Lipoid proteinosis unveiled by oral mucosal lesions: a comprehensive analysis of 137 cases.

OBJECTIVES: Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by deposits of hyaline material within skin and mucous membranes of the upper aerodigestive tract, especially the vocal cords. We aimed to investigate possible associations between oral LP (oLP) manifestations and demographic data and extra-oral lesions. MATERIAL AND METHODS: Cases of oLP were collected following a systematic search of Medline's PubMed and Google Scholar (1948-2014). We added four new cases. Demographic data, consanguineous marriage status, oral lesion site(s), and related symptoms were analyzed for potential associations. RESULTS: A total of 137 patients with oLP lesions were analyzed. Parental consanguinity status was known for 52 patients, and the parents were not related in 38 (73%) of them. The tongue was the most commonly affected oral site (68%), and it was associated with significantly more affected family members (P = 0.002). The palate and gingiva were the least involved sites (25 and 6%, respectively): the former had a tendency to be affected in younger patients and the latter in older ones. Patients with palatal and labial lesions had significantly less skin scarring (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Extra-oral manifestations are easily recognizable and they can lead to early and accurate diagnosis of LP. In spite of early voice manifestations, diagnosis of LP might be obvious only later in life and usually sought due to presence of oral lesions. CLINICAL RELEVANCE: The diagnosis of oLP with obscure extra-oral signs is challenging, with dental surgeons playing a key role in its establishment.

Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases.

INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature. REPORT OF CASE: We describe a case of a 54-year-old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis but the presence of HCC was unknown. METHODS AND RESULTS: The English language literature was searched for documented cases of HCC metastasis to the jaw, applicable data was evaluated. The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death. CONCLUSIONS: This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis.

Key architectural changes in tumor-negative lymph nodes from metastatic-free oral cancer patients are valuable prognostic factors.

Regional lymph node (LN) metastasis in oral cancer patients is the most significant grave prognostic factor. We evaluated the relationship between clinical outcomes and different histopathological changes in tumor-negative LNs (LN0) selected from neck dissections without metastatic disease (pN0). A total of 435 LN0 selected from pN0 neck dissections (up to three nodes in each level) were scored for histopathological parameters of LN areas, capsule thickness, subcapsular and medullary sinus ectasia, lobular architecture and percent of cortical reactive follicles. These were compared to 328 LN0 selected from neck dissections with metastases (pN+) after exclusion of metastatic LNs. Data were presented by maximum scores of each parameter in I-III (close) and in IV-V (distant) levels. Limited data from level V and regression analyses inferred that the values in level IV represented the worst changes for most patients. Cox proportional hazard regression on each parameter in close and distant levels demonstrated that capsule thickness, number of lobules and percent of reactive follicles were significantly associated with time to death from disease. The higher the change in distant levels, the shorter the time to death, while the higher the change in close levels (given a stable change in distant levels), the longer the time to death. After adjustment for gender, age and location, only the effect of the percent of reactive follicles retained their significant effect. Logistic regression of metastases demonstrated that all parameters except for percent of reactive follicles were significantly associated with risk of metastases, with differences between close and distant levels similar to those found for time to death. After adjustment for gender, age and location, only the area and number of lobes retained their significance. The findings of this study suggested that selective histopathological changes in tumor-negative LNs in metastatic-free patients provide new valuable prognostic parameters.

Wrong tooth extraction: root cause analysis.

OBJECTIVE: Errors made by clinicians in dental practice require changes in the original planning of patient management. The purpose of this study was to analyze events that led to wrong tooth extraction. METHOD AND MATERIALS: A total of 54 insurance claims for wrong tooth extractions were reported and evaluated by Medical Consultants International from 1993 to 2004. Data were collected and analyzed according to parameters regarding the clinician who performed the procedure, the nature of the referral for extraction, the demographics of the patient, the venue in which the extraction took place, the reason for the error, and the nature of the insurance claim. RESULTS: General practitioners performed 72% of the extractions, 49% of the referring clinicians were orthodontists, 74% of the errors were made during extraction, and 77% of the errors were made in polyclinics. CONCLUSIONS: Errors during treatment and poor communication among clinicians led to extraction of the wrong teeth. This can be avoided by greater caution on the part of the extracting clinician when following the treatment plan. Guidelines toward this end are recommended.

