Orofacial Cysticercosis: A Review Ambika Gupta*, Aarti Singh, Monal B Yuwanati, Harneet Singh and Cheena Singh Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India * Corresponding author: Ambika Gupta, MDS, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India, Email: drambika79@rediffmail.com Received date: November 2, 2017; Accepted date: November 29, 2017; Published date: December 1, 2017 Copyright: ©2017 Ambika G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Cysticercosis is a common healthcare problem, especially in developing countries. Orofacial presentation of the disease is rare. It usually manifest as an asymptomatic nodular swelling that is difficult to differentiate clinically, from other orofacial swellings. Diagnosis of cysticercosis is usually not possible clinically owing to its rarity and asymptomatic presentation in orofacial region. Ultrasonography (USG) is the initial and most reliable diagnostic modality for cysticercosis. This review discusses the various oral manifestations, differentials and investigations for oral cysticercosis. Keywords: Orofacial; Cysticercosis; Nodules; Echogenic foc Introduction Cysticercosis was frst described in pigs by Aristophanes and Aristotle in 3rd century BC. Latter it was noticed in human by Parunoli in 1550 [1]. Cysticercosis is an infection caused in humans by the larval form of the pork tapeworm T. solium (i.e, Cysticercus cellulosae) [2]. T. solium exists worldwide but is most prevalent in Latin America, sub-Saharan Africa, China, southern and Southeast Asia, and Eastern Europe [3]. Te pork tapeworm eggs, when ingested through the contaminated food, water or dirty hands leads to the parasitic infestation [4]. Life Cycle of Cysticercosis Life cycle of Taenia solium comprises two natural hosts, humans as the defnite and swine as the intermediate host. When pork containing cysticerci is consumed by the humans, the larva form enters the small intestine and develops into an adult worm. Te adult worm attaches itself to the intestinal mucosa by scolex equipped with four lateral suckers and a rostellum, which bears 25-50 hooklets. Aided by their hooklets, the oncospheres cross the intestinal wall and local venules, enter systemic circulation and are carried to diferent organs of the host (skeletal muscles, central nervous system, subcutaneous tissue, eye, etc.) [1]. Route of Infection Te route of entry is predominantly oral. Te eggs of Taenia enter the gastrointestinal tract of the humans through consumption of contaminated water and improperly cleaned raw fruits and vegetables or by the process of autoinfection due to reverse peristalsis in the people infected with its adult form and harboring eggs in the stomach [5]. Manifestations in Human Living larvae can easily evade immune recognition and may not elicit infammatory reaction. When these larvae die, a vigorous granulomatous infammatory response is induced and this may be responsible for producing the clinical symptoms [2]. Generalized symptoms include headache, fever and myalgia. Multiple tissues of the body may be involved but, the most serious involvement is that of the central nervous system, followed by ocular involvement. Clinical spectra of the disease depend upon the localization of the cyst. Literature review reveals that neurocysticercosis (cyst lodged in the CNS) is the commonest form of cysticercosis, with the brain parenchyma most commonly involved. Ophthalmic cysticercosis (intraocular) manifests symptoms like proptosis, diplopia, and loss of vision while extraocular cyst resembles slow growing tumour or nodule with focal infammation. Te larva has a strong afnity for muscular tissue. Cysts in muscles may manifest as muscular pain, weakness or pseudohypertrophy. Subcutaneous cysticercosis is frequently asymptomatic but may manifest as palpable nodules [1]. Te most common site for occurance of subcutaneous nodule is trunk, followed by upper arm, eyes, neck, tongue, face and breast [6]. Oral Manifestations In the maxillofacial region, the locations of calcifed cysticerci present on muscles of mastication and facial expression, the suprahyoid muscle, and the posterior cervical as well as the tongue, buccal mucosa, or lip [7]. But, despite the abundance of muscular tissue in the oral and maxillofacial region, this is not a frequent site of occurrence [8]. Whenever, orofacial cysticercosis is present, multiple foci may be involved. So, every case of oral cysticercosis should be thoroughly investigated for presence of multiple foci. Te orofacial lesions usually present as insidious, benign, asymptomatic, nodular swellings that are well tolerated by the patients. Rarely, these may be painful when the larva dies and there is a leakage of fuid from the cystic cavity. Alternatively, when the implanted larvae die as a result of immunological defense of the host, the cystic fuid may become turbid due to signs of hyaline degeneration of the scolex (colloidal stage). Tis is followed by the calcifcation of the larvae and thickening of the capsule (granular stage). Te remnants of the dead larvae may become mineralized (calcifed stage) and appear radiographically as calcifed nodules [5]. J o u r n a l o f C l i n i c a l & E xp e r i m e n t a l P a t h o l o g y ISSN: 2161-0681 Clinical & Experimental Pathology Ambika et al., J Clin Exp Pathol 2017, 7:6 DOI: 10.4172/2161-0681.1000328 Review Article Open Access J Clin Exp Pathol, an open access journal ISSN:2161-0681 Volume 7 • Issue 6 • 1000328