A rare case of upper lip schwannoma: A case report with analysis of the histological, immunohistochemical and pathogenesis aspects

INTRODUCTION AND IMPORTANCE

Schwannoma, a benign tumor originating from Schwann cells, is a rare case found intraorally. The tongue, palate and buccal mucosa are the most common sites of intraoral Schwannoma while it is very rarely found on the lips. Previous studies reported only twelve cases of Schwannoma on the upper lip. The etiology of Schwannoma is unknown, but in some literature, Schwannoma occurs due to a defect in the NF2 gene. Management of Schwannoma is excision of the capsule. The prognosis is good, and the recurrency is low. This article reports a rare case of upper lip Schwannoma in adolescent and its management with its histological, immunohistochemical and pathogenesis aspects.

CASE PRESENTATION

A 16-years old female presented a painless, semi-solid, mobile lump on the upper lip measuring of approximately 1.5 × 3 cm that had similar color with the surrounding tissue. The lump appeared 7 years ago.

CLINICAL DISCUSSION

Excision of the capsule and margins of the tumor. Histopathological examination showed a unique feature of Schwannoma, the Verocay bodies. Subsequent immunohistochemical examination of S100 protein showed a classic type of Schwannoma.

CONCLUSION

Upper lip schwannoma is a very rare tumor, and this type of tumor cannot be distinguished from other benign soft tissue tumors based on clinical findings. Immunohistochemical results are in accordance with the Histopathological results for the final diagnosis of Schwannoma. Schwannoma can be used as a differential diagnosis in cases of lumps on the lips with sessile, similar color like surrounding tissue, painless, and movable features.

Quantifying female upper lip lengthening with age by direct surface measurement: A guide for the lip lifting procedure

Upper lip lifting is a very popular procedure but there is no objective guidelines on how much skin has to be removed to obtain an optimal result. We have measured and compared the philtral height in two groups of young and old female Lebanese subjects. We have found a mean philtral height of 14.3 ± 1.9 mm in the young group and 19.8 ± 2.4 mm In the old group, with a mean philtral lengthening of 5.5 ± 2.9 mm. We suggest using these results to plan the amount of skin that has to be removed during a lip lift procedure.

Alar crease as a donor site for the extension limb of modified nasolabial V-Y advancement flap

BACKGROUND

The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects.

METHODS

A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap.

RESULTS

The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications.

CONCLUSION

The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

Cavernous hemangioma of the lip: combined treatment with intralesional laser and surgery

Infantile cavernous hemangioma is a benign vascular tumor in childhood. Cavernous hemangiomas have a tendency of slow enlargement with subsequent complications such as ulceration and bleeding. We report a case of a large cavernous hemangioma affecting the median upper lip in an 11-year-old girl. The lesion was growing and painful on pressure. The patient felt stigmatized. Treatment was wished for by patient and parents. After careful examination including Doppler ultrasound, we suggested a combined approach. In the first step the lesion was coagulated with an intralesional neodymium-YAG laser using a blunt tip. In the second step, immediately after the action of the laser, the lesion was removed completely by surgery. Defect closure was realized with bilateral tissue-expanding vermillion myocutaneous flaps. The patient was followed-up to 5 months. Disfigurement and functional impairment were eliminated. The result was satisfying for both patient and parents. Vascular lesions of the upper lip-particularly when close to Cupid's bow-can become disfiguring and cause functional impairment. We propose a combined approach with intralesional neodymium-YAG laser photocoagulation to avoid bleeding and to shrink the lesion before complete surgical removal. For defect closure, bilateral tissue-expanding vermillion myocutaneous flaps (Goldstein technique modified by Sawada) were used.

Reconstruction with facial artery musculo-mucosal flap (FAMM.F) after resection of upper lip pleomorphic adenoma: Case report

INTRODUCTION

Although pleomorphic adenoma (PA) is the most common neoplasm of both minor and major salivary glands, its presence in the buccal surface of upper lip is rare.