Serologic bone markers for predicting development of osteonecrosis of the jaw in patients receiving bisphosphonates.

PURPOSE: Osteonecrosis of the jaw is a well-documented side effect of bisphosphonate (BP) use. Attempts have recently been made to predict the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). We prospectively investigated the predictive value of serum levels of C-terminal telopeptide of collagen I (CTX), bone-specific alkaline phosphatase, and parathyroid hormone for the development of BRONJ. PATIENTS AND METHODS: Data on the demographics, comorbidities, and BP treatment were collected from 78 patients scheduled for dentoalveolar surgery. Of the 78 patients, 51 had been treated with oral BPs and 27 had been treated with frequent intravenous infusions of BPs. Blood samples for CTX, bone-specific alkaline phosphatase, and parathyroid hormone measurements were taken preoperatively. Surgery was performed conservatively, and antibiotic medications were prescribed for 7 days. RESULTS: Of the 78 patients, 4 patients taking oral BPs (7.8%) and 14 receiving intravenous BPs (51.8%) developed BRONJ. A CTX level less than 150 pg/mL was significantly associated with BRONJ development, with an increased odds ratio of 5.268 (P = .004). The bone-specific alkaline phosphatase levels were significantly lower in patients taking oral BPs who developed BRONJ. The parathyroid hormone levels were similar in patients who did and did not develop BRONJ. CONCLUSION: The incidence of BRONJ after oral surgery involving bone is greater among patients receiving frequent, intravenous infusions of BPs than among patients taking oral BPs. Although the measurement of serum levels of CTX is not a definitive predictor of the development of BRONJ, it might have an important role in the risk assessment before oral surgery.

Risk management in endodontics.

INTRODUCTION: Endodontic claims are the most frequently filed malpractice claims in dentistry. The aim of this study was to categorize and review errors and complications related to endodontic procedures that resulted in legal actions against the treating practitioner. METHODS: All dental malpractice complaints reported to the Medical Consultants International Company (MCI) in Israel between the years 1992-2008 were retrospectively analyzed according to a structured form. All complaints were categorized as either financial risk bearing (eg, justified) or financial non-risk bearing (eg, nonjustified). The treatment errors that were found in the files were categorized according to phases of treatment: preoperative, intraoperative, and postoperative errors. RESULTS: A total of 720 complaints were analyzed including 520 complaints (72.2%) that were found to be justified and 200 complaints (27.8%) that were judged as not justified. Most of the treatment errors occurred during the intraoperative phase. In lower anterior teeth and in cases involving more than 1 tooth, significantly more errors were found during instrumentation and root canal filling (P < .05). There was a similar distribution of operator errors and of negative outcomes for teeth with elective endodontic treatment and teeth with endodontic treatment as a result of a pathologic process. CONCLUSIONS: The technical skills of the dental practitioners performing root canal treatments require improvement. All possible risks and complications should be considered and explained to the patient before treatment.

Bisphosphonate-related osteonecrosis of the jaw associated with dental implants.

