Lip Lesions Research Articles

An Investigation of Mucosal Leishmaniasis in the Military Health System.

Leishmaniasis is a protozoal infection with an increased risk of transmission to those serving in the U.S. Military due to theaters of operation in endemic regions. There has, in recent decades, been robust experience with old-world leishmaniasis in the Military Health System (MHS); however, new-world leishmaniasis, which may result in mucosal leishmaniasis, has been less studied. A total of 88 patients from 2012 to 2022 with diagnosis codes for "mucocutaneous leishmaniasis" or "leishmaniasis, unspecified" were identified in the Military Data Repository and reviewed. Within this cohort, upon medical records review, there were 2 cases of leishmaniasis that met inclusion criteria. Case 1 was a 28-year-old active duty male with recent travel to Belize who presented with a mucosal lip lesion that was biopsied and had inconclusive species confirmation but was thought to be either L. braziliensis or L. mexicana. The second case involved a 30-year-old active duty male with a history of travel to French Guiana who had a cutaneous lesion on his left hand that was identified as L. guyanensis, a causative species for mucosal leishmaniasis. Neither had evidence of any further mucosal involvement on otolaryngologic evaluation, and both subsequently received systemic therapy with a good clinical response. Although only 2 cases were identified over an 11-year period, this disease remains an important medical consideration when conducting military operations within Central and South America, as both cases had recent military-specific travel to areas endemic for leishmaniasis.

Spindle cell carcinoma of the lower lip: A case report and review of the literature

To document the lip as an unusual site of clinical presentation of spindle cell carcinoma and to conduct a review of the literature. A 66-year-old male patient presented with an ulcerated lesion of the lower lip. Morphological examination and immunohistochemical profiling of the lesion were performed.

Lichen Planus of the Lip-Case Series and Review of the Literature.

Background and Objectives: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. Materials and Methods: Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the "Carol Davila" University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. Results: Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. Conclusions: Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.

Rare Congenital Upper Lip Pit.

Congenital lip pits are characterized by sinuses or fistulas in the lips that can occur in isolation or as part of a genetic disorder. A 6-year-old girl with a right upper lip lesion present at birth presented with recurrent swelling and occasional erythema. Examination revealed a mildly swollen punctum at the right upper wet/dry vermillion with expressible serous drainage. There were no other phenotypic or cognitive concerns. The lesion was surgically excised using vertical wedge resection. The postoperative course showed well well-healed incision. The pathology report confirmed a lip pit. The family was referred to genetics for further evaluation. Van der Woude syndrome (VWS) is a genetic disorder associated with abnormal development of the paramedian lip. Most congenital lip pits are primarily found on the lower lips, with paramedian lip pits being the most common. Upper lateral lip pits with or without accompanying lip pits are considerably rarer. Though VWS is commonly associated with mutations in the interferon regulatory factor 6 or grainyhead-like protein 3 genes, ~25% of affected individuals lack an identified genetic etiology. A high index of suspicion for VWS is warranted if lip pits are present in the absence of other phenotypic abnormalities and should prompt genetic testing for interferon regulatory factor 6 and grainyhead-like protein 3 mutations. Multidisciplinary teams should consider patient self-esteem, quality of life, and potential family planning when deciding on surgical intervention for lip pits. Surgical management of pits should entail tissue-preserving techniques such as vertical wedge resection and inverted T-lip reduction to prevent whistle-lip deformity.

Combination of phototherapy for treatment of labial necrotizing lesion

Lip necrotizing lesions are painful, complex to heal, and negatively impact the patient’s orofacial condition. The present study reports a clinical case of a necrotizing lesion on the lower lip in a 38-year-old male patient, previously healthy, f ive days after receiving the first dose of the SARS-COV-2 vaccine, with an initial diagnosis of labial herpes zoster, with secondary infection and unsatisfactory response to clinical treatment. After debridement of the necrotic tissue, followed by a combination of antimicrobial photodynamic therapy (aPDT), photobiomodulation therapy (PBMT) and hydrofiber dressing with silver, the patient evolved with complete healing of the lip lesion and satisfactory restoration of orofacial functions after 7 days. According to the present case report, this combination of phototherapy modalities suggests to be a promising tool for the treatment of necrotizing labial lesions.

Correction to: Treatment of vascular lesion in the lower lip with photocoagulation: a case report

Correction to: Treatment of vascular lesion in the lower lip with photocoagulation: a case report

Incidental finding of a human-like tusavirus in a lamb with lip lesions and fatal pneumonia.

