Granulomatous Diseases of Orofacial Region – A Review

Granulomatous diseases encompass a large family of disorders, sharing the histological denominator of granuloma formation. The granulomatous diseases of the head and neck are very unique entities that can mimic or hide malignant tumors and a wide assortment of diseases. They can cause a wide range of signs and symptoms in the head and neck region and also throughout the body. It poses a diagnostic dilemma for the clinician. The frequency of infectious granulomatous diseases is increasing with the increasing incidence of AIDS, multi-drug resistance and with the widespread use of immunosuppressive drugs. It is essential to nd the etiology of the disease and to recognize the granulomatous pattern in a biopsy specimen. Thus, a thorough history and a complete physical examination, along with radiological, histological and laboratory evaluation may be required for the correct identication of the granulomatous disease for its specic treatment. In this review, we have highlighted the features of the various granulomatous diseases of the orofacial region that are caused by diverse immunologic, idiopathic, neoplastic, infectious, and fungal processes and their diagnostic procedures.

1. Textbook of Pathology by Harsh Mohan, 7th edition.
2. Walter & Israel General Pathology, 7th Edition.
3. Williams CT., Granulomatous inammation – a Review: J Clin Pathol; 1983;36; 723-733.
4. Kauzman, Orofacial Granulomatosis: 2 Case Reports and Literature, J Can Dent Assoc 2006; 72(4):325–9.
5. ReviewSwati Gotmare et al Granulomatous Diseases of the Oral tissuesAn etiology & Histopathology, Scientic Journal Vol. I – 2007.
6. Jain P, Jain I. Oral Manifestations of Tuberculosis: Step towards Early Diagnosis. Journal of Clinical and Diagnostic Research: JCDR. 2014;8(12):ZE18-ZE21.
7. R. A. G. Khammissa, N. H. Wood, R. Meyerov, J. Lemmer, E. J. Raubenheimer, and Liviu Feller, “Primary Oral Tuberculosis as an Indicator of HIV Infection,” Pathology Research International, vol. 2011, Article ID 893295, 4 pages, 2011.
8. Cotran RS, KumarV., Robbins S. : Robbins pathologic basis of diseases: 5th ed.
9. Color Atlas of pathology – Pathologic principles Associated Disease sequel.
10. Prerna Pratik et al. Granulomatous Diseases Affecting Oral Cavity: A Review IJPCBS 2014, 4(4), 849-855.
11. Fucci da Costa AP, Augusto da Costa Ner y J, Wan-del-Rey de Oliveira ML, Cuzzi T, Ramos-e-Silva M. Oral lesions in leprosy. Indian J Dermatol Venereol Leprol 2003;69:38 1-5.
12. Miller M., Haddad AJ., Review article; Cervicofacial Actinomycosis; Oral Surg. Oral Med. Oral Pathol. Oral Radio endol: 1998; 85: 496-508.
13. Laura W. Lamps, and Margie A. Scott Cat-Scratch Disease - Historic, Clinical, and Pathologic Perspectives (2004) American Journal of Clinical Pathology, 121, S71-S80.
14. Leão Jair Carneiro, Gueiros Luiz Alcino, Porter Stephen R.. Oral manifestations of syphilis. Clinics. 2006 Apr ; 61( 2 ): 161-166.
15. Saccente M, Woods GL. Clinical and Laboratory Update on Blastomycosis. Clinical Microbiology Reviews. 2010;23(2):367-381.
16. Kruse et al. Primary blastomycosis of oral cavity. J Craniofac Surg. 2010 Jan;21(1):121-3.
17. Patil K, Mahima VG, Prathibha Rani RM. Oral histoplasmosis. Journal of Indian Society of Periodontology. 2009;13(3):157-159.
18. Vidyanath S, Shameena P, Sudha S, Nair RG. Disseminated histoplasmosis with oral and cutaneous manifestations. Journal of Oral and Maxillofacial Pathology: JOMFP. 2013;17(1):139-142.
19. Sreenath G, Prakash AR, Kanth MR, Reddy PS, Vidhyadhari P. Rhinomaxillary Mucormycosis with Palatal Perforation: A Case Report. Journal of Clinical and Diagnostic Research: JCDR. 2014;8(9):ZD01-ZD03.