PURPOSE: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented devastating side effect of long-term bisphosphonate (BP) use. There is scarce information in the literature on BRONJ associated with dental implants (DIs). The purpose of this study was to present a large series of cases of this association. PATIENTS AND METHODS: The files of all patients with BRONJ associated with DIs who were treated in the department of oral and maxillofacial surgery from 2003 to 2009 were reviewed. Data on demographics, medical background, type, and duration of BP treatment before the development of BRONJ, mode of therapy, and therapeutic outcome were retrieved. RESULTS: Of the 27 patients enrolled into the study, 11 (41%) developed BRONJ while taking oral BPs and 16 (59%) developed BRONJ associated with intravenous BPs. BRONJ developed after mean periods of 68 months (median, 60), 16.4 months (median, 13), and 50.2 months (median, 35) in patients on alendronate, zoledronic acid, and pamidronate, respectively. Only 6 patients developed BRONJ during the first 6 months after DI placement. When BP treatment had been started before DI placement, there was a mean duration of 16.2 months (median, 11) until the appearance of BRONJ development. Long-term antibiotics and only essential surgical procedures comprised the treatment of choice, and the response rate was considerably better for patients taking the oral type of BPs. There was no significant association between BRONJ and diabetes, steroid intake, or smoking habits. CONCLUSION: Patients undergoing BP treatment and who receive DIs require a prolonged follow-up period to detect any development of BRONJ associated with DIs.

Oral tongue squamous cell carcinoma: recurrent disease is associated with histopathologic risk score and young age.

PURPOSE: To apply the Brandwein-Gensler et al.'s histopathologic risk score (RS) system and to evaluate its impact on locoregional recurrence and overall survival in a series of cases of oral tongue cancer, along with variables of patient age and margin status. METHODS: Sections of the resection specimens (N = 50) were submitted to a RS assignment of three components: the worst pattern of invasion, lymphocytic infiltration and perineural invasion. Risk scores of 0-2 were classified as low-to-intermediate and RSs > or = 3 were classified as high with respect to recurrence and survival. Margins were considered as "clean" if the tumor was > or = 5 mm away from them, otherwise they were defined as "positive". Patients < or = 60 years were considered "young" and those >60 years "old". Kaplan-Meier survival analysis with univariate and Cox multivariate regression model with stepwise forward selection tests were used. RESULTS: Univariate analysis showed that locoregional recurrence was negatively influenced by high RSs (P = 0.011), "young" age (P = 0.027) and positive margins (P = 0.027). Multivariate analysis revealed that the risk of recurrence was increased by high RSs (hazard ratio 11.14; P = 0.022) and "young" age (hazard ratio 3.41; P = 0.022). "Young" patients with high RSs had a higher frequency of recurrence rate compared to "young" patients with low-to-intermediate scores (P = 0.008) and "old" patients with low-to-intermediate and high RSs (P = 0.012 and P = 0.011, respectively). CONCLUSIONS: The histopathologic RS can serve to identify a subgroup of patients <60 years who have a high recurrence rate of oral tongue cancer, irrespective of the margin status.

Tumor-host histopathologic variables, stromal myofibroblasts and risk score, are significantly associated with recurrent disease in tongue cancer.

Margin status, a major prognostic parameter in oral cancer, was analyzed vis-à-vis the histopathologic parameters of risk scores and stromal myofibroblasts. Specimens of tongue carcinoma (n = 50) were submitted to a risk score assignment consisting of the worst pattern of invasion, lymphocytic infiltration, and perineural invasion. Frequency of stromal myofibroblasts (alpha-smooth muscle actin stain) was assessed. A triple immunostaining assay with E-cadherin, Ki-67 and alpha-smooth muscle actin was used to identify carcinoma cells undergoing epithelial-mesenchymal transition. Margins were considered 'clean' if the tumor was >or=5 mm away from them. Patients

Foreign body granulomas after injection of Bio-alcamid for lip augmentation.

Bio-alcamid is one of the newest agents on the market for soft tissue augmentation. Seven studies were documented in the medical literature that examined the safety of Bio-alcamid (Polymekon, Brindisy, Italy); all reported no cases of tissue migration, foreign body granulomas, allergenicity, or interference with the control of cell proliferation. On 2 separate occasions, a woman who had recently undergone lip augmentation presented at our hospital with submucosal nodules of the lip. Histologic examination revealed multiple foreign body-type granulomas composed of giant cells, epithelioid cells, and chronic inflammation of the lip. Efforts to produce a cosmetic material that fulfills all the criteria as an "ideal" agent has not yet been found because all injectable foreign agents have the potential to induce adverse reactions. Caution must be exercised in all cases and the risks explained to the patient before its use.