PRESENTATION OF CASE

A 70-year-old male presented with a chief complaint of recent rapid growth of a mass in the buccal aspect of the upper lip. A well-circumscribed mass measuring 3 × 2 cm with intact overlying mucosa without regional lymphadenopathy was evident. Core needle biopsy report was suggestive of PA. Complete excision of the tumor was performed. The defect was large and primary closure was not possible. Reconstruction with FAMM flap was planned. After 4 weeks, the flap was covered with epithelia and created a satisfactory result.

DISCUSSION

The definite diagnosis of PA is based on histopathological examination. The following features help to differentiate PA from other tumors; tubuloalveolar and gland-like structures, islands of cuboidal or polygonal cells in a chondroid, hyalinized, fibroadipose or mucinous hypocellular stroma which are stained positively for periodic acid-Schiff and Alcian. Despite these characteristics, differentiation of PA from dermal mixed tumor may be challenging especially when the specimen is from the upper lip. The main advantages of FAMM.F are being thin and pliable flap, having wide arc of rotation; being suitable for reconstruction of mucosal defects; resistance against postoperative radiotherapy and easy harvesting.

CONCLUSION

The FAMM flap is a reliable reconstruction technique for medium-sized intraoral defects with limited morbidity to the donor site. It provides functional reconstruction of the oral cavity with a low risk of post-operative complications.

Exploration of surgical approach to reconstruct smile-like lip shape in East-Asian women

BACKGROUND

To investigate the clinical effects of surgical treatment to improve the lip morphology for a smile-like appearance (joy and happiness) in East-Asian women.

METHODS

From October 2016 to April 2020, 63 patients who had received surgery to lift the commissure of the mouth and adjust the shape of the upper red lip to form a smile-like shape were analyzed and evaluated.

RESULTS

The lip shape of enrolled patients was improved to a certain extent after surgery without any obvious scar hyperplasia, and the satisfaction rate of people after the surgery was 85.71%.

CONCLUSION

For East-Asian women with thin and flat lips, surgical approach can be used to improve the shape of lip, such that the appearance of the lip is in a smile-like shape, which can enhance affinity and also exhibit the aesthetic characteristics of East-Asian women. This treatment can be used for clinical reference.

LEVEL OF EVIDENCE

Level IV.

Width of the orbicularis oculi fibers extending to the upper lip with the lateral and inferior lengths of the orbicularis oculi at the lateral canthus level: application to botulinum neurotoxin type A injection for crow's feet

PURPOSE

The aim of this study was to determine the width of the fibers that extend from the orbicularis oculi muscle (OOc) to the upper lip, and the lateral and inferior lengths of the OOc at the lateral canthus level.

METHODS

The OOc was investigated in the 40 hemifaces of 20 Korean cadavers. The lateral fibers of the OOc (OOc lat) were traced to determine whether or not these fibers extended to the upper lip.

RESULTS

The OOc lat extended to the upper lip at the lateral canthus level in 31 of the 40 specimens (77.5%), whereas some inferolateral fibers of the OOc that extended to the upper lip were observed near the level of the lower margin of the OOc in the other 9 specimens (22.5%). The mean ± SD and maximum widths of the OOc lat that extended to the upper lip at the lateral canthus level were 6.9 ± 3.3 mm and 14.3 mm, respectively.

CONCLUSION

The obtained data will be helpful to distinguish the muscles that underly the wrinkles around the lateral canthus for safer and more-efficient BoNT-A treatments for crow's feet.

Lip Lift Techniques in Smile Design

The lips are the main aesthetic component of the facial lower third and simultaneously a substantial element for an ideally perceived smile. One of the most accepted and common procedures that is widely used to enhance the shape and contours of the upper lip is the lip lift. With a careful treatment plan and a professional surgery, a lip lift can reliably be used for the reduction of the philtrum height, enlargement of the upper vermilion, improvement of the dental show, restoration of facial aesthetic proportions, and creation of an enchanting smile.

