Facial soft tissue changes in adolescent patients treated with three different functional appliances: a randomized clinical trial.

INTRODUCTION: Patients with Class II, division 1 malocclusion generally seek treatment to improve facial esthetics. Therefore, the orthodontist needs to know the changes in the soft profile produced by functional appliances. OBJECTIVE: This study evaluated the soft tissue profile changes in patients treated during the peak of the pubertal growth spurt. METHODS: Thirty selected patients were randomized into three treatment groups: Twin Block (TB), Herbst with dental anchorage (HDA), and Herbst with skeletal anchorage (HSA). All patients had computed tomographic images: pretreatment (T1) and after 12 months of active treatment (T2). Twenty-four soft tissue cephalometric measures were analyzed. The normality of all data was assessed by the Shapiro-Wilk test. Intragroup comparisons were analyzed using the t-paired test; the inter-group comparisons were determined through ANOVA and the post-hoc Tukey test. RESULTS: At T1, no significant differences were observed between groups. At T2, in the intragroup comparison, facial soft tissue changes were statistically significant in the three groups for the lower lip, sulcus inferioris, facial soft tissue convexity in HDA group and TB group, and H angle in HDA group and HSA group, and soft tissue pogonium in TB group. In the inter-group comparison, no statistically significant differences were observed. CONCLUSION: It can be concluded that there were significant changes in soft tissue measurements that benefited Class II, division 1 patient's facial profile treated with the functional appliances Twin Block, Herbst, and Herbst with skeletal anchorage. Nevertheless, no significant differences were detected among the effects obtained by the three treatment protocols.

Late Facial Edema After Lip Filling With Hyaluronic Acid: Possible Association With the Use of Ozempic.

In recent years there has been an extraordinary increase in the use of different filler materials as facial cosmetic treatments. The popularity of injectable tissue fillers among individuals who wish to restore volume and gain a more youthful appearance is because it is a minimally invasive esthetic procedure for soft tissue augmentation. However, although they are considered efficient and safe, they can trigger complications such as swelling, bruising, erythema, pain, infection, nodule formation, vascular occlusion, and pigmentary changes. The objective of this article was to present a case of a 46-year-old patient who presented with significant facial edema 3 months after lip and infraorbital filling with hyaluronic acid, resistant to medication, which appeared and worsened after starting to use Ozempic for weight loss. Therefore, we chose to perform an intralesional application of hyaluronidase 2.000utr, immediately observing the decrease in edema. After a week, the patient was completely recovered, with no signs of edema, no allergic reactions and feeling very well. The etiology of late inflammatory reactions is unclear and we believe that some medications may be capable of initiating these immune responses. Hyaluronidase is an effective treatment to reverse adverse reactions from hyaluronic acid injection, dissolving the peptide bond proteins within the hyaluronic acid, increasing the viscosity of the material and allowing it to be dispersed throughout the soft tissue.

Comparative morphology of the rhinarium and upper lip in sigmodontine rodents: Refined nomenclature, intertribal variation in a phylogenetic framework, and functional inferences.

Rodents have received substantial attention in the study of olfaction. However, the rhinarium, the naked part of the nose, which plays an important role in chemical, tactile, and thermal perception, has been relatively overlooked. This study presents a comprehensive analysis of the rhinarium morphology and spatially associated structures (i.e., upper lip, and philtrum) in sigmodontines, a diverse group within the Cricetidae rodents. The research covers 483 specimens representing 145 species, accounting for 74% of genera in the clade, including all 13 recognized tribes, three incertae sedis genera, and the murid representatives Mus musculus and Rattus norvegicus. The inconsistent use of terminology in describing rhinarium traits across the literature poses a challenge for comparative analyzes. To address this issue, a standardized terminology was proposed to characterize the rhinarium. A paired complex protuberance typically with epidermal ridges (i.e., rhinoglyphics), termed here the tubercle of Hill, was identified as a distinctive feature in muroid rhinaria. Comparative assessments among tribes revealed unique sets of features defining each major clade, encompassing variations in hairiness, dorsum nasi complexity, size and positioning of the tubercle of Hill, and other key attributes. Two primary rhinarium configurations were discerned: one shared by Oryzomyalia and Sigmodontini and another specific to Ichthyomyini. The former groups display a ventrally positioned rhinarium prominently featuring the tubercle of Hill and sculptured areola circularis. In contrast, Ichthyomyini exhibit a frontally directed rhinarium characterized by an enlarged dorsum nasi fused to the tubercle of Hill, resulting in a distinctive "cherry" appearance. Convergent rhinarium structures observed in fossorial species, characterized by well-developed plica alaris and hair fringes, are presumed to mitigate potential damage during digging. Conversely, semiaquatic carnivorous sigmodontines showcase an integrated apical structure in their rhinarium, facilitating enhanced somatosensory capabilities crucial for predation activities during diving expeditions.

