Caliber-persistent labial artery: report of 3 cases

The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

Post-traumatic lip lesion mimicking rhabdomyomatous mesenchymal hamartoma in a pediatric patient

We report a 7-year-old boy who presented with a nodule on the upper lip. A previous clinical history of mechanical trauma in the lesional area had been noted. After surgical excision, microscopy revealed fibrocollagenous fascicles associated with neurovascular bundles and skeletal striated muscle fibers in diffuse subepithelial distribution, suggesting rhabdomyomatous mesenchymal hamartoma. However, strict clinicopathological correlation favored a healing process with trapped striated skeletal muscle tissue. After three years of follow-up, an improvement in the aesthetic appearance of the upper lip was observed. To the best of our knowledge, a case of pseudo-rhabdomyomatous mesenchymal hamartoma has not been reported to date.

Orolabial Lymphogranuloma Venereum, Michigan, USA

Orolabial lymphogranuloma venereum was diagnosed for a man in Michigan, USA, who had sex with men, some infected with HIV. High index of suspicion for lymphogranuloma venereum led to accurate diagnosis, successful therapy, and description of an L2b variant with a unique genetic mutation.

Integrating piezoresistive sensors on the embouchure analysis of the lower lip in single reed instrumentalists: implementation of the lip pressure appliance (LPA)

Background

It is essential to understand, characterize, and measure the embouchure mechanism of a wind instrumentalists, where the applied forces on the perioral tissues can usually promote discomfort or pain.

Methods

The sample consisted of five clarinet players and five saxophone players. The embouchure force measurements at the lower lip area were assessed using a piezoresistive sensor (FlexiForceTM, Tekscan, Boston, USA, 0.07 kgf/cm2) placed on the lower part of the mouthpiece of the single reed instrument. Furthermore, each participant performed three times three different notes at different pitches: high, medium, and low. An intraoral device was manufactured in order to dissipate the existing pressures.

Results

The piezoresistive sensors applied to the mouthpiece of the five clarinetists presented values between 16 and 226 g of force. In the case of the five saxophonists, the values registered were between 5 and 320 g of force.

Conclusions

Piezoresistive sensors are a valid option to characterize that single reed instrumentalists apply substantial forces at the lower lip that can be equivalent to medium orthodontic forces. The implementation of the Lip Pressure Appliance can be a valid solution on the prevention of eventual lesions resulting from the embouchure forces.

A case of minor salivary gland sialolithiasis of the upper lip

BACKGROUND

Sialolithiasis is the most common disease of the salivary glands. Sialolithiasis usually develops in the major salivary glands, and rarely in the minor salivary glands, with only 2% of all cases of sialolithiasis occurring in the minor salivary glands and sublingual glands. Sialoliths in the minor salivary glands result in few or no clinical symptoms and are seldom identified on imaging.

CASE PRESENTATION

We report herein our experience with a case of minor salivary gland sialolithiasis in a 67-year-old woman. On examination, an elastic soft, mobile, and well-circumscribed mass was palpable within the left upper lip. Ultrasound examination revealed a hypoechoic mass with heterogeneous internal echoes. The mass was excised under local anesthesia. Based on histopathological findings, a diagnosis of minor salivary gland sialolithiasis was established.

CONCLUSIONS

Diagnosis of minor salivary gland sialolithiasis is challenging due to the difficulty of detecting sialoliths on imaging. A well-circumscribed mass was detected in the upper lip, and ultrasound examination revealed a round lesion, raising the suspicion of a benign tumor. Other diseases that can develop at the upper lip are calcified lymph node, phlebolith, fibroma, pleomorphic adenoma, myxoma, vascular malformation, salivary gland tumor, non-specific sialadenitis, and malignant tumor. Surgical excision is the favored approach for confirming a diagnosis of intramucosal nodular lesions.

Eosinophilic pustular folliculitis with labial and oral involvement: report of a rare presentation

Eosinophilic pustular folliculitis (EPF) is a recurrent inflammatory dermatosis primarily involving hair follicles. Several subtypes of EPF have been described: Classic EPF, infantile EPF, and immunosuppression-associated EPF. Although classic EPF has a predilection for face, involvement of hairless areas such as palms and soles has been reported frequently. There are rare case reports of mucosal EPF. Herein, we report a woman who presented with classic EPF involving the lip and oral mucosa.

