Lip Trauma Research Articles

Clinical Accuracy of Differential Diagnoses for Submitted Biopsy Cases

<h3>Introduction</h3> Data gathered from the biopsy database located at the University of Utah was used to analyze the accuracy of submitting clinicians' respective differential diagnoses. The main objective was to identify deficiencies in provider education to help guide presenters' selection of topics for future lectures to the dental professional community. <h3>Materials and Methods</h3> The database was analyzed by cross-sectional comparison of 7,463 submitted samples. Each submitted "Clinical History" section (which prompts clinicians to submit a differential) was evaluated in com- parison to the final histopathological result. Certain categories of submissions were excluded, such as lower lip minor salivary gland biopsies to evaluate for Sjogren's Syndrome. Results were compiled with keyword searches. Result:39% of submitted sample results were included within the differential diagnosis and 14% were similar in type to the final diagnosis. 7% were inaccurately predicted, 10% provided no information at all and 30% provided only descriptive information with no entities named. The most common misidentified lesion was the fibroma. Qualitative analysis revealed that when inaccuracies occurred it was often due to failure to identify key predicting information, such as identifying a fibroma after lower lip trauma had created a fluctuant mass. <h3>Conclusions</h3> With over half of submitted differentials having a high level of accuracy, clinicians are demonstrating success at providing differential diagnoses. The low percentage of inaccuracies reflects unexpected final diagnoses, severity biases, or failure to identify key predictors. The 30% of clinicians who only provided descriptive infor- mation, and the 10% who provided no additional information, represent a significant portion of clinicians where additional training could be targeted. The formation of a differential diagnosis is helpful in correlation with clin- ical appearance and for informing patients of possible biopsy diagnoses. Future lectures could focus more on the formation of reasonable differential diagnoses.

Lip and Perioral Trauma: Principles of Aesthetic and Functional Reconstruction.

Successful management of lip and perioral trauma requires a nuanced understanding of anatomy and surgical techniques. Surgical correction is particularly challenging in instances of tissue loss, due to a narrow tolerance for aesthetic deformity and highly specialized functions of the perioral region, including facial expression, communication, and oral competence. Restoring continuity of the orbicularis oris musculature is critical for dynamic sphincter function of the upper and lower lips. Lip and perioral tissue symmetry are also critical for aesthetic balance, and failure to restore a natural appearance can adversely affect personal identity, with attendant psychological trauma. This discussion of lip and perioral trauma management encompasses lip and perioral anatomy, evaluation of injuries, reconstructive techniques, and prevention and management of complications. Perioral injuries are classified by size, depth, and extent of injury, and the corresponding reconstructive approaches are a function of complexity. These approaches proceed sequentially up rungs of the reconstructive ladder including primary repair, local flaps, grafting, regional flaps, as well as microvascular free tissue transfers. Procedures may be single stage or require multiple stages or subsequent refinement. Regardless of the defect size or location, the guiding principle of repair in the perioral region is restoring natural function and aesthetic appearance. This still-evolving area of facial plastic and reconstructive surgery lends itself to artistry and technical precision, offering opportunities for further innovation to improve the outcomes of patients with lip and perioral trauma.

Inadvertent lip trauma and non-healing ulcer as a result of proclined maxillary anterior teeth.

Healing a traumatic injury can be cumbersome if the area is being traumatized consistently. With the quantity and quality of the facial vasculature, injuries in the region heal very fast compared to the other parts of the human body. Natural teeth either whole or even a small part have been implicated in the development of dysplasia if they irritate the mucosa continuously. We present a case of a non-healing traumatic ulcer of the mandibular lip, suffered as a result of a fall that was not healing in a young boy aged 19 years. The extraoral examination demonstrated protruded large mandibular lip, protruded maxillary teeth and a large ulcer on the mandibular lip. Intraoral examination revealed a loss of maxillary central incisors with the remaining two lateral incisors directly traumatizing the mandibular lip. Enameloplasty, nightguard and multivitamin therapy were used as a multi-directional treatment plan. The non-healing ulcer healed within a space of a week.

