions in Greek children and adolescents: An 11-year retrospective study

ObjectiveTo determine the epidemiology, histological diagnosis and treatment outcome of oro-facial tumours and tumour-like lesions in Greek children and adolescents. Material and methodsThe medical records of patients with oro-facial lesions who presented at the Department of Oral and Maxillofacial Surgery at “A. & P. Kyriakou” Children's Hospital from 2000 to 2010 were reviewed. Data was analyzed in relation to age, gender, location, histology, treatment choice and outcome. ResultsTwo hundred and eleven oro-facial lesions were identified. Age ranged from 14 days to 15 years (mean 8 years); the male-to-female ratio was 1.09: 1; 90.05% of the lesions were benign and 9.95% malignant. Vascular anomalies were the most common benign lesion (22.1%) and rhabdomyosarcoma was the most prevalent malignancy (28.57%). One hundred and ten lesions (52.1%) involved soft tissue, most commonly the tongue and 96 cases (45.5%), involved hard tissue, most frequently the mandible; 5 lesions (2.4%) involved both hard and soft tissue. Surgery was performed under general anaesthesia in 198 cases (93.84%). Some malignant lesions were treated with chemotherapy and/or radiotherapy. ConclusionsOro-facial tumours and tumour-like lesions are not uncommon in the Greek paediatric population; although most frequently benign, these may cause considerable morbidity. As such early diagnosis and treatment are imperative.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients. Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'. Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness. Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.