Orofacial Granulomatosis in Upper Lip : A Case Report

Introduction: In 1985 Wiesenfeld et al., suggest the terminology of “Orofacial granulomatosis (OFG)” to explain a chronic granulomatous lesion that involving the orofacial area include the lip, face and oral cavity, the histopathological examination usually associated with noncaseating granulomas and multinucleated Langhans‑type giant cells Aim of Reporting This Case: The aim of reportioning this case is highlighting the awareness of orofacial granulomatosis disease after excluding all diseases that has granulomatous lesion Case presentation: A 30-year-old male patient was referred to the oral medicine clinic due to swelling of the upper lip and redness of the gingiva. Clinical examination revealed a nodular lesion in the central area of the upper lip with a firm sensation upon palpation. Additionally, there was slight redness in the gingiva. The patient was medically fit, and our clinical differential diagnoses included Crohn’s disease, Wegener's granulomatosis, sarcoidosis, and orofacial granulomatosis. Lab tests requested for the patient included CBC, ACE, ESR, and CRP. All investigations yielded negative results.The patient was also referred to internal medicine for endoscopy.A biopsy was taken from the inner area of the upper lip under local anesthesia (1.8 mL of lidocaine with epinephrine) and sent for histopathological evaluation. The histopathology report showed non-caseating granulomas, confirming the final diagnosis of orofacial granulomatosis. Intra-lesional injection of triamcinolone acetonide (40 mg/10 mL) was initiated. At the 2-week follow-up visit, the patient reported softening of the upper lip, though the redness persisted. Conclusion: Swelling in the upper lip can have various potential causes, including Crohn’s disease, Wegener’s granulomatosis, sarcoidosis, and orofacial granulomatosis. Greater awareness of the oral manifestations of these conditions is essential for accurate diagnosis and effective treatment.