Caliber-persistent labial artery: report of 3 cases

Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

Técnica de Kapetansky-Juri modificada para la corrección de defectos labiales en silbido / Modified Kapetansky-Juri technique to correct whistling lip defects

RESUMEN La deformidad en silbido es uno de los defectos residuales más frecuentes entre pacientes operados de hendiduras congénitas del labio superior. La técnica de Kapetansky-Juri ha permitido corregir los defectos en silbido (moderados y graves). Se presentó una paciente de 16 años de edad operada de una hendidura bilateral labio palatina; a causa de esta hipoplasia regional y tras el proceso de crecimiento y desarrollo craneofacial, persistió la insuficiencia del prolabio como un defecto en silbido moderado. La paciente fue tratada con la técnica de Kapetansky-Juri con una pequeña modificación, lo que permitió, no solo dar volumen al prolabio, sino también un intento en la corrección del arco de Cupido. Los resultados alcanzados fueron satisfactorios y se corresponden con los objetivos finales de toda cirugía reparadora de las hendiduras labio alveolo palatinas.

ABSTRACT Whistling deformity is one of the most frequent residual defects in patients operated on for congenital clefts of the upper lip. Kapetansky-Juri technique has made it possible to correct whistling defects (moderate and severe). We present a 16-year-old female patient operated on a bilateral cleft lip and palate; given this regional hypoplasia and after the process of growth and craniofacial development, insufficiency of the prolabium persisted as a moderate whistling defect. She was treated with the Kapetansky-Juri technique with a small modification, allowing us not only to give volume to the prolabium, but also an attempt to correct the Cupid's bow. The achieved results were satisfactory and correspond to the final objectives of all reconstructive surgery of the cleft lip and palate.

Abordagens terapêuticas não-cirúrgicas para a queilite actínica / Non-surgical therapeutics approaches for actinic cheilitis

A queilite actínica (QA) é uma desordem potencialmente maligna que se desenvolve principalmente no lábio inferior, decorrente da exposição crônica a luz solar. O objetivo desse estudo é elucidar, a partir de uma revisão da literatura, as abordagens não cirúrgicas mais atuais para o tratamento da QA. Foi realizada uma busca nas bases de dados PubMed, Scielo e Cochrane, sendo obtidos 280 artigos e após aplicação dos critérios de elegibilidade, foram utilizados no presente traba lho 16 estudos. Várias abordagens, como, diclofenaco sódico, mebutato de ingenol, imiquimode, 5-fluorouracil, fludroxicortida e terapia fotodinâmica, são apontadas e estudadas como forma de tratamento para a QA. Entretanto, faltam trabalhos para que se estabeleça um consenso sobre a terapêutica não-cirúrgica mais adequada... (AU)

Actinic cheilitis (AC) is a potentially malignant disorder that develops mainly on the lower lip, result ing from a chronic exposure to sunlight. The objective of this study is to elucidate, from a literature review, the most current non-surgical approaches for the treatment of AC. A search was performed in the PubMed, Scielo and Cochrane databases, obtaining 280 papers and after applying the eligibility cri teria, 16 studies were used in the present study. Various approaches, such as diclofenac sodium, ingenol mebutate, imiquimod, 5-fluorouracil, fludroxycortide and photodynamic therapy are pointed out and studied as a form of treatment for AC. However, there is a lack of work to establish a consensus on the most appropriate non-surgical therapy... (AU)

Portuguese translation and validation of the YQOL ­ FD (Youth Quality of Life Instrument­Facial Differences) for brazilian adolescents with craniofacial deformities / Tradução e validação em português do YQOL - FD (Youth Quality of Life Instrument ­ Facial Differences) para adolescentes brasileiros com deformidades craniofaciais

