OSCE — Orofacial granulomatosis and Melkersson-Rosenthal syndrome

Brief (to candidate)

You will assess a patient with a presentation consistent with Orofacial granulomatosis and Melkersson-Rosenthal syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Orofacial granulomatosis (OFG) is a chronic, non-caseating granulomatous inflammatory disorder of the orofacial soft tissues that presents with persistent or recurrent swelling of the lips, face, and oral mucosa. The complete Melkersson-Rosenthal syndrome is the triad of (1) recurrent orofacial swelling, (2) facial nerve palsy, and (3) fissured (scrotal) tongue; cheilitis granulomatosa (isolated lip swelling) is the most common incomplete form. OFG is associated with Crohn's disease, sarcoidosis, and dietary/contact allergy (cinnamaldehyde, benzoates, tartrazine). Management is stepwise: eliminate triggers (elimination diet), intralesional corticosteroid, steroid-sparing systemic agents (hyd

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]