oral med - OFG Flashcards
What is OFG?
Clinical Presentation of oedema (increase in fluid) in the oral and facial soft tissues by blockage of lymphatic drainage due to an immune reaction.
Describe how OFG swelling presents.
why is this the case?
swelling comes up quickly and settles very slowly – over weeks or months if at all - can be continuous.
This is because the trigger is present all the time/intermittently = often there is continuous swelling which changes in intensity from day to day or week to week.
Describe how OFG appears clinically. (10)
- Erythema of perioral tissues (not limited to the mouth – can extend to eye and ear)
- Swelling of the lower lip
- Angular cheilitis
- Changes in skin quality
- Fissuring and crusting of the lips
- Full thickness gingivitis (starts as erythema and then progresses)
- Can be plaque associated as false pocketing progresses with gingival enlargement
- Swelling of intraoral tissues e.g. FOM called stag horning
- Tagging of the oral tissues
- Ulceration (will have granulomas on biopsy) not associated with deficiency but associated with granulomas
What causes OFG?
Granulomas present within the tissues
What type of hypersensitivity reaction is associated with OFG?
Explain the reaction. (6)
Type 4 hypersensitivity reaction (delayed type):
- Trigger via an allergen
- T helper cells are activated and interact with macrophages
- active macrophages produced
- active macrophages phagocytose the allergen
- If phagocytosis of the allergen isn’t possible the macrophages fuse into multinucleated giant cells and try again to phagocytose the allergen
- MNGC obstruct the lymphatics
In OFG (and crohns) = Difficulty in removing the immune trigger = why we can see MGC histologically.
Why are multinucleated giant cells found histologically in OFG?
Difficulty in removing the immune trigger = cannot phagocytose the allergen
What other diseases can cause oral granulomas?
what disease is it important to differentiate from OFG?
Crohn’s Disease = common
- Sarcoidosis = rare (unless present in other body sites e.g. LN and salivary glands)
- Tuberculosis = rare (unless there is also pulmonary disease)
Crohns!!
How do we screen for Crohns? (3)
Ensure Parental awareness and stress importance of child’s altered bowel habits or abdominal pain
- Growth monitoring at each hospital visit via height and weight charts
- Measure Faecal Calprotectin assay (in those > 7) = Unreliable in younger children
= Good predictor of Crohn’s disease activity
Describe how a child with nutritional/bowel problems would appear on a height and weight chart.
Children should follow along any of the sentile lines on the charts (doesn’t matter which one)
If children growing across the lines and jumping from one to another = problem with nutritional and bowel problems
in what age of children are faecal calprotectin assays useful for crohns screening?
> 7 years old
Describe the characteristics of OFG - presentation. (2)
Can present at ANY age
- Common in later childhood and adolescent
however can appear unexpectedly in adult/elderly
Often present at a low level – patient unaware of the changes
What are the consequences of severe and unremitting forms of OFG? (3)
- Significant reduction in their quality of life
- Issues with appearance at a very important part of a child’s development
- Often will lead to depression and withdrawal from social contact when extreme
What is angio oedema?
oedema of the oral and facial soft tissues due to an INCREASE in fluid exudate/increase in vascular permeability which increased leakage of this fluid into the soft tissues = overwhelms drainage to the lymphatics
Describe how angio oedema swelling presents.
how does this differ to OFG and why?
Angio-oedema swelling comes up quickly (within an hour) and settles quickly – usually in 24-48 hours
vs OFG which is not caused by an increase of exudate from the capillaries into the tissues but is actually caused by obstruction of lymphatic drainage= accumulation of fluid in the soft tissues and has slow resolution since there are drainage issues
however AO can drain the exudate since there are no drainage issues
tissues are just brieft overwhelmed by the volume of exudate
What type of hypersensitivity reaction is associated with AO?
Explain the reaction. (2)
Type 1 hypersensitivity reaction
- degranulation of mast cells in response to an allergens
- these granules send vasoactive compounds into the tissues which increases the permeability of local blood vessels and fluid exudate
