There are few diseases that will cause chronic swelling of one or both lips other than cheilitis granulomatosa or Miescher's cheilitis. This form of cheilitis combined with fissured tongue and facial nerve paralysis constitutes the Melkersson-Rosenthal syndrome. Although labial swelling is the most common presentation, no orofacial tissue is immune. Facial skin, gingiva, buccal mucosa, tongue, and palate may be affected. The term orofacial granulomatosis recognizes the disparate forms of this condition. Females are more often affected than are males and the mean age of onset is 33 years. It is ushered in by cycles of unexplained edema and resolution that ultimately lead to swelling without remission. Examination of biopsy material reveals non-caseating, epithelioid granulomas devoid of foreign material and organisms. Granulomas may be few in number and multiple sections may be required to find them. In some instances, edema and a subtle lymphocytic infiltrate are the sole finding. It has been claimed that Miescher's cheilitis is an oligosympto-matic form of sarcoidosis and there are published accounts linking it to Crohn's disease. Though infrequently found, these conditions should be considered in the differential diagnosis. Intralesional injection of steroid suspension is standard treatment, and more than one round may be required. The literature contains reports of success with clofazimine and ciproheptadine. The role of cheiloplasty is controversial and probably should be reserved for debulking of advanced disease.
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