Lower Labial Mucosa Research Articles

Glabellar rotation flap technique in patient with squamous cell carcinoma in right upper eyelid: case reports

Introduction : Squamous cell carcinoma (SCC) is the second most common skin malignancy after basal cell carcinoma, with an increasing incidence worldwide. Found in various parts of the body, in the eye and periocular area, it may affect the skin of the conjunctiva, cornea, and eyelid. Surgical excision is the preferred mode of SCC treatment. After excision, reconstructive surgery is often required for the best functional and cosmetic results. Early diagnosis and treatment of tumors and follow up care for at least 5 years have a significant impact on patient survival.
 Case Illustration: Description of two cases squamous cell carcinoma that had undergone reconstructive biopsy and blepharoplasty procedure with glabellar rotation flap technique alone in one case and together with a cheek advancement flap in the second one. In both cases, conjunctival replacement by using lower labial mucosa.
 Discussion : In both cases tumor affects the margin of the upper eyelid, therefore flap reconstruction is necessary to maintain eyelid function and esthetics. The glabellar flap has the advantages of being a fast surgery, having a good vascular supply, and being able to fill deep abnormalities because it is a thick flap. A cheek lateral rotation flap was designed to avoid unnecessary facial distortion in second case.
 Conclusion : Glabellar rotation flap alone or together with cheek advancement flap was done to maintain function and physical aesthetic of eyelid. Additional cheek lateral rotation flap could reduce skin tension.

Human Papillomavirus-Associated Oral Epithelial Dysplasia: Report of 5 Illustrative Cases from Latin America.

Human papillomavirus-associated oral epithelial dysplasia (HPV-OED) is a distinct oral epithelial disorder characterized by viral cytopathic changes caused by transcriptionally active high-risk HPV. The aim of the present study was to report 5 additional cases from Latin America. Clinical data from five patients with HPV-OED were obtained from the archives of three oral pathology services from Brazil and Chile. All cases were submitted to morphological, p16 expression and in situ hybridization (ISH) for HPV analyses. Four patients were male and one patient was female, with a mean age of 55.4 years. Four patients were HIV seropositive and two were smokers. Three cases affected the buccal mucosa and commissure, one of which had an additional plaque in the soft palate, and one case each occurred on the floor of mouth and lower labial mucosa. Most cases presented as well-demarcated white plaques with a verrucous surface. One case presented multiple lesions ranging from normal to white-colored slightly elevated plaques with a cobblestone surface. Peripheral mucosal pigmentation was observed in two cases. All five cases presented with the characteristic microscopic features of HPV-OED, including severe dysplasia with numerous karyorrhectic and apoptotic cells, full-thickness "block positivity" for p16 and high Ki-67 index (> 90%) sharply demarcated from the adjacent non-dysplastic epithelium. Wide-spectrum DNA ISH-HPV was positive in 4 cases. All patients were treated with conservative surgical excision with no signs of recurrence after a mean of 39-month follow-up. This represents the first series of HPV-OED from Latin America; most cases presented as well-demarcated papillary white plaques affecting the buccal mucosa and commissure of HIV-positive middle-aged men, two of them exhibiting peripheral pigmentation caused by reactive melanocytes. The typical microscopic findings of HPV-OED were observed in all cases, which also showed strong p16 positivity in a continuous band through the full thickness of the epithelium and high Ki67.

ORAL MANIFESTATIONS OF SECONDARY SYPHILIS: A CASE REPORT

Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects. Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects.

AFATINIB-RELATED ORAL ULCERATION

Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement. Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement.

Condilomatosis oral en niña de 9 años. Reporte de un caso clínico

A clinical case of a 9-year-old patient who seeks care for elevated lesions of the oral mucosa is presented. A disease caused by HPV was diagnosed. This case might potentially involve child abuse due to modes of disease transmission. On clinical examination, an ulcerated papillary lesion of approximately 0.5 cm was observed in the right lip corner. Multiple raised warty lesions were seen on both cheeks and the lower labial mucosa. We conclude about the importance of a good clinical history and a complete oral examination to implement the right treatment and follow-up of pathologies.