Sequência didática para o ensino de fendas labiopalatinas / Didactic sequence for the teaching of cleft lip and palate / Secuencia didáctica para la enseñanza de labio leporino y paladar hendido

Introdução: A fenda labial e a fissura palatina, apresentam elevada prevalência na população brasileira, sendo necessária uma formação acadêmica de cirurgiões que gere saberes que transformem a realidade. Diante do exposto, o presente manuscrito objetivou descrever o desenvolvimento, a aplicação e a avaliação de uma sequência didática sobre fissuras labiais, palatinas e labiopalatais com enfoque em aprendizagem significativa em que houve a associação de duas metodologias ativas, a construção de modelos didáticos e a sala de aula invertida. Metodologia: A sequência didática foi realizada na educação superior, com equipes de discentes de Odontologia, seguindo três etapas: planejamento; confecção do modelo didático semiplano de fissuras labiais, palatinas e labiopalatais; apresentação em roda de conversa. O desempenho dos acadêmicos foi avaliado em cada etapa. Resultados: Inicialmente, os discentes possuíam pouco conhecimento sobre o tema. Os modelos didáticos foram construídos com facilidade e durante a roda de conversa foram utilizados os modelos didáticos e compartilhados os conhecimentos sobre Embriologia, Teratologia, aspectos clínicos e tratamento odontológico para cada fenda representada, evidenciando a eficácia do método. Conclusões: As metodologias ativas adotadas utilizadas no processo de planejamento, confecção e debate sobre fissuras labiais, palatinas e labiopalatais foram ferramentas valiosas no processo ensino-aprendizagem na educação em Odontologia... (AU)

Introduction: Cleft lip and cleft palate showed prevalence in the Brazilian population, being an academic training of surgeries that generates knowledge that transforms reality. Given the above, this manuscript aimed to describe the development, application and evaluation of a didactic sequence on cleft lip, palate and lip and palate with a focus on meaningful learning with the association of two active methodologies, the construction of didactic models and the inverted classroom. Methodology: The didactic sequence was carried out in Higher Education with teams of Dentistry students following three stages: planning; making the semiplane didactic model of cleft lip, palate and lip and palate; presentation in conversation circle. Academic performance was assessed at each stage. Results: Initially, the students had little knowledge on the topic. Didactic models were easily built. During the conversation, didactic models were used and knowledge about Embryology, Teratology, clinical aspects and dental treatment was shared for each gap represented, showing the effectiveness of the method. Conclusions: The active methodologies adopted used in the process of planning, making and debating cleft lip, palate and lip and palate were valuable tools in the teaching-learning process in Dentistry Education... (AU)

