局限性口腔颌面部特异性感染的诊治与预防

口腔颌面部特异性感染是指由结核杆菌、放线杆菌、梅毒螺旋体、白色念珠菌等特异性病原体所引起的发生在口腔颌面局部的感染.发病率虽低,但若未经及时、有效治疗,可引起较为严重的颌面部感染,甚至危及患者的生命健康.文章就口腔颌面部特异性感染的病因、临床表现、诊断、治疗及预防等进行阐述,以期为口腔医生正确认识及有效诊治口腔颌面部特...     

Gardner综合征诊疗现状及进展

Gardner综合征是口腔颌面部疾病中比较罕见的一类疾病,以多发结直肠道息肉、多发性骨瘤、皮肤和软组织肿瘤三联征为特征.其早期治疗有更好的预后,因此早期诊断非常重要.Gardner综合征早期病变一般在口腔颌面部表现出来,因此,口腔医生在本病的早期诊断中扮演了重要角色.本文总结了Gardner综合征与基因突变相关的病因研究,并且归纳了Gardner综合征以口腔颌面部畸形、多发胃肠道息肉以及硬纤维瘤为特点的临床表现及其相关治疗的进展,综述如下.     

书籍名称：《新编口腔颌面部综合征》

本书介绍了临床常见的口腔颌面部综合征的相关知识。书中对每一综合征分别按别名、病因、病理、临床症状和口腔颌面部表现、诊断与鉴别诊断、治疗、预后等作了详细阐述。     

口腔颌面部出血急症分析

对五年收集的５００例口腔颌面部出血急症的病案进行分析，好发年龄以２５－４５岁为多，主要病因为交通事故损伤，拔牙术及口腔颌面部手术后并发出血及全身性疾病继发出血，在常规对症治疗的基础上，着重突出了综合性的临床急救原则，同时对口腔颌面部急症的病因诊断及治疗进行探讨，以提高对口腔颌面部出血急症的临床急救水平。     

口腔颌面部血管和脉管畸形治疗指南发布

<正>由中华口腔医学会口腔颌面外科专业委员会脉管性疾病学组起草制定的《口腔颌面部血管和脉管畸形治疗指南》在2008年12月出版的最新一期中国权威医学杂志《中华医学杂志》上全文发表。脉管性疾病包括血管瘤和脉管畸形两大类病损,系来源于血管或淋巴管的肿瘤或畸形。20世纪80年代以前,国内外学者对于脉管性疾病的研究未予足够重视,其分类和命名一直比较混乱。由此,给予我国警示和提示:必须制定口腔颌面部脉管性疾病的治疗指南,用科学的理论规范医疗行为,减少医疗纠纷和事故,不断提高口腔颌面部脉管性疾病的诊断、治疗和研究水平,为广大患者造福。     

嗜酸性淋巴肉芽肿四例误诊报告

嗜酸性淋巴肉芽肿四例误诊报告湖北医科大学口腔医学院·口腔医院（邮４３００７０）江波，赵怡芳嗜酸性淋巴肉芽肿亦称嗜伊红细胞增生性淋巴肉芽肿，是一种好发于颌面部软组织和淋巴结的肉芽肿性疾病，临床上易误诊为肿瘤等病奕。现就我科４例误诊病例报告如下，并对有关...     

卡瑞利珠单抗致牙龈及唇化脓性肉芽肿1例报道及文献回顾

目的 探讨卡瑞利珠单抗致口腔颌面部化脓性肉芽肿的临床表现、病理特征及治疗。方法 报道1例卡瑞利珠单抗致牙龈及唇化脓性肉芽肿病例并结合文献进行系统性回顾分析。结果 患者使用卡瑞利珠单抗治疗肝癌4个月后,出现全身反应性毛细血管增生症（reactive capillary hemangiomas,RCH）,随后出现下唇及牙龈多发肿物,患者行牙周基础治疗后,切除下唇及牙龈肿物并停用卡瑞利珠单抗,病理结果为牙龈化脓性肉芽肿/肉芽肿型血管瘤,术后随访口腔内未见新生肿物。文献回顾表明,RCH是卡瑞利珠单抗最常见的药物不良反应,发生于口腔者较少。目前尚未明确RCH病因,有研究表明卡瑞利珠单抗可能通过激活血管内皮细胞使其增殖为血管瘤;联合使用卡瑞利珠单抗安全性优于单用;RCH有自限性,大多数停药后可自行消退;若肿物引起功能障碍,可行手术切除。结论 卡瑞利珠单抗可致口腔颌面部反应性毛细血管增生症并发化脓性肉芽肿。     

