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.

[Necrotic lesion of the lip and cough with fever: cutaneous and pulmonary anthrax]

Anthrax disease is an anthropozoonosis caused by Bacillus anthracis. It appears in three clinical forms: pulmonary, intestinal, and cutaneous. We report a case of pulmonary and cutaneous anthrax in a one-year-old Moroccan infant.

Excessive gingival display--etiology, diagnosis, and treatment modalities

Extensive exposure of the gingiva during a smile, called excessive gingival display, may be a point of concern for both patients and clinicians. Patients often present to the dental clinic seeking a solution to their "gummy" appearance. A clinician must fully understand the various factors involved in this situation, to provide patients with an appropriate answer. Thorough examination followed by the right diagnosis is imperative for achieving an esthetic and predictable result in the treatment of such situations. The aim of this article is to discuss the various aspects of excessive gingival display and its etiology and to present the current solutions that exist in the literature.

Bilateral nasolabial cysts: a case report

The nasolabial cyst is one of the rarer soft tissue cysts, and presents beneath the alae of the nose. There have been few reports of an association between nasolabial cysts and dacryocystitis (an infection of the nasolacrimal sac). This case report describes a female who presented with bilateral nasolabial cysts and longstanding symptoms of epiphora (watery eye).

A case of mucous membrane plasmacytosis successfully treated with cryotherapy

Mucous membrane plasmacytosis is a rare, often idiopathic, inflammatory disorder that frequently presents as an erythematous, velvety, or lobulated plaque on a mucosal surface. While mucous membrane plasmacytosis often runs a benign course, plaques are known to erode, ulcerate, and bleed. Moreover, according to a recent review of mucous membrane plasmacytosis, treatments of this disorder are inconsistently successful. We report a case of erosive, hemorrhagic mucous-membrane plasmacytosis of the lips treated successfully with cryotherapy. To the best of our knowledge, this case represents the second case of mucous membrane plasmacytosis successfully treated with cryotherapy. The long term response of our patient's condition to cryotherapy with no functional side effects may warrant further study of this technique for severe erosive mucous membrane plasmacytosis.

Treatment of Mucocele of the Lower Lip With Carbon Dioxide Laser

PURPOSE

The aim of this report was to evaluate the outcome and complications of the treatment of numerous patients with mucoceles of lower lip by means of CO(2) laser vaporization.

MATERIALS AND METHODS

This study included 82 patients with biopsy-confirmed mucocele of the lower lip who were treated with CO(2) laser vaporization from January 1999 to December 2003; the data on recurrence and complications were collected.

RESULTS

There was a recurrence in 2 cases. Complications were rare, except for mild discomfort. One patient felt temporary numbness at the operative site. There was no bleeding and minimal scar formation.

CONCLUSION

CO(2) laser vaporization to treat the mucocele of the lower lip is effective and has few complications. Because the operative time is shorter than with the excisional method, it is especially good for children and for less cooperative patients with this lesion.

Development of lichen planus and psoriasis on lesions of vitiligo vulgaris

This paper reports a unique case of coexistence of vitiligo vulgaris, lichen planus and psoriasis vulgaris in a 53-year-old man. Five years after the onset of vitiligo, lichen planus developed on his lower lip. Another 4 years after the onset of lichen planus, he also exhibited psoriasis on his upper arms and trunk. Both the lichen planus and psoriasis occurred on lesions of the preceding vitiligo vulgaris. We discuss potential mechanisms for association of these three dermatoses, including Koebner phenomenon and photodamage.

Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings

Although inflammatory bowel disease (IBD) typically presents with gastrointestinal complaints, mucocutaneous lesions are commonly associated and can precede gastrointestinal symptoms, thereby alerting the clinician to the diagnosis of IBD before the onset of gastrointestinal symptoms. Nine children are reported who had no gastrointestinal symptoms suggestive of IBD but presented with mucocutaneous findings of IBD and were subsequently diagnosed with Crohn's disease or ulcerative colitis based on characteristic features on gastrointestinal endoscopy and/or biopsies. The majority of the patients had oral and perianal lesions. We believe that IBD is a common etiology for persistent oral lesions in the pediatric population. In addition to a good history, children with unexplained oral mucous membrane lesions should have an examination of the rectal and genital mucosa as well as tests for complete blood count, iron levels, sedimentation rate, albumin, and occult blood in the stool with endoscopy and biopsies to rule out IBD if indicated.

Bilateral nasolabial cysts associated with recurrent dacryocystitis

OBJECTIVE

Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis.

CASE REPORT

A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic.