Tusaviruses in the genus Protoparvovirus of family Parvoviridae were first identified in a diarrhoeic Tunisian child in 2014. Thereafter, high prevalence of a genetically similar virus was demonstrated in faeces from caprine and ovine species in Hungary. Here, we describe an investigation into the cause of scabby lip lesions in a 6 month-old lamb, submitted from a farm experiencing weight loss and scouring in lambs in England. Transmission electron microscopy visualised small circular particles of 18 and 22 nm in diameter in lip lesions identified as tusavirus and flumine parvovirus by Next Generation Sequencing. Liver, kidney, lung, small intestine content and faeces were also strongly positive for the tusavirus DNA as well as 10 % of faecal samples of the flock collected 2 months after the initial lip sampling. NS1 and VP1 amino acid sequences of this tusavirus displayed 99.5 and 92.89 % identity to those of a human tusavirus, respectively. These amino acid identities were at 95.5 and 89.68 % when compared to those of a goat tusavirus. Phylogenetic analysis of the NS1 and VP1 also grouped the virus in the genus Protoparvovirus and close to tusaviruses detected in human, ovine and caprine species. Wider surveillance of the virus indicated a broader geographical distribution for the virus in England. Histology of the lip tissue revealed localised areas of epidermal hyperplasia and hyperkeratosis affecting haired skin, with mild leucocyte infiltration of the subjacent dermis, but no changes to implicate virus involvement. Flumine parvovirus was concluded to be an environment contaminant. Broader studies in prevalence of these virus in UK sheep flocks and human population, animal models and experimental infections could provide insights into the pathogenesis of these novel viruses and their zoonotic potential.

Oral Verrucous Carcinoma: Case Report

Verrucous carcinoma is usually considered a low-grade variant of squamous cell carcinoma. Our case is a 56-year-old woman presented to our department of maxillofacial surgery of Ibn Sina hospital in Rabat with a budding lesion of the upper lip evolving 2 years ago. The diagnosis retained was that of well-differentiated squamous cell carcinoma of the verrucous type with infiltration of the chorion. The therapeutic decision was to perform a surgical excision with a safety margin of 1 cm followed by suturing of the defect and commissuroplasty. Its diagnosis is based on clinical and histological features. The treatment is not well codified. Surgery remains the treatment of choice.

Yellowish oral mass occurring after nasolabial dermal filler

Intra-oral lesion of the lower lip occurred two months after nasolabial folds dermal filler. The lesion appeared as a yellowish submucosal painless mass of approximately 15mm on the intraoral side of the inferior lip. An incisional biopsy was performed and definitive diagnosis of foreign body reaction to calcium hydroxyapatite was made. The lesion underwent complete spontaneous regression within eight months.

Malignant Transformation of Actinic Cheilitis: A Decade-long Retrospective Study in Southern Brazil.

Actinic cheilitis (AC), an oral potentially malignant oral disorder (OPMD), predominantly affects fair-skinned individuals, particularly males, with a higher prevalence in their sixth and seventh decades. In the Southeast region of Brazil, oral cancer ranks as the fourth most common tumor among males, with squamous cell carcinoma (SCC) constituting 90% to 95% of lip tumor cases, primarily impacting the lower lip. This retrospective study aims to evaluate the malignant transformation rate in previously diagnosed AC patients between 2008 and 2018, utilizing biopsy records. We retrospectively reviewed medical records of lip lesion patients at the Department of Oral and Maxillofacial Surgery (DOMS) during the stated period, collecting demographic and medical data for analysis. Among the 224 analyzed AC cases, 67.8% were male, with an average age of 65 years. Approximately 87.6% of patients reported occupational exposure to AC-associated risk factors. Malignant transformations occurred in 27 patients (12.05%). Our study underscores the possible effect of early intervention and preventive measures in stabilizing AC lesions and averting their progression to malignancy. These findings underscore the significance of prompt AC diagnosis and management to mitigate the risk of malignant transformation. Key words:Actinic cheilitis, oral squamous cell carcinoma, malignant transformation.

