Extragingival Pregnancy Pyogenic Granuloma on the Lip.

Pregnancy pyogenic granuloma is considered a benign common growth that usually develops on the gingiva in the second and third trimester of gestation, in response to local irritation, trauma or hormonal factors. Here, the authors report a case of a primigravida who presented an extragingival pyogenic granuloma with a rapid progression in the post-partum. The occurrence on the lower lip in the first few days after delivery was a relatively rarity in the present case which provoked a meaningful state of anxiety and cancerophobia to the female. Complete excision was curative and brought immediate relief of pain and discomfort. This clinical report highlights the possibility of pyogenic granuloma presenting like a rapid-growing mass on the lip and the importance of clinical differential diagnosis of such presentation in this atypical location.

Labial Incompetence in Mobius Syndrome: LeFort I Impaction Case Report and Review of Management Strategies.

Difficulty with speech intelligibility in Mobius syndrome patients due to bilabial incompetence is common yet rarely discussed. We present a patient with Mobius syndrome who underwent counterclockwise LeFort I impaction to improve her labial competence. In addition, we present a literature review of management strategies for labial incompetence correction in Mobius patients. At 7-year follow-up after LeFort 1 impaction, the patient reports improvement in speech intelligibility, specifically regarding the ability to pronounce bilabial consonants. This is the first published report of LeFort I impaction to improve labial competence and bilabial consonant pronunciation in a Mobius syndrome patient.

Effects of Fat Grafting Containing Stem Cells in Microstomia and Microcheilia Derived from Systemic Sclerosis.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease with multisystem involvement, dominated by a general fibrosis. The early stage of the disease is associated with progressive damage to microcirculation, particularly in the respiratory tract, the gastrointestinal tract and skin. The face assumes a typical appearance characterized by microstomia (reduction of mouth opening) and microcheilia (thinning of the lips). These conditions cause a considerable reduction in performance status of patients. We treated them by fat grafting, rich in adipose stem cells, and we evaluated through time clinical, functional and aesthetic evaluation of oral pathology associated with SSc. MATERIALS AND METHOD: From September 2014 to May 2016, we enrolled and treated seven patients in the plastic, reconstructive and aesthetic surgery clinic. Through time, we evaluated the following parameters: evaluation of mouth opening (maximum opening in superior-inferior and lateral directions) and lip thicknesses, both measured by doctors of the aforementioned operating unit; variation in the quality of life as perceived by patients according to the MHISS scale (Mouth Handicap Systemic Sclerosis); variation in severity of labial fibrosis assessed by microscopic analysis of pre- and post-fat transfer samples in the pathology clinic; safety of the protocol, according to the management of side effects resulting from the procedure; aesthetic evaluation, made by external observers and non-experts in the field, on pre- and post-operative photographs. RESULTS AND CONCLUSIONS: We reported satisfying results, both functionally and aesthetically, for all parameters except one, for which the sample size might have proven critical. These data should be a starting point for further experimental research and clinical trials. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Congenital Midline Sinus of the Upper Lip.

An extremely rare patient of congenital midline sinus of the upper lip in a 2-year-old boy is presented. The sinus was located on the midline of the philtrum just below the base of the columella. Surgical removal of the sinus was performed via an extra- and inraoral approach. Histopathological examination of the resected sinus revealed it to be lined by keratinized stratified squamous epithelium with sebaceous glands and hair follicles. Three postulates can account for the formation of the congenital midline sinus of the upper lip: the fusion theory, the merging theory, and the invagination theory. However, the etiology of this rare abnormality remains obscure.

[Median congenital fistula of the upper lip associated with Goldenhar syndrome: Report of a case]. / Fistule congénitale médiane de la lèvre supérieure associée à un syndrome de Goldenhar : à propos d'un cas.

