The Diagnostic Dilemma and Prognostic Implications of Orofacial Granulomatous Diseases (OGD)

Abstract

Background: Orofacial granulomatous diseases (OGD) are heterogeneous group of disorders characterized by granulomatous type of chronic reaction. Its multifactorial causes and indistinct presentations may pose diagnostic challenge with great implications on the treatment outcome.

Objective: This study aimed to evaluate the prevalence, diagnostic challenges and its implications of the orofacial granulomatous diseases seen in a tertiary hospital.

Methods: A retrospective study of all histopathologically diagnosed granulomatous diseases of the orofacial region over 30 years period (January 1990 – September 2022). The data were retrieved from the archive of the Department of Oral Pathology and Medicine and were analyzed.

Results: A total of 12 cases were diagnosed histopathologically as orofacial granulomatous diseases within the study period. The mean age was 27.3 ± 9.9years with peak age group at 2nd decade of life (n=5, 41.7%). There were 7(58.3%) males and 5(41.7%) females with male to female ratio 1.4:1. The mid-facial region (n=9, 75%) was the commonest site of occurrence. Prior to biopsy, these 12 cases had clinical diagnosis of chronic granulomatous lesions (n=2, 16.7%), carcinoma of the maxillary antrum (n=1, 8.3%), ameloblastoma (n=1, 8.3 %), lymphoma (n=1, 8.3%), necrotizing fasciitis (n=1, 8.3%) and 6 cases (50.0%) had no clinical diagnosis. Only 3 (25%) cases did ancillary investigations and had definitive diagnosis; one case each of actinomycosis (n=1, 8.3%), aspergillosis (n=1, 8.3%) and (n=1, 8.3) deep mycoses. There was a case of Wegener’s granulomatosis (n=1, 8.3%) as the definitive diagnosis based on histopathology only.

Conclusion: The diagnostic challenge associated with OGD is due to arrays of possible aetiological factors and non-specific presentations. Hence, detailed history, prompt histopathological diagnosis with ancillary investigations is necessary for positively impact prognosis.