Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)

Granulomatous cheilitis is a chronic swelling of the lip due to granulomatous inflammation. Miescher cheilitis is the term used when the granulomatous changes are confined to the lip. Miescher cheilitis is generally regarded as a monosymptomatic form of the Melkersson-Rosenthal syndrome, although the possibility remains that these may be 2 separate diseases. Melkersson-Rosenthal syndrome is the term used when cheilitis occurs with facial palsy and plicated tongue.

Melkersson-Rosenthal syndrome is occasionally a manifestation of Crohn disease or orofacial granulomatosis.

Causes

The cause is unknown. A genetic predisposition may exist in Melkersson-Rosenthal syndrome; siblings have been affected, and a plicated tongue may be present in otherwise unaffected relatives. Crohn disease, sarcoidosis, and orofacial granulomatosis may present in a similar clinical fashion, and with identical histologic findings. Dietary or other antigens are the most common identified cause of orofacial granulomatosis. Contact antigens are sometimes implicated.

Medical Care

Simple compression for several hours daily may produce significant improvement. Intralesional corticosteroids may be helpful in some patients. Success with other treatments has been reported anecdotally. None of the agents listed below has been systematically evaluated.

• Nonsteroidal anti-inflammatory agents
• Antibiotic treatment of dental abscess (resulted in remission in anecdotal cases)
• Mast cell stabilizers
• Clofazimine
• Tetracycline (used for anti-inflammatory activity)
• Methotrexate
• Tacrolimus
• Infliximab

Surgical Care

• Surgery and radiation have been used.
• Surgery alone is relatively unsuccessful.
• Reduction cheiloplasty with intralesional triamcinolone and systemic tetracycline offer the best results. Give corticosteroid injections periodically after surgery to avoid an exaggerated recurrence.