Lip Involvement Research Articles

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.

Traction-assisted endoscopic submucosal dissection for resection of ileocecal valve neoplasia: a French retrospective multicenter case series.

The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. All patients who underwent traction-assisted ESD for an ICV lesion at three centers were identified from a prospective ESD database. En bloc and R0 rates were evaluated. Factors associated with non-R0 resection were explored. 106 patients with an ICV lesion were included. The median lesion size was 50 mm (interquartile range 38-60) and 58.5% (62/106) invaded the terminal ileum. The en bloc and R0 resection rates were 94.3% and 76.4%, respectively. Factors associated with non-R0 resection were lesions covering ≥75% of the ICV (odds ratio [OR] 0.21. 95%CI 0.06-0.76; P=0.02), and involving the anal lip (OR 0.36, 95%CI 0.13-0.99; P=0.04) or more than two sites on the ICV (OR 0.27, 95%CI 0.07-0.99; P=0.03). Traction-assisted ESD for treatment of ICV lesions was a safe and feasible option. Large lesions and anal lip involvement appeared to be factors predictive of difficulty.

Spectrum of the Oral Lesions in a Rural-based Tertiary Care Teaching Hospital in Central India

Background: The oral cavity is a common site for pathological lesion with a wide spectrum of neoplastic and nonneoplastic lesions. They are either symptomatic or asymptomatic. Some lesions may prove to be premalignant and may be a cause of malignancy in future. Histopathological reporting is very important and essential part because the core finding we provide in reporting significantly influences the treatment part.Material and Methods: This study was carried out in the Department of Pathology, Amaltas Institute of Medical Sciences, Dewas (Madhya Pradesh) from May 2021 to March 2023. The study included all the patients admitted in ENT, Surgery and Oncology wards of hospital presenting with oral pathology and given written informed consent. A total 80 cases were taken in to account and were studied, in relation with age, sex, site predilection.All biopsy specimens and resected tissues/organs were received in 10% formalin solution and were processed as per standard protocol and slides of standard thickness were prepared for histopathological examination. After thorough microscopic study, the diagnosis was made and categorized into major groups (non-neoplastic, benign, borderline and malignant) and subgroups according to type of lesion on histopathological examination.Results: The site of involvement of various lesions shows maximum involvement of buccal mucosa 43(53.75%),followed by tongue 19(23.75%), tonsil 7(8.75%), alveolus 4(5%) , floor of mouth 3(3.75%) and least involvement of lip and palate with 2(2.5%) cases in each. Of the inflammatory lesions tonsils were the commonest site of involvement.Conclusion: We conclude our study with the findings that lesions of buccal mucosa is commonest site andsquamous cell carcinoma was the commonest entity with diversity in lesions and a wide age group of presentation. This emphasizes the role of histopathological study and diagnosis in oral lesions and provides us with valuable information of the lesion being neoplastic or non-neoplastic and timely intervention could be planned.

Study of Treatment and Patient Factors of Hemoporfin‐Photodynamic Therapy for Port‐Wine Stains

Background. Port‐wine stains (PWS) affect a substantial number of people, and despite the use of pulsed dye laser as the gold standard therapy, some patients fail to respond, and new modalities are needed. Recently, hemoporfin‐photodynamic therapy (hemoporfin‐PDT) has shown good efficacy and safety in treating PWS, with increasing evidence. Objectives. To evaluate the efficacy and safety of hemoporfin‐PDT in the treatment of PWS and to analyze the factors that influence efficacy. Methods. The clinical data of 215 patients (79 men and 136 women aged 3–71 years) from a single center were retrospectively analyzed, out of which 173 were valid for efficacy analysis and 129 for safety analysis. Efficacy was rated as excellent (≥75% improvement), good (≥50% to <75% improvement), fair (≥25% to <50%), and poor (<25% improvement) by two blinded dermatologists. The patient‐assessed efficacy was collected based on the aforementioned criteria using an electronic questionnaire. The association of efficacy with possible influential factors was investigated, namely, age, sex, history of previous treatment, combined scars caused by previous treatments, lesion site, lesion type, lesion size, degree of lip involvement, and number of hemoporfin‐PDT sessions. Adverse events were investigated to evaluate the safety profile. Results. Excellent, good, fair, and poor efficacy was achieved in 78 (45.1%), 38 (22.0%), 36 (20.8%), and 21 (12.1%) patients, respectively, after a variable number of sessions of hemoporfin‐PDT. More treatment sessions (p < 0.001), age ≥18 years (p = 0.037), no previous treatments (p = 0.020), and head/neck location (p = 0.009) were associated with better outcomes. Pain, edema, exudation/crusting, and hyperpigmentation were common adverse events, with satisfactory recovery. Scarring occurred in 2.3% of the patients. Conclusions. For treating PWS with hemoporfin‐PDT, more treatment sessions and head/neck location are predictors of better outcomes, whereas previous treatment history is a predictor of poorer outcomes.