Safety and efficacy of Staged Extubation Set in patients with difficult airway: a prospective multicenter study.

A safe extubation is the extension of any airway management strategy. Despite different guidelines, a number of extubation accidents still occurs. Re-intubation failure could be fatal, thus a strategy and safe and efficient devices for this purpose are essential. Multicentric prospective observational study on adult patients with endotracheal intubation and known difficult airway. A Staged Extubation Set® (SES) was used for extubation. Demographics, ASA, El Ganzouri, type of surgery, re-intubation success/failure and complications were recorded. The aim of the study was the assessment of the rate of re intubation failure, complications during failures, patients' comfort and evidence of airway injury. Overall, 114 subsequent difficult airway patients were enrolled. Fifteen patients (13%) required re-intubation: ten of 15 (66%) were successfully re-intubated, with a first-pass success rate of 100%. In five patients (33%), re-intubation over SES was unsuccessful, with re-intubation difficulty rate three (easy), three (quite easy) and nine (very difficult) and five cases of desaturation. Complications included one case of esophageal intubation, one case of lip trauma, and two cases of airway edema. Of 114 patients, eight (7%) perceived the procedure as intolerable. The results from this study show a relatively satisfactory success rate with a relatively high number of re-intubations failure and a low incidence of complications when using a SES in a cohort of difficult airway patients, all failures due to guidewire dislodgement during or after extubation. Further research is needed to improve success rate; at the same time the need for an extubation protocol is strongly advocated.

INTRAMUSCULAR HEMANGIOMA OF THE LOWER LIP

Intramuscular hemangioma (IH) is relatively uncommon, accounting for less than 1% of all hemangiomas, usually located within the skeletal muscles of the trunk or limbs, particularly in the pelvic region. Approximately 10% of IH may occur in the head and neck region, most commonly affecting the masseter, sternocleidomastoid, and trapezius muscles. A 57-year-old man was referred for evaluation of a 4-cm asymptomatic, bluish, and slow-growing swelling of the lower lip. The patient's history included lower lip trauma and bleeding 5 years earlier. The clinical differential diagnosis included mucocele, angioleiomyoma, and salivary gland tumor. The patient was submitted to excisional biopsy under general anesthesia. Microscopically, proliferating vascular channels lined by endothelium and smooth muscle were observed infiltrating diffusely skeletal muscles, adipose tissue, and connective tissue. The final diagnosis was IH. The patient is under regular follow-up with no recurrence. IH rarely affects the lips. Intramuscular hemangioma (IH) is relatively uncommon, accounting for less than 1% of all hemangiomas, usually located within the skeletal muscles of the trunk or limbs, particularly in the pelvic region. Approximately 10% of IH may occur in the head and neck region, most commonly affecting the masseter, sternocleidomastoid, and trapezius muscles. A 57-year-old man was referred for evaluation of a 4-cm asymptomatic, bluish, and slow-growing swelling of the lower lip. The patient's history included lower lip trauma and bleeding 5 years earlier. The clinical differential diagnosis included mucocele, angioleiomyoma, and salivary gland tumor. The patient was submitted to excisional biopsy under general anesthesia. Microscopically, proliferating vascular channels lined by endothelium and smooth muscle were observed infiltrating diffusely skeletal muscles, adipose tissue, and connective tissue. The final diagnosis was IH. The patient is under regular follow-up with no recurrence. IH rarely affects the lips.