The Youth Quality of Life­Facial Differences (YQOL-FD), validated in the United States in 2005, was developed at the University of Washington by the Seattle Quality of Life Group (SeaQol), to evaluate quality of life of adolescents with facial deformities. Because no Portuguese version exists, the measure was not viable in Brazil. This study aimed to obtain linguistic and psychometric validation of a version of the YQOL-FD in Portuguese. Twenty-five patients with cleft lip and palate and five without facial deformity participated in Traumatology and Maxillofacial Prosthesis Surgery Clinic, School of Dentistry, University of São Paulo. The linguistic validation of the YQOL-FD was carried out by a team consisting of the researcher, as project manager, two native Portuguese-speaking consultants fluent in English, and one native English-speaking consultant fluent in Portuguese. After translation and back-translation, a Portuguese version was obtained, which was applied in a pilot test (n = 10); after the final adjustments the Seattle Quality of Life Group approved the official version of the YQOL-FD in Portuguese. To obtain the psychometric validation, we requested the participation of 20 patients with cleft lip and palate who answered the questionnaire twice in a range of 7 to 15 days. The Cronbach's alpha test was applied in the 48-item block, showing a high degree of internal consistency (0.949). The Wilcoxon Signal Post Test was applied to verify if the test and retest values were similar; the general agreement was 4/5 = 80%, indicating high reproducibility. It was concluded that the Portuguese version of the YQOL-FD is adequate for evaluating Quality of Life of Brazilian adolescents with craniofacial deformities.

O YQOL-FD (Youth Quality of Life ­ Facial Differences) validado nos EUA em 2005, foi desenvolvido na Universidade de Washington, pelo Seattle Qualitity of Life Group (SeaQol), com a finalidade de avaliar a qualidade de vida de adolescentes com deformidades faciais. Por não apresentar uma versão no idioma português o seu uso não poderia ser viabilizado no Brasil. O objetivo deste trabalho foi conseguir a validação linguística e a validação psicométrica de uma versão do YQOL-FD, no idioma português do Brasil. Participaram deste estudo 25 pacientes com Fissura de Lábio e Palato (FLP) e 5 sem qualquer deformidade facial, em atendimento na Clínica do Departamento de Cirurgia Traumatologia e Prótese Maxilofacial da Faculdade de Odontologia da Universidade de São Paulo. A validação linguística do YQOL-FD foi realizada por uma equipe constituída pelo pesquisador, como gerente de projeto, por 2 consultores nativos da língua portuguesa muito fluentes em inglês e por 1 consultor nativo de língua inglesa com fluência em português. Após a tradução e a retrotradução obteve-se uma versão em português, a qual foi aplicada em um teste piloto, com n = 10, sendo 5 adolescentes com FLP e 5 sem FLP, que após os acertos finais permitiu que o SeaQol aprovasse a versão oficial do YQOL ­ FD em português. Para a obtenção da validação psicométrica solicitou-se a participação de 20 pacientes com FLP que responderam ao questionário por 2 vezes em um intervalo de 7 a 15 dias. O teste de Cronbach foi aplicado no bloco de 48 itens mostrando alto grau de consistência interna (0,949). Na aplicação do Teste dos Postos Sinalizados de Wilcoxon, com o intuito de verificar se os valores do teste (t) e do re-teste (rt) são semelhantes, foi possível observar que a concordância geral é de 4/5 = 80%, portanto uma reprodutibilidade elevada. Concluiu-se que o YQOL­FD na versão em português pode ser utilizado como instrumento adequado para a avaliação da Qualidade de Vida dos adolescentes brasileiros com deformidade carniofacial.

Caliber persistent artery in the upper lip: a case report with unusual histopathological findings

Abstract Caliber persistent labial artery (CPLA) consists in a dilated portion of the main branch of the labial artery without loss of size. The aim of this study is to report a case of a patient diagnosed with CPLA in the upper lip, emphasizing unusual histopathological and immunohistochemical findings. A 67-year-old female patient with complaint of a pulsating upper lip lesion without painful symptomatology. Under a clinical diagnosis of CPLA, and considering that the patient was edentulous and used a total prosthesis, an excisional biopsy of the lesion was performed to avoid future traumas in the region and consequently possible exuberant local bleeding. At anatomopathological examination structures suggestive of lymphoid follicles and germinal centers were visualized. Immunohistochemistry showed positivity for CD20, CD68, desmin and CD34 and negativity for CD4. The patient did not have a history of allergies, cardiovascular, rheumatic or systemic diseases that could justified the findings. The case presents unusual histopathological structures, evidencing the necessity of more studies about this pathology so scarce in the literature.

