A patient is evaluated for a rare orofacial syndrome. The classical diagnostic triad of this condition is being reviewed. Which of the following is NOT a component of the Melkersson- Rosenthal syndrome triad?

1. A

   A. Lower motor neuron facial palsy

2. B

   B. Proptosis (forward displacement of the eyeball)

3. C

   C. Orofacial granulomatous oedema

4. D

   D. Fissured (scrotal) tongue

Appeared in: INI-CET EXAM -2026

Explanation

• Proptosis, the forward displacement or bulging of the eyeball, is not a recognized feature of the Melkersson-Rosenthal syndrome (MRS) triad.
• This symptom is a hallmark of other conditions, most notably thyroid eye disease (Graves' ophthalmopathy) or orbital tumors.
• The question requires identifying the component that does not belong to the classic triad, making proptosis the correct answer.

Why Other Options Were Wrong

• Option A: This is a core component of the MRS triad. It presents as recurrent, unilateral weakness or paralysis of the facial muscles.
• Option C: This is another defining feature of MRS. It is a persistent, non-pitting swelling, most commonly affecting the lips (cheilitis granulomatosa) and face.
• Option D: Also known as scrotal tongue or lingua plicata, this is a frequent finding in MRS, present in a significant portion of patients. The tongue has deep, painless grooves.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Diagnostic triad of Melkersson-Rosenthal syndrome to guide bedside assessment, documentation, and the next nursing action.
• Nurses should be aware that the full triad is present in only a minority of patients, making diagnosis challenging. The condition can present with just one or two features initially.
• Nursing care is primarily supportive, focusing on managing symptoms. This includes providing eye care for incomplete closure due to facial palsy (to prevent corneal drying), offering psychological support for altered body image due to facial swelling, and patient education on oral hygiene for a fissured tongue.
• What if? If a patient presents with recurrent facial swelling but no palsy or fissured tongue, the nurse should anticipate that the differential diagnosis will include allergic reactions, angioedema, and other granulomatous diseases like Crohn's disease or sarcoidosis, requiring a thorough diagnostic workup.

How to Approach the Question

• First, identify the core concept of the question, which is the classic triad of Melkersson-Rosenthal syndrome (MRS).
• Next, carefully note the negative framing indicated by the keyword 'NOT'. This means you must find the option that is an exception or does not belong.
• Recall the three components of the MRS triad: 1) recurrent facial palsy, 2) orofacial edema, and 3) fissured tongue.
• Systematically evaluate each option against the known triad.
• Option A (facial palsy), Option C (orofacial oedema), and Option D (fissured tongue) are all established components of the triad.
• Option B (Proptosis) is not related to MRS. Therefore, it is the correct answer to this 'NOT' question.

Concept Tested & Keywords

• Concept Tested: Diagnostic triad of Melkersson-Rosenthal syndrome
• Stem keywords: Melkersson-Rosenthal syndrome, diagnostic triad, orofacial syndrome
• Lead-in keywords: NOT
• Negative lead-in flag: Question asks for the feature that is NOT part of the triad.

Question ID

QttZ8ywyYgkwKRA5OqGvFB

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1958-1960