Orofacial granulomatosis


IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

Orofacial granulomatosis showing thickening of lips and tongue, fissured tongue; thickened tongue; microscopic view of chelitis/lip inflammation)

Lip swelling is the most common symptom

Lip swelling initially may only last a few hours at a time, and can be difficult to distinguish from another type of lip swelling known as angioedema. As the condition progress, swelling tends to last for days at a time, and eventually becomes permanent. Sometimes cracking and dryness of the lips occurs.

Other common symptoms
Swelling of the face and eyes also occurs. Some effected individuals have a "fissured tongue", and may sometimes develop facial paralysis. Mouth ulcers and inflammation of the gums, known as gingivitis, is sometimes seen. Other symptoms include tongue swelling or a sensation of a burning tongue.

Orofacial granulomatosis (OFG) is an inflammatory disease
Swelling and inflammation is seen in involved tissues, with clumps of many different types of white cells. While inflammation has been blamed on various infections from time to time, there is no definite proof that OFG is due to any one infectious organism. The cause of OFG is unknown.


  1. Bulletlip swelling

  2. Bulletinflammation of edges of mouth (angular chelitis) MINOR SYMPTOMS

  3. Bulletfacial swelling

  4. Bulletfacial paralysis

  5. Bulletswelling of gums and cheeks


  1. Bulletburning tongue

  2. Bulletaltered taste

  3. Bulletfacial numbness/tingling

  4. Bulletspasm of eyelids (blepharospasm)

  5. Bulletwatery eyes

  6. Bulletrunny nose, migraines

Confirming the diagnosis
As there are many possible causes of lip swelling, tests are often required to prove the diagnosis, and to exclude diseases that can mimic OFG. These tests may include blood tests, taking a sample of the involved tissue ("biopsy"), or sometimes x-rays or other specialized tests.

Sometimes swellings will resolve spontaneously without treatment, but most persist for many years. While no one treatment is always effective, a number of options are available. These include:

  1. BulletElimination diets

  2. BulletMedications that reduce inflammation

  3. BulletRadiotherapy

  4. BulletPlastic Surgery

  5. BulletInjected steroids


Allen, C. M., C. Camisa, et al. (1990). "Cheilitis granulomatosa: report of six cases and review of the literature." J Am Acad Dermatol 23(3 Pt 1): 444-50.

Armstrong, D. K., P. Biagioni, et al. (1997). "Contact hypersensitivity in patients with orofacial granulomatosis." Am J Contact Dermat 8(1): 35-8.

Balevi, B. (1997). "Melkersson-Rosenthal syndrome: review of the literature and case report of a 10-year misdiagnosis." Quintessence Int 28(4): 265-9.

Bourrat, E., C. Faure, et al. (1997). "[Anitis, vulvar edema and macrocheilitis disclosing Crohn disease in a child: value of metronidazole]." Ann Dermatol Venereol 124(9): 626-8.

Challacombe, S. J. (1997). "Oro-facial granulomatosis and oral Crohns disease: are they specific diseases and do they predict systemic Crohns disease? [editorial]." Oral Dis 3(3): 127-9.

Clayden, A. M., C. M. Bleys, et al. (1997). "Orofacial granulomatosis: a diagnostic problem for the unwary and a management dilemma. Case reports." Aust Dent J 42(4): 228-32.

Cleary, K. R. and J. G. Batsakis (1996). "Orofacial granulomatosis and Crohn's disease." Ann Otol Rhinol Laryngol 105(2): 166-7.

Cockerham, K. P., A. A. Hidayat, et al. (2000). "Melkersson-Rosenthal syndrome: new clinicopathologic findings in 4 cases." Arch Ophthalmol 118(2): 227-32.

De Aloe, G., P. Rubegni, et al. (1997). "Complete Melkersson-Rosenthal syndrome in a patient with Crohn's disease [letter]." Dermatology 195(2): 182.

Dummer, W., C. Lurz, et al. (1999). "Granulomatous cheilitis and Crohn's disease in a 3-year-old boy." Pediatr Dermatol 16(1): 39-42.

Eveson, J. W. (1996). "Granulomatous disorders of the oral mucosa." Semin Diagn Pathol 13(2): 118-27.

Gay, C. T. (1999). "An 8-year-old girl with unilateral facial and ear pain and isolated frontal headaches." Semin Pediatr Neurol 6(3): 182-8; discussion 189.

Hornstein, O. P. (1997). "Melkersson-Rosenthal syndrome--a challenge for dermatologists to participate in the field of oral medicine." J Dermatol 24(5): 281-96.

Ilnyckyj, A., T. A. Aldor, et al. (1999). "Crohn's disease and the Melkersson-Rosenthal syndrome." Can J Gastroenterol 13(2): 152-4.

Ingram, C. (1999). "Melkersson-Rosenthal syndrome or oro-facial granulomatosis (OFG): an update." J N Z Soc Periodontol 84: 24-5.

Jain, V. K., V. B. Dixit, et al. (1990). "Melkersson-Rosenthal syndrome: two case reports." Ann Dent 49(2): 30-1, 45.

James, D. G. (1997). "Differential diagnosis of facial nerve palsy." Sarcoidosis Vasc Diffuse Lung Dis 14(2): 115-20.

Kano, Y., T. Shiohara, et al. (1990). "Granulomatous cheilitis and Crohn's disease." Br J Dermatol 123(3): 409-12.

Kolokotronis, A., D. Antoniades, et al. (1997). "Granulomatous cheilitis: a study of six cases." Oral Dis 3(3): 188-92.