Pilot study in France about the infiltration of local anaesthetics associated to oral surgery procedures performed under general anaesthesia

Introduction: Opinions differ regarding the combined use of local anaesthesia (LA) and general anaesthesia (GA) in oral surgery procedures. The aim of this study was to evaluate practices in France concerning intraoperative LA for oral surgery performed under GA. Practitioners and method: We conducted a prospective survey of 250 oral surgery practitioners (CNIL-2045135v0 e) and carried out a literature review with the MEDLINE search engine (PubMed) covering the period from January 2000 to September 2017. Results: Among the 77 practitioners who participated, 88.3% were dental practitioners, the majority of whom were in the 25–34-yr age group. More than half (59%) infiltrated the surgical site; 46% pre-operatively, 24% intraoperatively and 11% post-operatively. Discussion: LA under GA appears to have advantages for post-operative pain management, dissection of the first mucosal plane and bleeding management pre- and post-operatively. The contraindications remain the same as for patients in a vigilant state. In children, it should be used in moderation to limit the risk of self-inflicted lip or mouth trauma during recovery. Conclusion: The indications of LA under GA are operator-dependent and the analysis of the literature did not allow us to determine the interest or not of LA administered intraoperatively during oral surgery performed under GA.

Surveying the Literature

Surveying the Literature

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of clinical performance of I-Gel with LMA-Proseal in elective surgeries under general anesthesia

Aim: To compare insertion characteristics of two different supraglottic devices [I-gel and LMA-Proseal] and to observe any associated complications. Materials and Methods: This prospective, randomized study was conducted in 60 patients [Group A- LMAProseal (n = 30) and Group B - I-Gel (n =30)] of ASA grades I/II, of either sex in the age group 18-60 years. Both groups were compared with respect to haemodynamic response to device insertion, success rate of insertion, time taken for insertion, ease of gastric tube placement, airway trauma by post operative blood staining of the device, tongue, lip and dental trauma and 24 hours after surgery we watched for sore throat, hoarseness and dysphonia. Result: Haemodynamic response to device insertion were comparable in both the groups (p >0.05). Mean insertion time for the I-gel (11.47 ± 1.914 sec) was significantly lower than that of the PLMA (13.53 ± 3.92 sec) (P = 0.0002). I-gel was easier to insert with a better anatomic fit. The success rate at first attempt of insertion were 29/30 (96.67%) for I-gel & 28/30 (93.3%) for LMA - ProSeal (P=0.0002). Ease of gastric tube insertion was significantly higher in I-gel group (P = 0.116). Blood staining of the device, trauma (tongue, lip and dental) and 24 hrs complications after surgery were more with Group A. Conclusion: I-Gel is better than LMA-Proseal in terms of faster insertion and ease of insertion with a low incidence of pharyngolaryngeal morbidity

Inverted ductal papilloma of the oral cavity secondary to lower lip trauma. A case report and literature review.

Inverted ductal papilloma of the oral cavity is an infrequent benign neoplasm of papillary appearance that originates in the secretory duct of a salivary gland. The etiology is unknown, though some authors have related it to human papillomavirus (HPV) infection. We present the case of a 40-year-old woman with a tumor of the lower lip mucosa. Histopathological study of the lesion diagnosed inverted ductal papilloma of the oral cavity. Human papillomavirus DNA detection and typing based on tumor lesion DNA amplification and posterior hybridization, revealed no presence of viral DNA. The antecedents of trauma reported by the patient could have played an important role in the development of this tumor. Key words:Inverted ductal papilloma, intraductal papilloma, oral papilloma, papillary epidermoid adenoma.

Marginal Mandibular Nerve Palsy Incidence in Neck Dissection

Objective: The marginal mandibular nerve (MMN), a branch of the facial nerve, is at risk of damage during neck dissections. The resulting asymmetry of the mouth can cause distress as well as physical problems (dental lip trauma and fluid spillage) and is often not appreciated preoperatively. The authors wished to: 1) ascertain the incidence of marginal mandibular nerve (MMN) palsy during neck dissections, and 2) correlate risk of nerve palsy with level of nodal clearance. Method: All neck dissections undertaken at a tertiary referral head and neck oncology center from the last 2 years 1/1/10-1/1/12 were examined. Data collected include type of neck dissection, levels cleared, and pre- and postoperative MMN function. Results: We collected data from 50 consecutive neck dissections. Seven of 50 (14%) patients had an MMN palsy postoperatively. Of these 100% were permanent. As expected, patients with level 1 clearance were those at highest risk of MMN palsy. The grade of the operating surgeon was not statistically significant. Conclusion: The incidence of MMN palsy in neck dissections is high. Despite being a recognized complication of neck dissection surgery, there are limited data regarding rates of MMN palsy or correlation with levels of nodal clearance. The authors suggest that preoperatively the patient should be alerted to the incidence of MMN plasy, especially if level I is to be included in the dissection.

Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study

Although repeated intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED intubation attempts are associated with an increased risk of adverse events. We conducted an analysis of a multicenter prospective registry of 11 Japanese EDs between April 2010 and September 2011. All patients undergoing emergency intubation with direct laryngoscopy as the initial device were included. The primary exposure was multiple intubation attempts, defined as intubation efforts requiring greater than or equal to 3 laryngoscopies. The primary outcome measure was the occurrence of intubation-related adverse events in the ED, including cardiac arrest, dysrhythmia, hypotension, hypoxemia, unrecognized esophageal intubation, regurgitation, airway trauma, dental or lip trauma, and mainstem bronchus intubation. Of 2,616 patients, 280 (11%) required greater than or equal to 3 intubation attempts. Compared with patients requiring 2 or fewer intubation attempts, patients undergoing multiple attempts exhibited a higher adverse event rate (35% versus 9%). After adjusting for age, sex, principal indication, method, medication, and operator characteristics, intubations requiring multiple attempts were associated with an increased odds of adverse events (odds ratio 4.5; 95% confidence interval 3.4 to 6.1). In this large Japanese multicenter study of ED patients undergoing intubation, we found that multiple intubation attempts were independently associated with increased adverse events.

Successful prevention of oral self-mutilation using a lip guard: a case report

Self-injurious behavior (SIB) is causing deliberate harm to the body without suicidal intent; this problem occurs in a number of psychiatric, behavioral, and developmental disorders. This report describes the case of a girl, aged 19 months, whose lower lip injuries due to SIB were successfully treated through the use a combination of extraoral and intraoral prostheses. A custom-made lip guard with a custom-made adjustable head strap was effective in the management of the lip trauma. SIB was prevented and there was no recurrence even at the 17-month follow-up appointment.

Self‐inflicted oral injury in an infant with transverse myelitis

Acute transverse myelitis (ATM) is an inflammatory disorder that affects the spinal cord. It is characterized by signs and symptoms of neurologic dysfunction in the motor and sensory tracts of the spinal cord bilaterally, resulting in weakness, sensory loss, and autonomic dysfunction with acute or subacute onset. We report on a child who had ATM and respiratory distress requiring ventilatory assistance who presented with severe self-mutilation involving his lips. Other findings included bruxism that had caused mobility of the primary teeth. Comprehensive dental care was carried out under sedation. The management of the lip trauma was achieved by the use of a soft, plastic mouth guard, and corticosteroid ointment.

Mandibular Incisor Apicoectomy in a Canadian Beaver

A 52-month-old Canadian beaver was presented for treatment of lip trauma resulting from overgrowth of the right mandibular incisor tooth following earlier loss of the right maxillary incisor tooth. Extraction of the affected tooth was considered, but rejected due to the length of the embedded portion of rodent mandibular incisor teeth. The lip injury was managed by crown reduction (odontoplasty) of the overgrowing incisor tooth pending a more permanent treatment plan. A 2-cm apicoectomy of the right mandibular incisor tooth was performed to arrest growth of the tooth when the beaver was 82-months-old. The remainder of the tooth continued to erupt and was completely expelled during a 9-month period with one additional odontoplasty being required. The beaver continued to feed normally with just the left maxillary and mandibular incisor teeth until its death at 118-months, with odontoplasty performed twice on the remaining incisor teeth during the 30-months following exfoliation.

Lip Biting in a Pediatric Dental Patient After Dental Local Anesthesia: A Case Report

Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia of the inferior alveolar nerve, particularly among children. Children presenting with this self-limiting condition are often times misdiagnosed as having a localized bacterial infection. In some extreme cases, children have been unnecessarily hospitalized and treated with systemic antibiotics or surgical interventions. This case report describes a child who bit his lip after a dental appointment and was subsequently hospitalized for monitoring. Pediatric nurses are in a unique position to help parents and primary care physicians properly diagnose and manage this benign condition palliatively.

