In addition to sinonasal, respiratory and renal changes a patient with Wegener's granulomatosis may develop a number of lesions in and around the oral cavity. Sometimes these changes may precede the systemic manifestations for a period of time.


Clinical findings:

(1) oral ulceration

(2) perforation of the palate

(3) swelling of the lips

(4) desquamation of the lips

(5) enlargement of the parotid glands

(6) cranial nerve palsy

(7) delayed healing of a dental extraction

(8) strawberry gum (focus of hyperplastic gingiva, red to purple, with a granular surface)

(9) loosening and/or loss of teeth


Histologic features in an oral biopsy:

(1) irregular hyperplasia of the epithelium

(2) extravasation of blood with hemosiderin in the submucosa

(3) microabscesses with neutrophils and/or eosinophils in the submucosa

(4) scattered multinucleated giant cells may or may not be present


Necrotizing and granulomatous inflammation may not be seen in oral biopsies since these biopsies are often too small or superficial to include small or medium arteries.


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