Wiesenfeld D, Ferguson MM, Mitchell DN, MacDonald DG, Scully C, Cochran K, Russell RI. Orofacial granulomatosis – a clinical and pathological analysis. Q J Med. 1985; 54:101-113
Campbell H, Escudier M, Patel P, Nunes C, Elliot TR, Barnard K Distinguishing orofacial granulomatosis from Crohn's disease: two separate disease entities?. Inflamm Bowel Dis. 2011; 17:2109-2115
Gibson J, Wray D. Human leucocyte antigen typing in orofacial granulomatosis. Br J Dermatol. 2000; 143:1119-1121
James J, Patton DW, Lewis CJ, Kirkwood EM, Ferguson MM. Oro-facial granulomatosis and clinical atopy. J Oral Med. 1986; 41:29-30
Campbell H, Escudier M, Patel P, Challacombe SJ, Sanderson JD, Lomer MC Review article: cinnamon- and benzoate-free diet as a primary treatment for orofacial granulomatosis. Aliment Pharmacol Ther. 2011; 34:687-701
Guttman-Yassky E, Weltfriend S, Bergman R. Resolution of orofacial granulomatosis with amalgam removal. J Eur Acad Dermatol Venereol. 2003; 17:344-347
Ellison R, Green C, Gibson J, Ghaffar S. Orofacial granulomatosis related to amalgam fillings. Scott Med J. 2013; 58:e24-e25
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; 98:1162-1167
Sainsbury CP, Dodge JA, Walker DM, Aldred MJ. Orofacial granulomatosis in childhood. Br Dent J. 1987; 163:154-157
Noble J, Ahing SI, Karaiskos NE, Wiltshire WA. Nickel allergy and orthodontics, a review and report of two cases. Br Dent J. 2008; 204:297-300
Jensen CS, Lisby S, Baadsgaard O, Byrialsen K, Menné T. Release of nickel ions from stainless steel alloys used in dental braces and their patch test reactivity in nickel-sensitive individuals. Contact Dermatitis. 2003; 48:300-304
Bourke J, Coulson I, English J. Guidelines for the management of contact dermatitis: an update. Br J Dermatol. 2009; 160:946-954
A case is presented of a 14-year-old male patient being treated with a fixed orthodontic appliance who presented with a persistent upper lip swelling. The patient was experiencing discomfort from the appliance and the appliance was debonded. A diagnosis of orofacial granulomatosis was established and the patient was managed carefully with a cinnamon- and benzoate-free diet leading to resolution of the swelling. Orofacial granulomatosis is a rare condition and its presentation, diagnosis, and management are discussed.
CPD/Clinical Relevance: Orthodontists should be aware of the presentation of orofacial granulomatosis and the possible challenges associated with managing these patients.
Article
Orofacial granulomatosis (OFG) is an uncommon chronic granulomatous inflammatory condition affecting the lips, face and oral mucosa in the absence of any recognized systemic condition.1 Swelling of the oral tissues is the most common presentation; erythema, cobblestoning, mucosal tags, ulceration, fissures and nodules may also be evident.2 The presence of long-standing disease may lead to the development of mucosal scarring. Histologically, OFG is characterized by non-caseating granulomas with multinucleated giant cells of macrophage origin, and oedema of the tissues.
The aetiology of OFG remains unclear with several theories having been postulated. Weak evidence exists for a genetic aetiology, as certain Human Leucocyte Antigen (HLA) alleles are more common in OFG patients than in the general population.3 An association with food intolerances and a history of atopy are also linked with this condition. A previous study has illustrated that up to 60% of patients with OFG were atopic, showing IgE reactions to common allergens.4 Food substances may be causative, or lead to the precipitation of the disease process. Common sensitivities include: benzoic acid, cinnamaldehyde, cinnamon, benzoates and chocolate.5 These can be found in foods which form part of a regular diet and may also be ‘hidden’ when used as food additives and labelled as ‘E-numbers’.
Register now to continue reading
Thank you for visiting Orthodontic Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
