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Ha DH, Kim HS, Lee JK. Intralymphatic histiocytosis of the upper eyelid in a patient of Korean descent: A case report. Medicine (Baltimore) 2023; 102:e36035. [PMID: 37960726 PMCID: PMC10637409 DOI: 10.1097/md.0000000000036035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
RATIONALE Diagnosing intralymphatic histiocytosis can be challenging due to its rarity. We present a case of intralymphatic histiocytosis in the upper eyelid of a Korean patient. We treated the condition by surgical debulking and intralesional triamcinolone injection. PATIENT CONCERNS A 59-year-old man was referred to our clinic with a 7-year history of unilateral swelling in the right upper eyelid. He had previously been treated with long-term oral steroids and immunosuppressants, but his eyelid swelling persisted. Unilaterally non-pitting erythematous edema was localized on the right upper eyelid without any itching or pain. His best corrected visual acuity at presentation was 20/20 for both eyes. Enhanced orbital computerized tomography revealed edematous soft tissue thickening in the right upper eyelid. In the laboratory testing, the erythrocyte sedimentation rate showed an increase of 19, and the antinuclear antibody titer was positive with a homogeneous pattern. DIAGNOSES We diagnosed the patient with intralymphatic histiocytosis based on the histopathological findings. INTERVENTION We attempted surgical debulking and biopsy on the right upper eyelid due to the persistent symptoms and the absence of a definitive diagnosis. OUTCOMES The patient has demonstrated significant improvement after receiving an intralesional triamcinolone injection in the right upper eyelid following the surgery and is currently under follow-up with no signs of recurrence. LESSON Ophthalmologists should consider intralymphatic histiocytosis in cases of persistent eyelid swelling that do not respond to treatment, even in Asian patients. Surgical debulking and intralesional triamcinolone injections may be beneficial for improvement.
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Affiliation(s)
- Dong Hee Ha
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Hee Sung Kim
- Department of Pathology, College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
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2
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Aukerman E, List M, Avashia-Khemka N. Melkersson-Rosenthal syndrome of the vulva. JAAD Case Rep 2022; 27:35-37. [PMID: 35996444 PMCID: PMC9391513 DOI: 10.1016/j.jdcr.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Erica Aukerman
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nidhi Avashia-Khemka
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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3
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Estacia CT, Gameiro Filho AR, da Silveira IBE, Gameiro RR, Barba ALSD. Melkersson-Rosenthal syndrome: a rare variant of the monosymptomatic form. GMS OPHTHALMOLOGY CASES 2022; 12:Doc04. [PMID: 35291587 PMCID: PMC8900159 DOI: 10.3205/oc000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melkersson-Rosenthal syndrome (MRS) is a rare condition without any known etiology. It is characterized by the triad facial paralysis, facial swelling, and the development of folds and furrows at the tongue (fissured tongue). This study aims to report a case of a 59-year-old patient complaining about asymmetric eyelid swelling that had started two years before, associated with pain and redness on her right eye, without repercussions on her visual acuity. The patient underwent a skin biopsy of the right eye's lower eyelid, which was compatible with the monosymptomatic form of MRS. Consequently, five injections of triamcinolone were performed for the period of one year, with gradual and satisfactory improvement. One year after the end of the treatment, the patient returned with recurrence of the swelling, and therapy with triamcinolone associated with oral steroids was started. However, due to the lack of improvement, Tacrolimus ointment 0.03% was initiated. The patient evolved with an important and significant reduction of the eyelid edema, still being followed at the Hospital Federal dos Servidores do Estado do Rio de Janeiro.
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Affiliation(s)
- Carolina Tagliari Estacia
- Hospital Federal dos Servidores do Estado do Rio de Janeiro (HFSERJ), Rio de Janeiro, Brazil,*To whom correspondence should be addressed: Carolina Tagliari Estacia, Hospital Federal dos Servidores do Estado do Rio de Janeiro (HFSERJ), R. Sacadura Cabral, 178, Saúde, Rio de Janeiro – RJ 20221-161, Brazil, E-mail:
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4
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Alessi DM, Azhdam AM, Borrelli M. A Case of Melkersson-Rosenthal Syndrome Treated With 5-FU. EAR, NOSE & THROAT JOURNAL 2021; 100:873S-875S. [PMID: 34448401 DOI: 10.1177/01455613211038391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The rarity of Melkersson-Rosenthal syndrome, or orofacial granulomatosis, can present with persistent midface bogginess. The management for previous reported cases has included corticosteroid injections, antihistamines, and antibiotics. In the current reported case, the patient was treated with 5-fluorouracil and has been responding positively. Additionally, the patient has not shown signs of steroid atrophy.
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Affiliation(s)
| | - Ariel M Azhdam
- 97174Rosalind Franklin University of Medicine and Science, Chicago Medical School, IL, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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5
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Carton I, Balès D, Bargain A, Le Pors Lemoine P. Vaginal tuberculosis as differential diagnosis of cancer: A case report. IDCases 2020; 21:e00924. [PMID: 32775209 PMCID: PMC7396821 DOI: 10.1016/j.idcr.2020.e00924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis remains a worrying public health problem. But if pulmonary tuberculosis’s symptomatology is well known by the medical profession, this is not the case of genital tuberculosis. We take advantage of a case of vaginal tuberculosis to review the international literature about clinical diagnosis, further tests, and treatment of this extremely rare tuberculosis localization.
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Affiliation(s)
- Isis Carton
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - Diane Balès
- Département de Gynécologie Obstétrique et Reproduction Humaine, CHU Anne de Bretagne, 16 Bd de Bulgarie BP 90347, F-35 203, Rennes Cedex 2, France
| | - Alain Bargain
- S.C.P Docteurs A.Bargain et S. BARGAIN-Leguen, 18 avenue du 78ème R.I.T, 35406, Saint-Malo cedex 84, France
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6
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Lehman JS, Sokumbi O, Peters MS, Bridges AG, Comfere NI, Gibson LE, Wieland CN. Histopathologic features of noninfectious granulomatous disorders involving the skin. Hum Pathol 2020; 103:127-145. [PMID: 32544405 DOI: 10.1016/j.humpath.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022]
Abstract
Granulomatous dermatoses may represent primary skin inflammation or can serve as the harbinger of a multitude of underlying systemic disorders or drug reactions. Taken together with clinical findings, the microscopic features from skin biopsy can allow recognition of various patterns and facilitate a precise diagnosis. Accurate classification of entities in this category of inflammatory dermatoses may prompt clinicians to investigate for underlying systemic problems, thereby allowing the pathologist to add considerable value in the care of affected patients. This review article categorizes clinical and microscopic features of common and uncommon causes of noninfectious dermal and subcutaneous granulomatous inflammation.
