title: Miescher's cheilitis: Surgical management and long term outcome of an extremely severe case.
abstract: BACKGROUND
  Miescher's cheilitis is clinically characterized by persistent swelling of the lip(s). Its pathogenesis is still unknown. Histopathologically is characterized by sub-epithelial edema, increased number of dilated lymphatic vessels and an inflammatory infiltrate and/or non-caseating/non- necrotic granulomas. Even if the disorder must be controlled by medical therapy, surgery may be required to treat most severe cases.
  
  
  METHODS
  We report a 30-year-old man who presented a persistent swelling of both lips since 8 years, previously treated with intralesional steroid and immunosuppressive therapy. Clinical examination did not show facial nerve palsy or other associated conditions. On the base of clinical and histopathological findings, a diagnosis of Miescher's syndrome was made. Patient underwent Conway's reduction cheilopasty repaired with local flaps. At one-year follow-up, the patient does not show local recurrence of the deformity; both oral continence and lip sensation are preserved.
  
  
  CONCLUSIONS
  Because of its extreme rarity and unknown etiopathogenesis, Miescher's cheilitis receives poor attention and may often remain misdiagnosed. Several medical therapies are proposed, in particular steroids and immunosuppression. Even if medical therapy remains the main treatment, surgery may be required.
  
  
  CONCLUSIONS
  Satisfactory results have been obtained combining medical therapy and surgical approach.
authors.affiliation: Plastic and Reconstructive Microsurgery, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy. Electronic address: innocentialessandro@alice.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Innocenti
authors.affiliation: Plastic and Reconstructive Microsurgery, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Innocenti
authors.affiliation: Section of Anatomic Pathology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Taverna
authors.affiliation: Plastic and Reconstructive Microsurgery, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Melita
authors.affiliation: Plastic and Reconstructive Microsurgery, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mori
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciancio
authors.affiliation: Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Giorgi
authors.affiliation: Department of Medical Geriatric-Immunology and Cellular Therapies Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Parronchi
authors.affiliation: Department of Medical Geriatric-Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Vultaggio
authors.affiliation: Department of Medical Geriatric-Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Matucci
keywords: Case report; Cheilitis granulomatosa; Cheiloplasty; Lip; Miescher’s cheilitis; Swelling of the lips