Non-infectious granulomatous disorders of the upper lip: clinicopathological analysis of 11 patients

Background

Non-infectious granulomatous disorders of the upper lip represent a special chapter of oral and maxillofacial pathology. In this work we report a case-series of this process, to analyse its main clinicopathological features and find differential data that allow us improve its diagnosis and understand its pathogenesis.

Methods

We present 11 cases of non-infectious granulomatous disorders of the upper lip, 8 women and 3 men with an age range of 29–84 years, who have been attended at the Oral Medicine Department of the IUCT (France) and the Oral Medicine Unit of the UPV/EHU (Spain). All clinicopathological data were collected in a specific protocol.

Results

We recognized 4 different subtypes of non-infectious granulomatous disorders of the upper lip: (1) associated with Crohn’s disease (1 case), (2) associated with foreign body (2 cases), (3) associated with gingivitis lichenoid-like (4 cases), (4) idiopathic (4 cases).

Conclusions

Clinicopathological differences were identified between these subtypes. A good differential diagnosis is necessary in all cases to rule out the presence of local or systemic etiopathogenic factors.

Expression of R-spondins/Lgrs in development of movable craniofacial organs

Wnt signaling plays a critical role in the development of many organs, including the major movable craniofacial organs tongue, lip, and eyelid. Four members of the R-spondin family (Rspo1-4) bind to Lgr4/5/6 to regulate the activation of Wnt signaling. However, it is not fully understood how Rspos/Lgrs regulate Wnt signaling during the development of movable craniofacial organs. To address this question, we examined the expression of Rspos, Lgrs, and Axin2 (major mediator of canonical Wnt signaling) during tongue, lip, and eyelid development. The expression of Axin2, Rspos and Lgrs was observed in many similar regions, suggesting that Rspos likely activate canonical Wnt signaling through the Lgr-dependent pathway in these regions. Lgr expression was not detected in regions where Axin2 and Rspos were expressed, suggesting that Rspos might activate canonical Wnt signaling through the Lgr-independent pathway in these regions. In addition, the expression of Rspos and Lgrs were observed in some other regions where Axin2 was not expressed, suggesting the possibility that Rspos and/or Lgrs are involved in non-canonical Wnt signaling or the Wnt-independent pathway. Thus, we identified a dynamic spatiotemporal expression pattern of Rspos and Lgrs during the development of the eyelid, tongue, and lip.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair

Background

The postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).

Methods

Ninety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.

Results

Values of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).

Conclusions

The conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.

Aesthetic Surgical Enhancement of the Upper Lip: A Comprehensive Literature Review

BACKGROUND

The recent rise in popularity of minimally invasive facial aesthetic procedures has resulted in the overall heightened patient interest in lip rejuvenation. There is a variety of techniques and modifications for surgical upper lip enhancement described in the literature but no single method is considered optimal. The aim of this literature review is to provide a comprehensive analysis of the studies dealing with surgical upper lip enhancement and evaluate their short- and long-term outcomes, as well as complication profiles.

METHODS

A comprehensive review of the published literature through July of 2019 was performed. The PUBMED and Cochrane databases were searched for all English language articles on aesthetic surgical enhancement of the upper lip. Only articles dealing with the aesthetic aspect of the upper lip subunit were included. Preoperative assessment, patient selection and technique execution were assessed. Data were abstracted on all postoperative complications and outcomes.

RESULTS

Overall, 52 articles were screened for inclusion, of which 17 met the inclusion criteria. The total number of patients treated in these studies was 2265. The average follow-up period was 30 months. The most commonly used surgical method across the studies was the subnasal lip lift (93.6%). The bull's horn excision pattern was utilized to perform the subnasal lip lift in 71.7% of the cases, and the wavy ellipse excision was used in 18.1% of patients. Lip advancement by vermillion border excision pattern was the technique of choice for 49 patients (2.2%). Across all patients the most common complication was a non-aesthetically appealing result or adverse scarring with a mean incidence of 7.23%. Overall, the studies reported improvement in the aesthetic appearance of the upper lip after surgical enhancement, along with few but promising reports of high patient satisfaction. There is a relative paucity of high-quality data regarding complication profiles, patient selection, indications and contraindications.

