Oro-facial Granulomatous Disorders

Infectious
1. Tuberculosis
  1. Types of infection
    1. 3) Secondary
      1. Reactivation usually with reduced host defences
      2. Oral (rare)
        Ulcers or nodules on tongue or hard palate
        single or multiple
        Painful or Painless
      3. Cervial LN & salivary gland swelling
    2. 1) Exposure to TB
      1. Primary
        Infection in lungs - formation of nodules
        Oral (rare)
        Tongue ulcers
      2. 95% asymptomatic
    3. 2) Bacteria latent
  2. Diagnosis
    1. Biopsy
      1. Ziehl Niesson staining
      2. Granulomas of TB with caseating necrosis
  3. Mycobacterium tuberculosis
  4. Droplet inhalation transmission
2. Tertiary Syphillis
  1. Treponema pallidum
  2. Sexually transmitted disease
  3. Presentation
    1. Rare - treated before this stage
    2. Gummas = granulomatous lesions
      1. Hard palate = common
        Can perforate
      2. can involve skin, CNS, liver
  4. Earlier stages
    1. Primary
      1. Presentation
        Chancre
        = painless, indurated ulcer
        At site of innoculation
        Most comon = genitals
        Can be on tongue, lip, palate
        Resolves itself in 3-6wks
        Highly infectious
        Bilateral, painless lymphadenopathy
    2. Secondary
      1. Presentation
        Most common = rash
        Red/pink macules
        Not itchy
        Arms, flanks, palms & soles
        Symmetrical
      2. Can last wks-months
  5. Other stages
    1. Latent
    2. Congenital
      1. From pregnant mother to foetus
      2. Effects
        Still-birth, neonatal death
        Hutchison's triad = notched incisors, deafness, ocular keratitis
  6. Treatment = antibiotics
  7. Diagnosis
    1. DIF/PCR/microscopy
    2. Serological tests
3. Actinomycosis
  1. Rare, chronic
  2. Actinomyces spp.
  3. Forms
    1. Cervicofacial = most common
      1. Slow, progressive, indurated mass
        Multiple abscesses & sinus tracts
      2. Yellow, purulent discharge
    2. Thoracic
    3. Abdominal
  4. Diagnosis
    1. Histopathology
    2. Cultures
4. Parasites
Non-infectious
1. Idiopathic OFG
  1. = restricted to oral cavity with no known granulomatous disease
2. Crohn's disease
  1. Clinical features
    1. Oral
      1. Angular cheilitis
      2. Cobblestone mucosa
      3. Aphthous-like oral ulcers
      4. Stomatitis
    2. Peripheral arthritis, erythema nodosum, pyogenic gangrenosum
    3. Uveitis, Episcleritis
    4. Diarrohea, weight loss, anaemia, abdominal pain
  2. = Inflammatory bowel disease
    1. Affects
      1. Proximal colon
      2. Terminal ileum
3. Melkerson's Rosenthal Syndrome
  1. Clinical presentation
    1. Fissured tongue
    2. Facial paralysis
    3. Facial swelling (lips)
      1. Most common = lower lip
    4. Rare for all to occur at the same time
  2. Management
    1. Elimination of diet
    2. Topical Steroids
    3. Weekly local injections of triamcinolone acetonide
  3. Aetiology
    1. Hypersensitivity
      1. Foods
      2. Dental materials
      3. Infections
        Mycobacteria
  4. Cheilitis granulomatosa
    1. Young adults
    2. Clinical presentation
      1. Recurrent, painless swelling of lips
      2. Swelling becomes firmer with each recurrence
    3. More common than complete triad
4. Wegener's granulomatosa
  1. Clinical presentation
    1. Systemic Vasculitis
    2. Necrotic glomerulonephritis
    3. Granulomatous lesions in respiratory tract
    4. Strawberry gingivitis = Hyperplastic granular gingivitis
    5. Hearing loss
    6. Lung symptoms (cough, haemoptysis
  2. Investigations
    1. Chest X-ray
    2. Biopsy
5. Sarcoidosis
  1. Clinical presentation
    1. Pulmonary issues
    2. Skin
      1. Erythema nodosum
    3. Liver
    4. Oro-facial
      1. Bilateral parotid swelling
      2. Soft tissue swelling
  2. Investigations
    1. Chest X-ray
      1. Bat wing
    2. Biopsy
    3. High blood ACE levels
  3. Young-middle aged women
  4. Treatment
    1. Corticosteroids
  5. = multisystem granulomatous disorder with unknown cause
6. Foreign body reaction

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Oro-facial Granulomatous Disorders

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	Created by Zainab Patel about 4 years ago

	Copied by sanna pathy about 4 years ago