The cobblestone appearance of the buccal mucosa is a classic oral manifestation of Crohn’s disease, resulting from granulomatous inflammation that causes swelling and fissuring of the mucosa. This pattern reflects the underlying transmural inflammation and edema characteristic of Crohn's, differentiating it from other oral lesions. It is often accompanied by aphthous ulcers and linear ulcerations. Recognizing this feature helps in the early diagnosis of Crohn’s disease, especially when gastrointestinal symptoms are absent or mild.

Reference: Oral Pathology, Neville et al., 4th Edition.