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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.
Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Necrotising otitis externa (NOE) causes facial palsy by compression of the stylomastoid segment. Facial schwanommas are benign and are only considered for treatment if the House–Brackmann score is 4 or more, since treatments rarely give House–Brackmann scores better than 3. Melkersson-Rosenthal syndrome is an inflammatory condition that presents with recurring facial swellings and fissured tongues.
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
Combination of ultra-low-dose isotretinoin and antihistamines in treating Morbihan disease – a new long-term approach with excellent results and a minimum of side effects
Published in Journal of Dermatological Treatment, 2021
Katharina Welsch, Martin Schaller
The classic differential diagnosis of Morbihan disease is Melkersson–Rosenthal syndrome. However, further possible underlying reasons for the persistent swelling, such as contact dermatitis, dermatomyositis, thyroid disease, or lupus erythematodes, need to be excluded (5). In this diagnostic procedure biopsies may be taken, but are usually not performed to spare the patient’s discomfort and scaring. Consequently, only little is known about classic histopathologic findings. Perivascular and perifollicular infiltration of lymphocytes are often described. Furthermore mast cells, which are believed to play an important role in the development of inflammation and fibrosis, can be observed. In accordance with the thesis of an imbalance in production and drainage of lymphatic fluid as pathogenetic factor in Morbihan disease dermal dilated lymphatics and perilymphatic epithelioid cell granulomas can be observed (6,7). These may lead to lymphatic damage and luminal obstruction by histiocytic infiltration.
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
Melkersson–Rosenthal syndrome (MRS) is a rare disorder of unknown aetiology and incidence [1,2]. The classic form of MRS consists of a triad of symptoms: recurrent facial palsy, recurrent orofacial oedema and fissured tongue (lingua plicata) [3]. All three symptoms are present only in a minority of patients, and symptoms can also manifest separately [3]. The most common form of MRS is the monosymptomatic form, cheilitis granulomatosa (CG), which presents with only facial or labial oedema. Histology of MRS may show non-caseating lymphoepithelioid granulomas [1,3,4].
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
Recurrent facial palsy may be related to Melkersson Rosenthal syndrome (MRS), tumor of facial nerve, middle ear tumor, sarcoidosis as well as otitis media [1–5]. Although relapse on the opposite side is frequently seen, relapse on the same side is more prevalent [6]. The understanding about mechanisms of idiopathic recurrent facial palsy (IRFP) is still largely insufficient.