An extraordinary case of syphilis presenting with a labial ulcer

In the differential diagnosis of patients with ulcers on the lips characteristics like the duration of the ulcer, number, size, depth, shape, base, margins, and distribution are considered. Such ulcers arise from many diseases particularly, viral and bacterial infections, malignancies can also be responsible. Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients. This study describes a case of a 38-year-old female patient presenting with a painful ulcer covering 3 quarters of the upper lip showing settlement on erythematous, edematous, and indurated plaque covered with hemorrhagic crusts. The aim of this study was to consider differences between the classic syphilitic chancre typically found in the genital region from extragenital chancres and to raise awareness of the possibility of primary syphilis when patients present with painful ulcers on the lip.

Sore or Swollen Lips Part 3: Diagnosis and Treatment

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

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Crohn’s disease (CD) is a chronic inflammatory bowel disease whose oral features remain underrated at clinical examination. The aim of the study was to report forerunner orofacial presentations leading to diagnosis of CD among nine patients of mean age 23 between 2008 and 2015. Linear ulcerative buccal lesions, cobblestoning, mucosal tags and perioral erythema are highly evocative and might precede intestinal signs for several years. Oral biopsies revealed highly suggestive lesions of CD for 45% of patients before any intestinal symptom or digestive investigation. Mean time to diagnosis was 14 months. Immunomodulatory therapy (azathioprine, infliximab, adalimumab) was introduced alone or in association for 89% of patients. Early diagnosis could lead to specific therapy, often necessary to reduce severity of lesions and improve quality of life.

Sore or Swollen Lips Part 1- Causes and Diagnosis

This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips. Clinical relevance: Sore and/or swollen lips are not uncommon, often have a local cause but may reflect a systemic disease. This first part of a series of three papers reviews their causes and diagnosis alphabetically, for ease of reference.

Itchy Lip-Swollen Tongue Swollen Lip It's not Always an Allergy to Dental Materials; Angioederna- Possibly Life Threatening! You Might See This in Your Practice

When providing dental treatment, the dental clinician (DC) is expected to be knowledgeable in recognition and emergency management of an allergic response. Common manifestations of localized allergic responses can present as a rash or hives (urticaria), running of the nose, and swelling of the lips, eyes, face, respiratory and gastrointestinal mucosa. More critically, there is the potential for breathing difficulties from laryngeal swelling. Airway obstruction can be potentially life threatening.' Anaphylactic shock can be another serious reaction. Although most of these allergic responses can be minimal and managed with an antihistamine (diphenhydramine), more serious allergic reactions (marked breathing difficulty, anaphylaxis) may require the use of an intramuscular injection of epinephrine. This case report describes a patient who had what appeared to be a common allergic response to some aspect of dental materials or treatment but was subsequently diagnosed with an allergic condition known as angioedema (AE) that had the potential to be non-responsive to dental office emergency medications. AE may be due to the more common histamine generated process as described below. However, if the patient's AE is due to alternate pathophysiology, the DC may not be able to manage breathing difficulties due to airway swelling, which could be rapidly fatal.

[Health lips beautiful smile: Conditions to know]

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

Congenital labial mucocele: rare presentation of a common disease

Oral mucoceles are common lesions characterized by accumulation of mucus following rupture of a minor salivary gland duct. However, congenital mucoceles are a rare and distinctive oral condition observed in newborns. This case report details the features of a congenital labial nodule diagnosed as congenital mucocele. These lesions are rare in the oral cavity and should be diagnosed in the delivery room, but many cases are referred for further evaluation. Management is simple, and recurrence is not expected.

Giant keratoacanthoma of the lower lip: case report and review of the published literature

Keratoacanthoma (KA) is an epithelial tumor mainly located on the sun-exposed skin of the face and hands of elderly patients. The giant form of KA affecting the lower lip is relatively rare, and only 2 of 9 recently reported cases were in women. This report describes a case of giant KA of the lower lip in a 62-year-old white woman and discusses clinical and histologic diagnosis and the therapeutic approach to this lesion. The patient reported a 2-month evolution of a nodule characterized by a brownish central plug of keratin and measuring approximately 2.0 cm in its greatest diameter. Keratoacanthoma may present some histopathologic features similar to those of squamous cell carcinoma, and careful attention is required to avoid an incorrect diagnosis. Following histopathologic confirmation of giant KA, complete excision of the lesion was performed. A 17-month follow-up examination revealed complete healing of the area and no signs of recurrence. Because giant KA of the lower lip may impair normal function and esthetics, surgical excision is the best choice for treating this lesion.