Introducción: Labio leporino y paladar hendido, presentan elevada prevalencia en la población brasileña, es necesária una formación académica de los cirujanos para generar conocimientos que transformen la realidad, dado lo anterior, este manuscrito tuvo como objetivo describir el desarrollo, la aplicación y la evaluación de una secuencia didáctica sobre el lábio leporino, fisura palatina y paladar hendido con un enfoque de aprendizaje significativo en el que hubo la asociación de dos metodologias activas, la construcción de modelos didácticos y el aula invertida. Metodología: La secuencia didáctica se realizo en la enseñanza superior, con equipos de estudiantes de odontologia, siguiendo tres etapas: Planificación; realización de um modelo didáctico semiplano de lábio leporino y paladar hendido; presentación del circulo de conversación. Se evaluo el desempeño de los académicos en cada etapa. Resultados: Inicialmente, los estudiantes tenían poco conocimiento sobre el tema. Los modelos didácticos se construyeron facilmente y durante la conversación se utilizaron los modelos didácticos y se compartieron sobre Embriologia, Teratología, aspectos clínicos y tratamiento odontológico de cada fisura representada, evidenciando la efectividad del método. Conclusiones: Las metodologias activas adoptadas y utilizadas en el proceso de planificación, realización y debate sobre lábio leporino, paladar hendido y fisura palatina fueron herramientas valiosas en el proceso de enseñanza-aprendizaje en la formación odontológica... (AU)

Manejo clínico e cirúrgico da miíase em face: relato de caso / Clinical and Surgical Management of Myiasis in the Face: Case Report / Manejo Clínico Quirúrgico de Miasis en la Cara: Reporte de Caso

Objetivo: O presente trabalho tem como objetivo relatar um caso de miíase em face, descrevendo as suas características e tratamento. Relato de caso: Paciente do sexo masculino, leucoderma, 39 anos, em condições de rua. Ao exame físico, havia perda de substância tecidual em região labial inferior, com extensão a tecidos adjacentes periorais, lábio superior e base nasal. Notava-se presença de miíase na região. Ao exame intra-oral, observou-se região endurecida à palpação pela extensão interna total do lábio inferior. Optou-se pela remoção cirúrgica das larvas, irrigação e debridamento do tecido necrosado. A condição acomete predominantemente indivíduos com deficiência neurológica e/ou locomotora, de baixo nível socioeconômico, com higiene precária, dependentes químicos e com lesões prévias. Conclusão: Quanto ao tratamento, há diferentes formas, como remoção manual de larvas e desbridamento cirúrgico, aplicação de substâncias asfixiantes e antibioticoterapia, principalmente com uso de ivermectina. A miíase é uma doença tratável que atinge populações específicas. Devido à agressividade da lesão, a prevenção e tratamento adequado em tempo hábil são necessários. O tratamento instituído neste caso foi eficaz e restabeleceu as condições do paciente... (AU)

Objective: The present work aims to report a case of myiasis in the face, describing its characteristics and treatment. Case report: Male patient, leucoderma, 39 years old, in street conditions. On physical examination, there was loss of tissue substance in the lower labial region, extending to adjacent perioral tissues, upper lip and nasal base. The presence of myiasis was noted in the region. On intraoral examination, a hardened region was observed on palpation due to the total internal extension of the lower lip. We opted for the surgical removal of the larvae, irrigation and debridement of the necrotic tissue. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor hygiene, chemical dependents and with previous injuries. Conclusion: As for the treatment, there are different ways, such as manual removal of larvae and surgical debridement, application of asphyxiating substances and antibiotic therapy, mainly with the use of ivermectin. Myiasis is a treatable disease that affects specific populations. Due to the aggressiveness of the lesion, prevention and adequate treatment in a timely manner are necessary. The treatment instituted in this case was effective and restored the patient's conditions... (AU)

