Orofacial Granulomatosis
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Lumps and Swellings
Clinical Oral medicine for the general practitioner: lumps and swellings Crispian Scully 1 his series of five papers summarises some of the most important oral medicine problems likely to be Tencountered by practitioners. Some are common, others rare. The practitioner cannot be expected to diagnose all, but has been trained to recognise oral health and disease, and should be competent to recognise normal variants, and common orofacial disorders. In any case of doubt, the practitioner is advised to seek a second opinion from a colleague. The series is not intended to be comprehensive in coverage either of the conditions encountered, or all aspects of Figure 1: Torus mandibularis. diagnosis or treatment: further details are available in standard texts, in the further reading section, or from the internet. The present article discusses aspects of lumps through fear, perhaps after hearing of someone with and swellings. ‘mouth cancer’. Thus some individuals discover and worry about normal anatomical features such as tori, the parotid Lumps and swellings papilla, foliate papillae on the tongue, or the pterygoid Lumps and swellings in the mouth are common, but of hamulus. The tongue often detects even a very small diverse aetiologies (Table 1), and some represent swelling, or the patient may first notice it because it is sore malignant neoplasms. Therefore, this article will discuss (Figure 1). In contrast, many oral cancers are diagnosed far lumps and swellings in general terms, but later focus on too late, often after being present several months, usually the particular problems of oral cancer and of orofacial because the patient ignores the swelling. -
The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid
YM Son, et al Ann Dermatol Vol. 23, Suppl. 3, 2011 http://dx.doi.org/10.5021/ad.2011.23.S3.S310 CASE REPORT The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid Young-Min Son, M.D., Hong-Kyu Kang, M.D., Jeong-Hwan Yun, M.D., Joo-Young Roh, M.D., Jong-Rok Lee, M.D. Department of Dermatology, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea Pemphigus vegetans is a rare variant of pemphigus vulgaris INTRODUCTION and is characterized by vegetating lesions in the inguinal folds and mouth and by the presence of autoantibodies Pemphigus diseases are a group of autoimmune disorders against desmoglein 3. Two clinical subtypes of pemphigus that have certain common features, and these diseases are vegetans exist, which are initially characterized by flaccid considered to be potentially fatal1,2. Pemphigus vegetans bullae and erosions (the Neumann subtype) or pustules (the is a variant of pemphigus vulgaris and is the rarest form of Hallopeau subtype). Both subtypes subsequently develop pemphigus; Pemphigus vegetans comprises less than 1∼ into hyperpigmented vegetative plaques with pustules and 2% of all pemphigus cases1,3,4. This variant is charac- hypertrophic granulation tissue at the periphery of the terized by flaccid bullae or pustules that erode to form hy- lesions. Oral administration of corticosteroids alone does not pertrophic papillated plaques that predominantly involve always induce disease remission in patients with pemphigus the intertriginous areas, the scalp, and the face; in 60∼ vegetans. We report here on a 63-year-old woman with 80% of all cases, the oral mucosa are also affected5,6. -
2017 Oregon Dental Conference® Course Handout
