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Macroheilit

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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Macroheilitis (granulomatous cheilitis Micher) is the leading symptom of the Melkersson-Rosenthal syndrome (Rossolimo-Melkersson-Rosenthal). The disease is characterized by a combination of macrochilite, folded tongue and paralysis of the facial nerve. Macroheilitis has a chronic course with alternating periods of exacerbation and remission. Over time, all symptoms of the disease can take a persistent character. Duration of the disease is possible up to 4-20 years.

ICD-10 code

Q18.6 Macroheilite.

Causes

The etiology of the disease is not completely understood, but it is considered an infectious-allergic genesis, developing against a background of hereditary predisposition. Macroheilit is accompanied by sensitization of the body to antigens of staphylococcus or herpes virus, which is confirmed by allergic tests with microbial allergens. This is a relatively rare disease. Macrochilite occurs more often in young men.

Symptoms of macrochilitis

Perhaps an asymptomatic course, but more often macrochilite is characterized by bursting, numbness in the lips and tongue. Note an acute onset - within a few hours one or both lips swell, the lip edge turns in the form of a proboscis, the lip increases 3-4 times, which makes it difficult to eat, speech. Usually the thickening of the lip is expressed unevenly (more in the center of the upper lip). The color of the lips can not change or becomes stagnant red. Consistency of the tissues of the lips is soft or tightly elastic. On the red border of the lip, peeling is possible.

Puffiness of the lip can persist for a month or more, sometimes the process is resolved, but then the macrochilite again recurs. Edema can gradually spread to the cheeks, tongue, nose, one or two halves of the face.

When the process spreads to the tongue, it thickens, its mobility becomes more difficult, areas of uneven protrusion or lobulation appear, more pronounced in the anterior and middle parts of the tongue, and taste sensitivity is disturbed.

Paralysis of the facial nerve is the second symptom of the Melkersson-Rosenthal syndrome, it can outrun the appearance of the remaining symptoms (macrocheylitis and folded tongue), and neurologic pains in the face or headaches are possible before paralysis develops. Paralysis is one-sided (accompanied by a smooth nasolabial fold, lowering the angle of the mouth, widening the eye gap) and has a tendency to relapse. In the zone of innervation of the affected facial nerve, motor function and sensitivity may be partially retained.

The third symptom of the disease is a folded tongue. Macroheilit is characterized by the presence on the surface of the tongue of deep furrows, giving it a humpy appearance. This symptom of macrocheilitis is not noted in all patients.

How to recognize macrohilite?

Diagnosis of the Melkersson-Rosenthal syndrome does not cause difficulties in the clinical manifestations of all the constituent symptoms.

With the isolated symptom of macrohella, the diagnosis is based on a pathomorphological study. The histological picture is characterized by edema and granulomatous inflammation of the tuberculoid, sarcoid, or lymphonodular-plasmatic type.

Differential diagnostics

Differentiate macrochialite with Quincke edema, erysipelas. Hemangioma.

Quincke's edema is not long-lasting, completely and quickly disappears when taking antihistamines.

With chronic erysipelas, the development of elephantiasis of the 176 region is possible, which is clinically manifested by a significant increase in them. However, the course of erysipelas is accompanied by exacerbations, with an increase in body temperature and inflammatory phenomena, which is not characteristic for Melkersson-Rosenthal syndrome.

Hemangioma is observed from birth or early childhood.

trusted-source [1], [2]

Treatment

Treatment of macrochilite is of a long-term nature and includes:

sanation of foci of chronic infection;
the appointment of antibiotics in the detection of microbial allergies (macrolides);
the appointment of antiviral drugs (long-term) with the detection of sensitivity to the herpes virus (acyclovir);
administration of antithistamine drugs (loratadine, desloratadine, etc.);
the appointment of immunomodulators (lycopide, poludan, galanite).

What is the prognosis of macrochilite?

The forecast is favorable.

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