title: The multiform and variable patterns of onset of orofacial granulomatosis.
abstract: BACKGROUND
  The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable.
  
  
  METHODS
  We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms.
  
  
  RESULTS
  A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case).
  
  
  CONCLUSIONS
  Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.
authors.affiliation: Department of Odontostomatological and Maxillofacial Sciences, Division of Oral Medicine, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy. mdmig@tin.it
authors.forename: Michele D
authors.initials: MD
authors.lastname: Mignogna
authors.forename: Stefano
authors.initials: S
authors.lastname: Fedele
authors.forename: Lucio
authors.initials: L
authors.lastname: Lo Russo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lo Muzio
mesh_terms: D000293:Adolescent; D000328:Adult; D002613:Cheilitis / Q000473:pathology; D002680:Chin / Q000473:pathology; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004487:Edema / Q000473:pathology; D005158:Facial Paralysis / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008556:Melkersson-Rosenthal Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis* / Q000473:pathology; D009916:Orbital Diseases / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D015050:Zygoma / Q000473:pathology