The removal of coins from the upper esophageal tract of children by emergency physicians: a pilot study

There are few reports in the medical literature describing removal of a coin from the upper esophageal tract of a child by an emergency physician. However, given the nature of their training and practice, emergency physicians are well suited to perform this common procedure. We describe our experience with this procedure. This was a retrospective review of a continuous quality improvement data set from a university-based tertiary care pediatric emergency department between Nov. 1, 2003, and Mar. 31, 2004. Thirteen children, with a median age of 20 months, underwent rapid sequence intubation and had coins successfully removed from their upper esophageal tract by emergency physicians. In 10 cases, the coin was visible at laryngoscopy and removed with Magill forceps. In 3 cases this approach failed and a Foley catheter was used to remove the coin. One child suffered a tonsillar abrasion and two sustained minor lip trauma, but all were extubated and discharged home from the emergency department with no significant complications. Eleven of the 13 patients were successfully followed up, and the parents reported no problems. This pilot study suggests that the removal of a coin from the upper esophageal tract by an emergency physician can be both safe and effective. A larger study is needed before this procedure can be generally recommended.

Treatment of muscle spasticity in patients with cerebral palsy using BTX-A: a pilot study.

This study was designed to verify the safety and efficacy of botulinum toxin type A (BTX-A) used as a neuromuscular block on spastic masticatory musculature of children with cerebral palsy. Six patients who had spastic-tetraplegic cerebral-palsy, aged 5 to 20 years were selected. All patients had spasticity of the jaw muscles, bruxism, lower lip trauma, limited mouth opening, and difficulties in cleaning the oral cavity. The patients were sedated under general anesthesia, while the dentist injected the masseter and temporalis muscles bilaterally with 150 and 75 units of BTX-A each. Clinical examinations were conducted at 7, 14, 30, and 90 days after the initial appointment. We found statistically significant decreases in muscle spasticity and bruxism (p = 0.002), improved inter-incisal opening (p = 0.002), improved oral hygiene (p = 0.031), and less lower lip trauma (p = 0.060) after the neuromuscular blocking.

Measurement of effects on tone with lip-protecting music splints for wind instrument players

To protect against lip trauma from wind instruments, music splints that cover the sharp edges of incisor teeth are often manufactured by dentists. Wind instrument players who have installed these custom-made music splints often express not only their lip comfort but also changes in their tone quality. In this study, we investigated the effect of the splints to the tone quality. We recorded three types of trumpet sounds such as long tones, arpeggios with perfect fifth, and tonguing tones with and without using a splint, respectively, by a professional trumpet player in an anechoic room. After fast Fourier transform, the higher harmonics was observed more in the splint group than in the nonsplint group, with sharp peaks from 5000 to 8000 Hz. We also examined the differences of these sound groups with recognition tests by two groups of listeners such as professional musicians and nonprofessional persons. Though sound-pressure levels of higher harmonics in two sound groups were lower than those at 400 to 2000 Hz, the musically trained persons recognized the difference perfectly. These results suggest the target of measurement to evaluate the effect of music splints.

Lip-biting in patients with profound neuro-disability.

Profound neuro-disability due to severe brain damage affects approximately 1200 people per year in the UK. Approximately half of these patients exhibit exaggerated or abnormal oral reflexes. Biting, bruxism and ruminating movements may result in dental or soft tissue trauma, with severe lip or tongue lacerations. This paper describes 10 patients referred to the dental department at the Royal Hospital for Neuro-disability with lip bites and/or severe bruxism, during a 12-month period. Management options include: monitoring the lesion; smoothing teeth; providing a bite raising appliance; or extracting teeth. This paper discusses the difficulty in management of lip trauma in this group of patients and emphasizes the importance of an interdisciplinary approach.