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Orofacial granulomatosis affecting lip and gingiva in a 15-year-old patient: A rare case report.

Bansal M, Singh N, Patne S, Singh SK - Contemp Clin Dent (2015)

Bottom Line: Histologically, OFG is characterized by noncaseating granulomatous inflammation.Thus, dentists may act as a first person to diagnose the lesion and play an important role in the multidisciplinary treatment of granulomatous disorders.Here, we present a case of OFG affecting lips and gingiva in a 15-year-old patient without any identifiable systemic or local causes.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

ABSTRACT
Orofacial granulomatosis (OFG) is a rare disorder affecting the orofacial region, and clinically characterized by diffuse, nontender, soft to firm, painless swelling restricted to one or both lips and intraoral sites such as tongue, gingiva and buccal mucosa. Histologically, OFG is characterized by noncaseating granulomatous inflammation. The early diagnosis of OFG is essential for the better prognosis of the lesion. Delay in diagnosis of OFG results into formation of indurated and permanent swelling of the lip that not only compromises esthetic appearance but also causes impairment in function such as speaking and eating. Early diagnosis of OFG is challenging to the health care professionals due to clinical and histological resemblance to other chronic granulomatous disorders. Thus, dentists may act as a first person to diagnose the lesion and play an important role in the multidisciplinary treatment of granulomatous disorders. Here, we present a case of OFG affecting lips and gingiva in a 15-year-old patient without any identifiable systemic or local causes.

No MeSH data available.


Related in: MedlinePlus

Stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in underlying fibrocollagenous stroma (H and E, ×40)
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Figure 4: Stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in underlying fibrocollagenous stroma (H and E, ×40)

Mentions: After the establishment of the diagnosis, intra-lesional injection in the upper and lower lip was planned. Upper and lower lip was anesthetized by infraorbital and mental nerve block to reduce the pain and discomfort arised after the intra-lesional injection. Intra-lesional injection of 3–10 ml of triamcinolone (10 mg/ml) was injected weekly into each lateral edge of the lower and upper lip up to 3 months. Gingival enlargement was initially treated by doing phase I therapy including scaling and root planing to remove the local deposits. After 1-month of phase I therapy, the gingival tissue was become more firm due to the reduction of edematous component of the enlargement. Thereafter, gingivectomy and gingivoplasty were done in the anterior region of maxilla and mandible under local anesthesia, and the periodontal dressing was placed for 1-week followed by another 1-week. After 3 months, the patient showed good response and is in regular follow-up from 6 months without any recurrence yet [Figure 3]. The patient was happy with the results of the treatment. Excised gingival tissue was sent for histopathologic examination. H and E staining at ×40 showed the presence of stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in the underlying fibrocollagenous stroma [Figure 4]. H and E staining at ×400 showed chronic granulomatous inflammation composed of epithelioid histiocytes admixed with lymphocytes [Figure 5].


Orofacial granulomatosis affecting lip and gingiva in a 15-year-old patient: A rare case report.

Bansal M, Singh N, Patne S, Singh SK - Contemp Clin Dent (2015)

Stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in underlying fibrocollagenous stroma (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374329&req=5

Figure 4: Stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in underlying fibrocollagenous stroma (H and E, ×40)
Mentions: After the establishment of the diagnosis, intra-lesional injection in the upper and lower lip was planned. Upper and lower lip was anesthetized by infraorbital and mental nerve block to reduce the pain and discomfort arised after the intra-lesional injection. Intra-lesional injection of 3–10 ml of triamcinolone (10 mg/ml) was injected weekly into each lateral edge of the lower and upper lip up to 3 months. Gingival enlargement was initially treated by doing phase I therapy including scaling and root planing to remove the local deposits. After 1-month of phase I therapy, the gingival tissue was become more firm due to the reduction of edematous component of the enlargement. Thereafter, gingivectomy and gingivoplasty were done in the anterior region of maxilla and mandible under local anesthesia, and the periodontal dressing was placed for 1-week followed by another 1-week. After 3 months, the patient showed good response and is in regular follow-up from 6 months without any recurrence yet [Figure 3]. The patient was happy with the results of the treatment. Excised gingival tissue was sent for histopathologic examination. H and E staining at ×40 showed the presence of stratified squamous epithelial lining with variable acanthosis and scattered chronic granulomatous inflammation in the underlying fibrocollagenous stroma [Figure 4]. H and E staining at ×400 showed chronic granulomatous inflammation composed of epithelioid histiocytes admixed with lymphocytes [Figure 5].

Bottom Line: Histologically, OFG is characterized by noncaseating granulomatous inflammation.Thus, dentists may act as a first person to diagnose the lesion and play an important role in the multidisciplinary treatment of granulomatous disorders.Here, we present a case of OFG affecting lips and gingiva in a 15-year-old patient without any identifiable systemic or local causes.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

ABSTRACT
Orofacial granulomatosis (OFG) is a rare disorder affecting the orofacial region, and clinically characterized by diffuse, nontender, soft to firm, painless swelling restricted to one or both lips and intraoral sites such as tongue, gingiva and buccal mucosa. Histologically, OFG is characterized by noncaseating granulomatous inflammation. The early diagnosis of OFG is essential for the better prognosis of the lesion. Delay in diagnosis of OFG results into formation of indurated and permanent swelling of the lip that not only compromises esthetic appearance but also causes impairment in function such as speaking and eating. Early diagnosis of OFG is challenging to the health care professionals due to clinical and histological resemblance to other chronic granulomatous disorders. Thus, dentists may act as a first person to diagnose the lesion and play an important role in the multidisciplinary treatment of granulomatous disorders. Here, we present a case of OFG affecting lips and gingiva in a 15-year-old patient without any identifiable systemic or local causes.

No MeSH data available.


Related in: MedlinePlus