Epidemiological Trends in Cleft Lip and Cleft Palate Frequency: An Analytical Perspective

Background: Cleft lip and/or palate (CL/P) represents a common congenital anomaly characterized by incomplete fusion of facial structures during embryonic development. Objective: To assess the epidemiological trends in cleft lip and cleft palate frequency: an analytical perspective. Study Design: Retrospective observational study. Settings: Department of Anatomy, Nowshera Medical College, Nowshera, Pakistan. Duration: From October 2022 to March 2023. Methods: The study included patients diagnosed with cleft lips, cleft palate, or both, who presented to the hospital. Medical records of both pediatric and adult patients were reviewed to ensure a comprehensive understanding of the prevalence and associated factors. Anatomical perspectives were assessed through clinical examination and imaging studies such as photographs and radiographs. Results: The mean age of the study population was 18.5±5.12 years. In terms of gender, males constituted 60.0% of the population, while females accounted for 40.0%. The distribution of cleft types among the study population revealed that 60% (n=105) were diagnosed with cleft lip only, while 25.7% (n=45) presented with cleft palate only. Additionally, 14.3% (n=25) of individuals had both cleft lip and palate. The anatomical description of clefts among the study population was as follows: For cleft lip, 40% (n=70) were classified as mild, 35% (n=61) as moderate, and 25% (n=44) as severe, indicating a varied spectrum of severity in lip involvement. Regarding cleft palate, 60% (n=105) were categorized as incomplete, while 40% (n=70) were classified as complete, reflecting the predominance of incomplete palatal clefts in the sample. In terms of cleft distribution, 55% (n=96) of cases were unilateral, 35% (n=61) were bilateral, and 10% (n=18) were midline, indicating diverse patterns of cleft distribution observed. Conclusion: In conclusion, our study contributes to the understanding of the anatomical variations and distributions of cleft lip and/or palate (CL/P) within our population, emphasizing the spectrum of severity and patterns of cleft involvement.

Outcomes of Squamous Cell Carcinoma of the Lip Treated With Mohs Micrographic Surgery: A Retrospective Cohort Study.

Cutaneous squamous cell carcinomas (cSCCs) of the lip have been reported to be at higher risk for poorer post-treatment outcomes. To examine outcomes of patients with SCC of the lip treated with Mohs micrographic surgery (MMS) and identify factors for recurrence. This retrospective review of a single tertiary referral center's Mohs case logs from 2010 to 2019 identified cases of lip SCC. Clinicopathologic characteristics and outcomes (local recurrence [LR], metastasis, and disease-specific death) were reviewed. One hundred ninety cases of SCC of the lip were identified and demonstrated that MMS offered a disease-free survival of 96.8% over an average follow-up period of 42 months. Younger age (61 vs 74 years p = .006), increased MMS stages ( p = .009), and higher American Joint Committee on Cancer and Brigham and Women's Hospital T stages were risk factors for LR. Immunosuppression, large tumor size, mucosal lip involvement, aggressive histology, and perineural invasion were not associated with LR. The results of this study show that SCC of the lip behaved similarly to cSCC outside the lip area, and that both primary and recurrent lesions can be treated effectively with MMS.