CONCLUSIONS

This review provides an overview of several techniques and modifications for upper lip enhancement. It highlights the paucity of high-quality data on their application and optimizing patient selection. Promising satisfaction rates and relatively low complication rates suggest a more prominent role for surgical cheiloplasty in facial rejuvenation.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medical device related pressure ulcer of the lip in a patient with COVID-19: Case report and review of the literature

Pressure ulcers of the lip constitute a rare entity faced by plastic surgeons and there is a relatively paucity of data regarding optimal management. In this study we present one case of upper lip pressure ulcer related to prone intubation for respiratory distress due to SARS-CoV-2 infection, treated with surgical excision and reconstruction. We also performed a review of the literature to identify other studies on pressure lip ulcers. Six studies were considered relevant. Conservative management constitutes the most common method of treatment; however, little is known about the aesthetic, and functional morbidity related to either surgical or non-surgical treatments.

Island Flap for Upper-Lip Reconstruction: Analysis of Key Aspects and a Case Series

Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications.

A rare case of dermoid cyst arising in the upper lip

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Dermoid cysts arising from the upper lip are relatively rare.

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Dermoid cysts have been histopathologically classified as epidermoid, dermoid and teratoid cysts.

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The diagnosis and management of dermoid cysts can be improved with the combined use of ultrasonography.

Introduction

Generally, dermoid cysts commonly arise from the anus and ovaries. Oral and maxillofacial lesions are most commonly observed in the midline of the floor of the mouth, and lesions arising from the upper lip are relatively rare.

Presentation of case

A 50-year-old man was referred to our hospital due to swelling of the left upper lip. Clinical examination revealed an elevated alar base, Gerber protrusion and nasal deformity. Ultrasonography revealed a clearly defined 30-mm lesion with more hypoechoic bands. Meanwhile, magnetic resonance imaging revealed a 30-mm mass below the orbicularis oris of the left upper lip. The lesion had a homogeneous, low-signal intensity on T1-weighted imaging. Thus, based on these findings, a dermoid cyst was suspected. The lesion was then removed en bloc without the overlying skin while the patient was under general anaesthesia. Histopathological examination revealed a cystic cavity lined by an orthokeratinised stratified squamous epithelium. However, skin appendages were not found. Based on the clinical and histopathological features of the lesion, a diagnosis of epidermoid cyst was made. Swelling of the left upper lip, nasal deformity and Gerber protrusion significantly improved after surgery.

Conclusion

Although dermoid cysts arising from the upper lip are rare, the diagnostic accuracy for dermoid cyst can be improved with the combined use of ultrasonography and other imaging modalities even though these lesions are difficult to distinguish from differential diagnosis.

Upper lateral lip flap for the coverage of large superficial labial defect

BACKGROUND

Reconstruction of large superficial defects of the upper lip is challenging, as it requires the restoration of both function and morphology. To achieve optimal results, facial features and landmarks should be preserved and similar skin should be used. Moreover, in male patients, upper lip pilosity should be restored. Although myriad of local flaps have previously been described, few address these issues. Herein, we describe our results with an upper lateral lip rotation flap for large upper lip cutaneous defects coverage.

PATIENTS AND METHOD

A retrospective study was performed including every patient who underwent an upper lateral lip flap between 2010 and 2017. Demographic data, defect dimensions, etiology, type of anesthesia, operative time, postoperative complications, functional and morphological outcomes were recorded.

RESULTS

A total of 31 patients were included. All procedures were performed under local anesthesia as outpatient procedures. The length of the operative procedure was 48minutes in average. The mean size of the superficial defect was 19mm (ranging from 6 to 30mm). All patients were fully healed after 15 days, and no flap necrosis (partial or total) was reported. No nasal or lip distortion was observed and facial hair was successfully restored in all male patients.

CONCLUSION

The upper lateral lip flap is a fast, safe, and reproducible procedure to cover defects of the lateral upper lip of up to 3cm. With scars hidden in natural folds and lip defects covered by lip tissues, this technique restores facial cosmetic features with very satisfying aesthetic outcome, especially in men as facial hair is restored.