2017 Oregon Dental Conference® Course Handout Nasser Said-Al-Naief, DDS, MS Course 8125: “The Mouth as The Body’s Mirror: Oral, Maxillofacial, and Head and Neck Manifestations of Systemic Disease” Thursday, April 6 2 pm - 3:30 pm 2/28/2017 The Mouth as The Body’s Mirror Oral Maxillofacial and Head and Neck Manifestation of Ulcerative Conditions of Allergic & Immunological Systemic Disease the Oro-Maxillofacial Diseases Region Nasser Said-Al-Naief, DDS, MS Professor & Chair, Oral Pathology and Radiology Director, OMFP Laboratory Oral manifestations of Office 503-494-8904// Direct: 503-494-0041 systemic diseases Oral Manifestations of Fax: 503-494-8905 Dermatological Diseases Cell: 1-205-215-5699 Common Oral [email protected] Conditions [email protected] OHSU School of Dentistry OHSU School of Medicine 2730 SW Moody Ave, CLSB 5N008 Portland, Oregon 97201 Recurrent aphthous stomatitis (RAS) Recurrent aphthous stomatitis (RAS) • Aphthous" comes from the Greek word "aphtha”- • Recurrence of one or more painful oral ulcers, in periods of days months. = ulcer • Usually begins in childhood or adolescence, • The most common oral mucosal disease in North • May decrease in frequency and severity by age America. (30+). • Affect 5% to 66% of the North American • Ulcers are confined to the lining (non-keratinized) population. mucosa: • * 60% of those affected are members of the • Buccal/labial mucosa, lateral/ventral tongue/floor of professional class. the mouth, soft palate/oropharyngeal mucosa • Etiopathogenesis: 1 2/28/2017 Etiology of RAU Recurrent Aphthous Stomatitis (RAS): Types: Minor; small size, shallow, regular, preceeded by prodrome, heal in 7-10 days Bacteria ( S. -
Orofacial Granulomatosis Presenting As Gingival Enlargement – Report of Three Cases
Open Access Journal of Dentistry & Oral Disorders Case Report Orofacial Granulomatosis Presenting as Gingival Enlargement – Report of Three Cases Savithri V*, Janardhanan M, Suresh R and Aravind T Abstract Department of Oral Pathology & Microbiology, Amrita Orofacial Granulomatosis (OFG) is an uncommon disease characterized School of Dentistry, Amrita VishwaVidyapeetham, Amrita by non-caseating granulomatous inflammation in the oral and maxillofacial University, India region. They present clinically as labial enlargement, perioral and/or mucosal *Corresponding author: Vindhya Savithri, swelling, angular cheilitis, mucosal tags, vertical fissures of lips, lingua plicata, Department of Oral Pathology & Microbiology, Amrita oral ulcerations and gingival enlargement. The term OFG was introduced by School of Dentistry, Amrita VishwaVidyapeetham, Amrita Wiesenfeld in 1985. The diagnosis of OFG is done by the clinical presentation University, India and histological picture and this may be further complicated by the fact that OFG may be the oral manifestation of a systemic condition, such as Crohn’s Received: October 16, 2017; Accepted: November 27, disease, sarcoidosis, or, more rarely, Wegener’s granulomatosis. In addition, 2017; Published: December 04, 2017 several conditions, including tuberculosis, leprosy, systemic fungal infections, and foreign body reactions may show granulomatous inflammation on histologic examination. They have to be excluded out by appropriate investigations. They have to be excluded out by appropriate investigations. -
Oral Pathology Unmasking Gastrointestinal Disease
Journal of Dental Health Oral Disorders & Therapy Review Article Open Access Oral pathology unmasking gastrointestinal disease Abstract Volume 5 Issue 5 - 2016 Different ggastrointestinal disorders, such as Gastroesophageal Reflux Disease (GERD), Celiac Disease (CD) and Crohn’s disease, may manifest with alterations of the oral cavity Fumagalli LA, Gatti H, Armano C, Caruggi S, but are often under and misdiagnosed both by physicians and dentists. GERD can cause Salvatore S dental erosions, which are the main oral manifestation of this disease, or other multiple Department of Pediatric, Università dell’Insubria, Italy affections involving both hard and soft tissues such as burning mouth, aphtous oral ulcers, Correspondence: Silvia Salvatore, Pediatric Department of erythema of soft palate and uvula, stomatitis, epithelial atrophy, increased fibroblast number Pediatric, Università dell’Insubria, Via F. Del Ponte 19, 21100 in chorion, xerostomia and drooling. CD may be responsible of recurrent aphthous stomatitis Varese, Italy, Tel 0039 0332 299247, Fax 0039 0332 235904, (RAS), dental enamel defects, delayed eruption of teeth, atrophic glossitis and angular Email chelitis. Crohn’s disease can occur with several oral manifestations like indurated tag-like lesions, clobbestoning, mucogingivitis or, less specifically, with RAS, angular cheilitis, Received: October 30, 2016 | Published: December 12, 2016 reduced salivation, halitosis, dental caries and periodontal involvement, candidiasis, odynophagia, minor salivary gland enlargement, perioral -