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala.

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.

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.

Frequency and Pattern of Presentation of Neck Lymphadenopathy in Oral Squamous Cell Carcinoma in Patients Presenting to Nishtar Hospital, Multan

Objective: Frequency and pattern of presentation of neck lymphadenopathy in oral squamous cell carcinoma. Study Design: Place and Duration of Study: Nishtar Institute of Dentistry Multan from 1st January 2021 to 31st December 2021. Methodology: Forty lymph nodal involvement were assed, either unilateral, bilateral and multiple or single. It was checked how many lymph nodes are involved; extra capsular spread was assessed. The findings of a histological examination of the removed tissue were obtained. Level of lymph adenopathy was measured. Results: Mean age was found to be 46.9 with minimum of 20 and maximum of 75. There were total 25(62.5%) males and 15(37.5%) females. Ten (25%) patients had lip involvement and 22(55%) had buccal mucosa, 6(15%) had gingival, 2(5%) has palate evolved. Eight (20%) were found to be having unilateral lymph node evolved while 32(80%) were found to be having bilateral evolvement. 20(50%) were having single lymph node involvement and 20 (50%) were having multiple lymph node involvement. Twenty (50%) were having <3 lymph node size and 20 (50%) were having 3-6 lymph node size. Consistency of lymph node was hard 18 (45%) and rubbery in 22 (55%). Twenty-six (65%) were having 1-3 lymph node involvement and 14 (35%) were having 5- 10 lymph node involved. Extra capsular spread was seen in 2 (5%) cases. Practical implication Conclusion: Most of cases presented of oral squamous carcinoma were stage I and stage II. Bilateral lymph nodal involvement was seen was common and buccal mucosa was commonly affected site. Keywords: Carcinoma, Oral squamous carcinoma, Lymph node, Lymph adenopathy

Mukozayı da etkileyen bir generalize subkorneal püstüler dermatozun siklosporin ile başarılı tedavisi: Bir olgu sunumu

Subcorneal pustular dermatosis (SPD), is rare, chronic, and relapsing pustuler eruption. Mostly, it affects middle-aged and elderly women. Mucosal involvement is extremely rare. Here we report a 31-year-old woman with generalized SPD with lip involvement. The patient had annular or serpiginous patterned well-demarcated plaques on the trunk, intertriginous areas and flexor aspects of the limbs, palmoplantar areas, face, and lip mucosa. The bullous lesions exhibited the typical half and half sign. The patient was treated successfully with systemic steroids and cyclosporine.

Philtral Height Discrepancy in Patients with Complete and Incomplete Cleft Lips + /-Palate - Results from a Single Nation Consecutive Cohort.

The aim of unilateral cleft lip repair is to restore form and function, including symmetrisation of cleft and non-cleft philtral height. Expectation of best outcome is achieved in situations with minimal asymmetry and is assumed occurs most often in incomplete cleft lip only patients. We sought to investigate philtral height discrepancy (PHD) in children with unilateral cleft lip + /-palate from a single nation cohort. Review of prospectively collected PHD measurements taken at time of surgery for all children undergoing unilateral cleft lip repair in Scotland born Jan 2017-December 2020. Data was collected using Microsoft Excel and analysed using embedded statistical software. 102 consecutive patients with unilateral lip involvement were identified from the national database. 94 had prospectively documented PHD (92.2%). The majority of patients had an isolated cleft lip (51.1%). Incomplete clefts presented more frequently (52.1%) than complete clefts (47.9%). Mean PHD for the whole cohort was 3.91mm (standard deviation 1.01mm, range 1-6mm). The difference in mean PHD (in-complete versus complete) was 1.1mm (3.4 vs. 4.5, p < 0.001). For lip only versus lip and palate the difference in mean PHD was 1.0mm (3.4 vs. 4.4, p < 0.001). This single country consecutive cohort review of PHD in children undergoing unilateral cleft lip repair statistically supports the anecdote that patients with an incomplete cleft lip and isolated cleft lip have lesser asymmetry at presentation. This study presents a consecutive cohort with a greater range of PHD than has previously been reported in the literature.

