Rare and Unusual Cause of Ulceration of The Inner Cheek

Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Rare and Unusual Cause of Ulceration of the

Inner Cheek
Authors
1) 2)
ZAHRA SAYAD¹: corresponding author NAJWA BELHAJ²:
Department of Oral and Maxillofacial surgery, Ibn Sina Department of ENT, Ibn Sina University Hospital center
University Hospital center City: Rabat
City: Rabat Country: Maroc
Country: Maroc
3) 4)
SOPHIA NITASSI²: RAZIKA BENCHEIKH²:
Department of ENT, Ibn Sina University Hospital center Department of ENT, Ibn Sina University Hospital center
City: Rabat City: Rabat
Country: Maroc Country: Maroc
5) 6)
ABDELILLAH OUJILAL²: M.A BENBOUZID²:
Department of ENT, Ibn Sina University Hospital center Department of ENT, Ibn Sina University Hospital center
City: Rabat City: Rabat
Country: Maroc Country: Maroc
7) 8)
SALMA BENAZZOU¹: Leila ESSAKALLI²
Department of Oral and Maxillofacial surgery, Ibn Sina Department of ENT, Ibn Sina University Hospital center
University Hospital center City: Rabat
City: Rabat Country: Maroc
Country: Maroc
9)
MALIK BOULAADAS¹:
Department of Oral and Maxillofacial surgery, Ibn Sina University Hospital center
City : Rabat
Country : Maroc
Abstract:- Mouth ulcers and mouth inflammation are Oral damage usually occurs in the form of an ulcer.
variable in appearance and size and can affect any part The value of early diagnosis and rapid treatment of
of the mouth, the types and causes of mouth ulcers are tuberculosis due to the progressive and contagious nature of
many and vary widely. These can be caused by infection, the disease. [2]
system disease, a physical or chemical irritant, or an
allergic reaction. In this work, we report the observation The objective of reporting this observation is to insist
of a patient presenting an ulceration of the inner right on the importance of evoking this diagnosis despite its low
cheek whose etiological assessment revealed a rare cause prevalence, to underline the interest of making the early
for an unusual location. diagnosis in the adequate management especially in the face
of this primary form with a localization that is unusual and
Keywords:- Ulcer, Inner Cheek, Tuberculosis. not obvious.
I. INTRODUCTION II. CASE REPORT
Tuberculosis (TB) is a chronic infectious disease We report in this work the story of a 45-year-old
caused by Mycobacterium tuberculosis. The lung is the most patient with a history of alcoholism and chronic smoking
common site, followed by lymph node damage. However, ceasing 2 years ago, without any notion of atopy, no notion
any organ in the body can be affected. Extra-pulmonary of follow-up for a particular system disease.
tuberculosis accounts for 25% of cases of which 10-15%
have been detected in the head and neck region, with oral The patient presented for a consultation with a chronic
involvement estimated at less than 5% of total tuberculosis ulcerative lesion on the inside of the right cheek that had
cases. [1,2] progressed for 4 months, painful, interfering with eating,
bleeding on contact, without lymphadenopathy, cough, or
other associated signs. (Figure 1)
IJISRT21MAR456 www.ijisrt.com 845