Orofacial Granulomatosis: a Review
DOI Number: 10.5958/0974-1283.2019.00181.6 Orofacial Granulomatosis: A Review Saloni Banga1, M K Sunil2, Hina Padaliya1 1Intern, 2Professor and Head of Department, Department of Oral Medicine & Radiology, Teerthanker Mahaveer Dental College & Research Center Moradabad Abstract Orofacial Granulomatosis (OFG) is an uncommon clinicopathological entity characterized clinically by the presence of persistent enlargement of the soft tissues of the oral and maxillofacial region and histologically by non-caseating and non-necrotizing granulomatous inflammation. The term ‘orofacial granulomatosis’ has been introduced to denote the group of various disorders, including Melkersson-Rosenthal syndrome and granulomatous cheilitis and has been noted to be associated with Crohn’s disease, Sarcoidosis and infectious diseases such as Tuberculosis. Although, various etiological agents such as dental materials, food additives and microbial agents have been recommended in the disease process. Treatment of orofacial granulomatosis is by corticosteroids but it’s not so efficient. It is more important to identify the pathogen first to specify the appropriate treatment line. Keywords— orofacial granulomatosis, Melkersson Rosenthal syndrome, crohn,s disease. Introduction Definition and its associated to other granulomatous disorders Orofacial granulomatosis term was introduced by Wiesenfeld in 19851. Granulomatosis is any condition Orofacial granulomatosis is an uncommon disorder1 characterized by the formation of multiple nodules or but is increasingly recognized. Orofacial granulomatosis granulomas in soft tissues. It encompasses Melkersson (as defined by Wiesenfeld in 1985) is the specific Rosenthal syndrome and Cheilitis granulomatosa1. histological finding of granulomas in mucosal or skin The true prevalence of this disease is unknown but is biopsies taken from the mouth or face in the absence suggested to be 0.8% (Mahler and Kiesewetter, 1996)3. -
Cinnamon Products As a Possible Etiologic Factor in Orofacial Granulomatosis
Med Oral Patol Oral Cir Bucal. 2007 Oct 1;12(6):E440-4. Orofacial granulomatosis caused by cinnamon flavoring Med Oral Patol Oral Cir Bucal 2007;12:E440-4. Orofacial granulomatosis caused by cinnamon flavoring Cinnamon products as a possible etiologic factor in orofacial granulomatosis Hiroyasu Endo 1, Terry D. Rees 2 (1) Assistant Professor, Department of Periodontology, Nihon University, School of Dentistry at Matsudo, Japan (2) Professor and Former Chairman, Director of Stomatology, Department of Periodontics, Baylor College of Dentistry, Texas A&M University Health Science Center, Dallas, TX, USA Correspondence: Dr. Hiroyasu Endo Dept. of Periodontology Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho Nishi, Matsudo Chiba, Japan. 271-8587 E-mail: [email protected] Endo H, Rees TD. Cinnamon products as a possible etiologic factor Received: 17-09-2006 Accepted: 25-03-2007 in orofacial granulomatosis. Med Oral Patol Oral Cir Bucal. 2007 Oct 1;12(6):E440-4. © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 Indexed in: -Index Medicus / MEDLINE / PubMed -EMBASE, Excerpta Medica -SCOPUS -Indice Médico Español -IBECS ABStract Objectives: It has been reported that clinical changes due to hypersensitivity reactions to various foods, preservatives, and oral hygiene products may be consistent with the characteristic signs of orofacial granulomatosis (OFG). The ob- jective of this study was to examine 37 well-documented cases of cinnamon-induced contact stomatitis for clinical and histological features consistent with a diagnosis of OFG. Study design: We reviewed the records of the 37 cases to screen them for the clinical and histopathologic features of OFG. -