Dupilumab in the Treatment of Cheilitis in Atopic Dermatitis Patients.

The lip is a unique tissue type that acts as a "barrier" to the mouth and receives many external stimuli. It is also a common symptom in atopic dermatitis. Dupilumab was the first targeted biological drug approved for the treatment of moderate-to-severe atopic dermatitis (AD). There is no real-world clinical data on the use of dupilumab in patients with AD and cheilitis. This retrospective study compared the improvement in skin lesions in AD patients with cheilitis after dupilumab treatment and evaluated the improvement in cheilitis. This is a retrospective case series. We investigated patients with AD treated with dupilumab in our department from September 2020 to May 2022, including those with cheilitis. Demographic information such as age, sex, AD or other atopy history, and the anatomical site of dermatitis was collected. Disease severity was assessed using the eczema area and severity index score (EASI), body surface area (BSA), and severity assessment of cheilitis (the cheilitis symptom score) at baseline and after 16 weeks. We reviewed 96 patients treated with dupilumab for AD, and including the 10 patients with cheilitis (10.4%). All patients demonstrated significant improvement in skin lesions, and lip symptoms improved in seven patients. Among AD patients with improved cheilitis, the average reduction in EASI was 35.0% for BSA (34.9%) and the cheilitis symptom score was 29.9% at week 8. At week 16, compared with the baseline score, the improvement in cheilitis symptom scores was 58.1%, EASI was 60.8%, and BSA was 56.2%, respectively. Effective treatment of both the skin and cheilitis was achieved with dupilumab. The improvement in cheilitis involvement was slower than that in skin lesions. This case series confirms that dupilumab could be a valuable approach for treating patients with atopic dermatitis-associated lip involvement.

Mucocutaneous Manifestations of COVID-19 among Iraqi Patients in Al Diwaniyah Province, Iraq: Case Series Study

Background:The relatively wide distribution of ACE2 receptors all over body tissues suggests the possibility of clinical manifestations other than that of the respiratory tract. The usual incubation period is about 14 days which is often followed by the usual respiratory symptoms and constitutional signs. Globally, additional novel manifestations, including dermatological ones have been reported. Aim:To characterise the skin manifestations in patients with COVID-19 in Al Diwaniyah Province, mid-Euphrates region of Iraq.Method: The present case series study included 54 patients with COVID-19 and a variety of skin manifestations. Those patients visited the dermatology unit at Al Diwaniyah teaching hospital, Al Diwaniyah province, Iraq during the period of the study. The study started in July 2020 and ended in June 2021.Results: The most common features were those of morbilliform eruptions accounting for 18.5% of cases followed by urticarial lesions accounting for 13.0% of cases for followed by ecchymotic pruritic lesion (11.1%). Other features such as oral ulceration and vesicular lesions were also seen in 9.3% of cases. All the body was involved in 29.6% followed by tongue and lip involvement. Morbilliform eruption was the most common diagnosis followed by acute urticaria, herpes simplex, leukocytoclastic vasculitis and then by a variety of other skin manifestations. Conclusion: Skin manifestations in association with COVID-19 were highly variable with onset and duration which could be due to infection, drug reaction or immune mechanisms.

The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction.

Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle. This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome. All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle. This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip.

Effect of Different Face Masks on Speech and Singing: Self-Perception and Acoustic Analysis

The aim of this preliminary study is to better understand the effects of transparent, surgical, cloth, KN95 (FFP2), and singer’s face masks on speech and singing in French. A survey gathered self-perception, and a local and global acoustic analysis of conversational, loud spoken and sung productions by the same individual were conducted. According to the 303 subjects surveyed, plosive consonants seem to be produced with the greatest difficulty. Consonants requiring lip involvement seem to be the most affected. The transparent and KN95 (FFP2) masks attenuate the intensity of all the consonants and spoken utterances as a whole, unlike the singer’s mask.

