Oro-facial aspects of leprosy: Report of two cases with literature review

Abstract

Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, respiratory system and the eyes. Leprosy induces various types of clinical presentation affecting the patient´s immune response. Cellmediated immunity is considered to be the crucial defence against the disease and the magnitude of this immunity defines the extent of the disease. The article presents two case reports of manifestations of leprosy in the oro-facial region, with a brief review of various other important oro-facial manifestations of leprosy. The first report deals with granulomatous nodules in the palate while the second report presents bilateral facial palsy in leprosy patients. Both the reports gain importance due to rare oral manifestation in a borderline leprosy patient in the first case, while the second case presents a rare bilateral Bell´s sign. The role of the dental profession and especially the Oral Medicine specialist is of great importance in early diagnosis of oral lesions.

Leprosy and its dental management guidelines

“…Although relatively uncommon, for dentists, cranial nerve involvement is an important feature of leprosy. This study found the trigeminal nerve and the facial nerve were the most commonly affected nerves, which is similar to previous studies and reports 15,16 . This may have specific implications for the teeth.…”

Oral Lesion in Leprosy: Borderline Tuberculoid Diagnosis Based on Detection of Mycobacterium leprae DNA by qPCR

“…A case of oral lesion associated with leprosy has been described elsewhere in a borderline tuberculoid Ada Derm Venereol 91 (BT)-MB patient with papulo-nodular lesions in the centre of the hard palate, by histopathological findings (5). However, oral mucosa lesions are not normally found in PB patients (5,6), and when they are present, manifestations have been described exclusively in the tuberculoid and borderline forms in the reactional state, with few scientific studies and poorly characterized descriptions (7).…”

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).…”

“…Although several reports on oral lesions in leprosy have been found, some of them described non‐specific lesions, including erythematous candidiasis, fissured tongue, and inflammatory fibrous hyperplasia (Morgado de Abreu et al , ), and few confirmed specific lesions through biopsy and histopathological analysis (Table ). Leprosy‐specific oral lesions are uncommon and, when present, occur in patients with advanced stages of the LL form, and usually involve the nasal mucosa, skin, and peripheral nerves (Ochandiano et al , ; Motta et al , ; Ghosh et al , ; Pallagatti et al , ; Taheri et al , ). However, oral lesions in the TT form were also reported in one study with no histological confirmation (Taheri et al , ).…”