Resumo Artéria labial de calibre persistente (ALCP) consiste em uma parte dilatada do ramo principal da artéria labial que penetra no tecido submucoso sem perda de calibre. O objetivo desse estudo é relatar um caso de uma paciente diagnosticada com ALCP em lábio superior, enfatizando os achados histopatológicos e imuno-histoquímicos incomuns. Paciente de 67 anos, sexo feminino, com queixa de lesão em lábio superior, pulsante, sem sintomatologia dolorosa. Diante do diagnóstico clínico de ALCP, e considerando que a paciente era edêntula e usuária de prótese total, foi realizada biópsia excisional para evitar futuros traumas na região e, consequentemente, sangramento local exuberante. Ao exame anatomopatológico foram visualizadas estruturas sugestivas de folículos linfoides e com formações sugestivas de centros germinativos. No exame imuno-histoquímico observou-se imunopositividade para CD20, CD68, desmina e CD34 e sem imunomarcação para CD4. A paciente relatou não possuir histórico de alergias, doenças cardiovasculares, reumáticas ou sistêmicas que justificassem os achados. O caso apresenta estruturas histopatológicas incomuns, corroborando a necessidade de mais estudos acerca dessa lesão tão pouco discutida na literatura.

EBV-negative lymphoepithelial-like carcinoma of the lower lip

Lymphoepithelial-like carcinoma (LEC) is a rare malignant neoplasm, which can be associated with Epstein-Barr virus (EBV) infection. Histologically, LEC is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. LEC appears to be an uncommon tumor type of lip carcinoma. An 82-year-old white woman presented a lesion on her lower lip that developed over the last year. The lesion was characterized by ulceration with flat edges, hardened base, painful, and absence of regional lymphadenopathy. Microscopical analysis evidenced an intense inflammatory infiltrate, composed of lymphoplasmacytic cells, associated with scarce pleomorphic epithelial cells. Immunohistochemistry highlighted the LEC cells with strong expression of pan-CK AE1/AE3, EMA, p63, and p53. CD138 was also faintly positive. Ki-67 was >85%. In situ hybridization analysis did not show evidence of EBV. A diagnostic of EBV-negative LEC was made. We present an uncommon type of lip carcinoma, which can represent a diagnostic challenge for clinicians and pathologists.

Complete enucleation surgical treatment and histological analysis of a mucocele in lower lip in a child: case report / Tratamiento quirúrgico de enucleación completa y análisis histológico de un mucocele en el labio inferior en un niño: reporte de caso

Objective: The aim of this case report is to describe the surgical removal of a mucocele and its histological analysis, in a child. Case Report: An 11-year-old female patient attended the Pediatric Dentistry clinic complaining of a lower lip lesion. During the anamnesis, the mother reported that the child had a habit of biting and sucking the spot frequently. Clinical examination showed the lesion was compatible with a mucocele. The proposed treatment was a complete enucleation of the lesion under local anesthesia. The incision and tissue divulsion were performed for maximum preservation of the mucosa, avoiding a possible recurrence. Total adjacent glands removal was also performed. The lesion was placed in 10% formaldehyde for histopathological analysis (H&E Staining), which showed dense connective tissue presenting chronic inflammatory infiltrate and extravasated mucin, presence of granulation tissue delimiting the area of extravasated mucin and presence of minor salivary glands. The patient was advised to quit the habit, and after seven days the sutures were removed. At the one-year follow-up there was no recurrence of the lesion. Conclusion: The proposed treatment proved to be effective without recurrence of the lesion.