Management of Lingual Traumatic Fibroma in An Epileptic Patient Using Diode Laser

Traumatic fibroma is a benign exophytic and reactive oral lesion that develops secondary to repetitive trauma or irritation. Most commonly affected sites are tongue, buccal mucosa, and lower labial mucosa. These are well demarcated, smooth, pedunculated or sessile, exophytic lesions which are similar to the surrounding mucosa in color. Generally, it is non-tender but local irritation may lead to painful ulceration. Treatment plan includes complete excision and removal of the cause of irritation. Excision can be done by scalpel, electrocautery or Laser. The excision of the fibroma with diode laser is a safe procedure, with minimum postoperative discomfort and complications. Recurrences are rare but may occur due to repetitive trauma at the same site.

Traumatic Fibroma of Tongue

Traumatic or irritational fibroma is a common benign exophytic and reactive oral lesion that develops secondary to injury. Fibroma is a result of a chronic repair process that includes granulation tissue and scar formation resulting in a fibrous submucosal mass. The most common sites of traumatic fibroma are the tongue, buccal mucosa and lower labial mucosa. This article presents the case of a 35-year-old female patient with 2 months-long proliferation on the tip of the tongue. Here, electrocautery was used for the complete excision of the lesion. The main advantages of using it is effective hemostasis that can be achieved in a short span, is less invasive, and better postoperative phase

Uremic stomatitis in patients with chronic renal failure undergoing hemodialysis

Patients with end-stage renal disease with or without hemodialysis are at risk of experiencing a number of comorbidities inclu-ding hypertension, anemia, risk ofbleeding and have oral manifestations related to the disease itself or due to hemodialysis; for example uremic stomatitis. This article describes uremic stomatitis in end-stage renal disease patient undergoing hemodialysis. A 14-year-old girl with chronic kidney disease had already undergoing hemodialysis, came with weak, pale condition and pre-viously vomiting, complaining sore mouth and difficult to eat. Extra oral revealed anemic conjunctiva, dry lips, exfoliative, ero-sive with serosanguinolenta crusts, tend to bleed, multiple purpuras and petechiae on the lower lip. Intra oral showed white plaque cannot be scrapped off on theventral tongue. Painful erosive area and white pseudomembranes on the lower labial mu-cosa, multiple white plaques can be scrapped off leaving erythematous area on the right buccal mucosa, purpura on the left buc-cal mucosa. Laboratory examination supported the diagnosis as as uremic stomatitis and exfoliative cheilitis. To overcome the complaints and improve the oral condition, the patient was treated with 0.12% chlorhexidine digluconate 0.12%, 0.9% NaCl solution, a mixture of tranexamic acid vials and aqua bides, and vaseline album. It was concluded that uremic stomatitis is an oral manifestation of end-stage renal disease, and appropriate therapy will improve the quality of life of the patient.

LOCAL ADVERSE EFFECTS CAUSED BY THE USE OF TOPICAL IMIQUIMOD ON ORAL MUCOSA: CASE REPORT

Imiquimod (INN) can cause chemical injury in the oral mucosa, leading to local irritation, including erythema, ulceration, and pain. We report a case of a 34-year-old male patient presenting a symptomatic lesion on the lower and upper lip mucosa. The patient reported that the lesion appeared after applying INN 5% cream prescribed by a dermatologist as treatment for a white, plaque-shaped, asymptomatic lower lip lesion. Clinically, the lesion presented redness and extensive ulceration and erosion area, which extended throughout the upper and lower labial mucosa. Therefore, the diagnostic hypothesis of chemical injury induced by topical INN was considered. Request for INN suspension and prescription of oral prednisone and topical clobetasol propionate were made. After 3 weeks, total lesion resolution was observed. Thus, we highlight that topical INN can cause local adverse effects, and an effective diagnosis is of utmost importance to promote adequate treatment.