Bisphosphonate-related osteonecrosis of the jaws: a single-center study of 101 patients.

PURPOSE: Osteonecrosis of the jaw (ONJ) is a devastating side effect of long-term bisphosphonate (BP) use. We present the largest case series from a single department. MATERIALS AND METHODS: This case series included 101 ONJ patients. Data on demographics, medical background, type and duration of BP use, possible triggering events, mode of therapy, and outcome were recorded. RESULTS: ONJ was associated with intravenous BPs in 85 patients and with oral BPs in 16 patients. It was diagnosed after 48, 27, and 67 months of pamidronate, zoledronic acid, and alendronate use, respectively. Long-term antibiotics and minimal surgical procedures resulted in complete or partial healing in 18% and 52% of the patients, respectively; 30% had no response. There was no association between ONJ and diabetes, steroid and antiangiogenic treatment, or underlying periodontal disease. Diagnostic biopsies aggravated lesions without being informative about pathogenesis. A conservative regimen is our treatment of choice. CONCLUSION: Solutions for decreasing morbidity and poor outcome of ONJ remain elusive.

Radiographic evaluation of the prevalence of root resorption in a Middle Eastern population.

OBJECTIVE: To evaluate radiographically the prevalence of various types of root resorption in different tooth groups in a Middle Eastern population. METHOD AND MATERIALS: Full-mouth radiographs of 712 patients (19,072 teeth) were evaluated for the presence of root resorption. Two observers evaluated each tooth from at least 2 radiographic projections on periapical films. RESULTS: Teeth exhibiting root resorption were found in 205 radiographs (28.8%). The most common form of resorption was pulpal infection (71.2%), mainly in mandibular molars ( P< .01) and in patients 45 years and older ( P< .005). Orthodontic pressure resorption was detected in 14.6% of root resorption cases, mainly in maxillary incisors ( P< .01). Impacted tooth or tumor pressure resorption was observed in 10.2% of all cases of resorption, mainly in mandibular molars ( P< .01), and periodontal infection resorption was identified in 3.9% of all resorption cases in all tooth groups ( P > .05). Ankylotic resorption was not found in this survey. CONCLUSION: The most common types of root resorption in the general population were pulpal infection-related root resorption, orthodontic pressure root resorption, and impacted tooth pressure resorption. It is probable that most are unrelated to traumatic injuries of the teeth.

[Etiology of maxillofacial trauma--a 10-year survey at the Chaim Sheba Medical Center, Tel-Hashomer].