AIM OF THE STUDY: We present the case of a patient with Goldenhar syndrome associated with congenital fistula in the middle of philtrum at the upper lip. PATIENTS AND METHODS: The patient was supported from birth for Goldenhar syndrome. Several procedures were performed in childhood to correct a macrostomia and mandibular hypoplasia right. At 14 years old, she has a rhinoplasty to correct a complex nasal malformation. During the procedure, a hole in the upper central incisor inter-space is found. It is extended by a fistula which runs through the front palate towards the vomer rail at the base of the partition. This fistula is blind behind the vomer and can be completely resected. Pathological examination of the resection reveals a squamous lining. RESULTS: The median fistula of the upper lip are extremely rare : less than 30 cases reported in the literature. The unusual run of the fistula and the recent appearance of a pituitary syndrome in this patient makes us look for a continuity between it and Rathke's pocket by computed tomography imaging type. CONCLUSION: The association of Goldenhar syndrome and median congenital fistula of the upper lip was never yet described in the literature. The association with hypopituitarism was suspected with the posterior extension of the malformation, not confirmed by the scanner, but strongly suspected jointly by the neurosurgical and plastic surgery team.

Cross Lip Vermilion Flap and Traumatic Upper Lip Avulsion: Reducing Donor Site Morbidity.

Using a cross lip vermilion flap for upper red lip reconstruction in cases other than whistle deformity in patients with cleft lip can lead to donor site morbidity. If the practitioner performs primary closure of the mucosa in lower vermilion after flap harvesting, the width and height of lower lip are reduced, which results in an increased lower incisor tooth show. Using free fat grafting is an effective method for reducing donor site morbidity in the lower lip following cross lip vermilion flap harvest.

Surgical approach to oral lichen planus by submucosal autologous fat grafting.

Oral lichen planus is a chronic autoinflammatory mucositis. Oral lesions are predominantly white; they tend to be bilateral while involving the buccal mucosa especially cheek, tongue, gums, lips, and palate. Many topical and systemic agents are currently used with unpredictable results. Fat grafting is characterized by the placement of multiple parcels of purified fat with blunt cannulas; at the beginning, it was introduced to improve facial aesthetics. Recently, it has been translated to other surgical cases such as posttraumatic deformities and craniofacial anomalies and as ancillary reconstructive procedure after tumor resections. The successful results of this procedure encouraged us to use this approach to a clinical case of oral lichen planus refractory to conventional therapy.

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.

Surgical technique for remodelling lip deformities due to overinjection of silicone oil.

BACKGROUND: The injection of large volumes of silicone oil for lip augmentation can lead to the formation of abnormally prominent or projected lips. Conservative treatment measures are largely ineffective. This observational study describes the application of a surgical technique developed at our center for the correction of silicone oil-induced lip deformities. PARTICIPANTS AND METHODS: Fifty-nine patients presented at a tertiary medical center over a 6-year period with complaints of lip deformities caused by injections of silicone oil for lip augmentation 2 to 4 years previously. All had proven refractory to conservative treatment. The patients underwent individually tailored surgery consisting of a series of wedge-like incisions and Z-plasties to reproduce a normal lip line. RESULTS: Patients returned to their normal daily routine after 3 to 7 days. Only two patients (3.4%) required revision surgery after 6 months to correct lip asymmetry. Ninety percent of the patients expressed satisfaction with the aesthetic and functional outcome after 3 months. CONCLUSION: Our innovative, individually tailored surgical technique for the correction of lip deformities due to silicone oil injection for lip augmentation is simple and safe to perform and yields a satisfactory outcome in most cases.

Conventional surgical treatment of oral mucocele: a series of 23 cases.

AIM: Mucocele is a common lesion of the oral mucosa that results from alterations of the minor salivary glands due to mucous accumulation, causing swelling. Conventional surgical treatment was planned for these lesions in a group of children and the success rates of the therapy during the transitional period from mixed to permanent dentition were assessed with a series of follow-ups. MATERIALS AND METHODS: A series of 23 cases of mucocele was observed in children under 10 years of age. Clinically the lesions consisted of a soft, bluish and transparent cystic swelling which normally resolved spontaneously and reappeared after rupture in few days. All cases were treated by conventional surgical procedure with excision of minor salivary glands and underwent a 3-year follow-up. RESULTS: Out of the 23 cases, 19 (82.6%) were in the lower lip, 2 (8.6%) in the cheek, 1 (4.3%) in the retromolar area and 1 (4.3%) in the upper lip. Those in the lower lip, 15 (79%) were away from the midline and 4 (21%) at midline. One (4.3%) recurrence was seen at the 6-month follow-up. After 3 years, recurrence rate remained the same. CONCLUSION: Conventional surgical excision with removal of affected minor salivary glands in paediatric patients is a definite treatment for mucocele.