Objetivo: El presente trabajo tiene como objetivo reportar un caso de miasis en la cara, describiendo sus características y tratamiento. Reporte de caso: Paciente masculino, leucoderma, 39 años, en condiciones de calle. En el examen físico, había pérdida de sustancia tisular en la región labial inferior, que se extendía a los tejidos periorales adyacentes, el labio superior y la base nasal. Se notó la presencia de miasis en la región. Al examen intraoral se observa región endurecida a la palpación por extensión interna total del labio inferior. Optamos por la extirpación quirúrgica de las larvas, irrigación y desbridamiento del tejido necrótico. La condición afecta predominantemente a personas con discapacidad neurológica y/o locomotora, de nivel socioeconómico bajo, con mala higiene, dependientes de sustancias químicas y con lesiones previas. Conclusión: En cuanto al tratamiento, existen diferentes vías, como la extracción manual de larvas y desbridamiento quirúrgico, aplicación de sustancias asfixiantes y antibioticoterapia, principalmente con el uso de ivermectina. La miasis es una enfermedad tratable que afecta a poblaciones específicas. Debido a la agresividad de la lesión, es necesaria la prevención y el tratamiento adecuado en el momento oportuno. El tratamiento instituido en este caso fue efectivo y restableció las condiciones del paciente... (AU)

Quantitative Assessment of Lip Morphology in Patients With and Without Cleft Lip and Palate Using 3-Dimensional Stereophotogrammetry.

This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60 y, mean age 44.0±12.0 y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59 y, mean age 43.5±12.0 y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.

Study of Lip Conditions Associated with Lip Print Patterns: A New Perspective on Cheiloscopy / Estudio de Afecciones Labiales Asociadas a sus Patrones de Huellas: Una Nueva Perspectiva en Queiloscopía

SUMMARY: Although almost all studies exclude lip conditions because they would affect furrow patterns, some authors maintain that they should be considered temporary or permanent disabilities, all of which require further research in this context.We present a study in which we associate lip conditions with lip print patterns to associate both morphological elements for fieldwork purposes. Fifty-seven women and 48 men aged between 19 and 38 years who resided in Temuco (Chile) were included. The lip conditions and their prints were recorded, and an analysis, comparison, evaluation, and verification protocol (ACE-V) for lip prints was applied. Of the participants, 27.4 % had healthy lips, while 71.7 % had some type of condition. Although patterns related to temporary and permanent lip conditions were recognized in the lip prints in a non-significant way, the diagnosis of "healthy" or "altered" lip status could be made significantly by a calibrated examiner. Although these conditions do not represent identifying variables without empirical studies to validate them, they can affect the quality of the evaluated lip print; therefore, they should be recognized during the analyses considering the prevalence of these conditions.

Aunque casi todos los estudios excluyen las afecciones labiales pues afectarían los patrones de sus surcos y huellas, algunos autores sostienen que deben ser consideradas alteraciones temporales o permanentes, por lo que se requiere mayor investigación en este aspecto. Se presenta un estudio en el que se asocian afecciones labiales con sus patrones de huellas para evaluar conjuntamente ambos elementos morfológicos con fines de trabajo forense de campo. Se incluyeron 57 mujeres y 48 hombres con edades entre 19 y 38 años residentes en Temuco (Chile). Se registraron las afecciones de los labios y sus huellas, y se aplicó un protocolo de análisis, comparación, evaluación y verificación (ACE-V) para las huellas labiales. De los participantes, el 27,4 % tenía labios sanos, mientras que el 71,7 % presentaba algún tipo de afección. Aunque los patrones relacionados con afecciones labiales temporales y permanentes se reconocieron en las huellas labiales de manera no significativa, un examinador calibrado podría realizar significativamente el diagnóstico de estado labial "sano" o "alterado". Si bien estas condiciones no representan variables de identificación sin estudios empíricos que las validen, pueden afectar la calidad de la impresión labial evaluada; por lo tanto, deben ser reconocidos durante los análisis considerando la prevalencia de estas condiciones.

The influence of different cheek and lip retractors and emissivity on intraoral infrared thermography.

