Arteria labial de calibre persistente / Caliber-persistent labial artery

La arteria labial de calibre persistente (ALCP) es una entidad poco común, que se caracteriza por una arteria labial cuyo calibre permanece invariable tras su penetración en la submucosa. El diagnóstico diferencial debe apoyarse en pruebas de imagen pues la biopsia puede ocasionar sangrados importantes. El tratamiento varía desde el seguimiento clínico hasta la escisión quirúrgica. Presentamos el caso de una mujer de 40 años que acude a nuestra consulta por una tumoración lineal submucosa en labio superior, que le ocasionaba problemas estéticos y funcionales. (AU)

Caliber-persistent labial artery is an uncommon lesion of the lip, which consists of a labial arteriy that penetrates into the submucosal tissue of the lip, without a loss of caliber. The differential diagnosis must be supported by image tests, since the surgical biopsy can cause significant bleeding. Treatment varies from clinical follow-up to surgical excision. We present the case of a 40-year-old woman who attends to our consultation for a lineal submucosal lesion that caused her aesthetical and functional compromise. (AU)

Neuromodulator for the Treatment of Congenital Unilateral Lower Lip Palsy.

INTRODUCTION:: Congenital unilateral lower lip palsy is an infrequently encountered condition that manifests as lower lip asymmetry during smiling, laughing, and crying. Treatment options are not well characterized. METHODS:: The authors present the case of a 51-year-old woman who was referred for surgical intervention for facial paralysis. Physical examination demonstrated a symmetric face at rest that became asymmetric when smiling. The asymmetry, evident by inappropriate inferior displacement of the lower lip, was secondary to unilateral contraction and presence of the depressor labii inferioris. The depressor anguli oris was symmetric bilaterally. Her presentation was consistent with congenital unilateral lower lip palsy. RESULTS:: Lidocaine was injected into the depressor labii inferioris on the side of the face that demonstrated unilateral presence and contraction. This resulted in symmetry of the smile and lower lip without untoward effect. Onabotulinum toxin A was thereafter injected into the depressor labii inferioris. In-office treatment with botulinum toxin injection resulted in a 4-month improvement in smile symmetry. CONCLUSION:: Chemodenervation is a safe and minimally invasive method to improve smile symmetry and lower lip position in cases of congenital unilateral lower lip palsy.

Sore or Swollen Lips Part 3: Diagnosis and Treatment.

This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips. Clinical relevance: Sore and/or swollen lips are not uncommon, often have a local cause but may reflect a systemic disease. The previous 2 papers in the series discussed their causes. This paper reviews their diagnosis and treatment.

Diseases of the lips.

Heath care providers should be comfortable with normal as well as pathologic findings in the lips, because the lips are highly visible and may display clinical manifestations of local, as well as systemic inflammatory, allergic, irritant, and neoplastic alterations. Fortunately, the lips are easily accessible. The evaluation should include a careful history and physical examination, including visual inspection, as well as palpation of the lips and an examination of associated cervical, submandibular, and submental nodes. Pathologic and microscopic studies, as well as a review of medications, allergies, and habits, may further highlight possible etiologies. Many lip conditions, including premalignant changes, are relatively easy to treat, when the abnormalities are detected early; however, advanced disease and malignancies are challenging for both the patient and clinician. Treatment should be focused on eliminating potential irritants or allergens and treatment of the primary dermatosis. In this paper we review physiologic variants as well as pathologic conditions of the lips.

Sclerotherapy and cryotherapy in the management of oral vascular lesions: a series of 10 cases.

Vascular anomalies such as hemangiomas or vascular malformations can produce negative esthetic effects in the maxillofacial region. These negative effects are the main complaints of patients. The clinical therapeutic efficacy of cryotherapy and sclerotherapy in the treatment of these lesions was evaluated in 10 patients who were clinically diagnosed with vascular lesions. Lesions were submitted to either cryotherapy or sclerotherapy, and follow-up showed that cryotherapy and sclerotherapy both were clinically effective in treating oral vascular lesions. Cryotherapy is an easy to perform method that requires only 1 session, but the high cost of the equipment is a limiting factor. Sclerotherapy is a noninvasive treatment widely accepted by patients, but more than 1 session is required.

[Health lips beautiful smile: Conditions to know].