口腔颌面部疾病的常用免疫诊断及其临床意义

口腔颌面部疾病的常用免疫诊断及其临床意义陆昌语口腔颌面部存在着与免疫有关的疾病，如感染性疾病、自身免疫性疾病以及免疫缺陷病等。免疫诊断有助于确诊与治疗这些疾病。在临床上具有一定意义。免疫诊断包括对机体的免疫机能的诊断及免疫性疾病的诊断。免疫机能的诊断...     

局限性口腔颌面部腺体组织感染的诊治与预防

口腔颌面部腺体组织感染是指具有分泌功能的腺体由于分泌通道阻塞合并细菌感染引起的感染性炎症.局限性腺体组织感染若未得到及时、有效治疗,感染可向腺体外组织扩散,引起口腔颌面部多间隙感染,也可通过血循环扩散发生败血症、脓毒血症或中毒性休克而危及生命.文章通过常见局限性腺体组织感染的病因、临床表现、诊断、治疗、预防以及特殊人群...     

口腔颌面部多间隙感染老年患者与中青年患者的临床比较

目的:通过与中青年患者的比较,分析口腔颌面部多间隙感染老年患者的临床特征。方法:对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析。所有病例根据年龄分为老年组和中青年组。研究内容包括一般资料、临床指标(全身系统性疾病、病因、症状发作到入院治疗的时间、受累间隙的数量和分布)、实验室检查(细菌学、入院时血糖水平、入院时白细胞总数和中性粒细胞百分比)和治疗结果(切口数量、住院天数和并发症)。采用SAS 8.0软件包对数据进行t检验、Fisher’s确切概率和χ2检验分析。结果:与中青年患者相比,老年患者患有更多的系统性疾病(P=0.0002),住院时程更长(P=0.02),全身各种并发症情况更多见(P=0.04)。结论:通过与中青年患者比较,揭示了口腔颌面部多间隙感染中的老年患者的临床特征,为临床上治疗老年口腔颌面部多间隙感染提供了重要的参考依据。     

Recurrent cutaneous metaplastic synovial cyst

Orofacial granulomatosis (OFG) is a granulomatous disease of the orofacial region. This clinicopathological entity describes patients with oral lesions characterized by persistent and/or recurrent labial enlargement, ulcers, and a variety of other orofacial features, which on biopsy have lymphedema and noncaseating granulomas. The cause is idiopathic but appears to represent an abnormal immune reaction. This may be a manifestation of Crohn's disease (CD) since some patients with oral lesions develop typical bowel symptoms of CD in ensuing months to years; tooth-associated infections, sarcoidosis, food or contact allergies, and viruses have also been implicated in causing OFG. Clinical features of OFG are highly variable and sometimes so insidious that signs and symptoms are frequently not severe enough to cause alarm. The lips are most commonly involved and demonstrate a nontender, persistent swelling. Because of the relatively nonspecific clinical findings associated with granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for clinicians. We report a case of OFG of the lower lip and cheek and describe its management to add to the current body of literature on the subject.     

Orofacial granulomatosis: review on aetiology and pathogenesis

Orofacial granulomatosis (OFG) is considered as an uncommon disease and nomenclature of the disease was subjected to debate for a long time. Although various aetiological agents such as food substances, food additives, dental materials and various microbiological agents have been implicated in the disease process its precise pathogenesis is yet to be elucidated. Delayed type of hypersensitivity reaction appears to play a significant role, although the exact antigen inducing the immunological reaction varies in individual patients. However, evidence for the role of genetic predisposition to the disease is sparse. The underlying immunological mechanism appears to show some similarities between OFG and Crohn's disease, emphasizing the need for more comparative studies of the two entities. Therefore, we propose the term idiopathic OFG as a better term for those cases restricted to oral region without any identifiable known granulomatous disease and the diagnosis should not be changed until the patient develops systemic manifestations of a specific granulomatous condition. This review attempts to discuss the role of different aetiological agents and certain aspects of pathogenesis of OFG.     