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Affiliation(s)
- Julia S Lehman
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Margot S Peters
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alina G Bridges
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lawrence E Gibson
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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7
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Miest RY, Bruce AJ, Comfere NI, Hadjicharalambous E, Endly D, Lohse CM, Rogers RS. A Diagnostic Approach to Recurrent Orofacial Swelling: A Retrospective Study of 104 Patients. Mayo Clin Proc 2017; 92:1053-1060. [PMID: 28601424 DOI: 10.1016/j.mayocp.2017.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify patients evaluated in an outpatient setting at our institution with a presentation of recurrent orofacial swelling and to review the spectrum of causes to outline a diagnostic approach. PATIENTS AND METHODS A retrospective study of 104 patients with more than 1 episode of orofacial swelling lasting for more than 5 days identified through a keyword search of the electronic health record from January 2, 2000, through July 5, 2011. RESULTS Patients were categorized according to final cause of orofacial swelling: idiopathic orofacial granulomatosis, solid facial edema due to rosacea and acne vulgaris, Crohn disease, contact dermatitis, sarcoidosis, exfoliative cheilitis, lichen planus, actinic cheilitis, cheilitis glandularis, lymphedema, miscellaneous, and multifactorial. Granulomatous inflammation was noted on biopsy in 40 of 85 patients (47%). Oral involvement was associated with Crohn disease (P<.001), and facial and periorbital swelling was associated with solid facial edema in the setting of rosacea and acne vulgaris (P<.001). CONCLUSION The broad range of diagnoses responsible for recurrent orofacial swelling underscores the diagnostic challenge and importance of a thorough multidisciplinary evaluation to identify underlying causes.
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Affiliation(s)
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Dawnielle Endly
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
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Chandna S, Mahendra A, Kaur R. Gingival Manifestations of Orofacial Granulomatosis: A Rare Finding. Clin Adv Periodontics 2017. [DOI: 10.1902/cap.2016.160048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shalu Chandna
- Department of Periodontology and Oral Implantology, Maharishi Markandeshwar College of Dental Sciences, Mullana, Haryana, India
| | - Aneet Mahendra
- Department of Skin and Venereal Diseases, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
| | - Ranveet Kaur
- Department of Periodontology and Oral Implantology, Maharishi Markandeshwar College of Dental Sciences, Mullana, Haryana, India
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González-García A, Barbolla Díaz I, Sifuentes Giraldo WA, Patier-de la Peña JL. Miescher syndrome: An uncommon cause of recurrent swelling of the lips. ACTA ACUST UNITED AC 2017; 13:363-364. [PMID: 28395859 DOI: 10.1016/j.reuma.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/27/2017] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
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Abstract
Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. In the non-infectious group, examples of necrobiotic or necrotizing granulomas include granuloma annulare; necrobiosis lipoidica; rheumatoid nodule; and lupus miliaris disseminates faciei. Non-necrobiotic/necrotizing and non-infectious lesions are exemplified by sarcoidosis; foreign-body reactions; Melkersson-Rosenthal syndrome; Blau syndrome; elastolytic granuloma; lichenoid and granulomatous dermatitis; interstitial granulomatous dermatitis; cutaneous involvement by Crohn disease; granulomatous rosacea; and granulomatous pigmented purpura. Histiocytic dermatitides that do not feature granuloma formation are peculiar reactions to infection, such as cutaneous malakoplakia; leishmaniasis; histoplasmosis; lepromatous leprosy; rhinoscleroma; lymphogranuloma venereum; and granuloma inguinale.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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11
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Recurrent Facial Palsy and Electrophysiological Findings in Oligosymptomatic Melkersson Rosenthal Syndrome. Indian J Pediatr 2016; 83:1188-90. [PMID: 27165478 DOI: 10.1007/s12098-016-2137-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Melkersson Rosenthal Syndrome is a rare neuro-mucocutaneous disorder characterized by the classic triad of facial swelling, recurrent facial nerve palsy and fissured tongue. The clinical course is usually progressive, and etiology is unknown. The authors describe oligosymptomatic Melkersson Rosenthal Syndrome in a young girl presenting sequentially with recurrent, metachronous facial nerve palsy and hemifacial swelling in early childhood followed by fissuring in the tongue in late-childhood. Histopathological examination from the affected labial area showed non-granulomatous inflammation. Bilateral facial nerve conduction and blink reflex studies showed asymmetrical affection of both facial nerves with mixed features of axonal and demyelinating involvement. The patient remained steroid-refractory, and subsequent attacks remitted with partial recovery. The combination of facial edema and facial palsy in a child should alert the physicians to the diagnosis of Melkersson Rosenthal Syndrome. A diagnostic mucosal biopsy, evaluation for systemic and oro-facial granulomatous disorders, and short course of corticosteroid treatment are recommended.
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13
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Capodiferro S, Scully C, Ficarra G, De Frenza G, Grassi R, Maiorano E, Favia G, Mastrangelo F, Tetè S. Orofacial Granulomatosis: Report of Two Cases with Gingival Onset. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0700500109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Orofacial granulomatosis is a unifying term comprising a variety of clinical conditions involving the face and the oral cavity and histologically characterized by the presence of chronic granulomatous inflammation. Lip swelling and erythema are the most frequent clinical signs. We report on the clinical-pathological features and the management of two cases of orofacial granulomatosis characterized by gingival onset, without other local and systemic manifestations. The diagnosis of orofacial granulomatosis with gingival onset is made by the exclusion of other conditions exhibiting gingival inflammation and/or enlargement. Detailed medical history, haematological investigations and gingival biopsy are fundamental for the definitive diagnosis. Though infrequent, orofacial granulomatosis with gingival involvement should be considered in the differential diagnosis of hyperplastic gingivitis of uncertain origin.
