WEGENERS GRANULOMATOSIS OF THE HEAD AND NECK

Among the more puzzling non-neoplastic necrotizing lesions of the head and neck area is Wegener's granulomatosis. This is a condition of unk nown cause that may present (in the head and neck area) with ulceratio n of the nasal septum, sinus mucosa, oral mucosa, or external ear cana l, or even destruction of the vocal cord. Diagnosis depends on the pat hologic finding of a characteristic inflammatory reaction pattern (whi ch, in its best-developed form, includes necrosis, granulomatous infla mmation, and vasculitis) and the serum finding of an elevated antinucl ear cytoplasmic antigen. Treatment is principally medical, with the us e of powerful immunosuppressive agents. Distinction from other conditi ons that may mimic Wegener's granulomatosis (such as malignant lymphom a and infections) is of critical importance in constructing an appropr iate treatment strategy.