A patient with Crohn's disease may develop oral lesions during or between episodes of active intestinal disease.
(1) recurrent aphthous ulcers
(2) painful ulcers in the vestibular sulci (vestibulum oris)
(3) swelling of the upper and/or lower lips
(4) swelling of the cheeks
(5) cobblestone-like thickening of the buccal mucosa
(6) mucosal tags
(7) angular stomatitis (angular cheilitis)
(8) vertical fissuring of the lips
(9) hyperplastic, granular gingivitis
(10) perioral erythema
(11) perioral scaling
(12) atrophic glossitis
(13) pyostomatitis vegetans
• Angular stomatitis and atrophic glossitis may be related to or made worse by vitamin and nutritional deficiencies.
• Some of these findings may be features of orofacial granulomatosis (OFG, see below)
• Some of the individual findings (mucosal erythema, painful ulcers, cobblestoning, etc) may be features of pyostomatitis vegetans.
(1) changes in lymphatics
(1b) endovasal granulomatous lymphangiitis (mononuclear cells in or about the walls of the lymphatic vessels)
(2) focal lymphocytic inflammatory response
(3) noncaseating granulomas (which may be missed if a superficial biopsy is taken)
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Specialty: Otolaryngology, Immunology/Rheumatology