Leprosy Specific Orofacial Aspects

Abstract

Leprosy is a chronic infection caused by Mycobacterium leprae, GHA. Hansen first identified the organism in 1873, so called Hansen disease. Mycobacterium leprae is a bacillus that presents a peculiar tropism for the skin and peripheral nerves. The upper airway has a great importance as a route of M. Leprae infection. The clinical spectrum of leprosy ranges from the tuberculoid form (TT) to the disseminative and progressive lepromatous form (LL). Cell-mediated immunity is considered to be the crucial defence against the disease and the magnitude of this immunity defines the extent of the disease. Facial lesions in leprosy can occur in all form of the disease and also in lepra reaction, oral lesions are rare but, when present, occur in the lepromatous form.

Leprosy of the hard palate: A rare case report

“…The Ridley-Jopling classification combines clinical, histopathological, and immunological criteria to identify five leprosy forms: tuberculoid (TT), borderline tuberculoid, mid-borderline (BB), BL, and Lepromatous (LL). [ 1 2 14 ]…”

“…Also according to the Indian classification, leprosy is divided into tuberculoid, borderline, lepromatous, indeterminate, and neurotic forms. [ 14 ]…”

“…The presence of two out of three cardinal features are considered to be diagnostic, and these include decreased or loss of sensation in skin lesions or the peripheral nerve involved, enlargement of the peripheral nerve, and presence of acid-fast bacilli in smears. [ 14 ] The method of choice, as propagated by the WHO, is the slit-skin smear. [ 3 ] Various assays have been developed for a demonstration of M leprae – specific DNA and ribosomal RNA sequences in various specimens such as nasal smears, skin, and blood.…”

The oral cavity in leprosy: what clinicians need to know

“…Facial manifestations in leprosy are similar to lesions in other parts of skin, and some of these changes can result in specific deformities for this site (Ghosh et al , ; Naik et al , ). Oral mucosal involvement in leprosy may result from hematogenous or lymphatic dissemination of M. leprae , or be secondary to nasal lesions (de Abreu et al , ; Motta et al , ).…”

“…Facial lesions can occur in any leprosy form and follow the spectrum of clinical manifestations, varying from localized, well‐defined, hypopigmented macules or plaques to multiple nodules coalescing in plaques on the forehead, ears, nose, and lips (Pavithran, ; Naik et al , ; Salgado and Barreto, ). In advanced stages, patients usually present loss of eyebrow hair and eyelashes, diffuse thickening of the facial skin, and deepening of natural facial lines characterizing the ‘leonine facies’ (Ghosh et al , ; Salgado and Barreto, ) (Figure a–c).…”