Clinical analysis of a case of neonatal exfoliative esophagitis in an 18-day-old neonate.

BACKGROUND: This study aims to provide guidance for clinical work through analysis of the clinical characteristics, endoscopic and pathological manifestations, diagnosis, and treatment of an 18-day-old neonate with exfoliative esophagitis. CASE PRESENTATION: The patient presented with vomiting but the parents did not pay too much attention. The pathological report revealed numerous fibrinous exudative necrotic, and inflammatory cells, as well as a small amount of squamous epithelium. Furthermore, milk allergy factors were considered. Conservative treatments, such as fasting, acid suppression, mucosal protection, parenteral nutrition, and the replacement of anti-allergic milk powder were given. Thereafter, endoscopic examination revealed that the patient returned to normal, and was discharged after 21 days. CONCLUSIONS: Exfoliative esophagitis has multiple causes; and has characteristic clinical and endoscopic manifestations. Endoscopic examination after 18 days presentation and conservative therapy revealed that the esophagus had returned to a normal appearance and the patient was discharged. Following discharge, the parents were advised to feed the patient ALFERE powder. Attention should be given to the timely detection of complications and corresponding treatment.

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.

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.

[Labial recurrent swelling revealing median congenital upper-lip fistula]. / Tuméfaction labiale récidivante révélatrice d'une fistule congénitale médiane de la lèvre supérieure.

Midline upper-lip fistulas are an extremely rare variant of congenital facial malformations. Less than 30 cases have been reported in the literature since 1970. We report the case of a 2 and a half-year-old girl presenting with a median congenital blind fistula of the upper lip, without any relation with the oral cavity. A recurrent swelling of the upper lip was the main symptom. Complete surgical excision of the cyst or of the fistulous tract must be obtained to avoid recurrence.

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.

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.

Cases with a spontaneous regression of an infiltrating non-crateriform keratoacanthoma and squamous cell carcinoma with a keratoacanthoma-like component.

We herein report the natural course of an early/proliferative stage keratoacanthoma (KA) with infiltrating islands of cytological malignancy (case 1) and a squamous cell carcinoma (SCC) with a KA-like component (case 2), which were observed until their complete regression. The presented case 1 suggests that one of the histopathological forms of KA includes this unusual, infiltrating, non-crateriform architecture, and also indicates the possibility of complete remission in the KA associated with infiltrating islands of cytological malignancy. In the presented case 2, the peripherally-associated KA-like focus was histopathologically considered to be either a remnant of KA focus or verrucous keratosis (hyperplasia). Therefore, the complete spontaneous regression of case 2 suggests that SCC arising in KA still has the potential of spontaneous regression, or that an extremely rare event, namely, the spontaneous regression of (traditional) SCC occurred in the present case.

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.

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.

[Painful and rapidly growing exophytic lesion of the vestibular upper lip]. / Schmerzhafte und rapid exophytisch wachsende Raumforderung der vestibulären Oberlippe.

A 49-year-old healthy woman presented with a painful exophytic-growing mucous lesion on her upper lip that had been primarily noted for 2 weeks. The biopsy showed histological changes of a dense infiltration of lymphoid cell elements. The immunohistological examination presented the diagnosis of primary cutaneous CD30-positive large cell T-cell lymphoma. In the diagnosis of oral lesions cutaneous CD30-positive large cell T-cell lymphoma constitutes a rare but important differential diagnosis.

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.

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.