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Mouth, tongue, lips and ears
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
In granulomatous cheilitis, the whole lip (upper or lower) is swollen. Initially this may fluctuate quite a lot, but eventually the swelling becomes permanent. The cause is unknown, although it can sometimes be due to an allergic contact dermatitis to toothpaste. If the buccal mucosa is also thickened, consider Crohn's disease. Ask about abdominal symptoms and look inside the mouth for the characteristic cobblestone appearance of the buccal mucosa. If necessary, do a barium follow through and a biopsy. If there is an associated facial nerve palsy and/or a fissured tongue (see p. 111) consider the Melkersson-Rosenthal syndrome. Injection of triamcinolone 5 mg/ml into the swollen lip is often helpful.
Middle Fossa Surgery
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Raghu N.S. Kumar, Sunil N. Dutt, Richard M. Irving
Decompression surgery is particularly appealing in cases of Melkersson–Rosenthal syndrome (MRS) and recurrent facial paralysis of unknown origin. MRS is a triad of recurrent alternating facial paralysis, recurrent facial and labial oedema (cheilitis granulomatosa) and fissured tongue (lingua plicata).24 The logical conclusion is that the oedematous process affects the entire nerve within a tight bony canal, causing entrapment neuropathy. Total decompression of the entire length of the nerve using a combined transmastoid and MF approach is recommended in cases of MRS where there is a significant increase in frequency, duration and severity of facial paralysis to prevent disabling sequelae, such as synkinesis and residual facial paralysis.24
Gastroenterology and hepatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Oral lesions:1 Traumatic ulceration.2 Aphthous ulcers (with associated lymph node enlargement).3 Infection (vesicles in herpes simplex; creamy white plaques in candidiasis).4 Atrophic or fissured tongue d/t vitamin deficiency (B12/riboflavin/nicotinic acid).5 Carious teeth.6 Hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu’s syndrome).7 Peri-oral pigmentation (not the tongue) – Peutz–Jeghers’ syndrome (associated with intestinal polyps).
Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results
Published in Acta Oto-Laryngologica, 2019
Fang Xing, Yudan Ouyang, Xiaowen Li
Patients suffering from severe IRFP who were treated in our hospital from February 2004 to February 2012 were recruited in this prospective research. The protocol was approved by the Ethics Committee of our hospital, and written informed consent was signed by each patient. In our research, severe palsy was determined if no less than 95% facial nerve degeneration was revealed by electroneurography. Recurrent facial palsy was determined when no less than two episodes of facial palsy occurred on the same side. Exclusion criteria: patients with relapse on the opposite side; patients with MRS; those with severe hypertension; those with tumor of facial nerve or middle ear; those with sarcoidosis; those with otitis media. MRS was recognized relying on fissured tongue as well as relapse of orofacial edema. High-resolution CT of temporal bone was applied to detect otitis media as well as tumor of facial nerve. Sarcoidosis in facial nerve was determined in conformity with imaging features of facial nerve as well as proof of sarcoidosis in additional tissues.
A 30-year follow-up study of patients with Melkersson–Rosenthal syndrome shows an association to inflammatory bowel disease
Published in Annals of Medicine, 2019
Anu Haaramo, Kaija-Leena Kolho, Anne Pitkäranta, Mervi Kanerva
The diagnosis of MRS is difficult, especially when the classic triad of symptoms – facial palsy, orofacial oedema, and fissured tongue – is not present. In many cases, there can be long intervals of months or years without symptoms, and when symptoms are present they may occur one at a time. The diagnosis is clinical and based on patient history and clinical features. Histological evidence of granulomas is not mandatory for the diagnosis. The granulomatous changes confirm the diagnosis, but they are not always present in biopsies, and their absence does not exclude the diagnosis of MRS [3]. Hence, the need for a biopsy is not clear, but if they are taken, they should be sampled during acute oedema to provide the highest probability of diagnostic findings [1]. In some cases, neuroimaging examinations may be necessary to exclude other diseases (e.g. neurosarcoidosis). Because of the challenges in diagnosing MRS, this disease may remain undiagnosed for years or even decades. However, increasing knowledge of this mysterious condition can lead to diagnosis within a shorter timeframe, although because of the nature of the condition, many times the diagnosis can only be established after several years of follow-up. It is important to consider MRS, and question patients about other symptoms, including possible oedema episodes from facial palsy patients, especially those experiencing recurrent palsy. Additionally, the mouth should be carefully examined for fissured tongue. Unfortunately, there is no specific treatment, and the management thus far is mostly empirical.