From Volume 51, Issue 6, June 2024 | Pages 418-420
Sarcoidosis involving the facial bones is rare; however, it may be identified as mild changes on dental radiographs. Awareness of this pathology is important to ensure early referral. Dental structures (if affected) should be preserved where possible.
CPD/Clinical Relevance: Awareness of the typical presentation of sarcoidosis, and the potential clinical signs, is relevant to dental practice.
Sarcoidosis is systemic multi-organ granulomatous condition characterized by non-caseating granulomas. This condition was first described by Hutchinson in 1875 and was termed ‘sarcoidosis’ by Boek in 1899.1 This condition most commonly affects the lungs, and presents with bilateral hilar lymphadenopathy; 20% of patients are asymptomatic. Multi-organ involvement occurs in moderate and severe cases, and can result in parotid gland enlargement.
Intra-osseous sarcoidosis is rare,2 and typically involves the hands and feet.3 This is termed sarcoid dactylitis (described as Perthes–Jungling disease in classical parlance),4 and involves 7% of cases. Radiographic diagnosis can be challenging because this condition is difficult to distinguish from degenerative arthropathies.4
Intra-osseous sarcoidosis involving the facial bones is rare. The published literature is limited to case reports.5,6 The majority of these report soft tissue lesions affecting the oral mucosa and periodontal tissues. These suggest that sarcoidosis can involve the oral tissues, periodontal tissues with and without bone loss, and the facial bones/alveolar mucosa without oral soft tissue lesions There are few cases reporting on involvement of the facial skeleton and alveolar bone. We present a case in which the dental manifestations of sarcoidosis were managed conservatively, with subsequent improvement in dental health with regression of the sarcoid lesion. This case highlights the importance of early diagnosis, early medical treatment, and limited operative intervention. A review of the literature shows that there does not appear to be a similar case of what appears to be complete resolution of an intra-osseous sarcoid lesion.
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