Oral and Maxillo-Facial Manifestations of Systemic Diseases: an Overview
medicina Review Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview Saverio Capodiferro *,† , Luisa Limongelli *,† and Gianfranco Favia Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (S.C.); [email protected] (L.L.) † These authors contributed equally to the paper. Abstract: Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease. Keywords: oral cavity; head and neck; systemic disease; oral signs of systemic diseases; early diagnosis; differential diagnosis Citation: Capodiferro, S.; Limongelli, 1. Introduction L.; Favia, G. Oral and Maxillo-Facial Oral and maxillo-facial manifestations of systemic diseases represent an extensive and Manifestations of Systemic Diseases: fascinating study, which is mainly based on the knowledge that many signs and symptoms An Overview. Medicina 2021, 57, 271. as numerous systemic disorders may first present as or may be identified by head and https://doi.org/10.3390/ neck tissue changes. -
Orofacial Granulomatosis
Division of Oral Medicine and Dentistry Orofacial Granulomatosis What is orofacial granulomatosis? How do we know it is OFG? Orofacial granulomatosis (OFG) is an uncommon condition of A dental specialist can usually diagnose OFG based on a good the mouth that causes lip swelling, and sometimes swelling of history, a thorough clinical examination, and a biopsy to the face, inner cheeks, and the gums. Tis swelling may come confrm the diagnosis. You may be sent to a specialist who can and go at frst, but over time, becomes persistent if not treated. perform a patch test of your skin to see if you are sensitive to Patients will typically describe their symptoms as swelling and foods, food preservatives or other substances. Te results of the tightness and sometimes, soreness. In addition, there may be patch test may help your doctor to suggest the best treatment some folding of the inside of the mouth giving it a “cobblestone” option for your disease. Patients may be referred to appearance. OFG may be part of Melkersson-Rosenthal a gastrointestinal specialist if a diagnosis of Crohn disease syndrome, a rare condition that consists of OFG, fssured is suspected. tongue (tongue with deep grooves) and paralysis of the face. How do we treat OFG? What causes OFG? A food diary can be helpful if food sensitivity is suspected or It is likely that patients with OFG are reacting to something confrmed by patch testing, and completely avoiding such foods although this is not always easy to identify. Some common may substantially reduce swelling. Te doctor who patch tested triggers are foods and food preservatives such as chocolate, you will provide you with a list of substances to avoid if you cinnamon favorings, and preservatives such as benzoates and patch tested positive to them. -
Oral Leukoplakia Associated with Amalgam Restorations Zeynep B
445 Journal of Oral Science, Vol. 58, No. 3, 445-448, 2016 Case Report Oral leukoplakia associated with amalgam restorations Zeynep B. Gönen1,2), Canay Yılmaz Asan1), Osman Etöz1), and Alper Alkan1) 1)Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey 2)Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey (Received January 27, 2016; Accepted March 18, 2016) Abstract: The World Health Organization has The etiological factors most commonly associated defined oral leukoplakia (OL) as “a white patch or with OL have been smoking, alcohol abuse, candidiasis, plaque of the oral mucosa that cannot be character- HPV infection, iron deficiency, and low serum levels of ized clinically or pathologically as any other disease”. vitamin A and beta-carotene (3). Zinsser-Cole Engman A 21-year-old male with OL presented with a bilateral syndrome, a genodermatosis commonly known as burning sensation in the buccal mucosa. The patient dyskeratosis congenita, includes oral manifestations such had amalgam restorations, and an epicutaneous as OL. Many different non-surgical and surgical modali- patch test indicated a positive response to amalgam. ties such as conventional surgery, electrocauterization, The amalgam restorations were therefore removed laser ablation, cryosurgery, and medications such as and the cavities were refilled with a composite resin vitamin A, vitamin B, and bleomycin, have been reported restorative material. During 5 years of follow-up, for treatment of OL (4). there was no recurrence of the oral lesions. This case Dental amalgams remain the most commonly used illustrates that amalgam fillings may cause OL lesions. posterior restorative material in dental practice. -