OBJECTIVES: To assess the influence of two conventional and one adapted cheek and lip retractors and three emissivity setting values on intraoral infrared thermography (IT) temperature values. METHODS: The sample was composed by 50 volunteers. Three cheek and lip retractors were tested: Group 1-flex retractor (FR); Group 2-FR adapted with Styrofoam; Group 3-U-type retractor (UR) for cheek and lip. All thermograms were acquired using FLIR T650 infrared camera. A set of three thermograms in frontal norm were acquired for each lip and cheek retractor at 0.91, 0.96, and 0.98ε, with an interval of 15 min between each set of images to avoid thermal interference. All images were assessed by two observers. The ROIs' mean temperature of the four upper incisors was recorded. Two-way ANOVA and Sidak post-test were used for data assessment with a significance level of 5%. RESULTS: Group 3 showed higher mean temperature than Groups 1 and 2 at all emissivity settings for all assessed teeth (P < .05). 0.91ε showed higher temperature than 0.96ε and 0.98ε for all assessed variables (P < .01). Contralateral teeth assessed using Group 3 at 0.91ε showed statistical differences between each other (P < .05). No statistical difference was observed between contralateral teeth assessed using Groups 1 and 2 at 0.96ε and 0.98ε (P > .05). CONCLUSIONS: The choice of cheek and lip retractor and emissivity setting can interfere on intraoral IT temperature values. U-type cheek and lip retractor and 0.91ε setting should not be used for IT image acquisition when assessing dental tissues.

Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies.

Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.

Secondary oral syphilis presenting as a tumor-like lesion on the lower lip.

This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial.

OBJECTIVE: The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB). MATERIAL AND METHODS: Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used. RESULTS: AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed. CONCLUSION: The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.

Deficiency in infiltration of CD8/CD3 positive lymphocytes and macrophages plays a role in lip carcinogenesis: an immunohistochemical study.

OBJECTIVE: To evaluate the immunoexpression profile for CD8, CD3, CD20 and CD68 in the process and carcinogenesis of Carcinoma of the vermilion lip. METHODS: Average cell count with positive expression for CD3, CD8, CD20 and CD68. The CD8/CD3 ratio calculated in the region was based on the percentage of positive cells in a total of malignant cells. Kruska-Wallis/Dunn, Mann-Whitney and Spearman correlation tests (SPSS, p < 0.05) were used. RESULTS: In the Aquitic Cheilitis samples, there was an increase in intraepithelial CD8+ and CD68+. In LSCCs, there was an increase in peritumoral and intratumoral CD3+, CD8+, CD20+ and CD68+ cells. In peritumoral LSCC, CD3+ and CD8+ showed a direct correlation (p = 0.004), and CD68+ and CD8+ (p = 0.017). In the intraepithelial region, CD8+ correlated with CD20+ (p = 0.014) and CD68+ (p = 0.013). In the CAs, CD3 (p < 0.001) and CD8 (p = 0.025) correlated intraepithelial and subepithelial. In LSCC CD3+ (p = 0.002), CD8+ (p = 0.001) and CD68+ (p = 0.030) had intra and peritumoral correlation. CONCLUSION: CD68+ is the first interacting cell with the greatest capacity to migrate to the tumor and interact with CD3, CD8 and CD20. Apparently, CD20 affects perineural invasion. LEVEL OF EVIDENCE: Level 2.

Reported physical examination methods for screening of oral cancer and oral potentially malignant disorders: a systematic review.

OBJECTIVE: This systematic review aimed to describe the method followed during physical examination and the anatomical structures of the head and neck assessed in screening for oral cancer and oral potentially malignant disorders (OPMDs). STUDY DESIGN: An extensive literature search was carried out using MEDLINE/PubMed, EMBASE, Scopus, LILACS, Web of Science, Cochrane databases, and gray literature. The risk of bias was available in all papers included. RESULTS: Of 9,688 records identified, 27 were included in this review, reporting data from 356,250 individuals screened and distributed across 11 countries. Most of these (n = 19) were based on 1 round of screening conducted by a dental professional or other health care workers. Most screening programs included visual inspection and palpation of the lips, oral cavity, and the most visible oropharyngeal sites, but the descriptions reported were imprecise. Additional inspection and palpation of the neck (submental, submandibular, cervical, and supraclavicular regions) to assess for the presence of swellings and any palpable neck nodes were also performed in 15 programs. CONCLUSION: In conclusion, there was considerable heterogeneity in the method of physical examination in screening programs for oral cancer and OPMDs among the included studies.