SCLEROSING POLYCYSTIC ADENOSIS OF THE MINOR SALIVARY GLANDS: A CASE REPORT

Sclerosing polycystic adenosis is a rare benign salivary gland lesion that more commonly involves the parotid. A 65-year-old male patient, without systemic changes, presented swelling in the lower lip for 18 months. Clinical examination revealed a painless submucosal nodule in the lower labial mucosa with a 5-mm diameter. The diagnostic hypotheses were mucocele and hyperplastic minor salivary gland, and total surgical excision was performed. Histopathologic examination showed a well-circumscribed lobular proliferation of ectatic ductal structures with cystic dilatation and periductal sclerosis. The ductal spaces were lined by flattened to cuboidal epithelium containing squamous and apocrine-like metaplasia and occasional mucin. The perilesional region showed minor salivary glands with an infiltration area along with focal lymphoplasmacytic inflammatory infiltrate. The final diagnosis of sclerosing polycystic adenosis was made based on clinical and histopathologic examination. The patient has been followed up for 6 months and is currently free of the lesion.

Oral Ulcer Healing Activity of Lemon Pepper Ethanol Extract Gel in Streptozotocin-Induced Diabetic Wistar Rats

Diabetes mellitus (DM) is a metabolic condition where the body's ability to produce and utilize insulin is impaired; thus, wound healing process is slower than usual in patients with DM. Lemon pepper has both antioxidant and anti-inflammatory properties. This study aimed to investigate the effect of topical application of lemon pepper fruit ethanol extracts on the healing process of oral traumatic ulcers in diabetic rats. This study was performed at the Pharmacology Laboratory, Faculty of Medicine, Universitas Prima Indonesia from September 2021–October 2021. Thirty males diabetic Wistar rats were thermally injured on the lower labial mucosa and divided into five groups: control, standard, and lemon pepper gel 5%, 7.5%, and 10% groups. The ulcer size was measured after injury and on the 7th and 14th day. On the last day, all rats underwent both routine blood count and histology study for oral ulcer tissue. On the 14th day, all treatment groups showed some significant difference wound contraction, with the highest tendency of wound contraction seen in both lemon pepper gel 10% and standard groups (62.50%. p-value =0.001). The improvement of wound contraction was also supported by reduced white blood cell count (p-value<0.05) in routine blood count and regeneration of epidermis and dermis tissues in the histology study. Hence, it can be concluded that the lemon pepper extract gel in all concentrations has good physical stability and the lemon pepper gel with the highest concentration group presents the best ulcer healing activity compared to other concentrations and has similar ulcer healing activity as the standard group that receives Kenalog® in Orabase.

Prevalence of aphthous stomatitis or recurrent aphthous ulcers in dental students

Aphthous stomatitis is a painful and recurrent inflammatory disorder affecting oral mucosa. It appears as oral manifestation of various diseases. It affects approximately 20% of the general population. Its etiopathogenesis is still unknown. Various risk factors and environmental factors are linked with its pathogenesis. Recently its association with stress has been emphasised in various studies. We tried to find out the most common site and cause of ulcerations in our subjects. A cross-sectional survey was conducted on 314 dental students by distributing a questionnaire via Google forms platform. Aphthae were most commonly seen on the lower labial mucosa and significant correlation with the mental stress was seen. The study concluded with acorrelation between stress of examinations and work deadlines to be an important factor behind the episodes of aphthous ulcer in dental students.

Oral mucocele – diagnosis and management: A series of 3 cases in children and adolescent

Mucoceles are salivary gland disorder seen in the oral cavity. Most common site for these lesions is lowerlip; however, they are also seen at other sites such as buccal mucosa, lower labial mucosa, floor of mouth, tongue, etc. Trauma due to lip biting habit is the main etiology behind these lesions. These are painless lesions which can be very easily diagnosed clinically. In this article, we present three cases of mucoceles in children and adolescents and also discuss clinical presentation, diagnosis and various treatment options available for management of mucoceles.