Reconstruction of severe burn contractures of the upper lip in males using a pedicled superficial temporal artery hair-bearing flap. Two case reports

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The use of the superficial temporal artery free flap has been described for upper lip burn contractures.

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However, the pedicled superficial temporal artery flap is much simpler to execute than free flaps.

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The main concern with the use of the pedicled superficial temporal artery flap in these cases is regarding the viability of the distal end of the flap.

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We demonstrate this in two case reports.

Introduction

Severe burn contractures of the upper lip are usually treated either with full thickness skin grafts or flaps. Most authors recommend the free radial forearm flap as the flap of choice. In males, another free flap option is the use of the superficial temporal artery hair-bearing free flap.

Case reports

In this report, we demonstrate that the superficial temporal artery hair-bearing flap may be used as a pedicle flap (rather than a free flap) for the reconstruction of severe upper lip burn contractures in males. We show our method of flap delay and design to ensure that the distal part of the flap will survive; and this will be demonstrated in two case reports.

Discussion

The pedicled superficial temporal artery flap is much simpler to execute than free flaps.

Conclusions

Severe post burn contractures of the upper lip in males may be reconstructed using the pedicled superficial temporal artery hair-bearing flap. In order for the flap to reach the contralateral side of the lip, it will have to cross the midline in the scalp. We demonstrate our method of flap delay and design to ensure flap safety and viability. We also show that concurrent burn deformities in close proximity of the upper lip should be treated prior to upper lip reconstruction. Finally, we stress on the principle of reconstructing the entire skin of the upper lip as one aesthetic unit.

Complex midfacial defects: Is the extended Abbé flap the ideal solution to a tough problem?

OBJECTIVES

The aim of this study was to investigate the role of the extended Abbé flap in the reconstruction of complex midfacial defects (upper lip, nasal base and medial cheek). We describe our personal experience with this method and present some interesting aspects from the relevant literature.

MATERIALS AND METHODS

Between 2003 and 2017 we retrospectively evaluated the records of all patients with defects of the upper lip and nasal base after the resection of malignant tumors or traumata and reconstruction by means of the extended Abbé flap. We looked for information on the origin of the defect, the functional result, the aesthetic outcome and postoperative complications. The functional result of the reconstruction of the oral commissure was assessed with regard to postoperative subjective speech integrity, preservation of competence of the oral sphincter and lip sensation. The aesthetic outcome was evaluated with regard to limitations in facial expression and scar formation.

RESULTS

The study included 8 patients. Follow-up in the oncological cases was 85 months (range: 20-150 months). No tumor recurrences were detected. All patients achieved normal oral competence and mouth opening. No cases of blunting or microstomia were detected.

CONCLUSION

Reconstruction of the upper lip and nasal base with the extended Abbé flap is associated with an outstanding functional outcome that is cosmetically very acceptable.

Pyogenic granuloma of the upper lip: A common lesion in an uncommon location

Pyogenic granuloma is a non-neoplastic reactive lesion that commonly occurs in gingiva. It is rarely found in other locations such as the lips, tongue, palate and buccal mucosa. Lesions affecting the upper lip are even rarer and very few cases have been reported in the literature. In such situations, the lesion may mimic other conditions such as minor salivary gland tumours, mesenchymal tumours, and infectious lesions, which may create diagnostic difficulty. This case report describes an uncommon location of pyogenic granuloma occurring on the upper lip in a 49-year-old male patient.

Pleomorphic Adenoma of Upper Lip: A Rare Case Presentation

Pleomorphic adenoma is the most common neoplasm of the salivary glands and is most commonly located in the parotid followed by the submandibular glands. The most common intraoral site includes hard and soft palate. This case report describes a rare and unusual lesion found in a 21 years old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed and firm mass, about 3 cm in diameter, almost protruding below the nose. Complete excision was performed by intraoral route and the histo-pathologic analysis showed pleomorphic adenoma. The tumor did not recur.

