Midfacial Necrotizing Diseases

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Abstract
Necrotizing and apparently nonhealing disease of the upper aerodigestive tract can be the result of a host of underlying causes. Exclusion of specific agents and malignancy masquerading as so-called nonhealing granulomas is mandatory. This done, four disorders enter the differential diagnosis; Wegener's granulomatosis, non-Hodgkin's lymphoma, polymorphic reticulosis and idiopathic midline granuloma. Given representative biopsy material, the first three have sufficient specific diagnostic features that separation is possible. Such identification is important because of the varying responses to therapy.