ISSN No:-2456-2165
The clinical examination objectified an ulceration of attainment of the inner face of the cheek which very little
the internal face of the right cheek, measuring 2 centimeters reported in the literature.
long, well limited, without extension towards the Stenon,
cervical palpation discovered lymphadenopathy. The Faced with this chronic ulcer, the diagnosis of
remainder of the body exam was normal. Faced with this tuberculosis is often misunderstood or forgotten by
clinical picture, we first evoked a cancerous pathology, a clinicians in the face of the multitude of differential
biopsy was performed under local anesthesia, the surprise diagnoses ranging from a simple trauma, syphilitic or
was that the anatomopathological study showed a significant syphilitic carcinoma squamous cell leading to a
polymorphous inflammatory infiltrate with the presence of misdiagnosis. Physicians and dentists should be aware of the
epithelioid granulomas centered on caseous necrosis in favor oral lesions of tuberculosis and take them into account in the
of caseo-follicular tuberculosis. (Figure 2) An x-ray of the differential diagnosis of suspect oral ulcers.
lung which returned to normal and a retroviral serology
which returned positive. Namely that oral tuberculosis is a disease paucity of
bacilli and the concentration of acid-resistant bacillus
The patient was referred to the internal medicine and (BAA) is significantly lower in saliva which makes the
infectious diseases department for retroviral treatment and sensitivity of microscopic examination as well as the culture
for anti-tuberculosis treatment consisting of a combination very low. In various studies, the positivity of the AFB smear
of 4 drugs [isoniazid (INH), rifampicin (RIF), pyrazinamide in various biopsy samples of the oral lesion was found at
(PZA) and ethambutol (ETO)] administered daily for the around 7.8%. [6]
first 2 months, followed by an additional 4 months with 3
drugs (INH, RIF and retroviral). The histopathological study of a biopsy sample is
necessary to rule out a carcinogenic origin but also to
The patient was seen again in consultation 2 months confirm the definitive diagnosis of TB by highlighting a
after starting the treatment, the endo-oral examination classic caseous granuloma with central necrosis, surrounded
showed a decrease in the diameter of the lesion, one year by epithelioid cells, type of Langhans giant cells and
after the evolution was satisfactory with the total lymphocyte infiltrate. However, under immunosuppressed
disappearance of the ulceration. conditions such as acquired immunodeficiency syndrome,
there may be an unseeded granuloma. In the majority of
III. DISCUSSION cases, a single biopsy may not be sufficient as
granulomatous changes may not be evident in early lesions.
Tuberculosis (TB) is a chronic granulomatous Sometimes repeated biopsies seem to be necessary. [4,7]
infectious disease that can affect various parts of the body,
including the oral cavity caused by Mycobacterium If oral tuberculosis is diagnosed, it is important to
Tuberculosis. [2] supplement with a full somatic examination, chest x-ray and
Mantoux skin test to eliminate systemic tuberculosis and
According to the World Health Organization, retain the primary character of oral impairment. [8]
tuberculosis is a major public health problem, which can
cause 1.7 million deaths a year worldwide, with about 10.4 Oral TB treatment is identical to systemic form,
million people infected in 2016, 90% of whom were adults, consisting of a combination of 4 drugs [isoniazid (INH),
65% were men, 10% were people living with HIV. [1,3] rifampicin (RIF), pyrazinamide (PZA) and ethambutol
(ETO)] administered daily for the first 2 months, followed
Lung disease remains the most common form, while by an additional 4 months with 3 drugs (INH, RIF and
extra pulmonary TB, particularly in the head and neck ethambutol). [1,4,9]
region, is found in 10% to 15% of cases, of which only 10%
are in the buccal cavity. [4] IV. CONCLUSION
Primary oral TB lesions without lung damage are Despite the rarity of oral TB, whether primary or
extremely rare and generally seen in younger subjects, while secondary, clinicians should include and think about this
most oral lesions are a secondary infection. [2,5] diagnosis as a differential diagnosis of any questionable
chronic ulcerative lesion. The value of early diagnosis with
Risk factors include poor oral hygiene (periodontitis, prompt and appropriate treatment ensures a complete
caries, etc.), trauma, leukoplakia, and immunosuppressed recovery of the patient but also the cessation of the spread of
conditions such as HIV, diabetes, malnutrition, prolonged the disease.
corticosteroid therapy and chronic kidney failure. [4,5]
CONFLICT OF INTEREST:
Clinically, it comes in the form of painful, irregular, The authors declare no conflict of interest.
and indurated ulcers most often or cracks, nodules etc.
Associated with an enlarged cervical ganglion. The most
affected site is the tongue, gum, lips, palate, palate amygdala
and floor. [2,5,6] The peculiarity of our observation is the

ISSN No:-2456-2165
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FIGURES
Fig 1:- Intraoral photograph showing the ulcer of the inner right cheek, with well-defined erythematous margins and covered by a
yellow necrotic layer.
Fig 2:- Histopathology of buccal mucosal biopsy section showing multinucleate Langhans giant cells and granulomatosis with
foci of caesous necrosis and plenty of lymphocyte.

Rare and Unusual Cause of Ulceration of The Inner Cheek

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Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology

Rare and Unusual Cause of Ulceration of the

I. INTRODUCTION II. CASE REPORT

IJISRT21MAR456 www.ijisrt.com 845

IJISRT21MAR456 www.ijisrt.com 846

IJISRT21MAR456 www.ijisrt.com 847

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