RT Journal Article SR Electronic T1 Extensive bony sarcoidosis of the head and neck region: a rare presentation JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e237105 DO 10.1136/bcr-2020-237105 VO 14 IS 1 A1 Iman Usama Hosni A1 Bhavesh Karbhari A1 Robert Orr A1 Neil Opie YR 2021 UL http://casereports.bmj.com/content/14/1/e237105.abstract AB 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.