BACKGROUND: The management of cranio-maxillofacial trauma includes treatment of facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Integration of several specialties is often needed due to the proximity of the cranial bones to important organs such as the eyeballs, the nose, the ears, and the brain. The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied. The differences between populations in the causes of maxillofacial fractures may be the result of risk factors and cultural differences between countries but are more likely to be influenced by the injury severity. Many epidemiologic investigations of maxillofacial fractures have appeared in the scientific literature over the years. Six main causes of injury were identified: motor vehicle accidents, occupational accidents, sport accidents, falls, assaults, and gun shot wounds. However, few reports, representing continuous long-term data on maxillofacial fractures in the state of Israel, are to be found. AIMS: This study was undertaken to provide information regarding gender, age, etiology and diagnosis of patients with maxillofacial fractures, gleaned from our experience in the last 10 years (1996-2005), and to compare this information to the findings from the years 1985-1995, at the Department of Oral and Maxillofacial Surgery in the Chaim Sheba Medical Center, Tel Hashomer. METHOD: The present study reviews retrospectively hospital records of 775 patients. Data regarding the 753 patients treated at the department in the years 1985-1995 was taken from previous publication. The diagnosis was based on radiographic data and clinical examination. The statistical analysis was carried out by the Statistics Department of Tel Aviv University. RESULTS: The majority of patients (74.2%) were males, the average age was 33.4 years, and the largest subgroup of patients (34%) was in the third decade of life. The most common cause of injury was falls (35%), followed by motor vehicle accidents (29%), and assaults (18%). The most frequent fractures in the male group involved the zygomatic complex (23.4%), followed by the subcondylar area (13.5%). In contrast, the most frequent fractures among females involved the subcondylar area (20.4%) followed by the zygomatic complex (18%). The average age of male patients was 31.2 years, whereas the average age of female patients was 39.6 years. In regard to gender, the first five decades were dominated by male patients, the sixth decade showed an equal distribution, and the females dominated the patient group in the seventh to tenth decades. A rise in the number of patients hospitalized due to falls and assaults, and a decrease in patients hospitalized due to motor vehicle accidents was noted during the years 1996-2005 compared to the years 1985-1995. CONCLUSIONS: Data from the world literature is similar to our findings, as regard to gender and age. Major differences between males and females regarding age, etiology, and diagnosis were found in our study. Nevertheless, the two most common fracture sites among males and females are the Zygomatic complex and the subcondylar area. Apparently, the Israeli society is becoming more violent, whereas the technological improvements, especially in the field of motor vehicle passenger safety, may play an important role in the decrease of upper body injuries.

Calcitonin nasal spray for treatment of central giant cell granuloma: clinical, radiological, and histological findings and immunohistochemical expression of calcitonin and glucocorticoid receptors.

OBJECTIVE: To provide clinical, radiological, and histopathologic analyses of 5 patients with central giant cell granuloma (CGCG) treated with calcitonin nasal spray; to compare the results to 11 well-documented cases in the literature; and to evaluate lesions for immunohistochemical expression of calcitonin receptors (CTR) and glucocorticoid receptors (GCR). STUDY DESIGN: Five patients with CGCG were treated with calcitonin nasal spray, 200 to 400 IU/day, for 13 to 64 months. CTR and GCR expression were examined at different treatment times. RESULTS: No lesions showed significant clinical and/or radiological improvement in size. The main benefit was thickening of the cortical plates. All patients eventually underwent curettage and continued calcitonin treatment. Significant radiological improvement was noticed 2 to 4 months postsurgical procedure. Each lesion exhibited a different immunoprofile for CTR and GCR, pretreatment and during treatment. CTR disappeared after long-term calcitonin treatment. GCR exhibited variable changes. CONCLUSION: Long-term nasal spray calcitonin was ineffective for CGCG management compared with calcitonin injections. It is suggested that lesions with an undesirable response should be evaluated for CTR and GCR expression at different treatment times for maximal benefit of calcitonin treatment.

Implant-retained feeding aid prosthesis for a patient following total glossectomy and laryngectomy: a clinical report.

This clinical report describes the prosthetic management of a patient following total glossectomy and total laryngectomy that severely compromised his oral function, caused facial disfigurement, and limited the patient's quality of life. A feeding aid prosthesis was designed to address the patient's chief complaint of difficulty in feeding and mastication. The prosthesis was designed as an implant-retained overdenture with a lingual metal plate to facilitate food introduction into the oropharynx. This treatment improved mastication, appearance, and the quality of the patient's social life.

Detection of non-diploid cells in premalignant and malignant oral lesions using combined morphological and FISH analysis - a new method for early detection of suspicious oral lesions.