Efficacy of influential factors in hemoporfin-mediated photodynamic therapy for facial port-wine stains.

Hemoporfin-mediated photodynamic therapy (HMME-PDT) is a vascular-targeted treatment for port-wine stains (PWS). However, the efficacy of this has varied and is difficult to predict. The objective of this study was to evaluate the efficacy of influential factors associated with HMME-PDT and provide a suitable method for predicting the efficacy. Patients with facial PWS who underwent HMME-PDT were retrospective analyzed. A total of 212 patients (93 males) with mean age of 13.01±12.67years (range, 1-51) years were included. There were 143 cases with red, 56 cases with purple, and 13 cases with hypertrophic-type PWS. The number of HMME-PDT sessions ranged 1-6. The excellent response rate after 1-4 PDT sessions was 9.4%, 17.6%, 32.7%, and 42.9%, respectively. The number of PDT treatments is associated with efficacy, and patients who underwent treatment with more than three sessions had response better than those who underwent treatment with less than three sessions (p=0.003). Response to HMME-PDT in patients of different ages, previous treatment history, lip involvement, and vessels morphology showed significant differences after two treatment sessions (p=0.001, 0.03, 0.014, and 0.001, respectively), while patients of different sex, subtype, lesion size, location (medial, lateral, or mixed), or non-vascular morphology showed no significant differences. Logistic regression analysis confirmed that the patients with lip hypertrophy (p=0.002), history of more than five times prior treatment (p=0.003), fewer PDT sessions (<3) (p=0.000002), linear vessels (p=0.007), and reticular vessels (p=0.0003) showed association with poor response of HMME-PDT. In conclusion, HMME-PDT is an effective treatment for PWS. Patients who had underwent treatment for more than five times prior, lip hypertrophy, and linear vessels or reticular vessels under dermoscope showed association with poor efficacy.

Insights into Mycoplasma‐associated mucocutaneous disease

We read with great interest the paper by Liccioli and colleagues concerning Mycoplasma pneumoniae (MP)-associated mucocutaneous disease in children.1 Interestingly, among a cohort of 10 patients, the clinical presentation was variable but oral mucositis was constantly present. In particular, the lip involvement reported in their pictures caught our attention because of marked lip enlargement and swelling of the vermilion border.

Resuming Oral Feeding in Patients With Oral Squamous Cell Carcinoma With Free Anterolateral Thigh Flap Reconstruction.

Quality of life and functional improvement have emerged as important goals for patients with oncologic disease. For patients with head and neck cancer, free anterolateral thigh (ALT) flaps serve as reliable reconstruction and provide functional restoration. Nevertheless, factors affecting the resumption of oral feeding are rarely described. This study aimed to evaluate and compare the functional outcomes of oral feeding for patients with different oncologic defect patterns and reconstructive ALT flap designs. We retrospectively reviewed patients with head and neck cancer undergoing oncologic ablation and free ALT reconstruction between January 2016 and April 2018 at National Taiwan University Hospital. Patients were categorized into 2 groups as through-and-through (T&T) and non-through-and-through (non-T&T) according to the defect pattern. We further subgrouped T&T patients into lip resection/lip sparing according to lip involvement. Reconstructive ALT flaps were of 2 designs, folded (F-ALT) and chimeric (C-ALT). Outcomes of oral feeding were analyzed using descriptive statistics, and differences between groups were compared using the Student t test. We identified 233 patients who received oncologic ablation and free ALT flap reconstruction. There was no significant difference in functional recovery between the T&T and non-T&T groups (81.2% vs 73%, P = 0.137). However, among patients who succeeded in resuming oral feeding, lip-sparing patients had better functional recovery in terms of early oral feeding within 6 months and nasogastric tube removal compared with lip-resection patients (100% vs 83.3%, P = 0.001). Moreover, the F-ALT design resulted in a higher success rate in resuming oral feeding compared with the C-ALT design (90.5% vs 54.6%, P = 0.032). Patients with head and neck cancer with T&T defects were associated with higher rates of secondary flap revision and a trend of delayed oral feeding. In the long term, improved oral feeding outcome with the F-ALT design was observed compared with the C-ALT design in the specific group with T&T defect.

