PERIO - Periodontal Practice Today
PERIO - Periodontal Practice Today 5 (2008), No. 4     4. June 2009
PERIO - Periodontal Practice Today 3 (2006), No. 1  (16.03.2006)

Page 43-48

Chronic Periodontitis in Conjunction with Melkersson-Rosenthal Syndrome: A Case Report and Literature Review
Bröseler, Frank/Neuber, Angelika
Background: Melkersson-Rosenthal syndrome (MRS) is a very rare neurological disorder. The origin of MRS is as yet unknown. The diagnosis of the disease usually occurs in the patient's second or third decade of life. The clinical symptoms are remittent swellings of the oral, pharyngeal and laryngeal mucosa as well as the lips. Due to the presence of granulomata in all orofacial soft tissues, a plicated tongue as well as facial nerve paralysis may occur. Intermittent increase of mucosal swelling, including swelling of the gingiva, may increase the risk of development of chronic periodontitis by inhibiting local plaque removal.
Case description: This article describes a case of a patient with chronic periodontitis who had been diagnosed with MRS 14 years previously. Based on the clinical features, a protracted history and the histological findings from biopsies taken from the gingiva and palatal tissues a working diagnosis of MRS was made. The complex issues surrounding MRS as a diagnosis and its relationship to other oral granulomatoses are discussed in this paper.
Conclusions: Chronic inflammation not responding to initial periodontal therapy may indicate underlying systemic conditions, which have to be ruled out by clinical investigations, such as biopsy. Morphological change of the gingiva is one of the possible manifestations of MRS. Periodontitis with severe alveolar bone loss seems to be an entirely co-incidental finding. However, it is possible that alterations in gingival morphology, secondary to MRS, inhibit plaque removal and act as a local risk factor for periodontitis.

Keywords: chronic periodontitis, Melkersson-Rosenthal Syndrome (MRS), Cheilitis granulomatosa, facial nerve paralysis, non-caseating epitheliod cell granuloma, oro-facial granulomatosis