OFG

Question 1

what is OFG

Answer 1

persistent enlargement of the soft tissues of the oral & maxillofacial region,
chronic inflammatory disease ,granulomatous inflammation
granuloma obstructing lymphatics
delayed hypersensitivity reaction resulting in swelling - Th1 cell response
fluid unable to drain

Question 2

cause of OFG

Answer 2

• Unknown aetiology – complex – interacting factors
• Host immune response
• Environmental triggers – particularly allergens
• Genetic susceptibility

Question 3

OFG and crowns argument for same

Answer 3

• OFG which only presents in mouth/face , same disease entity as crohns just localised to the face region
  “oral crohns” and OFG indistingushable
  histopathology indistinguishable
  relapsing and remitting course

Question 4

what is current thinking on OFG vs crohns

Answer 4

• OFG & Crohn’s share similar phenotypic presentation
• However, subtle clinical & pathological differences justify OFG as a separate disease entity
• Crohn’s disease in conjunction with OFG represents a distinctive clinical subtype of Crohn’s – ‘Crohn’s with Oral Involvement’
  differing immune profiles on biopsy

Question 5

how to differentiate with OFG and crohns

Answer 5

ask about GI symptoms

Question 6

what type of hypersensitivity is present in OFG

Answer 6

type 4 and 1

Question 7

what food may people with OFG be sensitive to

Answer 7

benzoic acid
food additives
perfumes and flavouring
cinnamaldehyde

Question 8

epidemiology of OFG

Answer 8

• tens to be children and young adults

Question 9

histopathology of OFG

Answer 9

• non caseating granuloma with or without multinucleate giant cells
  -granuloma deep in oral mucosa
  -lymphaedema
  -dilated lymphatics
  -perivascular lymphocytic infiltrate

Question 10

clinical features of OFG

Answer 10

• lip swelling
  -buccal cobblestoning
  -gingival erythema
  -submandibular duct staghorning
• ulceration
  -mucosal tags

Question 11

investigations for OFG

Answer 11

• FBC, Haematinics; Inflammatory markers
• Fecal calprotectin
• Oral biopsy – deep
• If abdo symptoms – endoscopy & biopsy
• Serum ACE
• Patch testing – though results do not predict outcome with dietary avoidance

Question 12

treatment of OFG

Answer 12

• strict benzoate and cinnamon exclusion diet - 3 months
  topical Tx for angular chelitis - miconazole
  topical steroid for intraoral involvement
• Bertamethasone 500mcg tablets in water
• Flixonase 400mcg nasules in water
• Beclometasone inhaler 100mcg
• Clobetasol ointment 0.05%
  topical tacrolimus 0.1% skin involvement and lip swelling

Question 13

what condition sometimes presents with ulcerative colitis

Answer 13

• pyostomatitis vegetans

-rare
- Multiple pustules on an erythematouse base
- Affects labial & buccal mucosa; gingivae; tonsillar region
- These can erode to form ‘snail track’ ulcers