Management of orofacial granulomatosis: a case report

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.

Primary orofacial granulomatous involvement of lip and gingiva only: A diagnostic challenge

“…Moreover, the synthetic characteristics of this molecule induce a metabolic effect and result in less sodium retention than that of hydrocortisone. [ 7 ] Systemic corticosteroid administration using prednisone is also effective but is not used because of frequent relapses upon discontinuation and other side effects associated with long-term use of the systemic drug.…”

“…The use of monoclonal antibodies and tumor necrosis factor-α inhibitors (thalidomide, infliximab, and adalimumab) is the second line of treatment and is effective in some cases refractory to topical and systemic anti-inflammatory treatments. [ 7 ]…”

Rares Clinical Entity - Idiopathic Orofacial Granulomatosis

“…Many treatment modalities executed for Orofacial granulomatosis are intra-lesional steroid injection, topical or systemic steroids, azathioprine, clofazimine, Ofazimine, methotrexate, metronidazole, minocycline, hydroxychloroquine, low-dose thalidomide and cyclosporine. Surgical therapy may be provided if needed 13, 14, 15 . The most ����� drug therapy in reducing the facial swelling and recurrences is corticosteroid therapy.…”