Melkersson-Rosenthal syndrome presenting with upper lid edema and facial palsy

Surgical management of Miescher's cheilitis: a case report

Miescher’s cheilitis, also known as cheilitis granulomatosa, is an infrequent disease characterized by chronic recurrent swelling of one lip or both lips. It is considered as one of the three main symptoms of the triad of the Melkersson-Rosenthal syndrome, although in many cases it may develop monosymptomatically.

The initial management is based on the administration of corticoids, followed in many cases by the use of other systemic treatments. Nevertheless, because recurrence is quite frequent, surgery remains in many cases as the only definitive treatment.

In this report we present the case of a Caucasian woman with Miescher’s cheilitis who was successfully surgically managed.

Isolated eyelid edema in Melkersson-Rosenthal syndrome: a case series

PURPOSE

To report the clinicopathologic features of a series of patients with Melkersson-Rosenthal syndrome (MRS).

METHODS

Patients in this clinicopathological case series were identified through retrospective review. Five Caucasian patients (2 women and 3 men; age range, 46 to 73 years) with isolated eyelid swelling presented over an 11-month period to two Canadian tertiary Oculoplastic referral centres. All underwent clinical examination and had tissue biopsies.

RESULTS

The patients presented with non-pitting, non-pruritic, painless and recurrent eyelid swelling. None had evidence of cranial nerve palsy or fissured tongue. The duration of symptoms before referral was between 1-5 years. Histopathological examination showed granulomatous inflammation in four patients. Granulomatous folliculitis was a novel finding in three patients.

CONCLUSIONS

Monosymptomatic patients with MRS require a high index of suspicion. Histopathological confirmation is vital for the diagnosis.

Modified Procedure for Secondary Facial Rehabilitation Following Total Bilateral Irreversible Peripheral Facial Palsy

We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.

Persistent unilateral orbital and eyelid oedema as a manifestation of Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome (MRS) is a complex neuromucocutaneous disorder characterized by localized orofacial oedema and cranial nerve dysfunction, frequently associated with minor signs, including furrowed tongue. Complete forms are rare whereas mono- and oligosymptomatic variants are more common. A 71-year-old man presented with a 2-year history of relapsing and progressively persistent oedema of the right eyelids and periorbital region. A fissured tongue and telangiectatic rosacea had been present since the age of 50 and 60 years, respectively. The patient was also affected by essential hypertension and diabetes mellitus. A skin biopsy showed a marked upper dermal oedema, and small epithelioid cell granulomas arranged in perivascular and perilymphatic location. Collections of small epithelioid cells were occasionally observed within lymphatic spaces. No acid-fast bacteria, fungi or foreign bodies were detected. Intralesional corticosteroids induced transient improvement, whereas minocycline, clofazimine and dapsone have been ineffective. MRS may present with unilateral eyelid and periorbital swelling. Differential diagnoses of such cases may include a variety of cutaneous, ophthalmic and systemic diseases.

Clinical Case Notes. Upper eyelid oedema in Melkersson- Rosenthal syndrome

Melkersson-Rosenthal syndrome is an uncommon disorder of uncertain aetiology characterized by orofacial oedema, facial nerve palsy and lingua plicata. The triad is seldom seen in its complete form, and oligo-symptomatic or mono-symptomatic forms are more common. An unusual case of Melkersson-Rosenthal syndrome involving the left upper eyelid is presented. The pathology, clinical features and management of this disorder are discussed.