Congenital midline sinus of the upper lip: A case report and review of literature

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Very rare case report, isolated congenital upper lip midline sinus.

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Surgical excision is curative, no recurrence.

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Upper lip midline sinus can be associated with syndromes or conditions.

Introduction

Congenital pits of the lip are uncommon and may be associated with conditions such as Van der Woude syndrome. Isolated lip pits are extremely rare developmental defects.

Presentation of case

A 7 year old Caucasian girl presented to plastic surgery clinic in Jordan University academic hospital complaining of an upper lip pit that has been present since birth. It was associated with a single episode of whitish discharge. On examination, an isolated upper lip midline sinus was found. She is otherwise fit and healthy. Surgical excision was curative with good cosmetic outcome.

Discussion

The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas. A total of 55 cases was found upon reviewing the English literature. No similar cases were reported in Jordan. Different presentations are mentioned in this review. Several embryologic theories are presented.

Conclusion

Upper lip sinus formations are rare developmental events, and the pathogenesis of these lesions still needs further evaluation. Simple surgical excision is the treatment of choice.

Upper lip reconstruction using a pedicel superficial temporal artery flap

INTRODUCTION

The hair-bearing superficial temporal artery free flap has been used in men for total upper lip reconstruction. In this paper we present a case of a partial upper lip defect in a man that was reconstructed with a pedicle superficial temporal artery flap.

PRESENTATION OF CASE

Following a car accident, a 35-year old man sustained a partial upper defect. The defect included the entire "outer lamella" (i.e. the skin and red lip) of the right hemi-lip as well as the outer part of the muscle (i.e. partial defect of the middle lamella). A pedicle superficial temporal artery flap was raised and utilized to reconstruct the upper lip defect. There were no post-operative complications. The cosmetic and functional outcomes were excellent.

DISCUSSION

The hair-bearing pedicle superficial temporal artery flap is commonly used for eye-brow and beard reconstruction. Free superficial temporal artery flaps have also been utilized to reconstruct total upper lip defects. For the first time in the literature, our report introduces the use of the pedicle flap in partial upper lip defects.

CONCLUSION

We demonstrate that the pedicle flap is much simpler than the free flap and is adequate for reconstruction of partial upper lip defects. We also demonstrate a good cosmetic and functional outcome; and highlight several technical points to ensure a satisfactory outcome.

[Upper lip lift]

The author revisits an old technique of shortening of the upper lip. He shows the interest of systematically analyzing the length of the upper lip in any consultation of face and especially of rejuvenation. He develops indications based on the visibility of the upper incisors at the half-open mouth rest. He details the technique and shows results.

Synchronous Polymorphous Adenocarcinoma and Canalicular Adenoma on the Upper Lip: An Unusual Presentation and Immunohistochemical Analysis

Multiple salivary gland tumors (MSGTs) are most common in the major than minor salivary glands. The most MSGTs are synchronous, either benign or malignant. A 61-year-old woman was referred presenting nine submucosal nodules, firm to fluctuant, being five nodules on the right side and four nodules on the left side of the upper lip. An incisional biopsy was performed. Hematoxylin and eosin staining was performed in 5-µm sections for histopathologic analysis. Immunohistochemical reactions were carried out in 3-µm sections in accordance with manufacturer's instructions. The histopathological analysis showed focal area containing low-grade polymorphous adenocarcinoma (PAC) and multiple canalicular adenomas (CAs). Immunohistochemical analysis for each lesion was carefully investigated. Here, we present an unusual case of synchronous PAC and multiple CAs of the minor salivary glands, affecting the upper lip, which appears to be the first case showing PAC and CA.

Rare Locations of Epidermoid Cyst: Case Reports and Review

Background

Epidermoid cysts are benign lesions encountered throughout the body. Eighty percent of epidermoid cyst seen in ovaries and testicles, whereas in head and neck region they account for only 1.6–7.0%. 1.6% of epidermoid cysts occur in oral cavity and they account for 0.01% of all the oral cavity cysts.

