Orofacial granulomatosis is also referred to as granulomatous cheilitis, and is characterised clinically by chronic/relapsing swelling of the lips and oral mucosa.

Histology of orofacial granulomatosis

In orofacial granulomatosis, sections show oral mucosa with a sparse inflammatory infiltrate and mild oedema (figure 1). Higher power examination shows ectasia of lymphatics next to rare loose granulomas (figures 2-4, arrows indicate granulomas). Sometimes the granulomas may be difficult to find and extensive serial sectioning of the biopsy is recommended.

Figure 1

Figure 2

Figure 3

Figure 4

Special studies of orofacial granulomatosis

Special stains for microorganisms may be performed to rule out an infection, given the granulomatous nature of the infiltrate.

Differential diagnosis of orofacial granulomatosis

Melkersson-Rosenthal syndrome: Shows the exact same pathology but clinically also shows facial nerve palsy and a “scrotal” tongue.

Crohn disease: Oral involvement with Crohn disease will be histologically identical. Clinical correlation is needed.

Sarcoid: Sarcoidal granulomas tend to be more overt and larger but some cases can be difficult/impossible to distinguish from orofacial granulomatosis.