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

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