Evaluation of the presence of Th1 response through T-bet and IFN-gamma immunohistochemical expression in lower lip and oral tongue squamous cell carcinomas.

INTRODUCTION: Evaluate the immunohistochemical expression of T-bet and IFN-γ in lower lip (LLSCC) and oral tongue squamous cell carcinoma (OTSCC), verifying the presence of Th1 responses in lesions with different clinical conditions. METHODS AND MATERIALS: Thirty OTSCC and 30 LLSCC were analyzed by immunohistochemistry. T-bet was quantitatively assessed by parenchyma cell and stroma quantification, and IFN-γ was semi-quantitatively analyzed: 1:0-25%; 2:26-50%; 3:51-75%; 4:> 75% immunopositive cells. Histological differentiation degrees were categorized as well differentiated (WD), moderately differentiated (MD), or poorly differentiated (PD). RESULTS: OTSCC presented the highest number of T-bet+, parenchyma (p: 0.006), stroma (p: 0.156), parenchyma/stroma (p: 0.015), with no relationship to histological malignancy grade. IFN-γ higher concentrations in LLSCC were detected in parenchyma, stroma and in parenchyma/stroma (p: 0.000), as well as greater immunoreactivity in WD and MD (p: 0.001). In OTSCC, a positive and statistically significant correlation was observed between T-bet+ in parenchyma and IFN-γ in stroma(r: 0.388; p: 0.034), in addition to a statistically significant positive correlation between T-bet in parenchyma compared to stroma(r: 0.411; p: 0.024) and for IFN-γ in both parenchyma and stroma(r: 0.775; p: 0.000) in LLSCC. Higher T-bet+ was observed in OTSCCs, although higher IFN-γ was detected in LLSCCs. CONCLUSION: Thus, we suggest that, even though LLSCC presented lower T-bet+, the favorable microenvironment in these lesions led to an expressive activation of IFN-γ by T-bet+, considerably acting on Th1 differentiation and in antitumor activity, which, admittedly, present less aggressive behavior, reinforcing once again the important role of this cytokine and its use in strategy to fight cancer.

Histopathologic findings in ointment pseudo-cheilitis: An alert to dermatopathologists.

Ointment pseudo-cheilitis is a recently recognized distinctive type of self-induced cheilitis. Lesions consist of a variable amount of crusts adhered to the vermilion. These crusts consist of dried saliva and dead cells mixed with applied medications attached to the lip surface. Patients are typically severely anxious or depressed; the condition impacts quality of life. Ointment pseudo-cheilitis is frequently misdiagnosed as exfoliative cheilitis or cheilitis glandularis. Biopsy reports are often non-revealing because there are no established histopathological criteria for this disease, and clinicians usually do not formulate the correct diagnostic hypothesis. Here, we present the histopathological findings of four cases of ointment pseudo-cheilitis. The most consistent finding was the presence of laminated parakeratotic material detached from the epithelium in biopsies that are devoid of other significant diagnostic changes. This material at the lip surface possibly represents physiologic labial desquamation mixed with dried saliva and applied medication. With this report, we intend to alert dermatopathologists to the diagnosis of ointment pseudo-cheilitis if they receive biopsies from patients who present clinically exuberant labial lesions that show only minimal histopathological changes.

Dermoscopic Evaluation of Actinic Changes in the Lips of Indigenous Children Living at High Altitude in Ecuador: A Descriptive Study.