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Affiliation(s)
| | - C. Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK
| | - G. Ficarra
- Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK
| | | | | | - E. Maiorano
- Department of Pathological Anatomy, University of Bari, Bari
| | | | - F. Mastrangelo
- Department of Oral Science, University of Chieti, Chieti, Italy
| | - S. Tetè
- Department of Oral Science, University of Chieti, Chieti, Italy
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Tronnier M, Mitteldorf C. Histologic features of granulomatous skin diseases. Part 1: Non-infectious granulomatous disorders. J Dtsch Dermatol Ges 2015; 13:211-6. [PMID: 25721629 DOI: 10.1111/ddg.12610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Granulomatous disorders affecting the skin belong to a heterogeneous group of diseases. With the exception of granulomas induced by infectious agents or foreign bodies, the etiopathogenesis of granulomatous disorders is still poorly understood. The knowledge of histopathologic changes is of great importance for understanding clinical presentation and disease course.
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15
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Melkersson-Rosenthal syndrome. J Formos Med Assoc 2015; 115:583-4. [PMID: 26375775 DOI: 10.1016/j.jfma.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
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Bohra S, Kariya PB, Bargale SD, Kiran S. Clinicopathological significance of Melkersson-Rosenthal syndrome. BMJ Case Rep 2015; 2015:bcr2015210138. [PMID: 26231188 PMCID: PMC4521530 DOI: 10.1136/bcr-2015-210138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 11/03/2022] Open
Abstract
Melkersson-Rosenthal syndrome (MRS) classically shows a triad of orofacial swelling, fissured tongue and facial palsy, more commonly the oligosymptomatic form. The orofacial swelling is characterised by swollen reddish-brown non-pruritic lips and facial oedema. In one-third to one half of patients, fissured tongue is seen, which also aids in diagnosis. The histological finding of MRS includes non-caseating, sarcoidal granulomas, but their absence does not exclude the diagnosis. All these findings together form a basis for a cautious search for confrontational reasons for the symptom complex of MRS.
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Affiliation(s)
- Shruti Bohra
- Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Wardha, Maharashtra, India
| | - Pratik B Kariya
- Department of Pedodontics and Preventive Dentistry, KM Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Seema Dinesh Bargale
- Department of Pedodontics and Preventive Dentistry, KM Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Shital Kiran
- Department of Pedodontics and Preventive Dentistry,Karnavati School of Dentistry, Gandhinagar, Gujarat, India
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Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
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Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Recurrent facial palsy in Melkersson Rosenthal syndrome: total facial nerve decompression is effective to prevent further recurrence. Am J Otolaryngol 2015; 36:334-7. [PMID: 25708818 DOI: 10.1016/j.amjoto.2014.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/24/2014] [Accepted: 12/02/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the role of total facial nerve decompression in preventing further recurrence of facial palsy in Melkersson Rosenthal syndrome (MRS). METHODS Total facial nerve decompression was performed on nine patients with recurrent facial palsy in MRS, and prednisolone treatment was given to 6 cases who declined surgery. They were incorporated into surgery group and control group, respectively. Patients in surgery group and control group were followed up for 5.4 ± 1.4 years (range, 4 to 8 years) and 6.0 ± 1.4 years (range, 4 to 8 years), respectively. RESULTS Further episodes of facial palsy affected none of 9 cases (0.0%) in surgery group, while they affected 3 of 6 cases (50.0%) in control group, with significant difference (p<0.05). CONCLUSIONS Total facial nerve decompression was effective to prevent further episodes of facial palsy in MRS.
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Abdel-Aziz M, Azab NA, Khalifa B, Rashed M, Naguib N. The association of Varicella zoster virus reactivation with Bell's palsy in children. Int J Pediatr Otorhinolaryngol 2015; 79:328-31. [PMID: 25599860 DOI: 10.1016/j.ijporl.2014.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Bell's palsy is considered the most common cause of facial nerve paralysis in children. Although different theories have been postulated for its diagnosis, reactivation of the Varicella zoster virus (VZV) has been implicated as one of the causes of Bell's palsy. The aim of the study was to evaluate the association of Varicella-zoster virus infection with Bell's palsy and its outcome in children. METHODS A total of 30 children with Bell's palsy were recruited and were assayed for evidence of VZV infection. The severity of facial nerve dysfunction and the recovery rate were evaluated according to House-Brackmann Facial Nerve Grading Scale (HB FGS). Paired whole blood samples from all patients were obtained at their initial visit and 3 weeks later, and serum samples were analyzed for VZV IgG and IgM antibodies using ELISA. RESULTS A significantly higher percentage of Bell's palsy patients were seropositive for VZV IgM antibodies than controls (36.6% of patients vs 10% of controls) while for VZV IgG antibodies the difference was statistically nonsignificant. HB FGS in Bell's palsy patients with serologic evidence of VZV recent infection or reactivation showed a statistiacally significant less cure rate than other patients. CONCLUSIONS VZV reactivation may be an important cause of acute peripheral facial paralysis in children. The appropriate diagnosis of VZV reactivation should be done to improve the outcome and the cure rate by the early use of antiviral treatment.
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Affiliation(s)
| | - Noha A Azab
- Department of Rheumatology and Rehabilitation, Cairo University, Cairo, Egypt
| | - Badwy Khalifa
- Department of Otolaryngology, Cairo University, Cairo, Egypt
| | - Mohammed Rashed
- Department of Otolaryngology, Beni Suef University, Beni Suef, Egypt
| | - Nader Naguib
- Department of Otolaryngology, Beni Suef University, Beni Suef, Egypt
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Tronnier M, Mitteldorf C. Histologische Merkmale granulomatöser Hauterkrankungen: Teil 1: nichtinfektiöse granulomatöse Erkrankungen. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12610_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Tronnier
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS Klinikum Hildesheim
| | - Christina Mitteldorf
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS Klinikum Hildesheim
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Sun B, Zhou C, Han Z. Facial Palsy in Melkersson-Rosenthal Syndrome and Bell’s Palsy. Ann Otol Rhinol Laryngol 2014; 124:107-9. [PMID: 25124841 DOI: 10.1177/0003489414546398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to compare genetic predilection and recurrence tendency between facial palsy in Melkersson-Rosenthal syndrome (MRS) and Bell’s palsy Methods: We carried out an investigation on patients with facial palsy in MRS and those with Bell’s palsy who visited the outpatient department in our hospital between February 2009 and February 2013. They were asked about familial history and whether it was the first episode, with the results recorded and compared. Results: There were 16 patients with facial palsy in MRS and 860 patients with Bell’s palsy involved in the study. Familial history was positive in 5 of 16 patients (31.3%) with facial palsy in MRS and 56 of 860 patients (6.5%) with Bell’s palsy ( P < .01). Twelve of 16 cases (75%) with facial palsy in MRS and 88 of 860 cases (10.2%) with Bell’s palsy had a history of facial palsy in the past ( P < .01). Conclusion: Compared to Bell’s palsy, facial palsy in MRS has an obvious genetic predilection and recurrence tendency.
