The Melkersson-Rosenthal syndrome is a rare disorder of unknown etiology 
characterized by a triad of recurrent orofacial swelling, relapsing facial 
paralysis, and fissured tongue. Exacerbations and recurrences are common. The 
orofacial swelling is characterized by fissured, reddish-brown, swollen, 
nonpruritic lips or firm edema of the face. The facial palsy is 
indistinguishable from Bell's palsy. The fissured tongue is seen in one third to 
one half of patients and, although the least common manifestation, its presence 
assists in diagnosis. The classic triad is not seen frequently in its complete 
form; therefore, diagnosis is difficult. This is particularly true because 
monosymptomatic and oligosymptomatic variants are seen more commonly. Cheilitis 
granulomatosa of Miescher is an example of a monosymptomatic variant of the 
Melkersson-Rosenthal syndrome. The histologic findings of noncaseating, 
sarcoidal granulomas support the diagnosis. These granulomas are not invariably 
present, and their absence does not exclude the diagnosis of the 
Melkersson-Rosenthal syndrome. Thus, the Melkersson-Rosenthal syndrome is a 
disease with elements of orofacial granulomatosis. Orofacial granulomatosis is a 
clinicopathologic entity describing oral lesions with noncaseating granulomas. 
The spectrum of this entity includes patients with oral Crohn's disease, 
patients with oral lesions who will develop typical bowel symptoms of Crohn's 
disease in the ensuing months to years, patients with tooth-associated 
infections, patients with sarcoidosis, and patients with food or contact 
allergies. The value of the clinicopathologic construct of orofacial 
granulomatosis is to provoke the careful search for provocative causes for the 
reactive symptom complex of the Melkersson-Rosenthal syndrome.