Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Malignant myoepithelioma of the salivary glands: clinicopathological and immunohistochemical features.

Malignant myoepitheliomas (myoepithelial carcinomas) are uncommon, and we know of only 29 reported cases. We present a new case together with its clinical, histological, and immunohistochemical features. The tumour was located in the inferior vestibular sulcus of a 64-year-old woman. She was treated by wide local resection. Malignant myoepitheliomas are distinguished from benign myoepithelial neoplasms by their infiltrating and destructive growth. The tumour cells may be spindle-shaped or more rounded (plasmacytoid cells) and contain cellular pleomorphism and mitotic activity. The clinical and biological behaviour of this tumour is not yet known and there is little information about treatment and prognosis.

Eosinophilic ulcer of the oral mucosa: report of a recurrent case on the tongue.

Eosinophilic ulcer of the oral mucosa (EUOM) is an uncommon lesion that usually affects the tongue. The lesion is benign and self-limiting, develops rapidly and usually disappears after several weeks without treatment. Microscopically, it contains a diffuse polymorphous cell infiltrate composed mainly of eosinophils. The cause of EUOM is unknown, but the condition has been attributed to trauma. We now describe a case of EUOM on the lateral surface of the tongue with recurrence on its dorsal surface 3 years later. The occurrence of multiple lesions, whether at the same time or subsequently as reported here, makes a purely traumatic origin rather unlikely and suggests that there may be a predisposition of some patients to develop EUOM. Eosinophilic ulcer of the oral mucosa (EUOM) is an uncommon lesion that is very rarely reported in the dermatological literature. It usually affects the tongue and presents clinically as an ulcer with elevated and indurated borders. Recognition is important because it often mimicks tongue cancer; however, the lesion is benign and self-limiting, develops rapidly and usually disappears after several weeks without treatment. Usually the ulcer occurs in a single episode, but the possibility of recurrence at other sites has been poorly emphasized.

Tongue flaps for reconstruction of the oral cavity.

Pedicled tongue flaps (anterior, posterior, double) have proved to be an effective method of repairing defects due to tissue loss in the oral cavity. Their central position, mobility, and excellent blood supply make the use of these flaps feasible in a variety of sites.

Sarcomas of the head and neck.

Fourteen cases of sarcomas involving the head and neck over a period of 15 years were reviewed. The male to female ratio was 3.5:1. Mean age of occurrence was 33.4 years, with a range of 5-84 years. Soft tissue was the site of origin in three cases, maxilla in four and mandible in seven patients. Radical surgery with resection of adequate disease-free margins was the most effective mode of treatment. Radiotherapy and chemotherapy was used in selected cases. Recurrence occurred in 42.9% of patients, and was the main cause of death. Three patients (21.4%) developed distant metastases. The actuarial 2-year and 5-year survivals of the 14 patients assessed were 64% and 56% respectively.