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Clinical Q+A in Oral Medicine
Answer 1
SELLING OR BUYING A
THE CORRECT DIAGNOSES IS: Orofacial granulomatosis Orofacial granulomatosis (OFG) is a rare chronic inflammatory and granulomatous condition. OFG may be idiopathic, or may present in conjunction with other granulomatous diseases including Crohn’s disease or sarcoidosis. OFG is most common in young adults, but may present at any age, and there is no sex predilection. Clinically, OFG presents as a recurrent, usually painless soft orofacial swelling. Most commonly, the lip is affected however not always, as was the case with this patient. Eventually the swelling becomes persistent and indurated and often cosmetically undesirable. Other orofacial manifestations include ulceration, gingival involvement, angular chelitis and vertical fissures in established lesions. Biopsy of an appropriate location and depth will demonstrate non-necrotising granulomatous inflammation on haematoxylin & eosin staining, and the pathologist must exclude infectious causes (e.g mycobacterial or fungal infections) or foreign-body reactions. Systemic granulomatous diseases must be excluded by investigations such as blood tests and radiology as appropriate. As between 10 - 40% of patients with OFG have associated Crohn’s Disease, referral to a gastroenterologist is prudent even in the absence of gastrointestinal symptoms. The management of OFG is often difficult, with variable and unpredictable clinical outcomes. Treatment may include dietary restrictions, corticosteroid therapy or other immunomodulatory drugs. With prompt diagnosis and treatment, persistent orofacial swelling may be prevented. Follow-up is imperative, as recurrence is common. References: jacinta@omfp.com.au or alissa@omfp.com.au
