Page 30 - C:\Users\uromn\Videos\seyyedi pdf\

Javadzadeh et. al Approach to orofacial granulomatosis and review . . .

the healing process. Side effects of local treat- the diagnosis of OFG. A swelling with verruc-
ments are limited to skin atrophy and hypopig- ous, popular, plaque-like, or ulcerative skin ac-
mentation. Use of systemic corticosteroids are companied by inflammation of salivary gland
limited due to chronicity and recurrence of the orifices differentiates OFG with cheilitis glandu-
disease and long-term nature of complications. laris, Wegener’s granulomatosis, sarcoidosis and
[18,62]. Clofazimine is indicated to be effective some deep fungal infections. Lack of systemic
in treating OFG. In a survey, treatment with involvement such as fever, weight loss, fatigue,
100mg clofazimine four times weekly for 3-11 malaise involvement of other parts of the body
months resulted in complete healing in the ma- such as GI and respiratory system can rule out
jority of patients. This was also effective in pa- the possibility of sarcoidosis, Crohn’s disease
tients with severe cheilitis granulomatosis. and Wegener’s granulomatosis. In addition, lack
[61,63]. Low dose thalidomide has been shown of evidence related to antral and nasal involve-
to be effective, but is not administered for preg- ment (such as obstruction, discharge, hemorr-
nant women and requires regular checkup. How- hage, and depression of nasal bridge) will suffice
ever, such administration showed favorable re- to rule out Wegener’s granulomatosis and lepro-
sults in patients who failed to respond favorably sy. Swelling of the lip(s) occur secondary to the
to previous treatments [64]. Topical tacrolimus swelling and involvement of the nose and its sur-
ointment is effective in treating oral lesions of rounding skin due to the spread of infiltrative
Crohn’s disease in children whose intralesional lesions. This finding is not in favor of diagnos-
injection are problematic [65]. Infliximab is an ing mucocutaneous leishmaniasis, leprosy and
anti-TNF-K antibiotic which is highly effective deep fungal infections. In case manifestations
in patients with colitis and Crohn’s disease. are accompanied by facial nerve palsy the term
[66,67]. Adalimomab is a recombinant monoc- Melkersson-Rosenthal syndrome is used. Al-
lonal antibiotic against TNF-K with effects simi- though it can occur in Wegener’s granulomato-
lar to Infliximab and is influential in treatment sis, sarcoidosis, tuberculosis and leishmaniasis,
of Crohn’s disease [68]. Other treatments pre- lack of naso-antral symptoms or involvement of
sented in literature include hydroxychloroquine, other body parts can help in diagnosis of OFG. It
methotrexate, azathioprine, metronidazole, mi- cannot be overemphasized that diagnosing OFG
nocycline, dapsone, and danazol [18,61, 69,70]. is not an end. OFG patients should be monitored
Esthetic lip surgery are suggested by some clini- for their systemic gastrointestinal and respiratory
cians when lips are quite enlarged and mal- symptoms which sometimes necessitates changes
formed and the disease do not respond well to in treatment planning. It should be taken into
local corticosteroids [71]. consideration that lack of additional symptoms
strengthens the likelihood of OFG.
Discussion
OFG is an uncommon disease with unknown Conclusion
etiology and pathogenesis. Etiologic factors such According to the fact that clinical features of
as nutrients, dental materials, microbiologic and OFG are nonspecific in nature, correct diagnosis
genetic factors are suggested by some authors. and treatment planning requires a comprehensive
Contrary to the abundance of diseases presenting clinical, laboratory and microscopic evaluation
manifestations similar to those of OFG such as in most cases.
persistent swelling of the lip(s) and other parts of
the face, some features such as swelling charac-
teristics, systemic involvement, antronasal in-
volvement, and neurologic features can lead to References

Summer 2012; Vol. 24, No. 3 117