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Chronic granulomatous inflammatory reactions are uncommon in the oral cavity. These lesions are reactive in origin and are characterized by macrophages which fuse to form multinucleated giant cells or transform into epithelioid histiocytes. Multiple etiologies exist for CGIR and include foreign body reactions to endogenous and exogenous materials, allergic reactions, infectious diseases (fungal or bacterial), sarcoidosis, and Crohn's disease. Here we review CGIR seen over ten years and attempt to clarify their etiologies with the hope that this data will yield information which will allow us to better guide clinicians in the evaluation and treatment of their patients. A review of all cases of CGIR from New York Presbyterian/Queens between 2007-2016 was performed. After eliminating all lesions where foreign material or fungal organisms could be seen, 120 cases of CGIR were identified. Additionally, cases seen in conjunction with a lichenoid inflammatory infiltrate were excluded from the review as they warrant further, separate study. Using relevant clinical information submitted as well as responses to a ten-question survey sent to doctors which included questions regarding the etiology of the CGIR, medical work up, the presence of additional lesions, treatment, progression and recurrence, we identified the following information. Of the 120 cases, 56 were male and 64 were female. The age range was 3–88 years old. 122 sites were identified as some cases had multiple lesions. Only 13 of the 122 lesions were central in bone. The most striking findings was that 9 cases occurred under the age of 18 and all these were in males. Two of these patients had intrabony lesions. In this group, Crohn's disease was found to be the commonest etiology, seen in 5 patients. Therefore, the finding of granulomas, especially intrabony, in a young male warrants a gastrointestinal work up prior to an extensive medical evaluation. |
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