ANTIOXIDANT EFFECT OF MOUTHWASH CONTAINING ZINC, ALOE VERA, AND STABILIZED CHLORINE DIOXIDE FOR ORAL MANIFESTATION OF ACUTE MYELOBLASTIC LEUKEMIA (AML)

Objective: This paper aims to report a study regarding the successful treatment using zinc, Aloe vera, and stabilized chlorine dioxide as an antioxidant mouthwash in a patient with AML.
 Methods: A series of clinical examinations, including subjective and objective examinations, were done to establish the diagnosis.
 Results: A 9 y old boy, who was already diagnosed with AML, referred to the oral medicine division because of the hemorrhagic crust of his lips. The extra-oral examination showed severe hemorrhagic crust and erosions on the upper and lower lips. The intra-oral examination could not be evaluated in detail, but the active bleeding was seen. A hematology investigation showed pancytopenia. Patients received packed red cell (PRC) and thrombocyte concentrate (TC) blood transfusions, as well as an antioxidant mouthwash containing zinc, Aloe vera, and stabilized chlorine dioxide, for compressing the lips every 1-2 h with a duration of 30 min. Significant improvement in lip lesions was gained in a short time after blood transfusions and regular use of the mouthwash compresses.
 Conclusion: In this study, the mouthwash containing zinc, Aloe vera, and stabilized chlorine dioxide that can accelerate the healing process in our AML patient was estimated due to its antioxidant effects.

METHOTREXATE-INDUCED ORAL ERYTHEMA MULTIFORME

Objective: To discuss the management of oral erythema multiforme (EM) due to methotrexate (MTX) in gestational trophoblastic tumor patients.
 Methods: A 28-year-old woman was referred to the Oral Medicine Clinic with complaints of pain throughout the oral cavity accompanied by blackish encrustation on the upper and lower lip for 5 d. She previously underwent the first cycle of chemotherapy using MTX for the treatment of a gestational trophoblastic tumor. Extraoral, multiple diffuse blackish patches on the face and haemorrhagic crusts on the lips with painful erosions. Intraoral, multiple erosive and ulcerative lesions on the labial and buccal mucosa.
 Results: Management involved topical 0.025% hyaluronic acid mouthwash for erosion and ulceration, compressed 0.9% NaCl for crusted lesions on the lips, and petroleum jelly for the non-crusted lesions on the lips. Complete healing of oral and lip lesions was achieved within 10 d.
 Conclusion: Pharmacological management should be tailored to each patient with careful consideration of treatment risk or benefit. In our case, the use of non-steroidal anti-inflammatory topical agents was considered successful in treating oral EM.

THE USE OF TRANEXAMIC ACID MOUTHWASH IN THE GINGIVAL BLEEDING MANAGEMENT IN APLASTIC ANEMIA PATIENT

Objective: The aim of this study was to describe the role of tranexamic acid mouthwash in the management of gingival bleeding in aplastic anemia patients.
 Methods: Complete subjective, objective, and supporting examinations were carried out to confirm the diagnosis. Treatments were given in collaboration between the departments of internal and oral medicine. Anamnesis and history taking were done, and it was revealed that a 21-year-old male patient came with the chief complaint of active anterior mandible gum bleeding, starting two weeks ago and accompanied by fever. Extra-oral examination revealed a hematoma on the lip. Intra-oral examination found spontaneous bleeding from the anterior mandible gingiva and hematomas on the labial mucosa and lateral of the tongue. Laboratory examination results showed hemoglobin, hematocrit, erythrocytes, leukocytes, and platelets below the normal range, and the bone marrow morphology examination confirmed the diagnosis of aplastic anemia.
 Results: Treatment included a blood transfusion of 39 flasks for 14 d for the systemic condition. Tranexamic acid and chlorine dioxide mouthwash were given for intra-oral problems, and petroleum jelly to treat lip lesions. Gingival bleeding and hematomas resolved within 8 d.
 Conclusion: Tranexamic acid mouthwash, along with manual scaling of calculus, which is a predisposing factor for gingival bleeding, as well as blood transfusion, have an important role in the successful comprehensive management of gingival bleeding due to pancytopenia in patients with aplastic anemia.

Rare Oral Hemangioma in Pregnancy: A Case Series Providing Clinical Insight into Patient Care.

BACKGROUND Hemangiomas are defined as benign soft tissue vascular tumors that are histologically classified as capillary, cavernous, or mixed types. Hemangiomas can also be described based on clinical appearance as superficial, mixed, or deep lesions. Following a thorough search, only 3 case reports of superficial protruding lip mass were found in the literature. Other cases of tongue hemangioma have been reported in infants or young toddlers, and only rarely in adults. CASE REPORT The first case was a 43-year-old pregnant woman, with an unremarkable medical and surgical history, in the second trimester who presented to the Otolaryngology Clinic with a chief concern of a progressively growing lesion, measuring 0.7×0.5 cm, over the lateral right side of the tongue for the last 2 weeks after accidentally biting her tongue during dinner. The second case was a 26-year-old woman with unremarkable medical and surgical history who presented to our Otolaryngology Clinic with a chief concern of a non-painful soft fungating pink-red lip lesion 1.5×1 cm across the right lower lip growing for the last 4 months. This lesion appeared during the third trimester of pregnancy following a lip injury that was described as minor trauma. CONCLUSIONS Although hemangiomas can occur anywhere on the body, they are most commonly found in the head and neck. These lesions are usually recognized quickly by patients and treating physicians and are thus clinically diagnosed. Most vascular benign lesions regress on their own, but if detected early, they are surgically excised for cosmetic and functional reasons.