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Affiliation(s)
- Baochun Sun
- Department of Otolaryngology, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Chengyong Zhou
- Department of Otolaryngology, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Zeli Han
- Department of Otolaryngology, The First Affiliated Hospital of PLA General Hospital, Beijing, China
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Dai C, Li J, Yang S, Zhao L, Feng S, Li Y, Song Z, Lu J, Zhao K. Subtotal facial nerve decompression for recurrent facial palsy in Melkersson Rosenthal syndrome. Acta Otolaryngol 2014; 134:425-8. [PMID: 24512460 DOI: 10.3109/00016489.2013.863431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Subtotal facial nerve decompression seems effective to prevent further episodes of facial palsy and promote facial nerve recovery for recurrent facial palsy in Melkersson Rosenthal syndrome (MRS). The main inflammatory sites of recurrent facial palsy in MRS may be the mastoid segment, tympanic segment, geniculate ganglion, and labyrinthine segment. OBJECTIVE To present our surgical experience in preventing further episodes of facial palsy and improving facial nerve recovery of patients with recurrent facial palsy in MRS. METHODS We performed transmastoid subtotal facial nerve decompression on eight patients with recurrent facial palsy in MRS. They were followed up for 3.3 years on average (range 2-5 years). RESULTS There were no further attacks of facial palsy in any of the cases. Seven cases (87.5%) recovered to grade I or grade II, and three of eight cases (37.5%) recovered completely. We found obvious edema of the facial nerve at the mastoid segment in all cases, at the tympanic segment and geniculate ganglion in five cases (62.5%), and at the labyrinthine segment in only one case (12.5%).
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Affiliation(s)
- Chuanfu Dai
- Department of Otolaryngology Head and Neck Surgery, Medical Center Tsinghua University
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24
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Patel P, Brostoff J, Campbell H, Goel RM, Taylor K, Ray S, Lomer M, Escudier M, Challacombe S, Spencer J, Sanderson J. Clinical evidence for allergy in orofacial granulomatosis and inflammatory bowel disease. Clin Transl Allergy 2013; 3:26. [PMID: 23947721 PMCID: PMC3751572 DOI: 10.1186/2045-7022-3-26] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/09/2013] [Indexed: 12/13/2022] Open
Abstract
Background Orofacial granulomatosis (OFG) causes chronic, disfiguring, granulomatous inflammation of the lips and oral mucosa. A proportion of cases have co-existing intestinal Crohn’s disease (CD). The pathogenesis is unknown but has recently been linked to dietary sensitivity. Although allergy has been suggested as an aetiological factor in OFG there are few published data to support this link. In this study, we sought clinical evidence of allergy in a series of patients with OFG and compared this to a series of patients with inflammatory bowel disease (IBD) without oral involvement and to population control estimates. Methods Prevalence rates of allergy and oral allergy syndrome (OAS) were determined in 88 patients with OFG using questionnaires, skin prick tests, total and specific serum IgE levels. Allergy was also determined in 117 patients with IBD without evidence of oral involvement (79 with CD and 38 with ulcerative colitis (UC)). Results Prevalence rates of allergy in patients with OFG were significantly greater than general population estimates (82% versus 22% respectively p = <0.0005). Rates of allergy were also greater in those with CD (39%) and, interestingly, highest in those with OFG and concurrent CD (87%). Conversely, whist OAS was common in allergic OFG patients (35%) rates of OAS were significantly less in patients with concomitant CD (10% vs 44% with and without CD respectively p = 0.006). Amongst CD patients, allergy was associated with perianal disease (p = 0.042) but not with ileal, ileocolonic or colonic disease location. Allergy in UC (18%) was comparable to population estimates. Conclusion We provide compelling clinical evidence for the association of allergy with OFG whether occurring alone or in association with CD. The presence of gut CD increases this association but, conversely, reduces the expression of OAS in those with atopy. Interestingly, there is no evidence of increased allergy in UC.
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Affiliation(s)
- Pritash Patel
- Departments of Gastroenterology at Guy's & St, Thomas NHS Foundation Trust, London, UK.
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An unusual green macular lesion of the gingiva: a foreign-body granulomatous reaction. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:e65-9. [PMID: 23751268 DOI: 10.1016/j.oooo.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/21/2013] [Accepted: 04/02/2013] [Indexed: 11/20/2022]
Abstract
The current clinical case highlights the diagnostic process in characterizing an unusual green macular lesion of the maxillary gingiva. A review of the history revealed that the patient had suffered trauma to the oral tissues during a soccer match 2 years prior. An incisional biopsy was performed and microscopic analysis demonstrated the presence of a granulomatous reaction to a needle-shaped, birefringent foreign material. Comparative analysis of a specimen collected from the soccer field confirmed that the foreign material was artificial grass. Foreign material was also found inside the gingival epithelial cells.
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Naik V, Shivaprasad S, Ashok L, Kumar M, Prakash S. Orofacial granulomatosis: An unusual involvement of hard palate. Indian J Dent 2013. [DOI: 10.1016/j.ijd.2013.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wickramasinghe N, Gunasekara CN, Fernando WS, Hewavisenthi J, de Silva HJ. Vulvitis granulomatosa, Melkersson-Rosenthal syndrome, and Crohn's disease: dramatic response to infliximab therapy. Int J Dermatol 2012; 51:966-8. [PMID: 22788815 DOI: 10.1111/j.1365-4632.2011.05177.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND AND OBJECTIVES Crohn disease (CD) is an increasingly recognized problem in Saudi Arabia. The aim of this study was to describe the clinical pattern in children and adolescents with CD seen at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. DESIGN AND SETTING Retrospective hospital-based study conducted on data collected for the period between January 2001 and March 2010. PATIENTS AND METHODS Data for all children and adolescents diagnosed at KAUH with CD in the period were retrieved and analyzed. RESULTS Ninety-six patients were identified. The median age at diagnosis was 11.3 years (range, 0.12-17.6 years). Fifty (52.1%) were males. Sixty-four (66.7%) were Saudis. Nine (9.4%) had a first degree relative with inflammatory bowel disease. The most common presenting symptoms were diarrhea (88.5%), weight loss (84.2%) and anorexia (80.2%). At least one extraintestinal manifestation occurred in 24% of patients. Forty-two percent were underweight and 19% had short stature. The most common distribution was ileocolonic (37.5%), followed by colonic in 31.2%. Twenty-five (26%) patients had perianal disease, 13 (13.5%) had strictures and 15 (15.6%) had penetrating disease. Laboratory investigations revealed anemia in 84.4%, thrombocytosis in 50%, hypoalbuminemia in 64.6%, elevated erythrocyte sedimentation rate (ESR) in 50% and elevated C-reactive protein in 58.3%. Induction of remission was achieved with enteral nutrition in 20% of patients and with corticosteroids in the remaining. CONCLUSIONS The clinical pattern of CD in children from the Western Province of Saudi Arabia was found to be similar to reports from the West. Pediatricians should be aware of the varying presentations of CD. Early referral to specialized centers is crucial.