Experience with anti‐TNF‐α therapy for orofacial granulomatosis

J Oral Pathol Med (2011) 40 : 14–19 Background: Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti‐TNF‐α therapy is limited. We report our experience with infliximab (IFX) and adalimumab (ADA) for OFG in 14 patients, the largest reported series to date. Methods: A review of patients receiving induction and maintenance IFX for OFG +/? Crohn’s disease (CD) for active oral disease failing other therapies was performed. Clinical response defined by global physician assessment, aided by oral disease activity scores, was assessed at 2 months, 1 and 2 years. ADA was considered for patients failing IFX. Adverse events were recorded. Predictors of need for anti‐TNF‐α therapy were determined by comparison with OFG patients not requiring anti‐TNF‐α from our overall OFG database (n = 207). Results: Fourteen patients (9 men) were treated with IFX [OFG only (n = 7), OFG with CD (n = 7)]. Nine patients received concomitant immunosuppression. Median duration of treatment was 18 months. Short‐term response was achieved in 10/14 (71%) patients. Eight of 14 (57%) and 4/12 (33%) patients remained responsive at 1 and 2 years, respectively. Two patients who failed IFX responded to ADA. Factors predicting need for anti‐TNF‐α therapy were oral sulcal involvement, intestinal CD and a raised C‐reactive protein (CRP). Oral sulcal involvement predicted response at 1 and 2 years. Intestinal CD did not predict response. The only significant adverse event was an IFX infusion reaction. Conclusion: IFX provided good short‐term response for most OFG patients; however, a significant proportion lost response long term. Adverse events were uncommon. Patients failing IFX may respond to ADA.     

The multiform and variable patterns of onset of orofacial granulomatosis

BACKGROUND: The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable. PATIENTS AND METHODS: We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms. RESULTS: A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case). CONCLUSION: Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.     

Orofacial granulomatosis – a 20-year review

Orofacial granulomatosis (OFG) is the presence of persistent enlargement of the soft tissues of the oral and maxillofacial region, characterized by non-caseating granulomatous inflammation in the absence of diagnosable systemic Crohn's disease (CD) or sarcoidosis. Over 20 years have passed since OFG was first described and an extensive review of the literature reveals that there is no consensus whether OFG is a distinct clinical disorder or an initial presentation of CD or sarcoidosis. Furthermore, the precise cause of OFG is still unknown although several theories have been suggested including infection, genetic predisposition and allergy. The clinical outcome of OFG patients continues to be unpredictable. Current therapies remain unsatisfactory. Regular clinical review is indicated to identify the development of gastrointestinal or systemic involvement. The aim of this review was to analyse the developments in our understanding of the aetiology, pathogenesis and treatment protocols, with particular emphasis on management and outcomes of OFG since this entity was first described in 1985.     

Immunophenotype in orofacial granulomatosis with and without Crohn’s disease

Objectives: The aim of this investigation was to characterise and compare the inflammatory infiltrates in patients with orofacial granulomatosis solely (OFG-S) and OFG with coexisting Crohn’s disease (OFG+CD). Study Design: Biopsy specimens with granulomas were obtained from patients with OFG-S (n=11) and OFG+CD (n=11) and immunostained with antibodies against CD1a, CD3, CD4, CD8, CD11c, CD20, CD68 and mast cell tryptase, followed by quantitative analysis. Results: Analyses of the connective tissue revealed a significantly higher number of CD3-expressing T cells and CD11c-expressing dendritic cells in the connective tissue of patients with OFG-S compared to patients with OFG+CD. Mast cells displayed a high level of activation, although no significant difference was detected when comparing the two groups. Conclusions: The results show a different composition of the inflammatory infiltrate in patients with OFG-S compared to patients with OFG+CD. The present observations support that partly divergent immune mechanisms are involved in these two different subcategories of OFG. Key words:Granulomas, autoimmunity, T cells, B cells, dendritic cells, children, adults.     