Social exclusion and myiasis of the upper lip in a Brazilian rural resident.

CONTEXT: People living in rural or remote Brazil, as in other sub-tropical or tropical nations, are vulnerable to infections that would not normally occur in urban areas or wealthier nations. Brazil is a geographically extensive nation, historically marked by vast socioeconomic inequalities. Approximately 16% of the population live in rural areas. ISSUE: This clinical case report demonstrates the vulnerability of rural residents who are underserved by Brazil's 'universal' public healthcare system, despite social and economic challenges that increase their risk for disease. Myiasis (especially oral myiasis) is a rare health condition in humans caused by fly larvae. Oral myiasis usually appears in periodontal pockets and open wounds, such as after dental extractions. It is associated with poverty, lack of access to health care, and very poor overall health status. While myiasis has a worldwide distribution, it is particularly associated with the tropical and sub-tropical regions of North and South America. LESSONS LEARNED: This article describes a rare case of myiasis in the upper lip of a rural male patient. The case report demonstrate that rural and remote residents can be socially excluded from the benefits of technology and biomedicine, making them vulnerable to rare infections.

Diagnosis and surgical treatment of a nasolabial cyst.

Nasolabial cysts are uncommonly diagnosed nonodontogenic soft tissue lesions located close to the nasal alar region of the face, presenting as extraosseous swelling in the region of the nasolabial fold. Nasolabial cysts are likely to remain undetected unless and until they become infected or are associated with facial deformity. Histologically, it is lined with nonkeratinized squamous epithelium or, more frequently, with respiratory-type cylindrical epithelium with goblet cells. The aim of this article was to present and discuss the surgical management of a case of nasolabial cyst and to briefly review the literature.

Pregnancy-associated pyogenic granuloma of the lip: a case report.

Pregnancy associated pyogenic granuloma of the oral cavity especially the gingivae is not uncommon. However, pyogenic granuloma of the lip associated with pregnancy is a very rare clinical condition. A case of a 29 year-old pregnant woman (35 weeks gestation) who presented with a pregnancy associated pyogenic granuloma of the lower lip is reported. Chronic irritation of the lower lip which acts in an unidentified way with high gingival level of active progesterone is the suspected pathogenesis. Surgical excision was the treatment of choice, and no recurrence was noted.

Treatment of mucocele of the lower lip with diode laser in pediatric patients: presentation of 2 clinical cases.

Mucoceles are common benign lesions of the oral cavity that develop following extravasation or retention of mucous material from salivary glands in the subepithelial tissue. Most dental literature reports a higher incidence of mucocele in young patients, with trauma being a leading cause. Treatment may be performed by conventional surgery, cryotherapy, and, more recently, laser surgery and loser vaporization. The purpose of this report was to describe 2 clinical cases of lower-lip mucoceles treated by excision with a high-intensity diode laser in pediatric patients. Diode laser surgery was rapid, bloodless, and well accepted by patients. Postoperative problems, discomfort, and scarring were minimal. Treatment of mucoceles with high-intensity diode loser provided satisfactory results in the cases presented and allowed for a histopathological examination of the excised tissue.

Treatment of a post surgery defect of the lower lip: a case report.