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Affiliation(s)
- Omar I Saadah
- Department of Pediatrics, King Abdulaziz University, PO Box 80215 Jeddah 21589, Western Province, Saudi Arabia.
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Saracino A, Gordon K, Ffolkes L, Mortimer PS. Intralymphatic granulomas in lymphoedema secondary to anogenital granulomatosis. Australas J Dermatol 2012; 54:e59-61. [DOI: 10.1111/j.1440-0960.2012.00923.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 05/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kristiana Gordon
- Department of Dermatology & Lymphovascular Medicine; St George's Hospital; London; UK
| | | | - Peter S Mortimer
- Department of Dermatology & Lymphovascular Medicine; St George's Hospital; London; UK
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Archibald CW, Punja KG, Oryschak AF. Orofacial granulomatosis presenting as bilateral eyelid swelling. Saudi J Ophthalmol 2012; 26:177-9. [PMID: 23960989 DOI: 10.1016/j.sjopt.2012.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/14/2012] [Accepted: 02/25/2012] [Indexed: 11/29/2022] Open
Abstract
Orofacial granulomatosis (OFG) is an uncommon but increasingly recognized disease of unknown etiology. The typical presentation is chronic swelling of the perioral soft tissue, but eyelid edema can be the sole manifestation. Terminology of this disease can be confusing as it may also be referred to as granulomatous cheilitis and a monosymptomatic presentation of Melkersson-Rosenthal syndrome (MRS). Crohn's disease and sarcoidosis should also be considered in the differential as the histopathology can be similar. Corticosteroids are the mainstay of treatment but can lack efficacy. Atypical presentations and the possibility of systemic disease involvement can further challenge the management. We describe an unusual case in which OFG manifests solely as chronic eyelid swelling. This 69-year old Asian female patient had a delayed diagnosis that responded well to intralesional corticosteroid injection with surgical skin reduction. In addition to describing this unusual presentation of OFG, we review the relevant literature and evaluate the current terminology used to describe this entity.
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Affiliation(s)
- Curtis W Archibald
- Department of Surgery, Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
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31
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Campbell H, Escudier M, Patel P, Nunes C, Elliott TR, Barnard K, Shirlaw P, Poate T, Cook R, Milligan P, Brostoff J, Mentzer A, Lomer MCE, Challacombe SJ, Sanderson JD. Distinguishing orofacial granulomatosis from crohn's disease: two separate disease entities? Inflamm Bowel Dis 2011; 17:2109-15. [PMID: 21910172 DOI: 10.1002/ibd.21599] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/04/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare chronic inflammatory disease of unknown etiology sharing histological features with Crohn's disease (CD). This study aimed to 1) define the clinical presentation of OFG, 2) establish differentiating features for those with CD, 3) examine if onset of OFG is predictive of CD, and 4) establish differentiating features for children. METHODS Data were extracted from medical notes (n = 207) for demographics, clinical features, blood parameters, diagnosis of CD, and treatment's for patients with OFG. RESULTS Ninety-seven patients (47%) were female. The lips (184/203; 91%) and buccal mucosa (151/203; 74%) were mainly affected. Forty-six (22%) had intestinal CD. Ulcers (24/46; 46% versus 29/159; 15%, P = <0.001) were more common in patients with CD as was a raised C-reactive protein (24/33; 73% versus 60/122; 49%, P = 0.016) and abnormal full blood count (19/41; 46% versus 35/150; 23%). The buccal-sulcus (12/44; 27% versus 20/158; 13%, P = 0.019) was more often affected in those with CD. Half the patients with CD were diagnosed prior to onset of OFG. The remainder were diagnosed after. The incidence of CD is similar for children (16/69; 23%) and adults (29/132; 22%), although oral onset in childhood is more likely to occur prior to diagnosis of CD. CONCLUSIONS OFG mainly presents in young adults with lip and buccal involvement. Abnormalities in inflammatory markers, hematology and oral features of ulceration, and buccal-sulcal involvement are factors more commonly associated with CD. Initial presentation of OFG does not necessarily predict development of CD, although this is more likely in childhood.
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Affiliation(s)
- Helen Campbell
- Nutritional Sciences Division, King's College London, London, UK
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Patel P, Barone F, Nunes C, Boursier L, Odell E, Escudier M, Challacombe S, Brostoff J, Spencer J, Sanderson J. Subepithelial dendritic B cells in orofacial granulomatosis. Inflamm Bowel Dis 2010; 16:1051-60. [PMID: 19924808 DOI: 10.1002/ibd.21169] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a chronic, disfiguring, granulomatous inflammation of the lips and oral mucosa. The pathogenesis is unknown, but it has been linked previously to Crohn's disease (CD) and more recently to dietary sensitivity. The oral mucosa is an immunologically responsive site associated with the generation of protective mucosal and systemic immune responses to vaccination and also hyperresponsiveness to allergens in some individuals. Classically, immune responses in oral mucosa are considered to be mediated by mucosa-associated lymphoid tissues (MALT), secondary lymphoid follicles that are intimately associated with epithelia. METHODS Immunohistochemistry was used to investigate the inflammatory infiltrate in OFG and control tissue samples. Polymerase chain reaction (PCR), cloning of PCR products, and sequencing were used to characterize the local immunoglobulin gene profile in OFG. RESULTS We describe large, active, dendritic B cells in oral mucosa that were not associated with any organized lymphoid tissues in the local subepithelial microenvironment. They express activation induced cytidine deaminase, which is essential for immunoglobulin gene diversification by somatic hypermutation and class switch recombination. IgE is also expressed by these B cells. They do not align with any other previously described B-cell subset in secondary lymphoid tissues in terms of morphology, proliferative activity, or phenotype. CONCLUSIONS These subepithelial dendritic B cells may contribute to the immune responsiveness of the oral mucosa, including IgE-mediated allergic responses. In patients with OFG, further understanding of the role these cells play in oral immunity may lead to novel therapeutic possibilities.