Clinical evaluation of steroid ointment for the treatment of mucoceles

We examined whether steroid ointment (0.1% dexamethasone) is an effective treatment for mucoceles. Using a retrospective cohort study design, a statistical study was conducted of 91 patients diagnosed with mucoceles at the Department of Dental and Oral Surgery, Saga University Hospital, Saga, Japan, between January 2006 and December 2016. The patients' age and sex; shape, size, and site of the lesion; duration; and treatment response rate were evaluated. The most frequent site of mucoceles was the lower labial mucosa, and several were <10 mm in size. The age of onset was often <20 years, with no sex-based differences. The treatment response rate was 65.8% for steroid ointment and 100% for surgical removal. In the subgroup analysis according to each clinical factor, some subgroups showed statistically nonsignificant differences compared with the surgery group. Among them, the older age and short disease duration subgroups showed small risk differences, suggesting that application of ointment may lead to a response in these subgroups. Although its response rate was lower than that of surgical removal, topical steroid application is a noninvasive and useful treatment method that can be used for patients in whom surgical treatment is infeasible.

Mc Cune Albright Syndrome - Clinicoradiological Diagnosis of a Rare Case

Mc Cune Albright Syndrome (MAS) is a rare, sporadic disorder characterized by a triad of symptoms: fibrous dysplasia, cafe-au-lait spots, and endocrinopathy. It is thought to be caused by the mutation of the GNAS1 gene and is predominantly a disease of females. We hereby report a case of a 40-year-old man who presented with suppuration and mobility of teeth in the maxillary left posterior region. The patient also had a history of recurrent fractures of limbs since childhood. Clinical examination revealed asymmetry of the face, brownish-tan macules on the nape of the neck, back, and bilateral buccal mucosa as well as lower labial mucosa. The radiological investigation confirmed the presence of polyostotic fibro-osseous lesion while the biochemical investigations revealed endocrinopathy (hyperparathyroidism). This case report emphasizes the role of an oral physician in arriving at the diagnosis of a complex disorder like MAS.

Bruxism: Recognizing of Overlooked Contributing Factor in Recurrent Aphthous Stomatitis (A Case Report)

Objective: This paper aims to describe bruxism as the contributing the factor of RAS that needed an interdisciplinary treatment approach to achieve successful treatment. Methods: A 46-year-old male came to the Dental Hospital, Faculty of Dentistry, Universitas Hasanuddin with the complaints of mouth ulcers for 2 weeks since it was bitten while he was sleeping. These complaints often recur in the same area since about 10 years ago. He had seen the dentist several times, but there was no improvement. Clinical examination revealed two yellowish irregular ulcers accompanied with tooth indentation on the right lateral of the tongue and lower labial mucosa. We detected bruxism from the patient history, clinical examination, and questionnaire evaluation. We assumed that bruxism was the main contributing factor in this case. The management of oral ulcers included tooth grinding and prescribing Doxycycline oral rinses 100 mg three times a day. The patient was also referred to prosthodontists and psychologists for management of bruxism. Results: The patient felt complete improvement since routinely using a mouthguard and coping with his anxiety. Conclusion: Bruxism can play a role as a contributing factor in RAS. Recognizing and managing parafunctional habits is very important to achieve successful treatment in this case.

ORAL ULCERS INDUCED BY LOW METHOTREXATE DOSES: A CASE REPORT

A 66-year-old male patient with psoriatic arthritis who received methotrexate (MTX) 25 mg/wk was hospitalized for ureteral reimplantation, presenting nausea, vomiting, loss of appetite, and oral ulceration. Physical examination revealed multiple ulcerations in the lower labial mucosa, with intense painful symptoms and spontaneous bleeding. The diagnostic hypothesis was of ulcerations associated with the drug. Treatment was performed with 0.05% clobetasol propionate with no satisfactory response. Therefore, we chose to perform an incisional biopsy, with a histologic diagnosis of squamous mucosa with moderate chronic lichenoid inflammation and focal subepidermal cleavage. The final diagnosis was of pharmacodermia associated with the use of MTX. The patient was treated with Ad-Muc (Biolab Sanus) and low-intensity laser therapy. Eleven days after starting treatment the patient died. MTX is an immunomodulator with anti-inflammatory action widely used for the treatment of some autoimmune diseases.

