J. Angiocentric T/NK cell lymphoma: A special clinical-pathological entity of lethal midline granuloma. A case report. Laryngorhinoolologie 2001;80:410–415.
Lee PY, Freeman NJ, Khorsand J, et al. Angiocentric T-cell lymphoma presenting as lethal midline granuloma. Int J Dermatol 1997;36:419–427.
Mosqueda-Taylor A, Meneses-Garcia A, Zarate-Osorno A. et al. Angiocentric lymphomas of the palate: Clinico-pathological consideration in 12 cases J Oral Pathol Med 1997;26:93–97.
Torre V, Bucolo S, Galletti B, Cavallari V. Midfacial granuloma syndrome or an inflammatory non-specific disease? J Oral Pathol Med 2001;30:190–192.
Vidal E, Dean A, Alamillos F, et al. Lethal midline granuloma in a human immunodeficiency virus-infected patient. Am J Med 2001;111:244–245.
Angular Cheilitis
Angular cheilitis or perlèche is a common inflammatory disorder of the corners of the mouth.
Angular cheilitis has a multifactorial etiology. Systemic diseases (anemia, diabetes mellitus, human immunodeficiency virus [HIV] infection), xerostomia, habitual licking of the corners of the mouth, reduced vertical dimension of the face, and local infection by Candida albicans. Staphylococcus aureus and streptococci are the most common causes.
•Maceration, erythema, fissuring, erosions, and crusting at the commissures
•Saliva tends to pool at the corners of the mouth, keeping them moist and favoring Candida and bacterial infection
•Lesions are usually painful
The diagnosis is based on the clinical features.
Basic Guidelines
•Before any topical treatment the presence of a systemic disease should be ruled out. In cases with an underlying disease, control of the disease improves the angular cheilitis as well.
•If loss of vertical dimension is the cause it must be corrected by the dentist.
Suggested Therapies
•Application of a topical ointment with corticosteroids, antimycotics. and antibacterial agents, two to three times daily for 1-2 weeks improves the condition dramatically.
•Topical treatment with nystatin or imidazole ointment is helpful but not always curative.
•Systemic triazoles, e.g., itraconazole capsules 100 mg/day for 6 days or more, are necessary if oral candidiasis is diagnosed.
References
Appleton SS. Candidiasis: pathogenesis, clinical characteristics and treatment. J Calif Dent Assoc 2000;28:942–948.
Kuffer R, Husson C. Superficial and angular cheilitis. Ann Dermatol Venereol 2000;127:88–92.
Ohman SC, Dahlen G, Moller A, Ohman A. Angular cheilitis: A clinical and microbial study J Oral Pathol 1986;15:213–217.
Ohman SC, Jontell M, Dahlen G. Recurrence of angular cheilitis. Scand J Dent Res 1988;96:360–365.
Rose AJ, Aetiology of angular cheilosis. BDJ 1968;125:67.
Aphthous Ulcers
Recurrent aphthous ulcers (RAU) or recurrent aphthous stomatitis (RAS) are painful oral ulcerations that characteristically recur at intervals ranging from days to months or even years. They represent the most common lesion of the oral mucosa with an overall prevalence ranging from 15% to 30%. Females are more commonly affected than males. Although the lesions may appear at any age. they usually present during the second and third decades of life. Familial occurrence is common and about 30-40% of the patients with RAU have another affected family member.
RAU is one of the oldest oral diseases, to be known since the time of Hippocrates, yet its etiology still remains unclear. Many predisposing factors have been incriminated such as genetics, trauma, food hypersensitivities, stress, infections (Streptococcus sanguis and S. mitis, herpes simplex virus [HSV]-1, varicella zoster virus [VZV], cytomegalovirus), and systemic factors. Although predisposing factors may play a role in the development of RAU the disease is idiopathic and its etiology remains unknown. Accumulated data support the concept that the pathophysiology of RAU is immunologically mediated, and involves dysregulation of the cell-mediated immune response.
Based on clinical criteria, recurrent aphthae are classified into minor, major, and herpetiform ulcers (Table 1).
The main clinical features of the three forms are painful, recurrent oral ulcerations at intervals ranging from days to weeks or even months. The prodromal stage is variable and is usually characterized by discomfort and occasionally erythema of 1-3 days duration. This stage is soon followed by a painful oral ulcer.
The lesions are usually confined to movable nonkeratinized or poorly keratinized oral mucosa, e.g., buccal mucosa, labial mucosa, tongue, floor of the mouth, soft palate, and uvula.
Clinicians should bear in mind that RAU may be associated with several systemic disorders.
Systemic Disorders Associated with RAU
•Behçet disease
•Sweet syndrome
•Crohn disease
•Ulcerative colitis
•Celiac disease
•HIV infection
•Malabsorption syndromes
•Hematinic deficiencies
•Neutropenia
•FAPA syndrome