We present the clinical case of a patient, CT of 35 years who came to our observation for the appearance of a recurrent mucocele on the lower lip. The mucocele or retention cyst is a benign lesion of minor salivary glands characterized by swelling, which can vary from a few millimeters to several centimeters, as determined by retention of secretion due to partial or total obstruction of an excretory duct. Current thinking is that the mucocele is formed due to traumatic events or inflammatory, malformation of the excretory duct or parenchyma of the minor salivary glands. Once framed the patient from a clinical point of view we performed surgery, which provides complete enucleation of the lesion by about 7 mm. The clinical suspicion was confirmed by histological diagnosis as extraductal mucocele. After about six months after surgery, at complete healing, resulted a residual imperfections with a loss of substance in the area. To eliminate this defect, poorly tolerated by the patient, we decided to use a filler of hyaluronic acid, which, although it is an absorbable material, results in an excellent appearance and does not expose to complications like the use of inducible permanent.

[Bichat's buccal fat pad for reconstruction of posterior oral cavity defects]. / Le corps adipeux de la joue dans la reconstruction des pertes de substances postérieures de la cavité buccale.

Some losses of matter in the posterior area of the oral cavity require reconstruction with vascularized tissue to prevent retraction and a limited mouth opening. Bichat's fat pad or Bichat's fat ball is rarely used for oral mucosal reconstruction despite its proximity, easy availability, plasticity and simple use as a flap. Bichat's fat pad is resistant to lipolysis even in case of major weight-loss. It usually herniates in the exeresis site of a jugal tumor or intermaxillary commissure. When this is not the case, it can be obtained by a horizontal vestibular incision. The fat pad is unfolded and sutured without tension to the margin of the defect. The flap may be protected by a Bourdonnet dressing. Epithelialization begins 8 to 10 days after surgery. It is completed in the second or third week. The fat volume is variable, thus filling can only be applied to areas with loss of matter under 6cm. The technique is simple and quick. Postoperative evolution is usually uneventful; healing is quick as well as recovery of normal feeding function.

A case of congenital midline fistula of the upper lip.

Congenital fistulas of the lip are commonly found in the lower lip and accompany cleft lip. They are seen as a symptom of Van der Woude syndrome, which is predominantly hereditary. In contrast, congenital fistulas of the upper lip are rare. A number of hypotheses have been proposed to explain the pathogenesis of fistulas of the upper lip, including fusion failure of facial prominences and absence of mesoblasts, suggesting a relationship between this condition and the development of cleft lip. The pathogenesis of this disorder has been attracting attention. We report the case of a 5-year-old girl with congenital fistula of the upper lip.

Lower lip mucocele treated with an erbium laser.

Mucoceles are benign lesions of the minor salivary glands that are common in children. The most frequent localizations of these lesions include the lower lip and the cheek mucosa. Such mucoceles are caused by traumas, the rubbing of orthodontic devices, or biting habits. The purpose of this article was to describe the case of a 4-mm extravasation mucocele located on the lower lip of a 9-year-old girl. This mucocele was removed with an erbium loser after perilesional infiltration with 12 mg of 2% lidocaine and epinephrine 1:100,000. The histopathological report confirmed the presurgical diagnosis. The wound healed excellently and rapidly without sutures. No relapse was observed a year ofter the surgery. Lasers apply modern technology and are useful for soft tissue surgery in pediatric dentistry, as operations are rapid and wounds heal well without sutures.

Atypical location of pyogenic granuloma in two pediatric patients.

Pyogenic granuloma is a reactional lesion that is associated with dental calculi or trauma. It occurs most frequently in children and young adults, where the gingiva is affected most commonly. Its differential diagnosis is based on histopathological findings and treatment consists of surgical removal and elimination of the irritating factor. This article presents two cases of pyogenic granuloma in pediatric patients and explains the treatment methods used in each case.

Lasers and pediatric dental care.

There are several types of lasers that will allow pediatric dentists to remove soft tissue (such as diode or Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) lasers) or remove both hard and soft tissue (such as the Erbium:YAG laser), in addition to photobiostimulation or therapeutic lasers that produce their healing benefits without producing heat. Lasers allow pediatric dentists to provide optimal care without many of the fear factors that result from conventional dental techniques. Lasers are extremely safe and effective when the user has a proper understanding of laser physics. Using lasers for caries removal, bone removal, and soft tissue treatment can reduce postoperative discomfort and infection and make it possible for dentists to provide safe, simple treatments.