BACKGROUND High altitude increases sunlight exposure, resulting in actinic keratosis, which predisposes people to skin cancer. The dermoscopy procedure evaluates keratotic and pigmented skin changes. This study aimed to describe the clinical and dermoscopic actinic changes in the lips of 25 indigenous children living at high altitude in Ecuador. MATERIAL AND METHODS An observational study was conducted in a public school in the Andes region of Ecuador (August-November 2019). Twenty-five children, males and females, age 5-15 years were assessed by complete physical examination, digital dermoscopic photographs, and punch biopsies. Descriptive statistics and Fisher's exact test were used to summarize and analyze the data. RESULTS We included 17 (68%) boys and 8 (32%) girls with a mean age of 9.8±2.0 years. Clinical lips findings reported desquamation [52% Upper Lip (UL); 40% Lower Lip (LL)], fissuring (8% UL; 8% LL), scabs (8% UL; 8% LL), and discoloration (40% UL; 20% LL). Dermoscopic features included a white-yellow lip color (24% UL; p=0.02). The main morphologic pattern of blood vessels was monomorphic (88% UL; p<0.001), polymorphous (60% LL; p<0.001), dotted pattern (64% UL; 28% LL; p=0.02), and linear-irregular (32% UL; 72% LL; p=0.01). Girls had radiating white structures on UL (p=0.025), while boys presented white structureless areas (UL 63.6%; LL 77.8%; p=0.032). No differences in dermoscopic findings were observed according to Fitzpatrick scale score (FSS). Punch biopsies showed no indications of actinic cheilitis. CONCLUSIONS Dermoscopic features in indigenous children living in high altitudes were related to actinic damage, but histopathological findings were negative.

Effect of upper lip compression on pain reduction during local anesthesia. A split-mouth randomized clinical trial

Objectives: To evaluate the effect of pressure on the skin of upper lip in decreasing pain perception during a local maxillary anesthetic injection. Material and Methods: A split-mouth crossover randomized clinical trial was designed. Seventy-one volunteer students (23.6±1.9 years old, 53.5% women) were selected. A group chosen at random had their left or right side of upper lip compressed by a wooden clothes peg as the compression instrument and 0.6 ml of lidocaine 2% with epinephrine 1:100,000 was administered at the buccal apex level of the lateral incisors tooth. Two weeks later anesthesia was administered on the opposite side of the lip according to the randomization recorded. The intensity of perceived pain level between the two injections using a 100 mm visual analog scale (VAS) and co-variable effect were compared (Wilcoxon test p < 0.05, RStudio). Results: The average of the perceived pain with and without upper lip compression was 27.6±14.5 mm (range 0-80 mm) and 36.33±17.9 mm (range 10-90 mm) respectively (p= 0.002). No significant differences were recorded according the covariance analysis with the sex (p = 0.55) and age (p = 0.89). Conclusion: The upper lip compression significantly reduces the perception of pain during a local maxillary anesthetic technique.

Possible role of ALDH1 and CD44 in lip carcinogenesis.

BACKGROUND: Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (<60 years old), the female gender, white skin, not smoking or consuming alcohol, and a fast evolution, and not associated with the chronic exposure to UV radiation (p<0.0001). CD44 positivity was associated with patients who were male, feoderm, smoked, consumed alcohol, underwent occupational exposure to UV-radiation, and demonstrated lesions with log-time evolution (p<0.0001). ALDH1 + cells were associated with mild dysplasia using a system from the World Health Organization (WHO), and with a low risk of malignant transformation, according to the binary system (p<0.0001). CD44+ cells were also associated with moderated dysplasia, according to the WHO system. In LSCC, ALDH1 + cells were positively associated with patients who were older (≥ 60 years old), smokers, and with those who consumed alcohol (p<0.0001). CD44 + cells in LSCC were associated with older (≥ 60 years old) patients as well, but also with female patients, white skin, non-smokers, and individuals who did not consume alcohol (p<0.0001), all of whom showed distinct patterns in pre- and malignant lesions of both markers. Additionally, in LSCC, both ALDH1 and CD44 staining were associated with smaller tumor sizes (T1/T2; p<0.0001). In summary, although both ALDH1 and CD44 were associated with the presence of dysplasia in AC lesions, the present findings suggest that ALDH1 and CD44 may be activated by different etiopathogenic pathways, predominantly in distinct steps of oral carcinogenesis. CD44 would thus be more significantly related to the potentially malignant lesion, while ALDH1 would be closely linked to malignancy.