Trauma-Induced Giant Pyogenic Granuloma in the Upper Lip

Pyogenic granuloma (PG) is a reactive local benign vascular lesion, where connective tissue fibrovascular proliferation occurs. The most common etiology of PG is chronic, low-level irritation. PG affects females mainly. The purpose of this paper is to report a giant pyogenic granuloma caused by an acute trauma in the upper lip of an 11-year-old boy. The initial clinical diagnosis suggested PG, which was confirmed after an excisional biopsy and a microscopic exam. Oral lesions of large proportions in children can cause functional, esthetic, and behavioral issues, and should be promptly investigated.

Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips

INTRODUCTION

Accurate lip contour identification is demanding since variations in color, form and surface texture, even in normal lips, introduce artifacts in non-adapted segmentation algorithms. Herein, a method for vermilion border detection and quantification in healthy and diseased lower lips is presented.

AIM

To quantify the morphological irregularities of lower lip border, to validate its discriminative power in solar cheilosis diagnosis and to provide supportive tools toward, cost effective, non invasive, disease monitoring.

MATERIALS

Segmentation algorithm for lower lip border was based on spatial fuzzy c-means clustering algorithm with adaptive selection of fuzzy exponent m. Lip features measuring morphological lip border deviations were estimated. The method of lip border extraction and quantitative description was evaluated in a gold standard set of 25 young volunteers without onset of lip diseases. Quantitative descriptors were evaluated in terms of correct classification rates in differentiating 30 healthy control cases from 41 patients with solar cheilosis and were further applied to quantify the therapeutic outcome after immunocryosurgery in eight patients with solar cheilosis.

RESULTS

Adaptive estimation of fuzzy exponent m substantially boosted the segmentation quality in gold standard cases yielding quite smooth lip contours and uniformly low values of lip irregularity features. Discriminant analysis highlighted the distance between the extracted and modeled vermilion border as a feature with excellent diagnostic accuracy (sensitivity and specificity 98% and 93% respectively). Results on patients with solar cheilosis followed up after treatment with immunocryosurgery showed that proposed quantitative lip marker was able to trace the improvement of disease after treatment.

CONCLUSION

Correct lip border recognition is the prerequisite for extracting essential morphological descriptors from lips with epithelial diseases like solar cheilosis. In this paper we presented an efficient method for the automatic identification and quantitative description of lower lip vermilion border morphology in health and disease using digital photography and image analysis techniques.

Pediatric soft tissue oral lesions

This article provides an overview of common color changes and soft tissue oral nodular abnormalities in children and adolescents. The clinical presentation and treatment options to address these conditions are presented in a concise approach, highlighting key features relevant to the oral health care professional.

Letter:Annular atrophic lichen planus of the lip

Annular atrophic lichen planus is a rare form of lichen planus, clinically characterized by a circumscribed annular configuration. We report herein a 32-year-old female who developed depressed plaques on the lips. Physical examination showed well-circumscribed, erythematous plaques on the lower lip. The border was slightly elevated and the inner portion was depressed and atrophic. Also, a bean-sized well-circumscribed plaque with slightly elevated border was found on the upper lip. A biopsy specimen revealed that the epithelium of the mucous membrane was reduced in thickness and a mononuclear cell infiltration invaded the basement membrane of the epithelium. This is the first case of annular atrophic lichen planus involving the lip. She was treated with 0.1 percent tacrolimus ointment once daily, which resulted in a beneficial effect.

Letter: Isolated annular lichen planus of lower lip

Lichen planus (LP), the prototype of lichenoid dermatoses, is an idiopathic inflammatory disease of the skin and mucous membranes, hair follicles, and nails. It rarely occurs on the lips and usually then in association with oral lesions. We report a 40-year-old man with a 3-month history of an isolated single annular violaceous plaque of the lower lip. The rest of his mucosae, skin, hair and nails were normal. Histopathology confirmed the diagnosis of LP. The patient was advised to use topical tacrolimus 0.03 percent cream twice daily along with multivitamins, but the patient was lost to follow-up. Isolated LP of the lip is unusual, although this condition may be underestimated and therefore under-reported in the literature.