Case Details

Two case reports of epidermoid cyst has been discussed. One patient reported with well defined swelling in the right lower one third of the face, another one in the upper lip. Initially the cases were diagnosed as Lipoma and salivary adenoma respectively but histologically they turned out to be epidermoid cyst. Hence, we aim at highlighting the differential diagnosis pertaining to the anatomical location. The PubMed database search made on January 2016 yielded 674 articles of epidermoid cyst in the head and neck region. In that there is only one case reported occuring in the lower one third of face. In the current report, we outline the second case of epidermoid cyst localized to the right mandibular body region without bone involvement. Another case in our report was localized in the upper lip. In the literature totally seven cases were reported till now occurring in the lip.

Conclusion

Although epidermoid cysts are rarely encountered in the oral cavity, the possibility that they may occur warrants the need for successful management to avoid misdiagnosis.

Digitalized analysis of philtral anatomy for planning individual treatment

OBJECTIVE

Restoration of the philtral region following traumatic, cleft, and tumor surgeries is often difficult due to influence of this feature to whole facial beauty. The aim of this study is to investigate the types and measurements of the philtrum and its relationship with the upper lip using a software.

METHODS

Standard personal photographs of the philtral region were obtained from 200 young adults participated in this study. Linear analyses (the lengths of philtral column and dimple; the philtral width) and angular analyses (apex and central angles of Cupid's bow) were measured as reference points. As for the shape of the philtral column, it was categorized as four distinct types: parallel, triangular, concave, and unclear type.

RESULTS

The philtral width was 11.37 ± 1.9 mm in males, 10.21 ± 1.80 mm in females. The length of the philtral dimple was 18.16 ± 3.6 mm in males, 18.16 ± 3.6 mm in females. Compared with women, both of the measured average philtral reference lengths displayed a significantly greater value in men. In the meanwhile, compared to women, the angular measurements of Cupid's bow (i.e., the apex and central angle of Cupid's bow) were smaller in men. It was 127.47 ± 12.74° mm in males, 134.1 ± 11.38° mm in females. The triangular and concave types were associated with a substantial fraction in men, whereas the triangular and parallel types were predominant in women. There were significant gender differences in the esthetic rankings of philtral column shapes.

CONCLUSIONS

These results suggest digitalized reference values relative to the philtral column which may increase the success of the individual reconstructive treatment of the surgical procedures and reduce possible asymmetrical appearance. With the help of certain software, this research has made possible to investigate the ideal parameters of philtral construction in defining the best surgical solution for the patient.

Extra Nasopharyngeal Angiofibroma Simulating a Mucocele: A New Location for the Rare Entity

Angiofibromas are rare, benign, but locally aggressive vascular tumours which account for 0.05-0.5% of all head and neck neoplasms. The common variant of angiofibromas of head and neck region is Juvenile Nasopharyngeal Angiofibroma (JNAF) which is well published in the literature. Incidence of Extranasopharygeal Angiofibromas (ENAF) is relatively rare and most of the published literature favours maxillary sinus as the most common site. We report a rare clinical entity of ENAF involving the upper lip which is first of its kind in the light of literature review owing to its anatomical location. The present article not only complements a new location of angiofibroma (in the upper lip) but also concretely reinforces the inclusion of angiofibromas in the spectrum of differential diagnosis of soft tissue lesions pertaining to oral cavity.

Comprehensive Treatment of Upper Lip Arteriovenous Malformation

Arteriovenous malformations are uncommon congenital disorders in vascular development. They frequently involve craniofacial structures and result in a morphogenic abnormality with ominous arteriovenous shunting. We present a huge AVM of the upper lip in an 18-year-old patient who was successfully treated by the combination method of presurgical endovascular embolization and complete resection of the lesion. Subsequent surgical defect in upper lip, which involved more than two-third of the lip length, was reconstructed via Webster's modification of cheek advancement flap.

Upper lip reconstruction and aesthetic aspects in the female patient: our point of view

Brief title: A brief description of our point of view about upper lip reconstruction supporting a quite simple and effective surgical option, which surgeons could consider whenever little neoformations must be removed from the lips, an aesthetically important anatomical region.

