Malignant granuloma

t e n s s o nMalignant granuloma, lethal granuloma, granuloma gangraenescens, and osteomyelitis necroticans faciei, are different synonyms for a necrotic process localized to the soft tissues of the face and underlying bone and sinuses, the hard and soft palate, and the pharynx.The disease is well characterized both clinically and patho-anatomically; the course usually prolonged and progressive, terminating in death.Various etiologic considerations were discussed in an earlier paper (BERGQVIST & KOCH 1949).At that time it was chiefly two different etiologic factors that had been suggested in the literature: an inflammatory process of unknown nature, or a malignant neoplasm.The treatment in those days accordingly consisted of anti-infective agents, chiefly antibiotics, or roentgen irradiation in tumor doses.In some cases extensive and disfiguring surgical measures were employed.The results of these therapeutic methods were exceptionally poor; healing was obtained in only a few cases.I n recent years entirely new considerations have emerged, and the possibility has been suggested of an allergic etiology.HOOVER (1 941 ) called attention t o the histologic resemblance with the phenomenon of Arthus.WEINBERG (1946) showed that these lesions were not strictly limited t o the midline tissues of the face, but that here and there throughout the body a pathologic picture of periarteritis nodosa developed.TEILUM (1946) wrote that "by looking on these lesions from a common pathogenetic point of view, based on morphologic observations and experimental studies on the vascular and tissue changes in allergy, essential support has been obtained for the concept that these lesions are primarily vascular, and are of allergic nature".KLINGE (1933) had earlier stated that periarteritis nodosa was an allergic vascular lesion.