Levy, F. S., A. J. Bircher, et al. (1996). "Delayed-type hypersensitivity to cow's milk protein in Melkersson- Rosenthal syndrome: coincidence or pathogenetic role?" Dermatology 192(2): 99-102.

Lloyd, D. A., K. B. Payton, et al. (1994). "Melkersson-Rosenthal syndrome and Crohn's disease: one disease or two? Report of a case and discussion of the literature." J Clin Gastroenterol 18(3): 213-7.

Mahler, V. B., O. P. Hornstein, et al. (1995). "Granulomatous glossitis as an unusual manifestation of Melkersson- Rosenthal syndrome." Cutis 55(4): 244-6, 248.

Mainetti, C., I. Masouye, et al. (1994). "[Solid persistent facial edema of the young adult. Melkersson-Rosenthal syndrome]." Ann Dermatol Venereol 121(2): 165-70.

Marques, C., A. Machado, et al. (1994). "[Macrocheilitis and Melkersson-Rosenthal syndrome. Review of 19 cases]." Acta Med Port 7(10): 533-40.

McGrath, D. S., C. Doyle, et al. (1997). "The Melkersson Rosenthal syndrome--a differential diagnosis of facial sarcoidosis." Ir J Med Sci 166(4): 253-6.

McKenna, K. E., M. Y. Walsh, et al. (1994). "The Melkersson-Rosenthal syndrome and food additive hypersensitivity [letter]." Br J Dermatol 131(6): 921-2.

Miele, F. A., Jr. (1994). "The big lip. Diagnostic and treatment considerations." Gen Dent 42(3): 258-9.

Misra, S. and M. E. Ament (1996). "Orofacial lesions in Crohn's disease." Am J Gastroenterol 91(8): 1651-3.

Mucci, S. F. and A. Sismanis (1994). "Melkersson-Rosenthal syndrome: report of two cases and review of literature." Eur Arch Otorhinolaryngol Suppl: S165-7.

Mucci, S. F. and A. Sismanis (1994). "Melkersson-Rosenthal syndrome: report of two cases and review of literature." Eur Arch Otorhinolaryngol Suppl: S165-7.

Pachor, M. L., G. Urbani, et al. (1989). "Is the Melkersson-Rosenthal syndrome related to the exposure to food additives? A case report." Oral Surg Oral Med Oral Pathol 67(4): 393-5.

Plauth, M., H. Jenss, et al. (1991). "Oral manifestations of Crohn's disease. An analysis of 79 cases." J Clin Gastroenterol 13(1): 29-37.

Reed, B. E., A. P. Barrett, et al. (1993). "Orofacial sensitivity reactions and the role of dietary components. Case reports." Aust Dent J 38(4): 287-91.

Rees, T. D. (2000). "Orofacial granulomatosis and related conditions." Periodontol 21: 145-57.

Rey, R., J. P. Carreau, et al. (1996). "[Melkersson-Rosenthal syndrome. Value of reduction cheiloplasty]." Ann Dermatol Venereol 123(5): 325-7.

Rogers, R. S., 3rd (1996). "Melkersson-Rosenthal syndrome and orofacial granulomatosis." Dermatol Clin 14(2): 371-9.

Sussman, G. L., W. H. Yang, et al. (1992). "Melkersson-Rosenthal syndrome: clinical, pathologic, and therapeutic considerations." Ann Allergy 69(3): 187-94.

Tausch, I. and N. Sonnichsen (1992). "[Experiences with clofazimine therapy of Melkersson-Rosenthal syndrome]." Hautarzt 43(4): 194-8.

Thiriar, S., E. Deroux, et al. (1998). "Granulomatous vulvitis, granulomatous cheilitis: a single diagnosis?" Dermatology 196(4): 455-8.

Veller Fornasa, C., P. Catalano, et al. (1992). "Minocycline in granulomatous cheilitis: experience with 6 cases [letter]." Dermatology 185(3): 220.

Winnie, R. and D. M. DeLuke (1992). "Melkersson-Rosenthal syndrome. Review of literature and case report." Int J Oral Maxillofac Surg 21(2): 115-7.

Yeatts, R. P. and W. L. White (1997). "Granulomatous blepharitis as a sign of Melkersson-Rosenthal syndrome." Ophthalmology 104(7): 1185-9; discussion 1189-90.

Ziem, P. E., C. Pfrommer, et al. (2000). "Melkersson-rosenthal syndrome in childhood: a challenge in differential diagnosis and treatment [In Process Citation]." Br J Dermatol 143(4): 860-3.

Marttala A, Sihvonen E, Kantola S, Ylöstalo P, Tervonen T. Diagnosis and Treatment of Orofacial Granulomatosis. J Dent Child (Chic). 2018 May 15;85(2):83-87.

Wehl G, Rauchenzauner M. A Systematic Review of the Literature of the Three Related Disease Entities Cheilitis Granulomatosa, Orofacial Granulomatosis and Melkersson - Rosenthal Syndrome. Curr Pediatr Rev. 2018;14(3):196-203. doi:


Miest R, Bruce A, Rogers RS 3rd. Orofacial granulomatosis. Clin Dermatol. 2016 Jul-Aug;34(4):505-13. doi: 10.1016/j.clindermatol.2016.02.024.

Al-Hamad A, Porter S, Fedele S. Orofacial Granulomatosis. Dermatol Clin. 2015 Jul;33(3):433-46. doi: 10.1016/j.det.2015.03.008.

Last reviewed 10 June 2020


Orofacial granulomatosis (OFG: also known as Melkersson-Rosenthal syndrome, Cheilitis Granulomatosis, and Schuermann's Glossitis Granulomatosa) is an uncommon inflammatory condition effecting the face and lips. People of all ages can be affected, but it is most common in the early adult years.