presented by dr. amar sholapurkar - james cook … by dr. amar sholapurkar under the guidance of ......
TRANSCRIPT
![Page 1: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/1.jpg)
CHEILITIS GRANULOMATOSAReport of two Cases with Clinical
and Diagnostic ImplicationsPresented By
Dr. Amar Sholapurkar
Under the guidance of
Dr.Ausaf Ahsan
Department of Oral Medicine & Radiology, MCODS, Manipal.
![Page 2: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/2.jpg)
Introduction
• Cheilitis granulomatosa is a rare inflammatory disorder of unknown origin.
• The clinical recognition of this condition is important as is the subsequent investigation by an appropriate specialist.
![Page 3: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/3.jpg)
Introduction…
Accurate diagnosisMultiple
causes
Clinical features
Effective treatment
![Page 4: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/4.jpg)
Introduction…
• Age of onset – 2nd decade of life with female predilection.
• Estimated incidence – 0.08%
• We describe two cases of cheilitis granulomatosa, highlight to the general practitioner, the importance of differentiating this condition from other lip swellings.
![Page 5: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/5.jpg)
Chief complaintcase 1
• 66 yr old female patient – swelling of lower lip since 1 year.
• 31 year old male• Persistent painless
swelling of upper and lower lip since 2 years
case 2
![Page 6: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/6.jpg)
History of present illness
Case-I & Case-2
• lower lip became so swollen that it completely everted, compromising both speech and mastication.
• Patients c/o a cosmetic and very disturbing lip swelling
• painless & persistent.
• Swelling of both upper and lower lip occurred simultaneously.
![Page 7: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/7.jpg)
History of present illness….
• No h/o insect bite nor allergy to any substance.
• No h/o pus discharge, fever or any systemic symptoms.
• No h/o trauma or infection.
![Page 8: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/8.jpg)
History of present illness….
• No h/o GI symptoms.
• No past h/o tuberculosis.
• No episodes of facial paralysis.
• Both patients consulted family physician –antihistaminics prescribed – swelling did not subside.
![Page 9: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/9.jpg)
Past Medical History, Family History andDental History.
• Nothing relevant was reported.
• no oral habits.
![Page 10: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/10.jpg)
• Enlarged lower lip and middle 1/3rd of upper lip
• Lip was dry, shiny, with few fissures
• No evidence of vesicles or ulceration
• Enlargement of both upper and lower lips.
• Minor salivary ductal openings- not inflammed
• No evidence of vesicles or ulceration
EXTRAORAL EXAMINATION (Inspection)
Case 1 Case 2
![Page 11: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/11.jpg)
• Diffuse swelling which was everted to alarge extent exposing the vestibularmucosa. (case 1)
![Page 12: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/12.jpg)
Palpation revealed (case 1 & 2)
• No evidence of local rise in temperature.
• non tender and diffuse
• Rubbery in consistency.
![Page 13: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/13.jpg)
Case 1 Case 2
• Clicking was heard on right TMJ on opening the mouth.
• Right Submandibular lymph nodes were palpable, mobile and non tender.
• Normal.
• Normal
• Not Palpable
• Normal
TMJ examination
Lymph node examination
Facial nerve examination
![Page 14: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/14.jpg)
INTRAORAL EXAMINATIONcase 1 case 2
• Normal surface papillae
without fissuring.
• No enlargement
• normal
• Normal surface papillae
without fissuring.
• Prominent enlargement
• Nodular enlargement
Dorsum of tongue
gingiva
Buccalmucosa
![Page 15: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/15.jpg)
INTRAORAL EXAMINATION (case 2)
• Buccal mucosanodular enlargement
• Gingivaprominently enlarged
![Page 16: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/16.jpg)
DIFFERENTIAL DIAGNOSIS
Cheilitis Granulomatosa
• 1st diagnosis because of the presenting features. Labial tissues demonstrated a non tender, persistent swelling, with no h/o allergy, fever, trauma, infection or other systemic symptoms.
Melkersson-Rosenthal syndrome
• No signs of facial paralysis or fissured tongue.
![Page 17: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/17.jpg)
Cheilitis glandularisAbsence of • enlargement of labial salivary glands• Nodular texture of lip.• Inflamed erythematous duct orifices on labial
mucosa.
Angioedema• No h/o allergy to any substance.• The swelling was not recurring.• Did not subside even on treatment with
antihistaminics.
![Page 18: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/18.jpg)
Sarcoidosis
• No symptoms of fatigue, lethargy or any skin lesions, mediastinal involvement, and involvement of lungs or liver.
Crohn’s disease
• No GI symptoms
![Page 19: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/19.jpg)
Lymphangioma
• Congenital lesion
Hematoma, hemangioma and Ascher’s
syndrome were other less likely diagnosis
included.
![Page 20: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/20.jpg)
INVESTIGATIONS (case 1 & 2)Incisional biopsy of lower lip• Biopsy specimen revealed – non caseating
granulomatous infiltrates consisting of lymphocytes, foamy histiocytes, epitheloid cells and Langhan’s type of multinucleated giant cells.
• No foreign body
Case 1 Case 2
![Page 21: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/21.jpg)
Investigations….
Routine hematological tests
• normal
Silver methanamine stain
• Negative for fungal hyphae
Z-N stain
• Negative for TB bacilli
Chest radiograph
• Normal
![Page 22: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/22.jpg)
FINAL DIAGNOSIS(Case 1)
Based on history, examination,investigations and by ruling
out other conditions
CHEILITIS GRANULOMATOSA
![Page 23: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/23.jpg)
FINAL DIAGNOSIS(Case 2)
Orofacial granulomatosis with
cheilitis granulomatosa
as its component.
![Page 24: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/24.jpg)
TREATMENT• Intralesional injection of
triamcinolone acetonide – 10 mg/mL weekly for 8 weeks.
• Lip and buccal mucosaregained the normal consistency.
• Gingiva did not respond to treatment – gingivoplasty was advised.
![Page 25: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/25.jpg)
Pre-Treatment
Post-Treatment
![Page 26: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/26.jpg)
Pre-Treatment Post-Treatment
![Page 27: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/27.jpg)
CONCLUSION
• Cheilitis granulomatosa remains an
enigmatic disorder with multiple causes.
• The dental practitioner is likely to
encounter patients with this disorder and
hence correct diagnosis is imperative
which can play a major role in its
successful management.
![Page 28: Presented By Dr. Amar Sholapurkar - James Cook … By Dr. Amar Sholapurkar Under the guidance of ... gingivoplasty was advised. ... 8.ppt [Compatibility Mode]](https://reader033.vdocuments.site/reader033/viewer/2022051407/5ad14f3b7f8b9a0f198b4d15/html5/thumbnails/28.jpg)