Extra-Gingival Pyogenic Granuloma Displacing Teeth.

Pyogenic granuloma is a common cause of growth of soft tissue in the oral cavity, especially in the gingiva. It is mainly associated with local and chronic irritants besides hormonal changes during pregnancy. Here, the authors present an unusual patient of an extra-gingival pyogenic granuloma with large dimensions and displacing teeth arising in a male patient. This is an interesting patient to be reported due to its exacerbated and atypical clinical features.

Port-wine stains are more than skin-deep! Expanding the spectrum of extracutaneous manifestations of nevi flammei of the head and neck.

UNLABELLED: It is well known that port-wine stains of the upper part of the face may herald abnormalities of the brain or eye in the form of Sturge-Weber syndrome. This study focuses on other extracutaneous anomalies in patients with nevi flammei of the head and neck, giving rise to functional complications. PATIENTS AND METHODS: A retrospective study was performed on patients with port-wine stains involving the head and neck area. Records were reviewed for demographic parameters, extent of the lesion, clinical complications, diagnostic measures, previous treatments, ultimate therapeutic approach, and outcome. RESULTS: Nine patients, mean age 50.4 years, with port-wine stains and clinical symptoms due to extracutaneous involvement, were admitted and treated from 2006 to 2009. Major clinical features included macrocheilia in three cases, gingival bleeding in two, dysphonia with globus sensation, painful parotideal swelling with recurrent otitis, painful lingual swelling, recurrent epistaxis, and nasal obstruction in one case each. Cases with lower lip hypertrophy were treated by conventional surgical approaches. Recurrent epistaxis and nasal obstruction due to affected inferior turbinate were treated by Nd:YAG laser therapy, and globus sensation and dysphonia by speech therapy. Patients with gingival affection and recurrent otitis were treated by local ear care. CONCLUSION: Port-wine stains in the head and neck may develop extracutaneous manifestations causing severe problems. A multimodal and interdisciplinary approach is mandatory for an appropriate treatment.

A case of labio-facial necrotizing fasciitis complicating acne.

BACKGROUND: Facial necrotizing fasciitis is extremely rare. Most of the cases reported in literature are related to dental, sinus, tonsillar and salivary glands causes, but rarely as consequence of skin infection. We report a unique case of lower lip cellulitis, which was initially misdiagnosed as angioedema and subsequently progressed into lower lip necrotizing fasciitis. CASE PRESENTATION: This is a case report of necrotizing fasciitis involving the lower lip as a consequence of infected skin acne in a 19 year old black female. The patient had been diagnosed earlier as a case of angioedema by a physician and treated accordingly. She was mildly anemic, hyponatremic and hypokalemic. Treatment was started immediately by incision, drainage and full debridement of the whole necrotic tissue. Triple antibiotic therapy was administered and daily irrigation and dressing were performed until full recovery. Complete healing occurred within a month by secondary intention. CONCLUSION: This case demonstrates the misdiagnosis of a lip swelling leading to the development of labiofacial necrotizing fasciitis, a serious and life threatening condition. Lip angioedema is a common condition; however, lip fasciitis is rare. A broad differential diagnosis in case of lower lip swelling is essential to avoid inappropriate treatment delay.

P Elevator: An Innovatively Designed Elevator for Extraction of Third Molars.

OBJECTIVE: To modify the conventional straight elevator with a unique and innovative design in respect to approach and accessibility during extraction for patients with abrasions around corners of the mouth and with thick buccal mucosa, without causing overstretching of angles of the mouth. METHODS: The shank of the straight elevator in the shape of a 'U' was modified, giving it a shape similar to 'P' in the English alphabet hence it is named the P Elevator. The P elevator utilises a 'U' shaped bend in the shank of the conventional straight elevator making space for the buccal soft tissues and the angle of the mouth, to accommodate properly in the 'U' shank. The application of this elevator in the successful removal of third molars is described. RESULTS: Two hundred patients underwent extraction of third molars with the P elevator including 166 patients with disimpaction of all third molars, 23 patients with abrasion around the angle of the mouth, and 11 patients with thick buccal mucosa. Satisfactory results were obtained in all the cases with no postoperative complications. CONCLUSION: The P elevator permits prudent, meticulous, innovative and proficient extraction of third molars in patients with thick buccal mucosa and abrasions around the angle of the mouth, without overstretching the corners of the mouth. We introduce novel applications of the P elevator in third molar extraction that provide substantial advantages over a conventional straight elevator.

Coexistence of generalized morphea with hisotological changes in lichen sclerosus et atrophicus and lichen planus.

