Noncaseating granulomatous inflammation of the orofacial region and its potential association with underlying systemic disease: a clinicopathological analysis of 19 cases

Abstract

Introduction

Noncaseating granulomatous inflammation can be an inconclusive finding in many cases involving the oral cavity that may steer clinicians toward forming a differential diagnosis including (1) Crohn’s disease, (2) sarcoidosis, (3) chronic oral infection, (4) foreign material, or (5) allergies. Nineteen clinical cases were identified from the biopsy database at the University of Utah between October 2021 and March 2023. The main objective was to compare the findings and diagnoses of these cases through the lens of similar studies in today’s literature to leave clinicians better informed about trends of both systemic involvement and the most common location of clinical presentation. Materials and Methods. Five parameters were chosen to be evaluated: (1) patient’s age, (2) gender, (3) diagnosis, (4) location differing from the most common site of the upper lip, and (5) the absence of any diagnostic tests performed to arrive at proper diagnosis.

Results

Ages ranged from 6 to 83 years old—median being 52—nine male, 10 female. None of the lesions were associated with Crohn’s or allergies. One specimen was associated with sarcoidosis, one tested positive for infection, two for foreign material contamination, and two that were consistent with lichen planus. The remaining 13 had no definitive diagnosis but were signed off less-specifically as orofacial granulomatosis. Only one case presented on the upper lip.

Conclusions

Although only six of the 19 specimens were determined to have a more definitive cause, the other 13 were only given a diagnosis of either noncaseating granulomatous inflammation or orofacial granulomatosis because further testing for systemic factors was not performed. The hope is that future studies will highlight how much more common systemic involvement proves to be when patients elect to follow through with further systemic testing—allowing clinicians to treatment plan better for patients with these conditions.