Objetivo: El objetivo de este reporte de caso es describir la extirpación quirúrgica de un mucocele y su análisis histológico en un niño. Informe del caso: una paciente de 11 años de edad asistió a la clínica de Odontopediatria quejándose de una lesión en el labio inferior. Durante la anamnesis, la madre informó que el niño tenía la costumbre de morder y chupar el lugar con frecuencia. En el examen clínico, la lesión fue compatible con un mucocele. El tratamiento propuesto fue una enucleación completa de la lesión bajo anestesia local. La incisión y la divulgación del tejido se realizaron para la máxima preservación de la mucosa, evitando una posible recurrencia. También se realizó la extracción total de las glándulas adyacentes. La lesión se colocó en formaldehído al 10% para el análisis histopatológico (tinción H&E), que mostró tejido conectivo denso que presenta infiltrado inflamatorio crónico y mucina extravasada, presencia de tejido de granulación que delimita el área de mucina extravasada y presencia de glándulas salivales menores. Se aconsejó al paciente que abandonara el hábito, y después de siete días se retiraron las suturas. En el seguimiento de un año no hubo recurrencia de la lesión. Conclusión: El tratamiento propuesto demostró ser efectivo sin recurrencia de la lesión.

Development and evaluation of the efficiency of ointment for cheilitis treatment in patients with dental and jaw anomalies

Cheilitis is a group of chronic diseases of the vermilion border that are diverse in etiology, pathogenesis and clinical picture. The development of various forms of cheilitis is facilitated by defects of the architectonics of the lips, unhealthy lifestyle, anatomical features of the lip structure, adverse meteorological effects, decrease in specific and non-specific factors for protecting the oral cavity, the patient's psycho-emotional state, immuno-allergic factors and accompanying general somatic and dental pathologies. The issues of prevention and comprehensive treatment of lip diseases are especially relevant in dental practice. The article presents data on the prevalence of cheilitis and dentoalveolar anomalies and the need for their treatment in young people. Furthermore, the authors provide a composition justification and develop an ointment for the treatment of cheilitis in this category of patients.

Tratamento cirúrgico do lábio duplo: relato de caso / Surgical treatment of the double lip: case report

Introdução: O lábio duplo é caracterizado por excesso de tecido na mucosa labial, de aspecto normal, podendo acometer o lábio superior, inferior ou ambos. Ocorre com maior incidência no lábio superior, de forma uni ou bilateral, podendo ser congênito ou adquirido. A alteração geralmente é perceptível em repouso, durante a fala ou sorriso. O tratamento cirúrgico pode ser necessário, caso o paciente apresente comprometimento estético e/ou funcional. Relato de caso: Neste trabalho, é descrito um caso clínico de lábio duplo, adquirido em paciente do sexo masculino de 40 anos de idade cujas queixas eram estéticas e funcionais. Considerações Finais: Foi realizada cirurgia para remoção do excesso tecidual com incisão por planos em forma de elipse, solucionando, assim, a deformidade... (AU)

Introduction: The double lip is characterized by excess of tissue in the labial mucosa, of normal aspect, being able to affect the upper lip, inferior or both. Occurring with greater incidence in the upper lip of uni or bilateral form, being able to be congenital or acquired. The change is usually noticeable at rest, during speech or smile. Surgical treatment may be necessary if the patient presents with aesthetic and/ or functional impairment. Case report: This paper describes a clinical case of double lip acquired in a 40-year-old male patient, whose complaints were aesthetic and functional. Final considerations: Surgery was performed to remove tissue excess with incision through ellipse-shaped planes, thus solving the deformity... (AU)

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown etiology that affects the lip. It is characterized histologically by a dense infiltrate of plasma cells with a variety of clinical features. The response to different therapeutic modalities is controversial, especially regarding the effectiveness of corticosteroids. We present a case of a 56-year-old Caucasian man with a painful ulcerated and crusted area in the lower lip, resembling a squamous cell carcinoma or actinic cheilitis. Topical corticosteroid was used for one week, which resulted in partial regression and motivated a biopsy. The histological examination provided the diagnosis of PCC. The patient has been disease-free for six months. We also provide a discussion on the criteria of differential diagnosis and management of this rare condition.

