Etiology • A chronic, idiopathic condition • Part of orofacial granulomatosis spectrum that includes
Crohn’s disease, sarcoidosis, cheilitis granulomatosa
Clinical Presentation • Classic triad
• Chronic intermittent swelling of lip(s) or oral tissues • Fissured tongue • Facial nerve palsy (20%)
• Occasionally manifests as painless labial swelling (granulomatous cheilitis/Miescher’s granuloma)
• May be seen in association with intestinal Crohn’s disease • Lobulated, thickened mucosa of cheeks and tongue may be seen. • Gingival surface granularity may be present uncommonly. • “Correctable” causes must be excluded before an idiopathic
cause is accepted.
Crohn’s disease, sarcoidosis, cheilitis granulomatosa
Clinical Presentation • Classic triad
• Chronic intermittent swelling of lip(s) or oral tissues • Fissured tongue • Facial nerve palsy (20%)
• Occasionally manifests as painless labial swelling (granulomatous cheilitis/Miescher’s granuloma)
• May be seen in association with intestinal Crohn’s disease • Lobulated, thickened mucosa of cheeks and tongue may be seen. • Gingival surface granularity may be present uncommonly. • “Correctable” causes must be excluded before an idiopathic
cause is accepted.
Diagnosis • Biopsy • Key feature is noncaseating epithelioid granulomas with multi-
nucleated giant cells • Patch testing for contact allergy
Differential Diagnosis • Angioedema • Sarcoidosis • Cellulitis/erysipelas of lip
Treatment • If necessary, intralesional corticosteroid injections • Tapering dose of systemic corticosteroids • Clofazimine in slowly tapering dosage • Dapsone and other nonsteroidal anti-inflammatory drugs
Prognosis • Generally good • May be persistent