Orofacial tubercular lesions

The aim of this study was to evaluate the clinical characteristics of orofacial lesions like ulcer, swelling, discharge (with or without fistulae), nodules (tubercles), granulomatous growth, induration, diffuse inflammation, and extraction socket involvement in an Indian population through the case reports and review of literature.

Four case reports are presented of patients who had orofacial lesions which turned out to be tuberculous. The diagnosis of tuberculosis was possible because it was kept high on the list of differential diagnosis of orofacial lesions. In our study, we used the following clinical criteria: 1) Suspicious lymph nodes should be biopsied. 2) Excision of non-healing, fistulous, or non-responsive lesions should be considered for biopsy. 3) Histopathological evidence of granulomatous inflammation with epithelioid cells and Langhan's giant cells or acid-fast bacilli should on Ziehl-Neelsen staining. 4) The patients' medical records were reviewed for details relating to presenting signs and symptoms, site and appearance of the lesions, chest x-ray findings, and sputum smear and tuberculosis culture results.

In all cases, the patients were prescribed antituberculosis therapy (ATT) by the physician. Strict follow-up was done to ensure completion of intensive phase therapy and both oral as well as pulmonary lesions were resolved.

Dentists and physicians treating orofacial lesions should be alert to the possibility of orofacial tuberculosis. Medical history should be taken very carefully and lymph node biopsy as well as other radiological and microbiological investigations should be carried out to rule out oral tuberculosis. Antituberculous therapy leads to successful resolution of the orofacial lesions.