OFG Flashcards
What is OFG?
Oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to an immune reaction.
What is angio-oedema?
- Angio-oedema- increased vascular permeability and leaking into surrounding soft tissues (sudden increase in fluid overwhelms lymphatic drainage resulting in ballooning of tissues)
- Fluid present within connective tissue
- Happens quickly in an hour- settles within 24-48 hours
How does OFG differ from angio-oedema?
There is no excess exudate from capillaries into tissue
- Obstruction to lymphatic drainage occurs and accumulates causing swelling (caused by giant cells)
- Can happen quickly
- Settles slowly
- Triggers can be present all the time- so can last months and years (intensity of condition will vary)
What other disease could be responsible for granulomatous effects in face and mouth?
- Sarcoidosis- LN and salivary glands (more common in pulmnory system)
- Tuberculosis
- Crohns- can affect any part of GI tract
-> all associated with giant cell production
What are the oral signs of OFG?
- Less swelling than angio-oedema
- Immune reactions- irritation at angles of mouth (angular cheilitis)
- Lip fissuring
- Crusting
- Erythema of peri-oral tissues (can go to eye and ear)
- Swelling of lips
- Full thickness gingivitis (starts off as erythema)- initially not plaque related but as false pockets emerge it can become plaque associated
- Swelling in floor of mouth at SM duct area (stag horning)
- Tags of mucosa
- Ulceration can be present- linear at depth pf sulcus (filled with granulomas on biopsy)
What occurs as a result of T1 hypersensitivity and what disease is it associated with?
Degranulation of mast cells in response to allergen- granules send vasoactive compounds into tissues which act on local blood vessels and increase vascular permeability and fluid exudate
-> Seen in Angio-oedema
What are the other types of hypersensitivity reactions?
T2- antibody mediated
T3- immune complex
T4- delayed (t cells are activated by allergen then trigger activation of macrophages)
What occurs in T4 hypersensitivity that can result in OFG?
T helper cells are activated and interact with/activate macrophages which attempt to phagocytose the allergen
If this is not possible- macrophages fuse to give giant cells (multinucleated) which try to phagocytose allergen (not always possible)
When does OFG present?
Can be any age- more common in children and adolescents
What is the severity of OFG for patients?
Some patients are unaware
-> mostly mild and controlled simply
What are the issues with severe unremitting form of OFG?
Reduced QoL
Appearance issues
-> may hamper child development
-> if extreme can lead to depression and prevent social contact
How is crohn’s screening carried out in children?
- Look out for abdominal pain and altered bowel habit- ensure patients parents keep eye on this
- Do not do colonoscopy unless evidence of GI disease
- Measure Faecal Calprotectin- marker for inflammatory bowel change (if over 7)
- Measure height and weight- should follow centile lines (if they move from one to the other it implies that there is growth, nutritional and bowel issues)
What is involved in initial management of OFG?
Consider whether true Oro-facial or related to Crohn’s
-> if crohn’s carry out screening
Diet history
-> identify overuse of allergens
-> consider exclusion diet trial
What foods are involved in exclusion diet for OFG?
Benzoic acid
-> found in carbonated drinks, can be replaced with water
-> remind patient this is found in many tomato based sauces
Sorbic acid
Cinnamon products
Chocolate
E210-219 where not included in the above
-> 100% compliance required for 3 months
What can be used to ensure exclusion diet is stuck to?
Food maestro- barcode scanning system to identify if allergens are present