Diagnosis and management of lip pathologies should be part of the dentists' responsibilities. Lip pathologies might affect patient's function, appearance and quality of life. The routine clinical examination of the oral cavity includes lip examination--changes in lip color, size or texture should be recognized during the examination, as well as noticing any habit such as lip licking or mouth breathing.The aim of the review is to present common external lip lesions. Color changes--oral melanotic macule is a localized benign pigmented lesion. It might be similar to early melanoma therefore if it is a new lesion, growing or large it should be excised. White and red changes are usually seen at the lower lip which is exposed to the sun light mainly among light skin individuals. The color changes are showing epithelial and subepithlial permanent changes and is called Solar cheilitis. As a potentially malignant disorder the patient should be carefully examined and under follow- ups. These patients are also advised to reduce sun exposure and use sun screen lipsticks. Lichen planus of the lip can be seen as red and white changes the lips are less prevalent site of the disease and usually the patients will have in intra oral involvement as well. Size changes--angioedema is a quick enlargement of the lip sometimes the face as well. It is an allergic reaction to food drugs and other antigens and resolves spontaneously with 72 hours, but when the upper airway is involved an immediate emergency treatment should be given. A chronic swelling of the lip/lips may be a sign of orofacial granulomatosis--a complicated condition with an unknown etiology, diagnosed by a biopsy and elimination of other diagnoses. Treatment includes steroids in various forms or a combination of surgery. Changes of the epithelial surface of the lip can be a result of dry lips in a hot or dry environment or due to mouth breathing. Lip licking might worsen the situation by secondary infection. Angular cheilitis red and sometimes infected lesion of the commissures should be treated by antifungal and antibiotic and prevention of saliva drooling. Recurrent herpes labialis is a common condition that heals spontaneously but the dentist should be aware to local trauma or treatment that might trigger reactivation. In addition, contact of the vesicle fluid might spread the infection. Chronic ulcer or exophytic lesion is sign of lip carcinoma. The majority of patients in Israel are with lighter skin and sun exposure history. Most patients are over the age of 50. Risk groups should be examined carefully and routinely for any lip change. Israel is an endemic area of Leishmaniasis, and any chronic lip lesion among endemic areas residents or workers should be suspected as Leishmaniasis.

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.

Treatment of venous lesions of the lips and perioral area with a long-pulsed Nd:YAG laser.

The conventional treatments for venous lesions of the lip have been excision, cryotherapy, infrared coagulation, and sclerotherapy. We report the use of a long-pulsed Nd:YAG laser in 31 consecutive patients. At a mean follow up of 12 months (6 weeks to 3 years), 27 (87%) had no evidence of recurrence and one had a small contracted scar. The treatment is effective for both small and large lesions, and operation or other ablative techniques are no longer indicated, or considerably less relevant.

Mucosal leishmaniasis of the lip: an emerging clinical form in Tunisia.

BACKGROUND: Mucosal leishmaniasis (ML), which mostly occurs in the New World, is mainly associated with Leishmania braziliensis. Primary lip ML is very rare in the Mediterranean basin and particulary in Tunisia despite the endemicity of both cutaneous and visceral leishmaniasis in this area. OBJECTIVES: To highlight a recent emergence of primary lip ML in Tunisia, to describe its epidemiological and clinical features and to identify the causative Leishmania species. METHODS: Epidemiological, clinical and therapeutic data of 10 cases presenting a ML of the lip were collected. Diagnosis confirmation of leishmaniasis was obtained by microscopic examination of Leishmania parasites in Giemsa stained smears of the lesion sampling and in cutaneous biopsies. Polymerase chain reaction (PCR) detecting Leishmania DNA directly from dermal scraping was also performed for diagnosis and species identification. RESULTS: Seven men and three women with lip ML were diagnosed during the last 6 years (2008-2013). The mean age was 29.7 years. Clinical presentation was characterized by an infiltrated and ulcerated plaque leading to macrocheilitis involving the upper lip in eight cases and the lower lip in two cases. Mean diagnosis delay was 6.9 months. PCR identified L. infantum in seven cases and L. major in two cases. Seven patients received intramuscular injections of meglumine antimoniate (MA) and three patients received both MA intralesional injections of MA and cryotherapy. A clinical remission was rapidly observed in all cases (on average in 2.2 months). CONCLUSIONS: Primary lip ML is emerging in Tunisia. Macrocheilitis of the upper lip is the main clinical presentation. PCR revealed more sensitive than direct examination in the diagnosis of such form (P < 0.01). Leishmania infantum was the most identified species (7 cases) while L major was involved in only two lesions. A benign local evolution and a rapid recovery were observed in all cases after MA treatment.

Diagnosis and management of dermal filler complications in the perioral region.

BACKGROUND: Lip augmentation with injectable materials is a popular aesthetic procedure. When complications occur, patients often ignore which material was implanted, thus making subsequent treatments difficult. This study aims to present the diagnosis and management of dermal filler complications in the perioral region. STUDY DESIGN: The Medical charts of 26 patients with filler complications in the oral region were reviewed. All patients were submitted to High Frequency Ultrasound, often complemented by Magnetic Resonance Imaging (MRI) and White Blood Cell Scintigraphy, to evaluate filler characteristics and complication types. Antibiotic, corticosteroid or surgical treatment was therefore planned. RESULTS: Imaging always identified dermal fillers in the oral region, distinguishing among infections, fibrosis, granulomatous inflammation and product migration. Nine patients received surgery, ten received medical treatments, six received both, and one refused treatment. Eighty percent of the patients presented an improvement after three- year follow-up. CONCLUSIONS: Complications of oral region fillers are similar in clinical presentation but differ in etiology, therefore necessitating different clinical approaches. Imaging techniques add useful information for treatment planning.

Bilateral stellate ganglion blockade for recalcitrant oral pain from Burning Mouth Syndrome: a case report.

Burning Mouth Syndrome (BMS) is a chronic painful disorder characterized by unremitting bilateral burning oral pain often associated with taste abnormalities and complaints of dry mouth. The diagnosis is made by history and symptom presentation in the absence of an identifiable cause or oral lesion. It is commonly seen in perimenopausal women but is also seen in men, and is considered a small-fiber neuropathy. Management can be challenging and few effective treatments are available. This article presents a case report of stellate ganglion blockade as a treatment for recalcitrant pain from BMS.