口腔疾病防治 ›› 2020, Vol. 28 ›› Issue (7): 449-452.DOI: 10.12016/j.issn.2096-1456.2020.07.008

• 防治实践 • 上一篇    下一篇

肉芽肿性唇炎的诊治体会及文献复习

李洁婷(),欧阳瑾   

  1. 广东省中山市中医院口腔科,广东 中山(528400)
  • 收稿日期:2019-07-08 修回日期:2020-03-01 出版日期:2020-07-20 发布日期:2020-06-04
  • 通讯作者: 李洁婷
  • 基金资助:
    广东省中山市卫生局项目(2017J058)

Diagnosis and treatment experience of granulomatous cheilitis: case report and literature review

LI Jieting(),OUYANG Jin   

  1. Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan 528400, China
  • Received:2019-07-08 Revised:2020-03-01 Online:2020-07-20 Published:2020-06-04
  • Contact: Jieting LI

摘要:

目的 探讨肉芽肿性唇炎(granulomatosa cheilitis,GC)的病因、诊断以及治疗方法。 方法 对1例反复发作1年余的GC患者,不使用任何药物治疗,仅通过可能与疾病相关的牙齿的系统治疗,观察其疗效,并回顾相关文献。结果 患者右下唇唇红处明显肿胀,局部柔软,触之有垫褥感,压之无凹陷性水肿。右下颌皮肤可见大片暗红色皮疹,伴局部脱屑。口内见35、46、47残根,11~24烤瓷桥,15、16、26、36深龋洞,全口大量牙结石,牙龈缘明显充血红肿。组织病理检查示:真皮浅层大量淋巴细胞浸润,局部见肉芽组织,可见大量浆细胞及嗜酸细胞浸润。诊断为:①GC;②35、46、47残根;③15、16、26、36深龋;④牙龈炎。治疗方案为分次拔除35、46、47残根,牙周基础治疗,15、16、26、36充填治疗。除拔牙后常规口服头孢呋辛酯片3天外,未予任何其它药物治疗。治疗5周后下唇肿胀及皮肤皮疹完全消失,随诊观察半年,未见复发。通过文献回顾分析发现,GC可能与免疫、感染、遗传等多种因素有关,而口腔局部感染病灶可能与GC的发病密切相关。结论 去除口腔局部感染病灶对治疗GC有效,口腔局部感染病灶可能与GC的发病有密切关系。在治疗GC时,应注意对口腔情况进行系统检查,在治疗的早期即开始对口腔内可疑病灶进行治疗。

关键词: 唇炎, 肉芽肿性, 牙源性, 感染病灶, 发病机制, 牙齿系统治疗, 无菌性炎症, 淋巴细胞归巢

Abstract:

Objective To investigate the etiology, diagnosis and treatment of granulomatous cheilitis(GC). Methods For a patient with recurrent granulomatous cheilitis for more than 1 year in whom no medical treatment was used, only systemic treatment of the teeth was performed, and its efficacy was observed. We also reviewed the relevant literature. Results The vermilion of the right lower lip of the patient was obviously swollen and soft. There was rebound and no pitting edema with palpation. A large dark red rash with local desquamation was observed on the skin over the right mandible. There were residual roots in tooth 35, 46, and 47, a porcelain bridge on 11-24, deep caries in 15, 16, 26, and 36, and many calculi in the whole mouth, and the gingival margin was obviously congested and swollen. Histopathological examination showed many lymphocytes infiltrated the superficial dermis, and granulation tissue, plasma cells and eosinophils infiltrated locally. The diagnosis was as follows: ① GC; ② 35, 46, and 47 residual roots; ③ 15, 16, 26, and 36 deep caries; ④ gingivitis. The treatment included extraction of 35, 46, and 47 residual roots, periodontal basic treatment, and fillings for 15, 16, 26, and 36. No drugs were administered except for 3 days after tooth extraction. After 5 weeks of treatment, the swelling of the lower lip and the skin rash completely disappeared. There was no recurrence in the follow-up observation at six months. Through a literature review and analysis, we found that GC may be related to various factors such as immunity, infection, and genetics. Local oral infections may be closely related to the incidence of GC. Conclusion Resolution of local oral infections is effective for the treatment of granulomatous cheilitis, and local oral infections may be closely related to the onset of granulomatous cheilitis. In the treatment of granulomatous cheilitis, attention should be paid to the systematic examination of the oral condition, and the treatment of suspected lesions in the oral cavity should begin in the early stages of treatment.

Key words: cheilitis, granulomatous, odontogenic, infected lesion, pathogenesis, systemic treatment of the teeth, aseptic inflammation, lymphocyte homing

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