Actinic prurigo in a dermatological reference center in Colombia: 108 cases

ResumenIntroducción. El prurigo actínico es una fotodermatosis crónica. Afecta con mayor frecuencia a la población latinoamericana, predomina en mujeres y compromete la piel expuesta al sol, las conjuntivas y los labios.Objetivo. Actualizar la información sobre las características clínico-epidemiológicas y el tratamiento de pacientes con prurigo actínico en Colombia.Materiales y métodos. Se hizo un estudio de corte transversal que incluyó los registros clínicos de pacientes con prurigo actínico atendidos en el Servicio de Fotodermatología del Hospital Universitario Centro Dermatológico Federico Lleras Acosta entre el 2011 y el 2016, y se describieron sus características demográficas, clínicas e histopatológicas, así como su tratamiento.Resultados. Se incluyeron 108 pacientes, el 71,3 % de ellos mujeres y el 28,7% hombres, con predominio de los fototipos III-IV (70 %). La enfermedad se había iniciado durante la primera década de vida en el 66,4% de los casos y el 25 % de los pacientes tenía antecedentes familiares de la enfermedad. Las lesiones predominaban en el rostro (93,5 %), los antebrazos (79,6 %) y el dorso de las manos (70,4 %). También, se documentó compromiso ocular (87,9 %) y de los labios (88,8 %). Se hizo la prueba de fotoprovocación con radiación ultravioleta A en el 25 % de los casos y biopsia cutánea en el 19,4 %. Todos los pacientes se trataron con protección solar química y física. En los casos leves a moderados, se formularon corticoides tópicos (91,7 %) e inhibidores de la calcineurina (65,7 %), y en los graves, talidomida (33,3 %) y pentoxifilina (14,8 %).Conclusión. Las características de los pacientes colombianos con prurigo actínico son similares a las reportadas en otros países latinoamericanos: inicio temprano de la enfermedad, predominio en mujeres, compromiso frecuente de conjuntivas y labios, y adecuada respuesta al tratamiento tópico y sistémico.

Granulomatous cheilitis: Report of three cases and systematic review of cases and case series reported from India

Introduction: Granulomatous cheilitis (GC) is a rare idiopathic inflammatory disorder characterized by chronic persistent swelling of the lips. Despite a lingering controversy, it remains linked to orofacial granulomatosis and Melkersson–Rosenthal syndrome (MRS). Aim: To systematically review all cases of GC reported hereto from India with the three being reported now, analyzing patients'/disease characteristics, associated diseases, and treatment protocol. Materials and Methods: Using biomedical search engines such as PubMed, Scopus, and Google Scholar, a systemic review of cases/case series reported from India (1994–2018) was undertaken, and data on patients'/disease characteristics, association with other diseases, and treatment extracted discussed and analyzed without subjecting to statistical analysis due to the small population size. Results: The mean age at presentation of these cases (n, 73: Single, 39: Participants of 6 series, 31 plus presently reported, 3) was 29.36 years and at onset was 26.62 years. There was female preponderance of 1.8. Complete triad of MRS was recorded in 8 (10.95%), and oligosymptomatic forms were as follows: GC + facial palsy, 5 (6.85%); GC + fissured tongue, 4 (5.48%); and facial palsy + fissured tongue, 1 (1.37%). Monosymptomatic GC was seen in 55 (75.34%) and upper lip involvement in 29 (39.72%). Conditions associated with GC included Down syndrome, rosacea, granulomatous vulvitis, and pregnancy. None of the cases were associated with Crohn disease and sarcoidosis. Intralesional triamcinolone acetonide (33, 45.21%) was the most common modality of treatment. Conclusion: Cases of GC from India over the past quarter of a century were reported rarely and showed female preponderance. This chronically recurrent entity with variable severity lacks larger studies and randomized controlled trials for optimum treatment.