Orofacial Granulomatosis Flashcards
what is OFG
clinical presentation of oedema in oral and facial soft tissue by blockage of lymphatic drainage due to immune reaction
what is angio-oedema
oedema of oral and facial soft tissues due to an increase in fluid exudate from capillaries but with no lymphatic drainage
what is the difference between OFG and angio-oedema
OFG swelling does not settle for weeks/months whereas angio-oedema settles in 24-48hrs
histologically what happens in angio-oedema
lots of fluid in the connective tissue
histologically what happens in OFG
giant cells form within tissue obstructing lymphatics (multinucleic appearance)
what type of hypersensitivity is OFG
type 4 - delayed type reaction where T cells are triggered which trigger macrophages
what type of hypersensitivity is angio-oedema
type 1 - degranulation of mast cells
why are multinuclear giant cells present in OFG
as there is difficulty removing the immune trigger
what is the screening for crohns
bowel movement monitoring
growth monitoring
faecal calprotectin
how do you manage OFG
3 month dietary exclusion
topical treatment to angular cheilitis
topical treatment to lip swellings
what is the initial management of OFG
consider whether it could be part of crohns first - do screening
take dietary history - discuss exclusion trial
what foods must you avoid in dietary exclusion diet
benzoic acid
sorbic acid
cinnamon products
chocolate
how long is the dietary exclusion diet for
3 months
what topical treatment is used for OFG
miconazole to angular cheilitis
tacrolimus ointment to lip swelling
when is intralesional steroid injections used for OFG
into areas of swelling weekly for 3 weeks