CONCLUSION

There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.

Upper lip fistulas: three new cases

OBJECTIVE

We present three new cases of congenital upper lip fistula. Two of them were located in the philtrum midline, one of which was associated to a double maxillary frenulum, a medial lip cleft, and a medial cleft of the primitive palate. The other was located in the left side of the vermilion. All three patients had clear fluid discharge through the fistulous orifice without pain. Two of them had a history of recurrent swelling of the philtrum area.

CONCLUSIONS

A simple surgical excision is the treatment of choice in these cases, in which the anatomy is preserved; this fact is more consistent with a completed but aberrant development than with focal dysgenesis.

Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans

BACKGROUND

The incidence of angular cheilitis (angular stomatitis, perleche, commissural fissures) appears to be increased in people with Down syndrome (DS). Lip fissures are also (in our clinical impression) a fairly regular feature, yet this is scarcely mentioned in the literature.

OBJECTIVES

To establish the incidence of angular cheilitis and lip fissures in a substantial group of patients with DS and to examine the relationship with Candida albicans.

PATIENTS AND METHODS

The prevalence of orofacial soft tissue lesions was investigated in a group of 77 DS patients. Swabs were taken from lip lesions, palate and tongue and inoculated on Sabouraud's agar discs for the isolation of C. albicans, identified with commercially available kits.

RESULTS

Lip fissures were seen in at least one-quarter of DS patients. Angular cheilitis was also found in a similar percentage.

CONCLUSIONS

C. albicans was isolated from a substantial proportion of lesions tested, and was present more frequently than in those without lip lesions, but it is uncertain whether this represents cause or effect.

Palmoplantar keratoderma and oral leucoplakia with cutaneous horn of the lips

The inherited palmoplantar keratodermas (PPK) may be associated with a wide variety of other ectodermal abnormalities. The coexistence of PPK and leucoplakia may indicate the increased risk of oesophageal carcinoma in adult life. Cutaneous horn may develop over benign, precancerous, as well as malignant lesions, and frequently may be associated with actinic keratoses and Bowen's disease. On the other hand, the relationship of cutaneous horn and leucoplakia has been the subject of only a single case report. We present a case of PPK and diffuse oral leucokeratosis associated with relapsing cutaneous horn of the lips.

Plasma cell mucositis

A case of plasma cell mucositis is described for its rarity. A probable aetiological correlation with periodontitis is discussed. The patient showed good response to intralesional and topical steroids.

The Laugier-Hunziker syndrome

Laugier and Hunziker described a syndrome consisting of asymptomatic benign areas of hyperpigmentation affecting the lips, buccal mucosa and, in 50%, the fingernails. We report a 67-year-old woman with the clinical features of Laugier-Hunziker syndrome in association with vulval pigmentation. Histology, immunohistochemistry and electron microscopy from the various areas of pigmentation on the body confirmed the benign nature of the pigmentation. We review potential causes of oral and genital pigmentation, and suggest an expansion of the original syndrome described by Laugier and Hunziker to include more widespread areas of benign hyperpigmentation, which may associated.

Oro-facial granulomatosis: a laryngeal presentation

We report the first case of oro-facial granulomatosis (OFG) presenting in pregnancy with laryngeal manifestations.

Associated localization of morphea and lichen planus of the lip in a patient with vitiligo

Morphea, lichen planus and vitiligo are common diseases, but seldom associated. Morphea or lichen planus in the lips have not frequently been reported, and an associated localization of both lesions in the lip mucosa is indeed a rare event. A case of morphea and lichen planus localized in the upper lip mucosa in a patient with vitiligo is reported. Immunohistochemistry revealed a clear prevalence of T-lymphocytes in the inflammatory infiltrates of morphea and in the band-like infiltrate of the lichen, a finding consistent with previous reports of morphea, lichen planus, and vitiligo. The inverse ratio found between CD8+ and CD4+ lymphocytes, compared to other reports, seems to confirm that the pathogenesis of morphea and lichen planus evolves through different stages. The present report, besides presenting a rare case, may prompt to consider a common pathogenesis among morphea, lichen planus and vitiligo.

Congenital midline sinus of the upper lip

A rare case of congenital midline sinus of the upper lip is presented. The patient had recurrent cellulitis with swelling at the base of the medial crus of the right lower lateral cartilage. Excision was performed using the intraoral approach. Theories concerning the etiology of the midline sinus of the upper lip are discussed.

