Melkersson - Rosenthal Syndrome

The aim of this article was to review the literature on the presentation and management of Melkersson Rosenthal Syndrome following the presentation of a 28-years-old patient who had been previously managed for recurrent bell’s palsy for 5 years.

A computerized literature search using Medline, Science Direct and Google Scholar was conducted for published articles on manifestations, features and management of Melkersson Rosenthal syndrome. MeSH phrases like orofacial granulomatosis, Melkersson Rosenthal syndrome, Miescher’s Cheilitis, Lingua Plicata, Cheilitis Granulomatosa, Recurrent Bell’s palsy, Granulomatous Cheilitis, and MROS. Search parameter was set to select literatures under English language only. Adjunctive manual search was also conducted simultaneously to identify other published articles, considering similar parameters as used for Medline search.

The review yielded 452 articles of which 168 articles were relevant to the discussion, less than 10 of these articles were from the African literature. We reviewed the literature for age, gender, incidence, prevalence, propounded aetiopathogenesis, risk factors, clinical manifestations, histopathological findings and treatment protocols.

The variable clinical manifestation of MRS may make early diagnosis difficult and even completely missed hence MRS should be considered as a probable diagnosis in patients with bell’s palsy especially in recurrent and / or bilateral cases even in the absence of other clinical symptoms. 

This paper reviews the clinical manifestations of this rare lesion and its management especially in Sub- Saharan Africa where only a few of cases have been reported in documented literature. It also focused on the classes of drugs used in the medical management as only the first line of management of these drugs are available in low and middle income. We thus strongly believe that our manuscript represents a significant addition to the scientific literature as it pertains to occurrence and management of MRS in Sub-Saharan Africa. 

Clinicians should have a high index of suspicion of MRS with patients presenting with recurrent facial nerve palsy with or without history of orofacial edema (not only cheilitis), and topical or systemic corticosteroids serve as the mainstay of treatment especially in resource limited centres with the options of other alternatives when lesion is unremitting or resistant to treatment. 

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