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Affiliation(s)
- Pritash Patel
- Department of Gastroenterology at Guy's & St. Thomas NHS Foundation Trust, London, UK
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Kondratiev S, Heher K, Baker BJ, Laver NV. Melkersson-Rosenthal Syndrome Presenting as Chronic Eyelid Swelling. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-3. [PMID: 20337335 DOI: 10.3928/15428877-20100215-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2009] [Indexed: 11/20/2022]
Abstract
Melkersson-Rosenthal Syndrome (MRS) is a rare disorder characterized by orofacial edema, facial palsy, and fissured tongue. A 64-year-old man presented with a fissured tongue and persistent chronic right upper eyelid edema of 15 years duration. The diagnostic biopsy revealed non-necrotizing granulomatous inflammation adjacent to blood and lymphatic vessels. Characteristic granulomas with focal occlusion of dilated lymphatic channels were present. Special stains for fungi, acid-fast microorganisms and bacteria were negative. Ptosis due to a mechanical effect of the persistent eyelid edema required surgical treatment including debulking and advancement of the levator muscle. At 6 months after surgery the patient showed symmetrical eyelid position without edema. The case demonstrates an uncommon presentation of Melkersson-Rosenthal syndrome with prominent upper eyelid edema and lingua plicata, which was initially misdiagnosed. The clinical findings coupled with the characteristic granulomatous lymphangitis present in the biopsy are crucial for a definite diagnosis.
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Saalman R, Mattsson U, Jontell M. Orofacial granulomatosis in childhood-a clinical entity that may indicate Crohn's disease as well as food allergy. Acta Paediatr 2009; 98:1162-7. [PMID: 19397547 DOI: 10.1111/j.1651-2227.2009.01295.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Orofacial granulomatosis (OFG) is a rare clinical entity with orofacial swelling in association with oral lesions such as mucosal oedema, ulcerations and mucosal tags. The aim of this prospective study was to evaluate the connection between OFG in childhood and systemic disease. METHODS During a 3-year period, eight children (9-16 years old) who had been referred to the clinic of oral medicine were diagnosed solely with OFG. Thus, none of them had any known systemic disease or gastrointestinal symptoms at the time of referral. The children were then medically examined and followed up for 6-8 years at the department of paediatrics for systemic disease with specific emphasis on inflammatory disorders elsewhere in the gastrointestinal tract. RESULTS During follow-up, four patients were diagnosed with Crohn's disease (CD). Further, one girl was found to have a food allergy-induced OFG, with delayed-type hypersensitivity to oats. One boy developed both diabetes and celiac disease during the follow-up. Only two patients had no diagnosis of systemic disease at the end of the observation period. CONCLUSION OFG in childhood seems to be frequently related to systemic disease, and children with OFG should be referred to a paediatrician for examination and follow-up.
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Affiliation(s)
- Robert Saalman
- Department of Pediatrics, The Queen Silvia Children's Hospital, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Abstract
Orofacial granulomatosis (OFG) is the presence of persistent enlargement of the soft tissues of the oral and maxillofacial region, characterized by non-caseating granulomatous inflammation in the absence of diagnosable systemic Crohn's disease (CD) or sarcoidosis. Over 20 years have passed since OFG was first described and an extensive review of the literature reveals that there is no consensus whether OFG is a distinct clinical disorder or an initial presentation of CD or sarcoidosis. Furthermore, the precise cause of OFG is still unknown although several theories have been suggested including infection, genetic predisposition and allergy. The clinical outcome of OFG patients continues to be unpredictable. Current therapies remain unsatisfactory. Regular clinical review is indicated to identify the development of gastrointestinal or systemic involvement. The aim of this review was to analyse the developments in our understanding of the aetiology, pathogenesis and treatment protocols, with particular emphasis on management and outcomes of OFG since this entity was first described in 1985.
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Affiliation(s)
- B Grave
- Oral and Maxillofacial Surgery Unit, The Royal Melbourne Hospital, Melbourne, Australia
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36
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A diffuse but subtle swelling of the upper lip. ACTA ACUST UNITED AC 2008; 106:773-7. [PMID: 18755617 DOI: 10.1016/j.tripleo.2008.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/27/2008] [Accepted: 06/27/2008] [Indexed: 11/23/2022]
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Tekin M, Kati I. Anesthetic management of patients with Melkersson Rosenthal syndrome. J Anesth 2008; 22:294-6. [PMID: 18685938 DOI: 10.1007/s00540-008-0622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 03/02/2008] [Indexed: 10/21/2022]
Abstract
Melkersson Rosenthal Syndrome (MRS) is a rare disorder characterized by relapsing facial paralysis, persistent or recurrent orofacial edema, and lingua plicata. It may cause difficult airway, drug allergy, and angioedema. In our anesthetic management of two patients with MRS, preanesthetic immunological blood examination and skin tests for hypersensitivity to anesthetic drugs were applied. Because the principal goal is to avoid all factors that may stimulate, an allergic reaction, anesthetic drugs known to trigger urticaria were avoided. Body and operating room temperatures, changes of which may trigger allergic reactions, were kept constant during the perioperative period. Emergency precautions were taken for probable angioedema. MRS is a rare syndrome, and if its manifestations are misunderstood as simple facial paralysis, it may be overlooked by anesthesiologists. Anesthesiologists must be careful of several problems in patients with MRS.
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Affiliation(s)
- Murat Tekin
- Department of Anesthesiology, Kocaeli University, Medical Faculty, 41380 Kocaeli, Turkey
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Aluclu MU, Keklikci U, Guzel A, Unlu K, Tatli M. Melkersson-Rosenthal syndrome with partial oculomotor nerve palsy. Ann Saudi Med 2008; 28:135-7. [PMID: 18398275 PMCID: PMC6074525 DOI: 10.5144/0256-4947.2008.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mehmet Ufuk Aluclu
- Departments of Neurology, Ophthalmology, Neurosurgery, Medical School, Dicle University, Diyarbakir, Turkey.
