Waiting for self-healing as a primary management strategy for lower lip mucoceles.

OBJECTIVES: Oral mucoceles are most frequently encountered on the lower lip. A variety of treatment options are currently employed, including surgical excision, pharmacological injections, and laser therapy. However, each of these approaches may introduce risks and potential complications. Clinical practice has demonstrated a potential for self-healing in lower lip mucoceles, making a conservative observational approach more appealing. This research is a prospective study aimed at evaluating the self-healing capacity of lower lip mucoceles. METHODS: In this prospective study, patients with mucoceles were encouraged to intentionally delay medical intervention and to wait for self-healing. Disappearance of the mucocele for at least 3 months was defined as self-healing. RESULTS: Thirty patients with lower lip mucoceles were included. With no intervention, 24 patients (80%) reported self-healing of lower lip mucoceles. The mean natural duration of the mucoceles was 3.63 (± 4.7; 1-24) months. After self-healing of the mucocele, the patients were followed up for 17.21 (± 9.45; 2-30) months and there were no reported recurrences. CONCLUSIONS: Lower lip mucoceles have a high potential for self-healing and patients may be routinely encouraged to wait for self-healing. CLINICAL RELEVANCE: The high self-healing rate observed in this study suggests that a conservative, non-interventional approach might be considered as the first-line management for lower lip mucoceles.

The Evaluation of Upper Labial Swelling: An Arteriovenous Malformation.

Vascular malformations, which include disorders of the lymphatic or vascular systems, can appear in a variety of ways on radiographs, in the radiological department, and histologically. High-flow lesions with direct arteriovenous connections are known as arteriovenous malformations (AVMs). These lesions can cause soft tissue loss and deformity since they are difficult to diagnose early. This case report describes a 75-year-old female who presented with a severe bluish-purple swelling on her top lip. After conducting a thorough investigation, the patient's condition was quickly identified as AVM. After confirmation by USG Doppler and histological examination, the patient underwent a successful surgical resection that revealed a confined vascular lesion suggestive of AVM. The discussion explores the hemodynamic and embryologic factors that contribute to the formation of AVM, pointing out differences in hemodynamic properties and clinical symptoms. Treatment choices are influenced by the categorization of peripheral AVMs according to clinical standards and angiographic flow characteristics.

Bilateral Karapandzic Flap, a Saviour for Subtotal Lower Lip Reconstruction.

Lip plays an essential role in facial esthetic, food intake, and speech. Lip defect due to trauma or surgical excision needs proper reconstruction to preserve their function. Carcinoma lip is one of the common malignant lesions in the head and neck, which needs wide local excision with proper margin with neck clearance. When the size is more than two-thirds, it becomes a challenge to reconstruct and preserve its functionality and aesthetic issues. Bilateral karapandzic flap plays an important role in this case scenario. We have two cases of subtotal lower lip defect following squamous cell carcinoma of the lower lip excision, which was reconstructed with a bilateral karapandzic flap with reasonable functional outcome and cosmesis. Thus, bilateral karapandzic flap can be an alternative option to free flap in resource-constrained scenarios with acceptable functional outcomes.

Full-thickness nasolabial facial artery flap: A modified surgical approach for reconstruction of lower lip defects.

OBJECTIVES: Reconstruction of large lower lip defects remains challenging in terms of aesthetics, function and safety. The aim of this study is to explore a modified nasolabial flap to repair large lower lip defects. METHODS: The full-thickness nasolabial facial artery flap was used for reconstruction of defects in lip squamous cell carcinoma (LSCC) patients after tumor ablation. The postoperative recovery of patients was obtained through clinical review and follow-up in the first and sixth month. RESULTS: There were four LSCC patients who received tumor ablation at the Beijing Stomatological Hospital of Capital Medical University from November 2022 to March 2023, were included in our study. All patients did not suffer from postoperative infection, orocutaneous fistula, flap necrosis, and flap loss. One patient had the trapdoor deformity. These patients achieved better lip closure function. One patient developed cervical lymph node metastasis 2 months after surgery. CONCLUSIONS: The modified nasolabial flap could achieve good outcomes in terms of aesthetics, function, and safety. It provided a supplementary strategy for the using of nasolabial flap in larger defects of lower lip.

Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients.