Median cleft lip with associated midline sinuses

Midline upper lip sinuses alone are rare entitities, with less than 25 cases reported previously. Midline upper lip sinuses with associated cleft lip are even more rare. A patient report of median cleft lip with associated upper lip sinuses in a 16-year-old boy is presented. Controversy exists as to whether these abnormalities are related. This report demonstrates the plausibility of a cause-and-effect relationship between midline clefts and sinuses.

Coexistence of generalized morphea with hisotological changes in lichen sclerosus et atrophicus and lichen planus

We reported a 44-year-old Japanese woman with generalized multiple sclerotic plaques, which showed histological findings of morphea. This patient also had an erosive lesion on her mouth; its histological findings were consistent with lichen planus. A sclerotic lesion on her thigh showed the histological findings of lichen sclerosus et atrophicus (LSA). These data suggest that similar etiologic events or closely related pathologic processes are involved in morphea, lichen planus, and LSA.

Minor salivary gland hyalinisation and amyloidosis in low-grade lymphoma of MALT

Two patients with low-grade lymphoma of mucosa-associated lymphoid tissue (MALT) arising in primary Sjögren's syndrome developed solitary nodules in their lips. Histologically both lesions showed enlargement and hyalinisation of single minor salivary glands with acinar atrophy, loss of most ducts and conversion into almost acellular sclerotic eosinophilic masses. In one case the lesion was shown to contain an amyloid component. No amyloid was detected in the second case but deposition of collagen and basement membrane and sclerotic neoplasm were excluded.

[Lichen and hepatitis C]

We report a case of lichen planus in a patient with hepatitis C infection and discuss the relationship between these two diseases.

Median lip fissures and their management

Median lip fissures are an uncommon condition and usually give rise to pain and episodes of bleeding. We report three cases of median lip fissures which were treated by surgical excision.

Adverse reactions in the oral mucosa associated with anterior composite restorations

This is a descriptive study of patients with symptomatic lichenoid-like reactions of the lips in contact with composite restorations (n = 12). Clinically, the lesions appeared as symptomatic single or multiple erythematous areas that included white papules. Candida was found by cultivation or histopathological examination in 7 of the lesions. Patch testing (n = 7) did not reveal any reactions to composite components, except for one patient who showed a delayed hypersensitivity reaction to formaldehyde. Replacement of existing dental materials parallel to antifungal treatment resulted in healing or significant improvement in 7 of 9 patients. This study shows that resin components can be associated with adverse reactions in the oral mucosa of the lips and that these reactions may be accompanied by an infection with Candida.

[Follow-up study of dyskinesia-induced dysgnathias following myofunctional therapy]

Forty-eight patients with dysgnathia brought about by tongue dyskinesia underwent myofunctional therapy leading up to and at the beginning of orthodontic treatment. Short- and long-term results of this therapy were studied with the help of indirect palatography. Palatographs of empty swallowing and the test consonants "L", "N", "S" and "T" were evaluated visually and metrically. The palatographs were made prior to myofunctional therapy and thereafter first at the end of the therapy, then at the end of the control or supervision period, and finally, after on average 4 years. Visual evaluation revealed a clearly recognizable change in all functions when compared with the physiological palatographs. A change in the "S" consonant sound was the least conspicuous. Metric evaluation revealed for the 4 out of 5 of the test functions, namely, empty swallowing and the consonants "L", "N", and "T", marked long-term dorsal orientation of the tongue. The short-term changes in tongue function were more prevalent than the long-term.

Pyoderma gangrenosum associated with paroxysmal nocturnal haemoglobinuria

A case of pyoderma gangrenosum of the lip occurring in association with paroxysmal nocturnal haemoglobinuria is described. This is an extremely rare association, which has been documented in the literature on only two previous occasions. Pyoderma gangrenosum (PG) is an uncommon ulcerative skin disorder of unknown aetiology. Its clinical appearance is often distinctive, with established lesions consisting of a necrotic ulcer surrounded by a ragged undermined violaceous edge. Lesions are usually painful and are most often found on the lower limbs but can occur on the trunk, head and neck. The diagnosis is essentially clinical as there are no characteristic histopathological changes. Since its original description in 1930, PG has been frequently associated with a number of underlying systemic diseases. Foremost among these are inflammatory bowel disease and inflammatory polyarthritis. The association with haematological disorders is also well recognized, and includes acute and chronic lymphocytic and myeloid leukaemias, polycythaemia rubra vera, myelofibrosis, myelodysplastic syndrome, essential thrombocythaemia, hypogammaglobinaemia, monoclonal gammopathy, multiple myeloma and non-Hodgkin's lymphoma. We report a case of PG occurring on the lower lip of a 26-year-old man recently diagnosed as having paroxysmal nocturnal haemoglobinuria (PNH).