Paracoccidioidomicose com repercussão oral: relato de caso em zona urbana / Paracoccidioidomycosis with oral impact: case report in an urban area

Objetivo: relatar um caso de paracoccidioidomicose (Pbmicose), diagnosticado pelo cirurgião-dentista, e o tratamento instituído a um morador de zona urbana. Relato de caso: paciente do sexo masculino, com 59 anos de idade, leucoderma, compareceu à clínica odontológica com lesão em boca há cerca de vinte dias e queixa de mobilidade dental na região anteroinferior. Durante a anamnese, constatou-se dificuldade respiratória, hipertensão controlada, tabagismo e etilismo crônico. No exame físico, foi observado aumento de volume do lábio inferior, linfadenopatia bilateral submandibular e lesões ulceradas com aspecto moriforme em mucosa bucal e gengiva inserida do elemento 31 ao 45. Foi realizada biópsia incisional na lesão com resultado positivo para Pbmicose. O paciente foi medicado com itraconazol e apresenta-se periodicamente para acompanhamento. Considerações finais: as lesões bucais dessa doença correspondem a úlceras crônicas e granulomatosas, semelhantes à lesão provocada pelo carcinoma epidermoide oral, assim, o cirurgião-dentista deve conhecer esta micose e considerá-la na elaboração do diagnóstico diferencial. (AU)

Objective: to report a case of paracoccidioidomycosis (Pbmycosis) diagnosed by the dentist, as well as the treatment applied to a resident of an urban area. Case report: male patient, 59 years old, white, referred to the dental clinic with a lesion in the mouth of around 20 days and complaint of tooth mobility in the anteroinferior region. The anamnesis showed respiratory distress, controlled hypertension, and chronic smoking and alcoholism. The physical examination showed increased volume of the lower lip, bilateral submandibular lymphadenopathy, moriform ulcerated lesions in the buccal mucosa, and gum insertion from tooth 31 to 45. An incisional biopsy was performed on the lesion with a positive result for Pbmycosis. The patient was treated with itraconazole and he shows up periodically for follow-up. Final considerations: the oral lesions of this disease correspond to chronic and granulomatous ulcers, similar to the lesion caused by the oral squamous cell carcinoma, thus, the dentist should understand this mycosis and consider it when producing the differential diagnosis. (AU)

Abscesso labial por manipulação de acne: relato de caso / Lip abscess by acne manipulation: case report

Os abscessos labiais são entidades pouco relatadas na literatura científica. São infecções potencialmente graves, de origem poli microbiana, podendo causar necrose tecidual e deformidades na região. A microbiota dessas infeções costuma ser conhecida, dispensando, muitas vezes, a cultura e o antibiograma. Antibióticoterapia empírica e drenagem apresentam boa resolutividade. O presente trabalho tem como objetivo relatar um caso de abscesso labial, causado por manipulação de acne. Paciente do sexo masculino, 19 anos de idade, com relato de manipulação de lesão pustulosa na linha de transição muco-cutânea do lábio inferior há 05 dias, evoluindo abscesso labial. O tratamento foi realizado com antibióticoterapia empírica, penicilina de amplo espectro associado com sal potássico de ácido clavulânico e drenagem. Após sete dias, o paciente já apresentou aspecto de normalidade na região. Diagnóstico e abordagem precoce foram determinantes para a resolutividade do caso... (AU)

The lip abscesses cases are little reported in the scientific literature. They are potentially serious infections, polymicrobial and may cause tissue necrosis and deformities in the region. The microbiota of these infections usually known, often dispensing culture and sensitivity. Antibiotic empiric therapy and drainage have good resoluteness. This study aims to report a case of lip abscess caused by acne handling. A 19-year-old male patient, presenting a pustular lesion on the mucocutaneous transition line in lower lip with 5 days of evolution. The treatment was performed with empirical antibiotic therapy, broad spectrum penicillin associated with clavulanic acid potassium salt and drainage. After seven days, the patient presented aspect of normality in the region. Early diagnosis and approach were instrumental in solving the case... (AU)

Síndrome de Laugier-Hunziker / Laugier-Hunziker syndrome

El síndrome de Laugier-Hunziker es un trastorno pigmentario adquirido poco frecuente, caracterizado por presentar lesiones hiperpigmentadas cutaneomucosas idiopáticas que pueden asociarse a melanoniquia longitudinal. A pesar de ser considerado una enfermedad benigna sin manifestaciones sistémicas ni potencial maligno, es clave realizar el diagnóstico diferencial con otros trastornos pigmentarios, en especial con el síndrome de Peutz-Jeghers. Se presenta aquí el caso de un paciente con este síndrome poco frecuente. (AU)