BACKGROUND: Lower lip reconstruction is crucial to restore oral integrity post-cancer excision. A perfect balance between form and function should be achieved. With an aging demographic, adapting surgical methods to meet the unique needs of the elderly becomes imperative. Our study aims to introduce a specialized algorithm for lower lip reconstruction; it was tailored to geriatric patients and emphasized the use of "simpler flaps". Additionally, "Pearls and Pitfalls" were provided for surgeons approaching lower lip reconstruction. METHODS: Between January 2018 and June 2021, a retrospective study was carried out. Data collection included patient demographics, defect attributes, reconstructive approaches, flap viability assessment, wound healing, and complications. The follow-up was carried out for a period of a minimum of 6 months. RESULTS: Among 78 patients, squamous cell carcinoma predominated with a mean defect area of 3308 cm2. Postoperative complications were recorded in two patients. All patients reported sensory restoration and overall satisfaction at the 6-month follow-up; secondary procedures were not necessary. CONCLUSION: Our reconstructive algorithm, focused on elderly patients, prioritizes less invasive reconstructive techniques and introduces innovative modifications to the established methods to achieve both aesthetic and functional outcomes with a low complication rate. In patients undergoing lower lip reconstruction, the subjective microstomia was found to be less relevant than the objective microstomia.

Primary repair with no flaps for lower lip defects (30-80 %) after cancer excision.

Reconstruction of the lip is a necessary procedure when lip tumors are excised. Although many good techniques have been described, they often have disadvantages such as necrosis and extensive suture lines. In our approach, we aim to minimize the suture line and avoid tissue necrosis for medium-sized lip defects (30-80 %). This is a surgical technique report from a single center. After tumor resection, we made a bilateral 15 mm horizontal skin and mucosa incision from the angles of the lip to the lateral sides. The mucosa and skin were dissected from the underlying muscle, and the muscle was cut approximately 15 mm on each side. The lip defect was then closed and sutured in four layers. Finally, the released mucosa was sutured to the corner of the incised skin. We followed the patients for 36 months and found that their speech intelligibility, sensation, mobility, and aesthetic satisfaction were preserved. The scars were also less pronounced compared to flaps, and there were no signs of edema or drooling. In conclusion, our technique offers many advantages for moderate defects of lower lip tumors. By avoiding the use of flaps, we eliminate the complications associated with flap surgery while achieving aesthetically satisfactory results. However, further evaluation by other surgeons is necessary to fully examine the technique's benefits.

A Case of an Uncommon Lower Lip Swelling.

A woman in her fifty-seventh year appeared with a painless swelling on her left lower lip that had been present for three years. The size of the swelling was noticeably increasing in size over time. On examination, there was a lump that was firm, non-tender, and measured 2 cm x 1 cm above the lower lip. The oral cavity, as well as the intraoral mucosa, were normal and unremarkable in appearance. As fine-needle aspiration cytology revealed a spindle cell lesion, she had an excision biopsy performed, followed by bilateral advancement flap closure. Histopathological examination (HPE) revealed a schwannoma in the tissue sample. Schwannomas are rare, benign neural tumors originating from Schwann cells. They are mainly asymptomatic and have a moderate rate of growth. Excision is the recommended treatment for schwannomas. Proper surgical planning and postoperative monitoring are crucial for optimal wound healing and complete recovery.

Pleomorphic adenomia of lower lip: A case report.

Pleomorphic adenoma is a benign tumor of the salivary glands. It commonly occurs in the parotid gland, palate, upper lip and cheek. The authors present a rare case of a pleomorphic adenoma of the lower lip in a 30 years old female admitted on 20th of July, 2022 at Akbar Niazi Teaching Hospital, Islamabad with a complaint of painless, slightly itchy swelling on the lower lip for the last four months. Careful history and examination revealed a swelling of the lower lip which had gradually increased in size but was static for the last three months. As the patient complained of cosmetic and social inconvenience, it was surgically managed. Any post-operative complications were ruled out and the patient was sent home in a good condition. Much research is warranted to know the exact etiopathogenesis and appropriate management of pleomorphic adenoma of the lower lip.

Mucous Extravasation Cyst Associated With the Lower Lip and Its Management: A Case Report.

A 15-year-old female patient was reported with swelling on the right side of the lower lip for 15 days. A provisional diagnosis of mucocele was obtained based on the patient's history and clinical examination. Under all aseptic conditions and administration of local anesthetic, surgical mucocele removal was done using a scalpel. An excised soft tissue specimen was given for histopathological examination, confirming the final diagnosis of mucous extravasation phenomena or mucocele. Recall examination after seven days reveals satisfactory lesion healing and no discomfort. This case report demonstrates that surgical excision is a simple, efficient, and affordable method for treating mucoceles and giving aesthetic and functional clearance.

Comprehensive Management of a Giant Venous Malformation of the Lip: Vascular Embolization Followed by Surgical Resection and Reconstruction.

Venous malformations often manifest in early childhood and do not spontaneously resolve. Most vein malformations of the lips are typically treated at a young age, with giant arteriovenous malformations being particularly rare. Herein, we introduce the case of a 47-year-old man who presented to our department complaining of a progressive mass on his lower lip. Clinical examination revealed a mass measuring 10 cm × 8 cm × 4 cm in size, characterized by a soft texture and smooth edges. Despite a series of sclerotherapy interventions, the lesion remained unresponsive. Consequently, we performed a preoperative embolization of the malformed vessel using digital angiography, followed by extensive resection of the lesion and repair of the defect using an adjacent flap. The postoperative period was uneventful, and no local recurrence was observed during a 4-year follow-up period. Therefore, we recommend preoperative angioembolization as a valuable approach for addressing large lower lip deformities to enable extensive surgical resection and robust therapeutic outcomes.