Head and neck manifestations of tumoral calcinosis

Intraoral facial and laryngeal features of tumoral calcinosis are reviewed in six patients of Jewish-Yemenite descent. Extraoral features included calcified masses, erythematous patches, and angular cheilitis. Oral soft tissue findings included papillary hyperplasia of the lip vermilion and velvety-red macules on the tongue, palate, and buccal mucosa. Gingival findings included advanced periodontitis and an erythematous marginal gingivitis. In all patients, orthognathic evaluation revealed a concave profile, retruded maxilla, and relative mandibular prognathism. Although previously reported clinical dental abnormalities were not present, extracted teeth demonstrated abnormal dentin. Hoarseness was present in all patients and was the earliest appearing feature in two patients. The appearance of these head and neck findings preceded the classical manifestations of tumoral calcinosis and may be helpful in the early diagnosis of this entity. The varied reported features of tumoral calcinosis support the notion that this disease may present multiple formes frustes with variable clinical expressivity.

Treatment of Peutz-Jeghers lentigines with the carbon dioxide laser

Perioral dark brown macules quickly identify patients with Peutz-Jeghers syndrome. These lentigines may be cosmetically disfiguring. We report a successful outcome in the treatment of these lentigines with the carbon dioxide laser.

Oral melanotic macules in patients infected with human immunodeficiency virus

A group of 217 patients seropositive for human immunodeficiency virus (HIV) were studied for 2 years, during which time pigmented lesions of the oral mucosa developed in 14 (6.4%) of them. The lesions were well circumscribed in some cases and diffuse in others. In some patients the macules enlarged or recurred after surgical excision. In two patients the macules appeared during the administration of zidovudine. Clinical and laboratory evidence of adrenal insufficiency was not detected in any of the patients examined. The histologic appearances were those of melanotic macules. No ultrastructural alterations of the melanocytes were observed. Two of these macules also contained Epstein-Barr virus, and in one case normal oral mucosa was examined and also contained Epstein-Barr virus in the epithelial cells. As a control group we examined 180 health care workers who did not belong to any risk category, and 30 intravenous drug abusers who tested seronegative to HIV. Oral melanotic pigmentation was found in eight of the control subjects (3.6%). The difference was not statistically significant (p = 0.3097). Our study shows that oral macules do not occur more frequently in HIV-infected patients. However, the clinical behavior of these lesions appears to be different during the course of HIV infection. In some HIV-infected patients the cause of the macules might relate to the administration of zidovudine and antifungal or antibacterial drugs. In others the cause remains unknown and could be due to multiple factors.

Ectopic geographic tongue and AIDS

A 23-year-old man with AIDS developed a lesion with the clinical characteristics of an ectopic geographic tongue in the lower lip, near the right commissure.

Facial molluscum contagiosum in HIV-infected patients

Three cases of facial molluscum contagiosum in HIV-infected patients are reported. Unusual locations, multiple lesions and rapid recurrence after surgical excision may be seen in people who are infected with HIV.

[Hyperpigmentation of the Laugier-Hunziker-syndrome type appearing during antineoplastic polychemotherapy]

The Authors report a case of multiple brown slate macules localized on the lips and on the oral mucosa, occurred to a 66 year-old woman during cancer polychemotherapy with cis-diamminedichloroplatinum and Cyclophosphamide due to an ovary's serous cystadenocarcinoma with peritoneal metastasis. The histological test taken on a lip's lesion, fully excised, points out main focal hyperpigmentation of basal epidermal layer and numerous melanophages in the papillary dermis. The Authors, after a comparison among the information obtained from the literature, exclude any possible secondary reaction due to chemotherapy or any paraneoplastic syndrome. What they emphasize is the great similarity between the clinical and histological pictures noticed in this case and the ones described in the Laugier-Hunziker's syndrome. The particular association observed in this case is noteworthy but, nowadays following the existing knowledges, no relation of cause and effect between polychemotherapy, cancer and Laugier-Hunziker's disease can be advanced.

Bilateral lower lip mucoceles: cause of functional malocclusion in a three-year-old child

The case report of a three-year-old girl is presented, who had two nontender, bluish, fluctuant swellings diagnosed as superficial mucoceles present since the child was a few days old. The child had a unilateral crossbite with the mandibular midline shifted almost one tooth width to the left, a longstanding function adaptation producing malocclusion. The mucoceles were surgically removed, and the cross-bite disappeared.