We reported a 44-year-old Japanese woman with generalized multiple sclerotic plaques, which showed histological findings of morphea. This patient also had an erosive lesion on her mouth; its histological findings were consistent with lichen planus. A sclerotic lesion on her thigh showed the histological findings of lichen sclerosus et atrophicus (LSA). These data suggest that similar etiologic events or closely related pathologic processes are involved in morphea, lichen planus, and LSA.

Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature.

OBJECTIVE: To systematically review the current literature on the maxillary midline frenum and associated conditions and complications, as well as the recommended treatment options. METHOD AND MATERIALS: A detailed MEDLINE database search was carried out to provide evidence about the epidemiology, associated pathologies, and treatment options regarding the maxillary frenum. Of the 206 initially identified articles, 48 met the inclusion criteria. RESULTS: The maxillary frenum is highly associated with a number of syndromes and developmental abnormalities. A hypertrophic frenum may be involved in the etiology of the midline diastema. There is also a tendency by orthodontists to suggest posttreatment removal of the frenum (frenectomy). Studies on the cause of gingival recession due to the maxillary frenum are inconclusive. An injured frenum in combination with other traumas and doubtful history might point to child abuse. The involvement of hyperplastic frena in the pathogenesis of peri-implant diseases remains uncertain. There seems to be a clinical interest regarding lasers for surgery for treatment of maxillary frena. The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature. CONCLUSION: A maxillary frenum is a clinical symptom in numerous syndromic conditions and plays a role in the development of the median midline diastema. Nevertheless, the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial. Laser techniques are reported as the method of choice for the surgical removal of frena; however, this needs to be substantiated by appropriate prospective controlled studies.

Presurgical management of a child with missing lower lip using a new design of fixed lower tongue crib.

Missing of any perioral structure can result in imbalance of muscular forces leading to loss of structure and function along with esthetics especially in a growing individual and can result in permanent damage. Rehabilitation of such children is a challenge and requires an integrated multidisciplinary approach not only to correct the defect, but also to ensure normal development with minimal handicap. Here is a case report of a 10-year-old child with missing lower lip due to childhood infection and its presurgical management using a new design of fixed lower tongue crib used to limit tongue pressure, improve tongue position, and facilitate lower incisor retraction. A new clinical experience for lower lip missing cases in children are added, as these cases are rare.

Management of a xeroderma pigmentosum case with oral findings in a dental setup.

Xeroderma pigmentosum (XP) is heterogeneous group of disorder transmitted as autosomal recessive trait. It is characterised by photosensitivity, freckled pigmentation and premature skin ageing and malignant tumour development. The manifestations are due to a cellular hypersensitivity to ultraviolet light resulting from a defect in DNA repair. Multiple cutaneous neoplasms develop at a young age in persons with XP. Two important causes of mortality are metastatic malignant melanoma and squamous cell carcinoma (SCC). We report a case of XP in a 22 year-old male patient who developed SCC of lower lip with in a short period of 1 month.

Mucosal coronally positioned flap for the management of excessive gingival display in the presence of hypermobility of the upper lip and vertical maxillary excess: a case report.

BACKGROUND: Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. METHODS: A 24-year-old female presented for consultation regarding a gummy smile. At full smile the average gingival display ranged from 2 to 4 mm. A clinical examination revealed hypermobility of the upper lip and absence of generalized altered passive eruption. A cephalometric analysis pointed to the presence of vertical maxillary excess. The surgical procedure consisted of an elliptical mucosal excision followed by coronal advancement of the flap. This procedure aimed to limit the activity of the elevator muscles and reestablish the depth of the vestibule. RESULTS: Rapid surgical healing with minimal postoperative sequelae was observed. The patient reported significant reduction of gingival display at 1 week, which was maintained at the 1-year postoperative visit. Reduction in the amount of gingival display at the 1-year follow-up visit was stable. CONCLUSIONS: For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.

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.

Excessive gingival display--etiology, diagnosis, and treatment modalities.

Extensive exposure of the gingiva during a smile, called excessive gingival display, may be a point of concern for both patients and clinicians. Patients often present to the dental clinic seeking a solution to their "gummy" appearance. A clinician must fully understand the various factors involved in this situation, to provide patients with an appropriate answer. Thorough examination followed by the right diagnosis is imperative for achieving an esthetic and predictable result in the treatment of such situations. The aim of this article is to discuss the various aspects of excessive gingival display and its etiology and to present the current solutions that exist in the literature.

Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings.