Laugier-Hunziker syndrome is a rare acquired pigmentary disorder that is characterized by idiopathic mucocutaneous pigmentation that may be associated with longitudinal melanonychia. Although this syndrome is considered a benign disease with no systemic manifestations or malignant potential, it is important to rule out other mucocutaneous pigmentary disorders, especially Peutz-Jeghers syndrome. We report the case of a patient with this unusual syndrome. (AU)

Queiloplastia primária unilateral através da técnica de Fisher / Unilateral primary lip repair by Fisher technique

Introdução: As fissuras labiais são alterações congênitas que decorrem da não fusão dos processos nasais medianos com os processos nasais laterais, sendo sua ocorrência em aproximadamente 1:550 nascidos vivos. Essas fissuras podem apresentar-se bilaterais ou unilaterais nos lábios e acompanhadas ou não de fenda palatina. A cirurgia primária para reparação do lábio fissurado unilateral vem sendo descrita por diversas técnicas na literatura e geralmente envolve rotações de retalho e deixam cicatrizes visíveis bem como encurtamento do vermelhão do lábio. A técnica de Fisher foi proposta para resultar em uma cicatriz menos visível, em linha reta na região do filtro labial, colocando-a em uma região mais anatômica e simplificando a cirurgia. O objetivo deste artigo é mostrar um caso clínico de queiloplastia primária unilateral, utilizando a técnica de Fisher. Relado de Caso: Paciente CDSS, 8 meses de idade, portador de fissura lábio-palatina unilateral do lado esquerdo. A cirurgia do lábio foi realizada em ambiente hospitalar sob anestesia geral e a técnica utilizada foi a de Fisher. No acompanhamento de 30 dias o paciente apresentou-se com uma cicatriz bastante discreta, posicionada simetricamente em relação ao filtro labial do lado oposto. Conclusão: A técnica de Fisher mostrase como ótima opção para o tratamento de fissuras labiais unilaterais, pois proporciona uma excelente estética, a técnica cirúrgica é relativamente simples e acompanhada de bons resultados funcionais

Introduction: Cleft lip is a congenital abnormality arising from no merger of the median nasal processes with the lateral nasal processes, and their occurrence is approximately 1 in 550 live births. These clefts may present bilateral or unilateral lips and with or without cleft palate. The primary surgery for repair of unilateral cleft lip has been described by several techniques in literature and usually involves retail rotations and leave visible scars and lip vermilion shortening. Fisher technique has been proposed to result in a less visible scar, straight in the philtrum region placing it in a more anatomical region and simplifying the surgery. The purpose of this article is to show a case of unilateral primary lip repair using the Fisher technique. Case Report: Patient CDSS 8 months old has an unilateral cleft lip and palate on the left side. The lip surgery was performed in a hospital under general anesthesia and the technique used was Fisher. In the following 30 days, the patient is presented with a very slight scar, positioned symmetrically in relation to the philtrum of the opposite side. Conclusion: Fisher technique is shown as great option for the treatment of unilateral cleft lip, it provides an excellent aesthetic, the surgery technique is relatively simple and accompanied by good functional results

Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions

Abstract: The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability.

Necrosis de injerto de tejido conectivo subepitelial asociado a incompetencia labial: reporte de un caso clínico / Necrosis of a subepitelial connective tissue graft associated with lip incompetence: case report

Se describe el reporte del caso de una paciente sana con incompetencia labial portadora de un implante dental en la zona de 1.2, a la cual se le realizó un injerto de tejido conectivo utilizando la técnica del «sobre¼ para mejorar un leve defecto estético existente. El injerto sufrió una necrosis, posiblemente debido a la condición de deshidratación a la que están sometidos los tejidos en estos pacientes que presentan incompetencia labial y respiración bucal. Se describe la resolución quirúrgica del caso mediante una segunda cirugía de injerto de tejido conectivo, y se entrega el manejo clínico para evitar la aparición de esta complicación.