MALIGNANT MUCINOUS MYOEPITHELIOMA: A CASE REPORT

A 42-year-old female presented with asymptomatic fibrous submucosal mass that arose approximately 4 years earlier, in the left lower labial mucosa, measuring 40 mm. Aspiration showed a mucosanguinolent content. Histopathologic analysis of the incisional biopsy revealed glandular epithelial neoplasia characterized by proliferation of nests of cells in a fibrous connective tissue with areas of hyalinization. Signet ring cells, PAS-positive mucosal cells, and areas of mucus deposition were observed. Neoplastic cells presented severe cellular atypia. Immunohistochemistry was positive for p63, CK14, and CK7 and negative for SMA and S100. Ki-67 rate was 15.75%, confirming the diagnosis of malignant mucinous myoepithelioma. A head and neck surgeon performed the surgical resection of the tumor. No recurrence was observed after 5 months. Malignant mucinous myoepithelioma is a rare lesion that exhibits microscopic similarities with different entities, including other mucous-producing carcinomas, which makes its diagnosis a challenge. Support: CAPES, FAPEMIG.

Tumors of the labial mucosa: a retrospective study of 1045 biopsies.

Background To investigate the relative frequency of localized mucosal swellings of the upper and lower labial mucosa, the clinical-pathological diagnosis agreement and whether patient’s age and gender and tumor’s site and size may raise the suspicion of neoplasm. Material and Methods Retrospective analysis was performed on upper or lower labial mucosal tumors, histopathologically diagnosed between 2009-2018. The diagnostic categories developmental/reactive tumors, benign and malignant neoplasms were associated with patient’s age and gender and tumor’s site and size; clinical-pathological diagnosis agreement was, also, evaluated. Results Overall, 1000 (95.7%) developmental/reactive tumors, 35 (3.3%) benign and 10 (1%) malignant neoplasms were found. Upper/lower lip tumor ratio was 0.14:1. The diagnostic category was significantly associated with age (p<0.0001), site (p<0.0001) and diameter (p<0.0001). Age ≥60 years, tumor’s location on the upper lip and diameter >1cm were independent predictors for neoplasms. Patients presenting 2 or 3 of these variables were 20.2 times (p < 0.0001) or 33.6 times (p <0.0001), respectively, more likely to have a neoplasm. Complete/partial agreement between clinical and pathological diagnosis was seen in 96.3% of the cases. Conclusions Most lip tumors involve the lower lip and are reactive, but upper lip tumors measuring >1cm in patients≥60 years have significantly higher probability to be neoplasms. Key words:Lip, tumor, neoplasm, carcinoma, cyst.

CHARACTERIZATION AND POTENCY OF STICHOPUS HERMANNI ETHANOL EXTRACT ON ORAL WOUND HEALING

Background: Stichopus hermanni contains protein, glycosaminoglycans and EPA-DHA, which accelerate oral wound healing. Ethanol is solvent with universal nature and frequently used in the extraction. This study aims to know the characterization and potency of Stichopus hermanni in oral wound healing. Methods: Stichopus hermanni was dried by freeze-dry method and extracted using ethanol solvent. Characterization was examined the levels of protein, glycosaminoglycans and EPA-DHA. In vivo, male wistar rats made traumatic ulcer at the lower labial mucosa by using thermal burn. Thirty-two rats are divided into four groups (n=8), negative control group (K), positive control group (AH) was given hyaluronic acid gel 0.2%, and treatment groups were given Stichopus hermanni 60%-80% (SH60-SH80) gel. The ulcer formed was given gel for four days. The rat’s labial mucosa was measured. The difference between the first and fourth day is tabulated. Data were analyzed by Anova and Tukey-HSD tests. Results: The result of Spectrophotometry show the contents of protein (19.39), glycosaminoglycans (2.79–3.98). The result of in vivo showed a significant difference in ANOVA test (K=1.07; AH=1.27; SH60=1.89; SH80=1.66). In the Tukey-HSD test, the SH60 group shows a significant difference between K and AH groups. Conclusion: Stichopus hermanni ethanol extract gel contain protein and Glycosaminoglycans and potency for oral wound healing.