Orofacial Granulomatosis

Question 1

what is the clinical presentation of orofacial granulomatosis?

Answer 1

Oedema in oral & facial tissues by blockage of lymphatic drainage due to an immune reaction

Question 2

how do you manage orofacial granulomatosis for a patient?

Answer 2

3 month dietary exclusion (Benzoate, cinnamon etc)

Topical tx for angular cheilitis/fissures (Antifungals miconazole & hydrocortisone steroid cream)

topical tx to lip swelling or facial erythema

Question 3

how do you determine if the condition is OFG or part of Crohns but with orofacial symptoms?

Answer 3

Pt also presents with GI symptoms

Faecal calprotectin screening

Question 4

what foods should be avoided when doing a diet exclusion trial for a patient with OFG or crohns?

Answer 4

Benzoic acid (tomato products)
sorbic acid
cinnamon
chocolate
preservatives E Numbers

PT MUST BE COMPLIANT 100% for 3 months

Question 5

what medical therapy would a specialist give to a patient with OFG?

Answer 5

• topical tx (miconazole for angular cheilitis) (tacrolimus ointment for lip swelling & facial erythema)
• Intralesional steroid injection
• Systemic tx for immune modulation (prednisolone)