We describe a case report of a patient with lip incompetence and a healthy carrier of a dental implant in the tooth 1.2, which was performed using a connective tissue graft technique for improving an existing slight cosmetic defect. The graft necrosis was possibly due to the dehydration that the tissues are subjected to in these patients with mouth breathing and labial incompetence. The surgical resolution of the case by a second connective tissue graft, and its clinical management to prevent the occurrence of this complication is presented.

Tratamiento ortodóncico de compensación de un paciente adulto con Labio y Paladar Hendido bilateral. Reporte de Caso / Compensation orthodontic treatment of an adult patient with bilateral cleft lip and palate clip. Case Report

Se presenta caso clínico de un paciente de 28 años de edad con labio y paladar hendido bilateral el cual fue realizado en la clínica de labio y paladar hendido del posgrado de ortodoncia de la Universidad del Valle en el periodo de 5 años y 4 meses. El paciente presentaba una relación esquelética Clase II, Prognatismo maxilar, macrognatismo severo mandibular, una maloclusión mo- lar Clase I derecha y Clase II izquierda acompañada de retroinclinación severa y retrusión leve de incisivos superiores e inferiores al igual que malposiciones múltiples e Impactación del diente 12. Se desarrolló plan ortodóncico no quirúrgico de compensación, acompañado de un tra- tamiento inicial ortopédico de expansión maxilar y ortodóncico correctivomediante aparatología fija tipo brackets estándar slot 0.022x0.028 pulgadas, exodoncias de primeros premolares inferiores,tipificación de caninos como incisivos laterales, al igual que rehabilitación de los dientes anteriores superiores. Se obtuvo resultados satisfacto - rios en términos de una oclusión funcional y estética.

Clinical case of a 28 year old patient with bilateral cleft lip palate, who was treated during a period of 5 years and 4 months, at the University of Valle postgraduate orthodontic's clinic of lip and palate, is presented. The patient had undershot jaw, severe mandibular macrognatismo, molar malocclusionclass I and class II right and left, accompanied by severe recumbent and mild retrusión of upper incisors and lower and, multiple malposition and impaction tooth 12. A non - surgical orthodontic plan compensation was developed and accom - panied by an initial mandibular treatment, orthopedic expansion and corrective or - thodontic treatment, using fixed appliances such as standard braces slot 0.22x0.028 inches, extractions of lower first premolars, typing canines as lateral incisors as well as rehabilitation of the upper front teeth. Satisfactory results were obtained in terms of aesthetic and functional occlusion. Key words: Cleft lip, cleft palate, or - thodontic treatment of compensation, bilateral cleft lip and palate

Pentoxifilina como tratamiento efectivo de la lipoidoproteinosis / Pentoxifylline as an effective treatment of lipoidoproteinosis

La lipoido proteinosis es una enfermedad rara, que ocurre por un defecto en el gen que codifica la proteína de la matriz extracelular 1 (ECM1). Estogenera un aumento del colágeno tipo IV, que resulta en depósitos de material hialino anómalo en la dermis y otros tejidos. Actualmente no hay terapias curativas y los múltiples tratamientos utilizados han tenido resultados variables y efectos adversos relevantes.La pentoxifilina es un fármaco que inhibe al factor de crecimiento transformante beta (TGF-beta) y así, regula la producción de colágeno por los fibroblastos. Se ha empleado con éxito en casos de fibrosis renal, hepática y pulmonar y luego de la radioterapia. Se presenta este caso que constituye la primera comunicación de lipoidoproteinosis tratada con pentoxifilina, en el que se evidenció una mejoría clínica, ecográfica y laringoscópica.

Lipoid proteinosisis a rare disease, causedby a defect in the gene encoding the extracellular matrix protein 1 (ECM1), that leads to an increased of collagen type IV, resulting in abnormal deposits of hyaline material in the dermis and other tissues. Currently, there are no curative therapies; several ones have been used with varied results and adverse effects. Pentoxifylline is a drug with inhibitory effect on TGF-beta, thus regulates collagen production by fibroblasts. It has been successfully used in renal, liver and lung transplant and after radiotherapy fibrosis. We present this case because it is the first report of lipoid proteinosis treated with pentoxifylline; with demonstrated clinical, sonographic and laryngoscopic improvement.