Excision of Pyogenic Granuloma (PG) With Diode Laser on the Lower Lip in an Unusual Location: A Case Report.

Pyogenic granuloma (PG) is a tumor with regular growth expressed usually in the oral cavity, expressing characteristics of a non-neoplastic lesion. The first treatment option is surgical excision, which can be proceeded with surgical diode lasers (940 nm). This case report focuses on the surgical excision of a PG located in the lower lip using diode lasers. Post-operative follow-up of 6 months demonstrated adequate healing without esthetical compromise and no lesion recurrence, showing that diode lasers can be a safe and effective alternative for PG removal.

Role of the neck dissection in early-stage lower lip cancers.

Background: In early-stage lip cancer, spread to cervical lymph nodes is extremely rare. Elective neck treatment options include suprahyoid or supraomohyoid neck dissection, sentinel lymph node biopsy, or close follow-up. Aim: In this study, our aim was to investigate the effect of elective surgery on survival in patients operated for early-stage lip cancer. Methods: Patients who underwent surgical treatment for lower lip squamous cell carcinoma between 2005 and 2020 were retrospectively analyzed. Age, gender, neck dissection status (yes/no), clinical and pathological T stage of the tumor, grade, and perineural invasion were recorded and 3-year and 5-year overall (OS) and disease-free survival (DFS) rates were estimated. Results: Thirty patients were included: 20 patients had pT1 and 10 patients had pT2 tumors. Neck dissection was performed in 13 patients. The 5-year OS rate was 90.9% and 87.8% with and without dissection, respectively. Neck dissection did not appear to affect OS (P = 0.534) in these patients. The 5-year DFS rate was 96.4% in the overall group, while it was 91.7% and 100% in patients who did or did not undergo neck dissection, respectively (P = 0.756). Discussion: Patients with or without neck dissection did not differ significantly in terms of OS and DFS. Watchful waiting with regular ultrasound imaging of the neck in patients with T1 and T2 lip tumors may be an appropriate therapeutic option.

Incidence neurosensory deficit in mandibular fractures.

Sensory disturbances in the inferior alveolar nerve (IAN) prior to treatment can be attributed to various factors, including the site, type of fracture, and fracture displacement. Therefore, it is of interest to assess the incidence of inferior alveolar nerve injuries associated with mandibular fractures before and after surgical treatment. Group A consisted of patients with inferior alveolar nerve paresthesia before treatment, while Group B consisted of patients with inferior alveolar nerve paresthesia after treatment. A significant difference was observed between the two groups, with a p-value of 0.031 (p <0.05) with the overall incidence of IAN deficit was 57.33% before treatment and 61.33% after treatment. These findings highlight the importance of promptly identifying and managing IAN injuries to minimize long-term consequences.

A Novel Technique to Convert Static Sling into a Dynamic Sling in Reconstruction of Total Lower Lip Defects Using Palmaris Longus Tendon with Free Radial Forearm Flap and Case Series.

Lower lip reconstruction has been a major challenge for the reconstructive surgeons since time immemorial. Various types of reconstruction had been described for the reconstruction of lower lip ranging from local flaps to free tissue transfer to free functioning muscle transfer. For complete lower lip defects, the free radial forearm flap with palmaris longus tendon has been the standard of reconstruction for many years. Literatures suggests various techniques for utilizing palmaris longus tendon sling as a static as well as dynamic structure. The limitation with static reconstruction is the loss of sling support with time leading to eversion and drooping of the reconstructed lower lip and drooling of saliva. In this article we describe a simpler and novel technique which converts static reconstruction into a dynamic one with a series of 5 patients. Aim of this prospective study was to evaluate the post operative functional and aesthetic outcome of our technique of total lower lip reconstruction using free radial forearm flap with palmaris longus sling reconstruction. The medical records included were demographics, including age, gender, and reason for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. At 6 months follow up, all patients had satisfactory outcome and were able to take oral diets and none of the patients complained of drooling, an inability to eat in a public setting, or microstomia. This technique which is a simpler modification can be helpful in converting the traditional static sling reconstruction of lower lip into a dynamic one resulting in good aesthetic and functional outcomes.

Heterotopic sites of pleomorphic adenoma.