Typical target lesion with a central blister in erythema multiforme major caused by drug allergy in a toddler

Erythema multiforme (EM) is an uncommon acute mucocutaneous illness with target lesions primarily on the face and limbs. Slow-onset hypersensitivity reactions to infections (including herpes simplex virus and mycoplasma pneumonia) and medicines (including antibiotics, anticonvulsants, and nonsteroidal anti-inflammatory drugs) cause EM. A 4-year-old male with EM after taking metamizole, ampicillin, cloxacillin, and an unknown puffer, the major developed lip sores and blisters on various places of his body. Dermatological examination revealed haemorrhagic crusts on the lips. On both hands and feet, typical target lesions with central blisters, purplish red in color, well-defined boundaries, round to oval in form, and variable size were seen. There were erythematous macules and genital oedema. A blood test revealed higher levels of leucocytes and CRP. Serological testing revealed no IgG, IgM, or anti-HSV1&2 antibodies. The X-ray of the chest was normal. Clinical improvement occurred after elimination of suspected drugs and intravenous dexamethasone, gentamicin, and paracetamol, oral cetirizine, fusidic acid 2% cream, 0.9% NaCl compress, and sterile gauze. The diagnosis of EM was established based on the presence of multiple typical target lesions with central blisters, symmetrical distribution on the extremities (dorsal surfaces of hands and feet), and involvement of lip and genital mucosal lesions after taking drugs. Negative IgG and IgM Anti HSV 1&2 test results lead to the diagnosis of drug allergy-related Erythema Multiforme Major.

Treatment of vascular lesion in the lower lip with photocoagulation: a case report

Treatment of vascular lesion in the lower lip with photocoagulation: a case report

LABIAL SQUAMOUS CELL CARCINOMA IN A YOUNG PATIENT

A 27-year-old, leukoderma male patient, sought out dental care complaining of burning and a lesion on the lower lip. The patient had no risk factors and presented a history of trauma in the region. Intraoral examination identified a nodular lesion in the lower lip, firm, with ulcered surface, measuring about 1.0 cm, with an evolution of approximately 2 months. The diagnostic hypothesis was mucocele. An excisional biopsy was performed, and the result of the histopathological analysis was moderately differentiated squamous cell carcinoma (SCC). The patient underwent surgical treatment with no need for adjuvant treatment. SCC is more prevalent in males, with a peak incidence between 50 and 70 years of age. The relevance of the case is related to the patient´s early age and the importance of the histopathological analysis to confirm the diagnosis to establish adequate treatment. A 27-year-old, leukoderma male patient, sought out dental care complaining of burning and a lesion on the lower lip. The patient had no risk factors and presented a history of trauma in the region. Intraoral examination identified a nodular lesion in the lower lip, firm, with ulcered surface, measuring about 1.0 cm, with an evolution of approximately 2 months. The diagnostic hypothesis was mucocele. An excisional biopsy was performed, and the result of the histopathological analysis was moderately differentiated squamous cell carcinoma (SCC). The patient underwent surgical treatment with no need for adjuvant treatment. SCC is more prevalent in males, with a peak incidence between 50 and 70 years of age. The relevance of the case is related to the patient´s early age and the importance of the histopathological analysis to confirm the diagnosis to establish adequate treatment.

EXUBERANT MANIFESTATIONS OF LEISHMANIASIS IN THE UPPER LIP: A CASE REPORT

Leishmaniasis is an infectious disease caused by the protozoan Leishmania and is still a public health problem in Brazil. Oral manifestations of leishmaniasis may appear in some patients, leading to a challenging diagnosis. This study presents a case report of a 23-year-old male with a 2-month history of ulcerative lesions in the upper lip, with the presence of purulent secretion and elevated borders. Microscopic analysis revealed a predominance of a chronic inflammatory infiltrate, with variable amounts of macrofages presenting Leishmania in the cytoplasm. Immunohistochemistry for Leishmania was diffusely positive. Clinicians must include leishmaniasis in differential diagnoses of ulcerative lip lesions. Leishmaniasis is an infectious disease caused by the protozoan Leishmania and is still a public health problem in Brazil. Oral manifestations of leishmaniasis may appear in some patients, leading to a challenging diagnosis. This study presents a case report of a 23-year-old male with a 2-month history of ulcerative lesions in the upper lip, with the presence of purulent secretion and elevated borders. Microscopic analysis revealed a predominance of a chronic inflammatory infiltrate, with variable amounts of macrofages presenting Leishmania in the cytoplasm. Immunohistochemistry for Leishmania was diffusely positive. Clinicians must include leishmaniasis in differential diagnoses of ulcerative lip lesions.