20. Deepa A, Nair BJ, Sivakumar T, Joseph AP. Uncommon opportunistic fungal infections of oral cavity: A review. Journal of Oral and Maxillofacial Pathology: JOMFP. 2014;18(2):235-243.
21. Rath R, Baig SA, Debata T. Rhinosporidiosis presenting as an oropharyngeal mass: A clinical predicament? Journal of Natural Science, Biology, and Medicine. 2015;6(1):241-245.
22. Arseculeratne SN. Recent advances in rhinosporidiosis and rhinosporidiumseeberix. Indian J Med Microbiol. 2002;20:119–31.
23. Rameshkumar A et al Rhinosporidiosis Presenting as a Facial Swelling: A Case Report ,Journal of International Oral Health 2015; 7(2):58-60.
24. Kumar SL, Manuel S, John TV, Sivan MP. Extensive gingival myiasis - Diagnosis, treatment, and prevention. Journal of Oral and Maxillofacial Pathology: JOMFP. 2011;15(3):340-343.
25. Reddy MHR, Das N, Vivekananda MR. Oral myiasis in children. Contemporary Clinical Dentistry. 2012;3(Suppl1):S19-S22.
26. Sankari LS, Ramakrishnan K. Oral myiasis caused by Chrysomya bezziana. Journal of Oral and Maxillofacial Pathology: JOMFP. 2010;14(1):16-18.
27. Fabio Francesconi and Omar Lupi. Myiasis. Clin. Microbiol. Rev. January 2012 vol. 25 no. 1 79-105.
28. D Geraint James .A clinicopathological classication of granulomatous disorders. Postgrad Med J 2000;76:457-465 doi:10.1136/pmj.76.898.457.
29. Shigeyuki Asano. Granulomatous Lymphadenitis. J Clin Exp Hematopathol 52(1) : 1-16, 2012.
30. Jham et al. Granulomatous foreign-body reaction involving oral and perioral tissues after injection of biomaterials: a series of 7 cases and review of the literature. J Oral Maxillofac Surg. 2009 Feb;67(2):280-5.
31. Acharya S, Hallikeri K, Anehosur V, Okade A. Oral pulse or hyaline ring granuloma: A case report and a brief review. Journal of Indian Society of Periodontology. 2015;19(3):327-332.
32. Daley TD, Armstrong JE. Oral manifestations of gastrointestinal diseases. Canadian Journal of Gastroenterology. 2007;21(4):241-244.
33. Madala et al. Necrotizing Sialometaplasia: A Diagnostic Dilemma, OHDM - Vol. 13 - No. 3 - September, 2014.
34. Diane L. Carlson, MD , Necrotizing Sialometaplasia - A Practical Approach to the Diagnosis Arch Pathol Lab Med—Vol 133, May 2009.
35. Martínez DSM et al. Oral manifestations of Langerhans cell histiocytosis (LHC): Review of scientic literature and case report, Revista Odontológica Mexicana 2012;16 (2): 123-130.
36. Madrigal-Martínez-Pereda C, Guerrero-Rodríguez V, Guisado-Moya B, Meniz-García C. Langerhans cell histiocytosis: Literature review and descriptive analysis of oral manifestations. Med Oral Patol Oral Cir Bucal. 2009 May 1;14 (5):E222-8.
37. Batra P, Shah N, Mathur S. Midline lethal granuloma: A clinical enigma. Indian J Dent Res. 2003;14:174–83.
38. Mallya V, Singh A, Pahwa M. Lethal midline granuloma. Indian Dermatol Online J 2013;4:37-9.
39. Siar et al, Strawberry Gingivitis As The First Presenting Sign Of Wegener's Granulomatosis: Report Of A Case, Eur J Med Res (2011) 16: 331-334.
40. Rogers RS. Melkersson-Rosenthal syndrome and orofacial granulomatosis. Dermatol Clin. 1996 Apr;14(2):371-9.
41. Kaminagakura E, Jorge J Jr.Melkersson Rosenthal syndrome: a histopathologic mystery and dermatologic challenge. J Cutan Pathol. 2011 Feb;38(2):241-5.