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KAWAKAMI T, FUKAI K, SOWA J, ISHII M, TERAMAE H, KANAZAWA K. Case of cheilitis granulomatosa associated with apical periodontitis. J Dermatol 2008; 35:115-9. [DOI: 10.1111/j.1346-8138.2008.00426.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Kakimoto C, Sparks C, White AA. Melkersson-Rosenthal syndrome: a form of pseudoangioedema. Ann Allergy Asthma Immunol 2007; 99:185-9. [PMID: 17718107 DOI: 10.1016/s1081-1206(10)60643-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Melkersson-Rosenthal syndrome is an unusual cause of facial swelling that can be confused with angioedema. OBJECTIVE To describe a young woman with facial swelling initially considered to be angioedema. METHODS A biopsy specimen of the eyelid demonstrated findings consistent with Melkersson-Rosenthal syndrome. RESULTS After reviewing the differential diagnosis of pseudoangioedema, a presumptive diagnosis of Melkersson-Rosenthal syndrome was made. The patient was successfully treated with infliximab for Melkersson-Rosenthal syndrome. Owing to medication adverse effects, infliximab treatment was discontinued. Treatment was then continued with adalimumab, with good effect and without adverse events. CONCLUSIONS We report the case of a patient with Melkersson-Rosenthal syndrome presenting as angioedema. Furthermore, we report the first successful treatment of Melkersson-Rosenthal syndrome with adalimumab.
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Affiliation(s)
- Charlene Kakimoto
- Department of Dermatology, Naval Medical Center San Diego, San Diego, California, USA
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41
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Ketabchi S, Massi D, Ficarra G, Rubino I, Franchi A, Paglierani M, Simoni A, Capodiferro S, Favia G, Maiorano E, Tarantini F, Cirino G, Santucci M. Expression of protease-activated receptor-1 and -2 in orofacial granulomatosis. Oral Dis 2007; 13:419-25. [PMID: 17577330 DOI: 10.1111/j.1601-0825.2006.01317.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Orofacial granulomatosis (OFG) is a rare condition characterized by non-caseating granulomas in the orofacial region. Protease-Activated Receptors (PARs) play a role in inflammatory diseases in diverse human tissues. The aim of the study was to investigate the expression of PAR-1, PAR-2, MMP-2, MMP-9, COX-1, and COX-2 in tissues taken from OFG patients. METHODS PAR-1, PAR-2, MMP-2, MMP-9, COX-1, and COX-2 expression was evaluated by immunohistochemistry in biopsies taken from oral Crohn's disease (five cases), Melkersson-Rosenthal syndrome (MRS) (six cases), cheilitis granulomatosa (five cases) and normal oral mucosa (five cases). RESULTS PAR-1 was observed in mononuclear inflammatory cells in edematous/lichenoid lesions, whereas a strong PAR-2 immunostaining was detected in epithelioid histiocytes and giant cells in granulomatous lesions, irrespective of the clinical features (Crohn vs MRS). MMPs and COX-2 were expressed in the inflammatory component of edematous/lichenoid lesions and markedly overexpressed in granulomatous lesions. COX-1 was weakly and variably expressed in both edematous/lichenoid and granulomatous lesions. CONCLUSION Thus, PAR-1 and PAR-2 expressions were related to the intensity and type of inflammatory response but not to the type of clinical lesion. Simultaneous overexpression of PARs, MMPs and COXs suggests synergism among these proinflammatory receptors and enzymes.
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Affiliation(s)
- S Ketabchi
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
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Capodiferro S, Maiorano E, Urbani U, Dolci M, Favia G. Plicata tongue, oral tori and thyroiditis: is this a new head-neck syndrome? Int J Immunopathol Pharmacol 2007; 20:413-4. [PMID: 17624256 DOI: 10.1177/039463200702000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chan YC, Lee YS, Wong ST, Lam SP, Ong BKC, Wilder-Smith E. Melkerrson-Rosenthal syndrome with cardiac involvement. J Clin Neurosci 2007; 11:309-11. [PMID: 14975426 DOI: 10.1016/j.jocn.2003.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2002] [Accepted: 06/11/2003] [Indexed: 11/29/2022]
Abstract
Melkerrson-Rosenthal syndrome (MRS) is a granulomatous disease usually restricted to the orofacial region. We report a case of MRS in a 37-year-old Malay patient who presented with complete heart block on a background of recurrent oro-facial swelling and facial diplegia. Lip biopsy showed lymphohistocytic granulomatous inflammation typical for MRS. Extensive work-up excluded other causes of the complete heart block. To our knowledge, this is the first reported case of MRS affecting cardiac connective tissues and the first report of MRS in an ethnic Malay. We postulate granulomatous infiltration of the conductive tissues as the basis for the heart block. Another unusual feature of the case was the presence of left eye abduction limitation.
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Affiliation(s)
- Y C Chan
- Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, PD 11907, Singapore.
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Chiandussi S, Tappuni AR, Watson TF, White A, Escudier MP, Sanderson JD, Challacombe SJ. Lip impressions: a new method for monitoring morphological changes in orofacial granulomatosis. Oral Dis 2007; 13:93-8. [PMID: 17241437 DOI: 10.1111/j.1601-0825.2006.01255.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To develop and evaluate an objective method for assessing lip size and treatment-related morphological changes in orofacial granulomatosis (OFG) patients. MATERIALS AND METHODS Patients with swollen lips because of OFG (n=21) were enrolled. A light-body polyvinylsiloxane material was used to take lip impressions before and after treatment (n=10), or during treatment (n=11). Plaster models were cast from the impressions and the lips were measured using callipers. The intra-examiner and inter-examiner reproducibility of the technique were assessed. RESULTS OFG patients had significantly larger lips than controls (P<0.0001). The coefficient of variation on repeated measurements of the same impression was 1.6% and for duplicate impressions was 2.6%. Significant reduction in lip size was shown in all 10 patients after diet restriction (P<0.002). Seven of 11 patients whose impressions were taken at least 3 months after the initiation of cinnamon- and benzoate-free diet also showed reduction in lip size during follow up (P<0.002). CONCLUSIONS Serial lip impressions appear to be reliable for routine quantification of morphological changes of the lips in OFG patients. We present a new reproducible and sensitive method for assessing changes in lip size in response to treatment in OFG.