Oral Pathology Final Exam Review Table Tuanh Le & Enoch Ng, DDS
Oral Pathology Final Exam Review Table TuAnh Le & Enoch Ng, DDS 2014 Bump under tongue: cementoblastoma (50% 1st molar) Ranula (remove lesion and feeding gland) dermoid cyst (neoplasm from 3 germ layers) (surgical removal) cystic teratoma, cyst of blandin nuhn (surgical removal down to muscle, recurrence likely) Multilocular radiolucency: mucoepidermoid carcinoma cherubism ameloblastoma Bump anterior of palate: KOT minor salivary gland tumor odontogenic myxoma nasopalatine duct cyst (surgical removal, rare recurrence) torus palatinus Mixed radiolucencies: 4 P’s (excise for biopsy; curette vigorously!) calcifying odontogenic (Gorlin) cyst o Pyogenic granuloma (vascular; granulation tissue) periapical cemento-osseous dysplasia (nothing) o Peripheral giant cell granuloma (purple-blue lesions) florid cemento-osseous dysplasia (nothing) o Peripheral ossifying fibroma (bone, cartilage/ ossifying material) focal cemento-osseous dysplasia (biopsy then do nothing) o Peripheral fibroma (fibrous ct) Kertocystic Odontogenic Tumor (KOT): unique histology of cyst lining! (see histo notes below); 3 important things: (1) high Multiple bumps on skin: recurrence rate (2) highly aggressive (3) related to Gorlin syndrome Nevoid basal cell carcinoma (Gorlin syndrome) Hyperparathyroidism: excess PTH found via lab test Neurofibromatosis (see notes below) (refer to derm MD, tell family members) mucoepidermoid carcinoma (mixture of mucus-producing and squamous epidermoid cells; most common minor salivary Nevus gland tumor) (get it out!) -
A Rare Case of Orofacial Granulomatosis
A Rare Case of Orofacial Granulomatosis Dennis Keselman BA, David Swender D.O., Leah Chernin D.O., Robert Hostoffer D.O. and Haig Tcheurekdjian M.D. University Hospitals Richmond Medical Center Allergy/Immunology Fellowship, Cleveland, OH ABSTRACT CASE REPORT RESULTS SUMMARY DISCUSSION Introduction: Orofacial Granulomatosis(OFG) is a rarely occurring disease with greater propensity for Our patient is a 49y/o African American female with history of hypertension, DMII, glaucoma and asthma presented OFG is a rare but serious condition and must be a differential diagnosis in all patients presenting with chronic labial females which presents with swelling of the maxillofacial and oral tissue worsening overtime. It is often with paraoral and inner oral swelling over the past 10 years with recent worsening over the past 2-3 years. The patient • C1 esterase inhibitor and C4 were in normal limits to rule out possible hereditary angioedema. swelling. Do to the rarity of the condition as well as the sparse data available it may be overlooked by many considered as part of a spectrum of diseases including the more severe process, Chellitis Granulomatosa smokes half a pack of cigarettes daily. The swelling initially began with recurrent episodes which would last 1-2 days physicians (Johani, Moles, Hodgson, Porter, & Fedele, 2009). In our patient the definitive diagnosis took 10 years (CG) which may be a sign of Melkersson-Rosenthal Syndrome (MRS) which includes facial paralysis along and then resolve spontaneously. However over time the disease has evolved to the point of where her lip is always • Patient had an instance of elevated Anti-SM antibodies in 2006 with no other markers of autoimmune and in many a delay such as this may lead to debilitating problems with airway, eating or communication.