Orofacial Granulomatosis - Diagnosis and Management Algorithm Idiopathic OFG: isolated swelling of the lips, BX+ non-caseating granuloma Melkersson-Rosenthal syndrome: lip edema + fissured tongue + facial paralysis *Differential Dx: Crohn's, Sarcoidosis, TB, Foreign-body granuloma, Mycotic ulcer, Lymphoma, GPA, Syphilis, Cat-Scratch Dis. Up to 40% of children with OFG may have or develop CD Low threshold for eval. Mild Dx - Also applies to mild oral aphthous ulcers: • Elimination Diet* * • 5-ASA Mouthwash • Lidocaine pre-meals • Topical Steroids (Triamcinolone dental paste) • Intralesional Steroid Moderate-Severe DX - Moderate-Severe OFG, MRS: • Elimination Diet* * • Intralesional Steroid • Topical/Systemic Steroids • Immunomodulator • Biologic (Anti-TNF, UST) • Topical Tacrolimus • Dapsone, Clofazimine, Thalidomide Pyostomatitis Vegetans: • Rare oral manif. of IBD; UC>CD • Snail track appearance of oral mucosa • Asymptomatic or painful • Bx: eosinophilic microabscesses, • Resolve w Rx of IBD Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #OFG #Orofacial #Granulomatosis #Diagnosis #Management #Algorithm #treatment