Although inflammatory bowel disease (IBD) typically presents with gastrointestinal complaints, mucocutaneous lesions are commonly associated and can precede gastrointestinal symptoms, thereby alerting the clinician to the diagnosis of IBD before the onset of gastrointestinal symptoms. Nine children are reported who had no gastrointestinal symptoms suggestive of IBD but presented with mucocutaneous findings of IBD and were subsequently diagnosed with Crohn's disease or ulcerative colitis based on characteristic features on gastrointestinal endoscopy and/or biopsies. The majority of the patients had oral and perianal lesions. We believe that IBD is a common etiology for persistent oral lesions in the pediatric population. In addition to a good history, children with unexplained oral mucous membrane lesions should have an examination of the rectal and genital mucosa as well as tests for complete blood count, iron levels, sedimentation rate, albumin, and occult blood in the stool with endoscopy and biopsies to rule out IBD if indicated.

Bilateral lower lip mucoceles: cause of functional malocclusion in a three-year-old child.

The case report of a three-year-old girl is presented, who had two nontender, bluish, fluctuant swellings diagnosed as superficial mucoceles present since the child was a few days old. The child had a unilateral crossbite with the mandibular midline shifted almost one tooth width to the left, a longstanding function adaptation producing malocclusion. The mucoceles were surgically removed, and the cross-bite disappeared.

[Z-plasty technic, applied to hypertrophy of the upper labial frenum]. / La technique de la plastie en Z, appliquée à l'hypertrophie du frein labial supérieur.

The authors used the technique of Z-palsty in the surgical treatment of hypertrophy of the superior labial fraenum. They consider that this operation is indicated when there is hypertrophy of the fraenum with a low insertion, associated with an inter-incisor diastema, and that the lateral incisors have appeared without causing the diastema to disappear. This technique eliminates the possibility of a hypertrophic scar, a possible source of failure.

Adverse reactions in the oral mucosa associated with anterior composite restorations.

This is a descriptive study of patients with symptomatic lichenoid-like reactions of the lips in contact with composite restorations (n = 12). Clinically, the lesions appeared as symptomatic single or multiple erythematous areas that included white papules. Candida was found by cultivation or histopathological examination in 7 of the lesions. Patch testing (n = 7) did not reveal any reactions to composite components, except for one patient who showed a delayed hypersensitivity reaction to formaldehyde. Replacement of existing dental materials parallel to antifungal treatment resulted in healing or significant improvement in 7 of 9 patients. This study shows that resin components can be associated with adverse reactions in the oral mucosa of the lips and that these reactions may be accompanied by an infection with Candida.

Plasma cell mucositis.

A case of plasma cell mucositis is described for its rarity. A probable aetiological correlation with periodontitis is discussed. The patient showed good response to intralesional and topical steroids.

[Follow-up study of dyskinesia-induced dysgnathias following myofunctional therapy]. / Nachuntersuchung dyskinesiebedingter Dysgnathien nach myofunktioneller Therapie.

Forty-eight patients with dysgnathia brought about by tongue dyskinesia underwent myofunctional therapy leading up to and at the beginning of orthodontic treatment. Short- and long-term results of this therapy were studied with the help of indirect palatography. Palatographs of empty swallowing and the test consonants "L", "N", "S" and "T" were evaluated visually and metrically. The palatographs were made prior to myofunctional therapy and thereafter first at the end of the therapy, then at the end of the control or supervision period, and finally, after on average 4 years. Visual evaluation revealed a clearly recognizable change in all functions when compared with the physiological palatographs. A change in the "S" consonant sound was the least conspicuous. Metric evaluation revealed for the 4 out of 5 of the test functions, namely, empty swallowing and the consonants "L", "N", and "T", marked long-term dorsal orientation of the tongue. The short-term changes in tongue function were more prevalent than the long-term.

Head and neck manifestations of tumoral calcinosis.

Intraoral facial and laryngeal features of tumoral calcinosis are reviewed in six patients of Jewish-Yemenite descent. Extraoral features included calcified masses, erythematous patches, and angular cheilitis. Oral soft tissue findings included papillary hyperplasia of the lip vermilion and velvety-red macules on the tongue, palate, and buccal mucosa. Gingival findings included advanced periodontitis and an erythematous marginal gingivitis. In all patients, orthognathic evaluation revealed a concave profile, retruded maxilla, and relative mandibular prognathism. Although previously reported clinical dental abnormalities were not present, extracted teeth demonstrated abnormal dentin. Hoarseness was present in all patients and was the earliest appearing feature in two patients. The appearance of these head and neck findings preceded the classical manifestations of tumoral calcinosis and may be helpful in the early diagnosis of this entity. The varied reported features of tumoral calcinosis support the notion that this disease may present multiple formes frustes with variable clinical expressivity.