Orofacial Granulomatosis: A Clinicopathologic Correlation

Abstract

Orofacial granulomatosis is an uncommon disorder, but has been increasingly recognized in the past decade. It causes significant morbidity in the patient including oral ulcerations, enlargement of soft tissues which are often persistent and painful. This necessitates early medical intervention. We report one such case of a female patient who presented with a persistent upper lip enlargement. She had visited multiple general dental practitioners and general physicians but was undiagnosed. Ultrasonography proved an adjunctive tool in diagnosis. She was treated with a combination of topical and intra-lesional steroids. A 1-year follow-up did not show any evidence of recurrence.

Treatment of Orofacial Granulomatosis—9-Month Follow-up: A Case Report

“…Although several hypotheses, such as infection, genetic predisposition, and allergy, have been proposed, the precise cause of orofacial granulomatosis is still unknown. 7 As in our case, no correlation was found between OFG and systemic conditions such Crohn's disease or sarcoidosis in a study by Marcoval et al 8 There is no standard protocol for treating this disease; however, several researchers recommend using steroids as the first line of treatment, particularly during the acute stage. 9 If the underlying cause of OFG can be treated, not only will symptoms disappear more quickly, but steroid treatment can be used more sparingly and for a shorter period.…”

Orofacial granulomatosis and diet therapy: a review of the literature and two clinical cases

“…Histopathology should always reveal a chronic inflammatory infiltrate. 17 Although it is considered a granulomatous entity, less than half of patients have noncaseating granulomas, usually small and poorly defined, with lymphocytes surrounding epithelioid histiocytes 1 , 17 Multinucleated giant cells can also be seen, with edema of the corium, lymphangiectasia and perivascular lymphocytic infiltration. 11 …”

“… 7 Clinical outcome is unpredictable, however, persistent orofacial swelling can be prevented when OFG is diagnosed and treated early on. 17 , 19 Neurologic signs usually appear at an initial stage and are unlikely to develop afterwards. 1 Long-term follow-up is particularly important in patients under 16-years-old, since they seem to have a higher risk of developing CD later in life (up to 40%).…”

A rare case of primary orofacial granulomatosis of gingiva during pregnancy

“…Two case reports presented by Adel et al . suggested similar difficulties in diagnosis,[ 14 ] but one of the cases had symptoms of Crohn's disease. [ 15 ] A case report by Rana et al .…”