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Affiliation(s)
- S Chiandussi
- Department of Oral Medicine, King's College London Dental Institute of Guy's, King's College & St Thomas' Hospitals, London, UK
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White A, Nunes C, Escudier M, Lomer MCE, Barnard K, Shirlaw P, Challacombe SJ, Sanderson JD. Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet. Inflamm Bowel Dis 2006; 12:508-14. [PMID: 16775496 DOI: 10.1097/00054725-200606000-00011] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Although the cause remains unknown, there is evidence for involvement of a dietary allergen. Patch testing has related responses to cinnamon and benzoate to the symptoms of OFG, with improvement obtained through exclusion diets. However, an objective assessment of the effect of a cinnamon- and benzoate-free diet (CB-free diet) as primary treatment for OFG has not previously been performed. Thus, this study was undertaken to investigate the benefits of a CB-free diet as first-line treatment of patients with OFG. MATERIALS AND METHODS Thirty-two patients with a confirmed diagnosis of OFG were identified from a combined oral medicine/gastroenterology clinic. All had received a CB-free diet as primary treatment for a period of 8 weeks. Each patient underwent a standardized assessment of the oral cavity to characterize the number of sites affected and the type of inflammation involved before and after diet. RESULTS There was a significant improvement in oral inflammation in patients on the diet after 8 weeks. Both global oral and lip inflammatory scores improved (P<0.001), and there was significant improvement in both lip and oral site and activity involvement. However, improvement in lip activity was less marked than oral activity. Response to a CB-free diet did not appear to be site specific. A history of OFG-associated gut involvement did not predict a response to the diet. CONCLUSIONS The impact of dietary manipulation in patients with OFG can be significant, particularly with regard to oral inflammation. With the disease most prevalent in the younger population, a CB-free diet can be recommended as primary treatment. Subsequent topical or systemic immunomodulatory therapy may then be avoided or used as second line.
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Affiliation(s)
- Allison White
- Department of Dietetics, Kings College London, Medical and Dental Schools, Guy's, Kings and St Thomas's Hospital, London, UK
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Abstract
Melkersson-Rosenthal syndrome is a rare disorder characterized by a triad of recurrent orofacial swelling, recurrent paralysis of the facial nerve and lingua plicata. The complete triad only occurs in 25% of MRS cases. Monosymptomatic or oligosymptomatic variants are more frequent; other findings include granulomas in other facial sites, regional lymphadenopathy, fever, psychotic disorders and hyperplastic gingivitis are associated with MRS. This can be a diagnostic challenge. The etiology and pathogenesis of MRS are unknown. Corticosteroids or clofazimine appear the best therapeutic options.
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Affiliation(s)
- F Nagel
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Brunswiker Strasse 10, 24105 Kiel.
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Tonkovic-Capin V, Galbraith SS, Rogers RS, Binion DG, Yancey KB. Cutaneous Crohn's disease mimicking Melkersson-Rosenthal syndrome: treatment with methotrexate. J Eur Acad Dermatol Venereol 2006; 20:449-52. [PMID: 16643147 DOI: 10.1111/j.1468-3083.2006.01458.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A woman with a 5-year history of unilateral orofacial granulomatosis required repeated evaluations (including sequential colonoscopies) to establish the diagnosis of cutaneous Crohn's disease, a condition that proved responsive to low doses of oral methotrexate administered weekly. To our knowledge this is the first report describing the use of methotrexate for treatment of orofacial granulomatosis caused by underlying Crohn's disease.
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Affiliation(s)
- V Tonkovic-Capin
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
OBJECTIVE : Melkersson-Rosenthal Syndrome (MRS) is a rare granulomatous disease characterized by a triad, including orofacial swelling, facial palsy and lingua plicata with usually recurrent or progressive course. Orofacial swelling, the most often sign of MRS, leads to the both esthetic and functional deformities. Because of its unknown etiology, a rational treatment is difficult and management of MRS still remains symptomatic, aiming at to remove orofacial swelling mainly. Although the many nonsurgical therapies have been mentioned in the literature, none has been proved uniformly and predictably successful to date. In this paper, we present different surgical procedures and their outcomes in a series of 4 cases with MRS. The procedures including mucosa, submucosa and tangential muscle resection, crescent shaped commissuroplasty, and facial liposuction may be considered in surgical armamentarium when orofacial swelling becomes persistent. We think that the plastic surgeons may act more effectively in the management of the syndrome in the future.
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Affiliation(s)
- Onder Tan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University, Medical Faculty, Erzurum, Turkey.
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Sanderson J, Nunes C, Escudier M, Barnard K, Shirlaw P, Odell E, Chinyama C, Challacombe S. Oro-facial granulomatosis: Crohn's disease or a new inflammatory bowel disease? Inflamm Bowel Dis 2005; 11:840-6. [PMID: 16116319 DOI: 10.1097/01.mib.0000178261.88356.67] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Oro-facial granulomatosis (OFG) is a rare chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Histologically, OFG resembles Crohn's disease (CD), and a number of patients with CD have oral involvement identical to OFG. However, the exact relationship between OFG and CD remains unknown. METHODS Thirty-five patients with OFG and no gut symptoms were identified from a combined oral medicine/gastroenterology clinic. All underwent a standardized assessment of the oral cavity and oral mucosal biopsy to characterize the number of sites affected and the type of inflammation involved. Hematological and biochemical parameters were also recorded. All 35 patients underwent ileocolonoscopy and biopsy to assess the presence of coexistent intestinal inflammation. RESULTS Ileal or colonic abnormalities were detected in 19/35 (54%) cases. From gut biopsies, granulomas were present in 13/19 cases (64%). An intestinal abnormality was significantly more likely if the age of OFG onset was less than 30 years (P=0.01). Those with more severe oral inflammation were also more likely to have intestinal inflammation (P=0.025), and there was also a correlation between the histologic severity of oral inflammation and the histologic severity of gut inflammation (P=0.047). No relationship was found between any blood parameter and intestinal involvement. CONCLUSIONS Endoscopic and histologic intestinal abnormalities are common in patients with OFG with no gastrointestinal symptoms. Younger patients with OFG are more likely to have concomitant intestinal involvement. In these patients, granulomas are more frequent in endoscopic biopsies than reported in patients with documented CD. OFG with associated intestinal inflammation may represent a separate entity in which granulomatous inflammation occurs throughout the gastrointestinal tract in response to an unknown antigen or antigens.
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Affiliation(s)
- Jeremy Sanderson
- Department of Gastroenterology and Oral Medicine, King's College London, United Kingdom.
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Gerressen M, Ghassemi A, Stockbrink G, Riediger D, Zadeh MD. Melkersson-Rosenthal syndrome: case report of a 30-year misdiagnosis. J Oral Maxillofac Surg 2005; 63:1035-9. [PMID: 16003636 DOI: 10.1016/j.joms.2005.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marcus Gerressen
- Department of Oral and Maxillofacial and Plastic Facial surgery, Universitätsklinikum der RWTH Aachen, Aachen, Germany.
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