ORAL MYIASIS APPEARING AS A CRATERIFORM ULCER IN THE UPPER LIP

Oral myiasis is uncommon and can clinically appear as an exophytic, ulcerated, and destructive lesion. This study aimed to present a case of oral myiasis, appearing as a crateriform ulcer. A 46-year-old male was referred for evaluation of a painful lesion in the upper lip. Oral examination showed the presence of an extensive crateriform ulcer in the upper lip's mucosal surface. Several larvae could be observed inside the ulcer, and clinical diagnosis was oral myiasis. The patient was submitted to surgical debridement of the ulcer, associated with surgical removal of the larvae and some fragments of the oral mucosa in close contact with the ulcerated areas. Hematoxylin and eosin stained histological slides showed the presence of an inflammed oral mucosa associated with areas of necrosis and the presence of larvae, confirming the diagnosis of oral myiasis. The patient remains in clinical follow-up. Oral myiasis is uncommon and can clinically appear as an exophytic, ulcerated, and destructive lesion. This study aimed to present a case of oral myiasis, appearing as a crateriform ulcer. A 46-year-old male was referred for evaluation of a painful lesion in the upper lip. Oral examination showed the presence of an extensive crateriform ulcer in the upper lip's mucosal surface. Several larvae could be observed inside the ulcer, and clinical diagnosis was oral myiasis. The patient was submitted to surgical debridement of the ulcer, associated with surgical removal of the larvae and some fragments of the oral mucosa in close contact with the ulcerated areas. Hematoxylin and eosin stained histological slides showed the presence of an inflammed oral mucosa associated with areas of necrosis and the presence of larvae, confirming the diagnosis of oral myiasis. The patient remains in clinical follow-up.

LIP LESIONS: A 20-YEAR RETROSPECTIVE STUDY IN AN ORAL PATHOLOGY SERVICE

Objective To analyze the prevalence of labial lesions (LL) diagnosed in an Oral Pathology service. Study Design The present study was retrospective and descriptive. Between 2000 and 2019, all cases of LL diagnosed in a single service were selected for the study. Demographic and clinical data, such as age and sex of the patients, habits, location of the lesion, time of duration, clinical diagnosis, and histopathological diagnosis were recorded from patient medical charts. Results Of 7,213 cases, 1,284 (17.8%) were LL. The most prevalent lesions were mucocele (32.9%), fibrous hyperplasia (15.7%), sialoadenitis (11.1%), and actinic cheilitis (9.7%). The majority occurred in females (62.3%), with a mean age of 37.6 years. The main site of presentation was the lower lip (81.2%), with a mean duration of 16 months. Excisional biopsy was performed in 53.1% of the cases, and there was agreement between the clinical and histopathological diagnoses in 61.2% of the cases. The benign glandular neoplasms occurred mostly in the upper lip, while the reactive/inflammatory lesions were found in the lower lip. Conclusion The lips represent an important anatomical region as it includes a variety of lesions, whether reactional, potentially malignant, or neoplastic. To analyze the prevalence of labial lesions (LL) diagnosed in an Oral Pathology service. The present study was retrospective and descriptive. Between 2000 and 2019, all cases of LL diagnosed in a single service were selected for the study. Demographic and clinical data, such as age and sex of the patients, habits, location of the lesion, time of duration, clinical diagnosis, and histopathological diagnosis were recorded from patient medical charts. Of 7,213 cases, 1,284 (17.8%) were LL. The most prevalent lesions were mucocele (32.9%), fibrous hyperplasia (15.7%), sialoadenitis (11.1%), and actinic cheilitis (9.7%). The majority occurred in females (62.3%), with a mean age of 37.6 years. The main site of presentation was the lower lip (81.2%), with a mean duration of 16 months. Excisional biopsy was performed in 53.1% of the cases, and there was agreement between the clinical and histopathological diagnoses in 61.2% of the cases. The benign glandular neoplasms occurred mostly in the upper lip, while the reactive/inflammatory lesions were found in the lower lip. The lips represent an important anatomical region as it includes a variety of lesions, whether reactional, potentially malignant, or neoplastic.