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Extensive bony sarcoidosis of the head and neck region: a rare presentation
  1. Iman Usama Hosni1,
  2. Bhavesh Karbhari2,
  3. Robert Orr1 and
  4. Neil Opie2
  1. 1Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Chesterfield, UK
  2. 2Oral and Maxillofacial Surgery, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, Derbyshire, UK
  1. Correspondence to Dr Iman Usama Hosni; imanhosni{at}hotmail.co.uk

Abstract

We present a rare case of sarcoidosis with extensive bony destruction of the maxillofacial and skull base bones. A 65-year-old woman was referred with an asymptomatic, non-healing dental socket. Examination revealed an oroantral fistula that was biopsied and repaired under general anaesthesia. Investigations included plain and cross-sectional imaging. Serological tests, in particular ACE, were normal. Histology showed benign florid granulomatous inflammation. At 6 months, the patient remained asymptomatic. She was re-referred 3 years later with further bony destruction of her maxilla and mandible. Repeat imaging showed intrathoracic lymphadenopathy and skull base involvement. Repeat biopsy confirmed granulomatous inflammation. Given the pulmonary, histological and radiological findings, a sarcoidosis diagnosis was made. Following multidisciplinary team meetings, the patient was treated with methotrexate and arrangements made for close monitoring. This case highlights the need for a consensus in identifying, treating and developing a follow-up protocol in such patients.

  • dentistry and oral medicine
  • rheumatology
  • oral and maxillofacial surgery
  • lung function
  • respiratory system

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Footnotes

  • Contributors This work was supervised by NO and RO. The report was co-authored by IUH and BK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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