The majority of the tumours occurring in minor salivary glands are malignant with only 18% being benign. Among the benign tumours, pleomorphic adenoma is the most common. Although it presents more commonly in the parotid and submandibular glands, it can occur at any site where salivary glands reside. Only 6.4% of cases of pleomorphic adenoma occur in minor salivary glands, e.g. palate, cheeks, lips, para-pharyngeal space, etc. It occurs in females in the fourth or fifth decade. It presents as an asymptomatic and slow-growing mass. The treatment of choice is wide local excision due to the high rate of recurrence and malignant potential. We present rare case reports of two patients. The first case is of a young 18 years female presenting with recurrent neck (anterior triangle) swelling and the second case is of a 46-year-old female presenting with lower lip swelling. In both cases, it was a slow-growing mass and asymptomatic. Cytological examination of the lesion revealed the diagnosis of pleomorphic adenoma. It was completely excised with no post-operative complication. Pleomorphic adenoma, although a common benign neoplasm of major salivary glands, should always be kept as a possibility at the locations of minor salivary glands. As pleomorphic adenoma can transform into a malignant counterpart, therefore early diagnosis and treatment of the lesion can prevent further complications. The prognosis of pleomorphic adenoma is excellent. However, a close follow-up of the patient is required due to the high rate of recurrence.

Bleeding cavernous hemangioma of lower lip: a case report.

Hemangioma is a common benign vascular tumor. However, bleeding cavernous hemangioma of the lower lip are a rare condition. Case presentation: A 67-year-old female presented with bleeding from the lower lip. The bleeding increased with palpation. A clinical diagnosis of hemangioma of the lower lip was made. It was difficult to localize with ultrasound. It was explored and excised successfully. Clinical discussion: Hemangioma can be superficial, deep, or mixed. Generally, hemangioma involute spontaneously. Bleeding hemangioma causing functional disturbances need to be treated, for which various modalities are available, including excision. Conclusion: Hemangioma of the lip is a benign tumor of vascular origin. In selected cases, excision can be performed.

Lower lip reconstruction using McGregor fan technique with or without depressor anguli oris chimeric flap. Is there a difference in function and aesthetic outcomes?

BACKGROUND: Lower lip reconstruction aims to maintain facial subunit function and aesthetics. We present a minor modification of the McGregor flap technique, in which depressor anguli oris (DAO) muscle is separately elevated as a chimeric flap together to investigate the outcomes for reconstructing lower lip defects using various functional parameters. METHODS: The study included patients who underwent surgical repair of lower lip defects using a McGregor fan flap with or without DAO muscle chimeric flap between January 2018 and May 2021. The patients were divided into our modified technique with DAO chimeric flap (study group) and conventional McGregor (control group). The primary outcomes were functional evaluation of oral competency, speech intelligibility, and tactile sensation of reconstructed lip outcomes. The functional satisfaction and Patient and Observer Scar Assessment Scale (POSAS) were analyzed. RESULTS: A total of 20 patients were enrolled (10 patients for each group). Excellent oral competence was present in 12 patients, favorably significant in patients with DAO chimeric flap (n = 8/10, p = 0.018). All patients had intelligible speech with insignificant differences between the two groups. No patients demonstrated differences to light touch from baseline sensation at 1 year. Patients in the study group reported more lip function satisfaction (p = 0.049). The POSAS score indicates satisfaction with the appearance of all patients. CONCLUSION: McGregor fan technique combined with DAO muscle chimeric flap offers a good choice by maintaining sensory and motor functions. Our minor modification can ensure the integrity of the oral sphincter, leading to improved lower lip function.

Lower Facial Nerve Nomenclature Clarification: Cervical Branch Controls Smile-Associated Lower Lip Depression and Dental Display.

OBJECTIVE: In head and neck ablative surgery, traditional teaching is that the key facial nerve branch to preserve along the plane of the lower border of the mandible is the marginal mandibular branch (MMb), which is considered to control all lower lip musculature. The depressor labii inferioris (DLI) is the muscle responsible for pleasing lower lip displacement and lower dental display during natural emotive smiling. STUDY DESIGN: To understand the structure/function relationships of the distal lower facial nerve branches and lower lip musculature. SETTING: In vivo extensive facial nerve dissections under general anesthesia. METHODS: Intraoperative mapping was performed in 60 cases, using branch stimulation and simultaneous movement videography. RESULTS: In nearly all cases, the MMb innervated the depressor anguli oris, lower orbicularis oris, and mentalis muscles. The nerve branches controlling DLI function were identified 2 ± 0.5 cm below the angle of the mandible, originating from a cervical branch, separately and inferior to MMb. In half of the cases, we identified at least 2 independent branches activating the DLI, both within the cervical region. CONCLUSION: An appreciation of this anatomical finding may help prevent lower lip weakness following neck surgery. Avoiding the functional and cosmetic consequences that accompany loss of DLI function would have a significant impact on the burden of potentially preventable sequelae that the head and neck surgical patient frequently carries.