Clinical behaviour and long‐term therapeutic response in orofacial granulomatosis patients treated with intralesional triamcinolone acetonide injections alone or in combination with topical pimecrolimus 1%

Background: Orofacial granulomatosis (OFG) is a relapsing inflammatory disorder of unknown aetiology and non‐standardized treatment protocols. The aim of this study was to assess the clinical behaviour and long‐term therapeutic response in OFG patients treated with intralesional triamcinolone acetonide (TA) injections alone or in combination with topical pimecrolimus 1%, as adjuvant, in those patients partially responders to TA. Methods: We analysed data from 19 OFG patients followed‐up for 7 years. Demographic characteristics, clinical behaviour and long‐term therapeutic response were investigated. Results: Eleven (57.9%) OFG patients treated with intralesional TA injections therapy reached first complete clinical remission in a mean time of 10 ± 2.2 (95% CI, 8.5–11.5) weeks, while eight (42.1%) patients, partially responders to intralesional TA injections, were treated with TA injections plus topical pimecrolimus 1%, as adjuvant, achieving complete clinical remission in a mean time of 29.8 ± 7.8 (95% CI, 23.2–36.3) weeks. Relapses occurred in four TA responder patients with a disease‐free time of 35.8 ± 8.7 (95% CI, 21.9–46.4) weeks and in five patients treated with TA and topical pimecrolimus 1% with a disease‐free time of 55.8 ± 18.5 (95% CI, 32.8–78.8) weeks. Patients were followed‐up for a mean time of 56.3 ± 18.2 (95% CI, 47.6–65.1) months. At last control, all 19 patients were in complete clinical remission. Conclusion: These preliminary data suggest that intralesional TA injections still represent a mainstay in the treatment of OFG. It is unclear the role of topical pimecrolimus, as adjuvant, in leading OFG patients, partly responders to intralesional TA injections, to a complete clinical remission.     

Lip impressions: a new method for monitoring morphological changes in orofacial granulomatosis

AIM: To develop and evaluate an objective method for assessing lip size and treatment-related morphological changes in orofacial granulomatosis (OFG) patients. MATERIALS AND METHODS: Patients with swollen lips because of OFG (n=21) were enrolled. A light-body polyvinylsiloxane material was used to take lip impressions before and after treatment (n=10), or during treatment (n=11). Plaster models were cast from the impressions and the lips were measured using callipers. The intra-examiner and inter-examiner reproducibility of the technique were assessed. RESULTS: OFG patients had significantly larger lips than controls (P<0.0001). The coefficient of variation on repeated measurements of the same impression was 1.6% and for duplicate impressions was 2.6%. Significant reduction in lip size was shown in all 10 patients after diet restriction (P<0.002). Seven of 11 patients whose impressions were taken at least 3 months after the initiation of cinnamon- and benzoate-free diet also showed reduction in lip size during follow up (P<0.002). CONCLUSIONS: Serial lip impressions appear to be reliable for routine quantification of morphological changes of the lips in OFG patients. We present a new reproducible and sensitive method for assessing changes in lip size in response to treatment in OFG.     

Onset and progression of clinical manifestations of orofacial granulomatosis

Background:  There remain few studies describing in detail the early occurrence and long-term progression of clinical manifestations of orofacial granulomatosis (OFG) in a substantial number of patients.
Objectives:  The aim of this study was to determine the early and late clinical manifestations of a large case series of patients with OFG.
Patients/methods:  Clinically relevant data of 49 patients with OFG who attended an Oral Medicine unit in the UK were examined retrospectively. The analyzed parameters included occurrence and typology of initial manifestations at onset and with respect to long-term follow-up.
Results:  Five major patterns of disease onset were observed. Recurrent facial swelling with/without intra-oral manifestations was the single most common presentation at onset followed by intra-oral ulcers, and other intra-oral and neurological manifestations. The majority of patients later developed a spectrum of additional features.
Conclusions:  OFG results in multiple manifestations at different time points. The disease onset is characterized by manifestations other than facial swelling in about half of affected individuals. However, patients can develop cosmetically unacceptable lip/facial swelling at a later stage. Nearly all affected individuals ultimately develop lip/facial swelling while about half of all patients develop oral ulceration.