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BDS4 Oral Medicine > OFG > Flashcards

OFG Flashcards

1
Q

What is OFG

A
  • clinical presentation of oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to immune reaction
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2
Q

How does angio-oedema present

A
  • appears quicklu
  • settles quickly
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3
Q

What is angio-oedema due to

A
  • increased fluid exudate from capillaries, due to increased vascular permeability
  • no lymphatic drainage as level of fluid overwhelms lymphatic system
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4
Q

Why does angio-oedema settle quickly

A

24-48 hours needed for lymphatic system to drain that fluid exudate
lymphatic drainage is normal

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5
Q

Why does OFG settle slowly

A

lymphatic drainage is blocked by granulomas
can take weeks and months to settle with fluctuating swelling

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6
Q

Why is OFG considered a provisional diagnosis

A
  • only OFG when no cause identified
  • causes of ‘OFG’ are sarcoidosis, tuberculosis and crohn’s
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7
Q

What is sarcoidosis

A
  • formation of granuloma present
  • lungs usually effected
  • oral presentation uncommon
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8
Q

What is tuberculosis

A
  • bacterial infection
  • formation of granulomas
  • oral presentation uncommon
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9
Q

What is crohn’s

A
  • formation of granulomas
  • type of inflammatory bowel disease
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10
Q

What type of hypersensitivity reaction is angio-oedema

A
  • type 1
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11
Q

What is type 1 hypersensitivity reaction

A
  • degranulation of mast cells in response to an allergen which causes vasoactive compounds to be released
  • act upon local vessels to increase permeability and fluid exudate
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12
Q

What type of hypersensitivity reaction is OFG

A

type 4

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13
Q

What is a type 4 hypersensitivity reaction

A
  • delayed hypersensitivity
  • t cells are activated by an allergen
  • trigger macrophage activity which try to phagocytose the allergen
  • eventually form multinucleate giant cells due to their struggle phagocytosing
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14
Q

What is the presentation of OFG

A
  • any age - childhood/adolscent most common
  • often presents at low level where px is unaware
  • most cases are mild
  • severe and unremitting OFG can be extremely disabling for px
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15
Q

What are the clinical features of OFG

A
  • lip swelling and fissuring
  • angular cheilitis
  • cobblestoning
  • gingivitis (not plaque related)
  • ulceration
  • microscopic granuloma
  • erythema
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16
Q

How does the ulceration in OFG present

A
  • linear ulcer at depth of sulcus
  • filled with granuloma
17
Q

What screening is done for crohns based on OFG

A
  • make px aware to look out for altered bowel habits and abdominal pain
  • monitor growth - should follow one defined centile line. moving from line to line indicates nutritional and GI problem
  • faecal calprotectin test
18
Q

What does the faecal calprotectin test represent

A
  • good marker for inflammatory bowel changes
  • unreliable in <7YO
  • can be used for screening for endoscopy
19
Q

What is the initial management for OFG

A

reach definitive diagnosis
* rule out crohn’s
diet history
* exclusion diet

20
Q

What are the common dietary triggers for OFG

A
  • fizzy drinks
  • benzoic acid
  • sorbic acid
  • cinammon products
  • chocolate
  • remember tomato and tomato products contain benzoates
21
Q

What is an exclusion diet

A
  • remove all dietary triggers from diet
  • 100% compliance 3 months
  • can re-introduce slowly after and monitor for recurrance to identify exact triggers
22
Q

What are the medical therapies that specialists may prescribe

A
  • topical tx
  • intralesional steroid injection
  • systemic tx to modulate immune system
23
Q

What is the topical tx for OFG

A
  • miconazole for angular cheilitis
  • tacrolimus ointment for lip swelling and facial erythema
24
Q

What is intralesional steroid injection

A
  • injected into area of swelling
  • usually weekly for 3 wks
  • usually needs repeated every 6 months
25
Q

What is the systemic tx used to help immune modulation

A
  • pulsed azithromycin
  • systemic immune modulated - prednisolone, azathioprine, mycophenolate

BDS4 Oral Medicine (17 decks)

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