Rare benign mixed tumour of the upper lip: A case report

Background

Chondroid syringomas (CS) are rare benign mixed tumours. Clinical differentiation can be misleading due to the silent presentation, with only histopathological findings confirming the diagnosis.

Case report

A 23-year-old Caucasian gentleman presented with an eighteen month history of increasing size of his exophytic upper lip mass.

The initial clinical impression was thought to be related to the skin. Following a punch biopsy, histopathology confirmed appearance in keeping with part of a chondroid syringoma with subsequent excision of the lesion.

Discussion

CS present as a slow-growing, asymptomatic, non-tender, nonulcerated, smooth, firm subcutaneous, or intradermal nodule and can range from 0.5 to 3.0 cm, predominantly occurring in the head and neck region in patients aged above 35 years with a male predication. The most effective diagnostic method is microscopic examination. The gold standard treatment modality is by complete excision with a margin of normal tissue in order to examine the histopathologic features and prevent recurrence.

Conclusion

CS should be included as a differential diagnosis of facial subcutaneous skin lesions in middle aged male patients. Careful evaluation, with a view of total excision and adequate surgical margin will enable diagnostic confirmation, whilst maintaining the aesthetic and functional unit.

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CS are rare mixed tumours originating in the sweat glands.

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CS are slow-growing, asymptomatic, subcutaneous, or interdermal nodules ranging from 0.5 to 3.0 cm.

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CS are observed in patients above 35 years with a male predilection.

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CS require complete excision, adequate surgical margin to enable diagnostic evaluation and prevent recurrence.

[Labial recurrent swelling revealing median congenital upper-lip fistula]

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

Median cleft of the upper lip associated with a mass: a rare case

Median cleft lip is a midline vertical cleft through the upper lip. This is a very rare anomaly described in the literature. Median cleft lip is caused by the failure of fusion of the medial nasal prominences. In this case report, a 4-month-old boy with a median cleft associated with a mass of the upper lip is presented. The patient has no other anomalies of the nose or alveolus. The patient has normotelorism. A Z-plasty technique was used on the skin of the base of the columella. A vertical excision of the cleft with muscle approximation was performed on the white roll and the wet-dry border of either side of the defect of the upper lip. Postoperatively, the patient had a satisfactory result. The incisive scars were not visible. Cupid's bow was appropriately aligned, and the height of the upper lip was equal on both sides.

Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip

Pleomorphic adenoma is the benign tumor of salivary glands, which originates from the myoepithelial cells and intercalated duct cells. This tumor is more common in major salivary glands. This case report describes a rare and unusual lesion in a 55-year-old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, submucosal nodule, about 2.0 cm in diameter and was characterized by slow growth and rubbery consistency. Complete excision was performed and the histopathological analysis showed an epithelial salivary gland tumor with islands of plasmacytoid cells, duct like structures, in a variable stroma with chondroid, fibrous and myxoid appearance. No recurrence was observed 1 year after the surgery.

A malignant melanoma associated with a blue nevus of the lip

Blue nevi are characterized by a collection of pigment-producing melanocytes in the dermis. These lesions clinically present as well demarcated cerulean-blue or bluish black colored papules or plaques that usually measure less than 1 cm in diameter. They are typically found on the dorsal surface of the hands and feet or in the head and neck region; however, they are rarely found in the oral cavity. These lesions are usually benign and stable over time. However, malignant melanomas developing in or associated with a blue nevus (which is also called malignant blue nevus) have been only rarely reported. A malignant blue nevus might develop in a common blue or cellular blue nevus, a giant congenital nevus or in a nevus of Ota, or it may be malignant from the start. Malignant blue nevi most commonly are found on the scalp. A malignant blue nevus of the lip has not been previously reported in the medical literature. We report here on a patient with a malignant melanoma associated with a blue nevus of the lip. The malignant melanoma was presumed to have developed from a blue nevus that was present on the upper lip of a 50-year-old male.