Alteration in DNA content is an early event in oral carcinogenesis. We have examined oral brush samples to detect non-diploid cells (NDC) using simultaneous morphological and cytogenetic analysis. The study included 8 oral squamous cell carcinomas (OSCC), 22 premalignant lesions (OPLs), and 25 control individuals. Slides stained with Giemsa followed by FISH using chromosome 2 centromeric DNA probe, were scanned and fluorescent signals were simultaneously analyzed in parallel with the morphology. The proportion of NDC increased with the severity of the diagnosis. In two control subjects, 1-1.5% of the examined cells were NDC. Over 2% NDC were present in all OSCC cases and in 11 of the OPLs, of which, in 8 the histologic diagnosis was either epithelial hyperplasia or mild dysplasia. A significant number of NDC had normal morphology when cytomorphology and FISH were compared. Two patients with OPLs developed OSCC these patients had a significant proportion of NDC. We suggest that the combined morphological and cytogenetic analysis of cells collected by a non-invasive brush sampling can enhance early detection of potentially malignant cells.

Sequence of treatment in mandibular prognathism patients.

Intraoral vertical ramus osteotomy (IVRO) and advancement genioplasty are effective and predictable methods of treating selective individuals with mandibular prognathism. The sequence of performing these procedures does have a clinical effect, but this is not found in the literature. The purpose of this article is to introduce the clinical implication of the sequence of procedures and to recommend the preferred sequence based on experience. A retrospective study was conducted on 75 patients treated by IVRO with or without genioplasty. In 31 patients, IVRO was performed without genioplasty; only one patient suffered from transient hypoesthesia. When IVRO was performed before genioplasty (sequence I) in 20 patients, nine suffered from mental nerve hypoesthesia. However, when IVRO was performed after genioplasty (sequence II) in 24 patients, permanent mental nerve anesthesia occurred in five patients and mental nerve hypoesthesia in 15 patients. Based on these results, it is recommended that IVRO be performed before genioplasty.

Comparison of quality of life after surgical endodontic treatment using two techniques: a prospective study.

OBJECTIVE: The purpose of this prospective study was to compare patient experience of quality of life following surgical endodontic treatment using 2 different techniques: a technique that included the use of a dental operating microscope, root resection with minimal bevel and retrograde preparation with ultrasonic tips, and a traditional technique that included root resection with a 45 degrees bevel and retrograde preparation by bur performed without magnification. STUDY DESIGN: The study consisted of 66 patients referred for surgical endodontic treatment. One operator (I.T.) carried out all treatment. An equal number of patients were assigned to each group. Group 1 was treated by the traditional technique without an operating microscope and Group 2 by a technique using an operating microscope and minimal osteotomy. All patients were given a questionnaire with 15 questions to evaluate their quality of life for 7 days postsurgery. RESULTS: On day 5, patients in Group 1 reported significantly more pain and took significantly more analgesics (P < .05). On days 1 and 2, patients in Group 2 reported significantly more difficulty in mouth opening, mastication, and the ability to speak (P < .05). CONCLUSION: Patients in both groups reported a high incidence of symptoms. The technique using the operating microscope provided significantly less postoperative pain, but more difficulties in mouth opening, mastication, and the ability to speak immediately postoperatively.

Perianesthetic dental injuries: analysis of incident reports.

STUDY OBJECTIVE: To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem. DESIGN: Retrospective chart review of a large professional liability insurer. INTERVENTIONS: Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company. MEASUREMENTS AND MAIN RESULTS: There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients. CONCLUSIONS: In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.

[Silicone granuloma of the lip].

Silicone is considered a biocompatible material, and therefore has many applications in medicine. It can be used in a liquid form for subcutaneous injection, in gel form for implants, and in a solid state for prostheses, hemodialysis tubing, etc. The use of injectable liquid silicone for tissue augmentation is widespread, but there are many reports of side effects, some severe and debilitating such as the granulomatous reaction. We report on a patient with an upper lip swelling, who denied having been subjected to any type of lip augmentation. An incisional biopsy was taken, and the pathologist reported an atypical lyphomatous tumor. The patient was informed that a wide excision of the lip was necessary, and then she confessed she underwent silicone injections in the past. This is a case of a granulomatous reaction after silicone injection in the lip. The article also reviews the literature on the subject.