A Pigmented Bullous Maxillofacial Lesion in a Diabetic Patient: A Diagnostic Dilemma.

Diabetes mellitus (DM) can be complicated by a variety of cutaneous manifestations. Cutaneous manifestations, such as neuropathic foot ulcers are universally known and have predilection for the lower extremity. However, in the maxillofacial region diabetic lesion is not yet reported in the literature. It is because of enormous blood supply to the region. We present a case of 77-year-old female with pigmented bullous lesion in maxillofacial region as a result of uncontrolled DM, which was associated with reactive lymphadenitis due to infection from carious right mandibular first molar. The patient also had normocytic normochromic anemia secondary to progressive renal failure as a result of diabetic nephropathy (DN). The patient developed lesion due to trauma following fine-needle aspiration cytology and high sugar levels. She was successfully managed by good metabolic control, extraction of the offending tooth, antibiotic prophylaxis, and occlusive dressings. To the best of our knowledge, this clinical scenario has not been previously reported in the context of the diabetic lesion and, therefore, may be considered in the classification of dermatological lesions of diabetes.

Use of Nasolabial Flap in the Management of Oral Submucous Fibrosis – A Clinical Study.

Oral submucous fibrosis is a chronic debilitating disease associated with restricted mouth opening and poor oral hygiene. The treatment aims at good release of fibrosis and to provide long term results in terms of mouth opening. Various local grafts have been used to cover the buccal mucosal defects after the fibrotic bands are released in oral submucous fibrosis. Successful use of inferiorly based nasolabial flaps in the management of oral submucous fibrosis is projected. A total of 10 histologically proven cases of oral submucous fibrosis having a mouth opening of less than 20 mm were surgically treated .The procedure involved (1) bilateral release of fibrotic bands (2) measurement of intra-operative interincisal distance (greater than 35 mm achieved in all patients after release of bands) (3) covering the defects with inferiorly based nasolabial flap. All patients had post-operative physiotherapy, and were followed up regularly for one year. All flaps healed without evidence of infection, dehiscence, or necrosis. Results were assessed by comparing the pre-operative & pos-toperative maximum mouth opening. The inferiorly based nasolabial “islanded” flaps provide reliable coverage of defects of the buccal mucosa and improves mouth opening.