ORIGINAL ARTICLE Lip impressions: a new method for monitoring morphological changes in orofacial granulomatosis S Chiandussi 1 , AR Tappuni 1 , TF Watson 2 , A White 3 , MP Escudier 1 , JD Sanderson 3 , SJ Challacombe 1 1 Department of Oral Medicine, and 2 Department of Conservative Dentistry, King’s College London Dental Institute at Guy’s, King’s College & St Thomas’ Hospitals; 3 Department of Gastroenterology, Guy’s and St Thomas NHS Foundation Hospital, London, UK AIM: To develop and evaluate an objective method for assessing lip size and treatment-related morphological changes in orofacial granulomatosis (OFG) patients. MATERIALS AND METHODS: Patients with swollen lips because of OFG (n ¼ 21) were enrolled. A light-body polyvinylsiloxane material was used to take lip impres- sions before and after treatment (n ¼ 10), or during treatment (n ¼ 11). Plaster models were cast from the impressions and the lips were measured using callipers. The intra-examiner and inter-examiner reproducibility of the technique were assessed. RESULTS: OFG patients had significantly larger lips than controls (P < 0.0001). The coefficient of variation on repeated measurements of the same impression was 1.6% and for duplicate impressions was 2.6%. Significant reduction in lip size was shown in all 10 patients after diet restriction (P < 0.002). Seven of 11 patients whose impressions were taken at least 3 months after the initiation of cinnamon- and benzoate-free diet also showed reduction in lip size during follow up (P < 0.002). CONCLUSIONS: Serial lip impressions appear to be reliable for routine quantification of morphological changes of the lips in OFG patients. We present a new reproducible and sensitive method for assessing changes in lip size in response to treatment in OFG. Oral Diseases (2007) 13, 93–98 Keywords: orofacial granulomatosis; lip morphology; lip impres- sions; cinnamon and benzoate free diet Introduction Wiesenfeld et al (1985) introduced the concept of orofa- cial granulomatosis (OFG) to encompass, into a single entity, a group of conditions characterized by granulo- matous inflammation in the oral and maxillofacial region. OFG is a specific clinical and pathologic entity, which may occur in an isolated form or in association with other systemic conditions, including Crohn’s disease, Melkersson-Rosenthal syndrome and sarcoidosis. As OFG has a number of possible aetiologies which are not distinguishable on the basis of the histological features (Patton et al, 1985; Wiesenfeld et al, 1985; James et al, 1986), it is very important to carry out a scrupulous diagnostic work-up including careful clinical, haematological and radiographic investigations. In the absence of a specific systemic condition such as Crohn’s disease or sarcoidosis, the aetiology of OFG is still not clear and there is no evidence of a single causative agent (Challacombe, 1997). Various clinical features may be observed in orofacial granulomatosis with orofacial swelling being the most consistent component (Sciubba and Said-Al-Naief, 2003). Features include painless, non-pruritic, firm, asymmetrical, and occasionally unilateral oedematous swellings. Patients characteristi- cally present with lip swelling that can be so severe as to cause facial disfigurement and lip swelling is a feature in over 90% of patients (Sanderson et al, 2005). Labial oedema is usually accompanied by fissuring and purple discoloration. Although the swelling may be transient with complete resolution initially, repeated episodes of granulomatous inflammation may eventually lead to the formation of a firm indurated lip, secondary to fibrosis (Alexander and James, 1972). At the beginning, the lip enlargement can be unilateral, but it gradually becomes more symmetrical in nature (Nally, 1970; Vistnes and Kernahan, 1971; Alexander and James, 1972). Patients may present with swelling affecting only the upper or lower lip, but involvement of both lips is not uncommon. Gingivae, buccal mucosa, floor of the mouth and other sites in the oral cavity can also be involved (Hornstein, 1973; Worsaae et al, 1982; Levenson et al, 1984; Wiesenfeld et al, 1985; Mignogna et al, 2001). To date, there is no generally accepted or preferred treatment for OFG. Some authors believe that the administration of systemic corticosteroids combined with topical analgesic preparations is the only satisfac- tory treatment mode (Neuhofer and Fritsch, 1984; Williams and Greenberg, 1991). Several other Correspondence: Prof. Stephen Challacombe, Department of Oral Medicine and Pathology, Floor 28, Guy’s Tower, Guy’s Hospital, King’s College London Dental Institute at Guy’s, King’s College & St Thomas’ Hospitals, London SE1 9RT, UK. Tel: 02071884374, Fax: 02071884375, E-mail: stephen.challacombe@kcl.ac.uk Received 14 September 2005; revised 25 November 2005; accepted 16 January 2006 Oral Diseases (2007) 13, 93–98. doi:10.1111/j.1601-0825.2006.01255.x Ó 2006 Blackwell Munksgaard All rights reserved http://www.blackwellmunksgaard.com