Evaluación cefalométrica y electromiográfica de niños y niñas con incompetencia labial y anomalías dentomaxilares

Objetivo: Describir las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y el patrón de actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos de individuos incompetentes labiales y con presencia de anomalías dentomaxilares de 7 a 12 años de edad. Materiales y método: Cuarenta y seis participantes con incompetencia labial fueron sometidos a una toma de radiografía lateral de perfil para el análisis cefalométrico. Para el estudio electromiográfico se consideró el patrón de actividad de los músculos Orbicular superior de los labios, orbicular inferior de los labios y temporal anterior en funciones: reposo, fonoarticulación, deglución, máximo apriete labial. Resultados: Se observó clase II esqueletal y molar, retrusión mandibular, biprotrusión incisal, biprotrusión labial, disminución de vía aérea superior. La mayor actividad muscular fue observada en máximo apriete labial. Conclusión: Los niños y niñas con incompetencia labial y anomalías dentomaxilares presentan alteraciones en las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos.

Objective: To describe craniofacial, dentoalveolar, soft issue and airway features, and the muscular activity, determined through a cephalometric and electromyographic study in individuals with lip incompetence and dentomaxillary anomalies aged 7 to 12 years. Methods: Forty-six participants with lip incompetence underwent lateral profile radiography for cephalometric analysis. For the electromyographic study, the activity of the superior orbicularis oris, inferior orbicularis oris and anterior temporalis muscles was considered in the following functions: rest, speaking, swallowing, and reciprocal compression of the lips. Results: Skeletal and molar class II, mandibular retrusion, labial biprotrusion, incisal biprotrusion, and upper airway dysfunction were found. The highest muscular activity was observed in reciprocal compression of the lips. Conclusion: Children with lip incompetence and dentomaxillary anomalies have alterations in the craniofacial, dentoalveolar, soft issue, and airway features, and in the muscular activity , determined through a cephalometric and electromyographic study.

Avaliação da composição e rotulagem de fotoprotetores labiais comercializados em farmácias / Evaluation of the composition and labeling of lip photo protectors marketed in pharmacies

Introdução: os efeitos deletérios da radiação ultravioleta (UV) sobre os tecidos labiais podem desencadear diversas lesões, inclusive de caráter maligno. A utilização de produtos fotoprotetores tem sido a melhor opção contra os efeitos nocivos dessa radiação. Diversas marcas de fotoprotetores labiais (FPL) estão disponíveis no mercado, onde o consumo é diretamente influenciado por qualidade e preço. Objetivo: analisar e comparar FPLs disponíveis em farmácias quanto à composição, ao preço e às características de rotulagem, segundo regulamentações da ANVISA. Metodologia: foi realizado estudo descritivo, que avaliou FPLs, quanto a FPS, indicação, constituintes químicos, FPUVA, preço e rótulo. Informações sobre as substâncias presentes e suas funções foram obtidas no INCI (Comissão Europeia), e os filtros solares foram identificados na INN (Organização Mundial da Saúde). As avaliações de rotulagem foram baseadas nas Resoluções da Diretoria Colegiada da ANVISA de nº 30/12, nº 7/15 e nº 69/16. Resultados: dezessete FPLs foram avaliados. Cinco apresentaram FPS 15; três, FPS 20; seis, FPS 30; e três, FPS 50. Dez filtros UV foram identificados, estando o Ethylhexyl Methoxycinnamate presente em maior número de FPLs. Doze produtos informaram ter proteção UVA. As características dos rótulos se encontravam dentro das determinações da ANVISA, na grande maioria dos casos. Houve alta variação do preço. Conclusão: a partir deste estudo, foi possível conhecer mais sobre a composição e as características dos FPL, principalmente sobre FPS e FPUVA, bem como se estão de acordo com as normas estabelecidas pela ANVISA, propiciando um maior conhecimento dos produtos que estão sendo comercializados.

Introduction: the deleterious effects of ultraviolet (UV) radiation on lip tissues can trigger several lesions, including malignant ones. The use of photoprotective products has been the best option against the harmful effects of this radiation. Several brands of lip sunscreens (FPL) are available on the market, where consumption is directly influenced by quality and price. Objective: to analyze and compare SPFs available in pharmacies in terms of composition, price and labeling characteristics, according to ANVISA regulations. Methodology: a descriptive study was carried out, which evaluated FPLs, in terms of SPF, indication, chemical constituents, PPD, price and label. Information on the substances present and their functions were obtained from the INCI (European Commission), and the sunscreens were identified from the INN (World Health Organization). The labeling evaluations were based on the Resolutions of the Collegiate Board of Directors of ANVISA No. 30/12, No. 7/15 and No. 69/16. Results: seventeen FPLs were evaluated. Five had SPF 15; three, SPF 20; six, SPF 30; and three, SPF 50. Ten UV filters were identified, with Ethylhexyl Methoxycinnamate present in the highest number of FPLs. Twelve products reported having UV protection. The characteristics of the labels were within the determinations of ANVISA, in the vast majority of cases. There was a high price variation. Conclusion: from this study, it was possible to know more about the composition and characteristics of FPL, mainly about SPF and UV, as well as whether they are in accordance with the standards established by ANVISA, providing a greater knowledge of the products that are being marketed.

Queiloplastia de Castañón: una técnica viable y efectiva en la reconstrucción parcial del labio inferior / Castañón Cheiloplasty: a viable and effective technique in the partial reconstruction lower lip

Introducción: Para el tratamiento del carcinoma epidermoide labial existen varias modalidades terapéuticas, pero la cirugía constituye la primera elección. Numerosas técnicas han sido descritas para el manejo de lesiones que afectan más de un tercio del labio inferior. Sin embargo, la selección de alguna en particular depende del cumplimiento de los principios reconstructivos de esta unidad. Objetivo: Ejemplificar los beneficios de la utilización de la queiloplastia de Castañón, para la reconstrucción labial parcial, en un paciente con carcinoma epidermoide de labio inferior. Presentación de caso: Se presenta un paciente masculino de 68 años de edad, con antecedentes de hábito de fumar y alcoholismo, que acudió a consulta de Cirugía Oncológica de Cabeza y Cuello por presentar lesión localizada en bermellón de labio inferior. Se realizó biopsia, mediante incisión, que informó un carcinoma epidermoide moderadamente diferenciado. Se estudió como un T2N0M0, etapa II y se trató quirúrgicamente mediante queilectomía subtotal y reconstrucción con técnica de Castañón. Conclusiones: Se presentó el caso clínico de un paciente con carcinoma epidermoide de labio inferior, entidad patológica de alta incidencia. La cirugía constituyó la única modalidad de tratamiento utilizada. Una vez realizada la resección quirúrgica de la lesión, se reconstruyó el defecto, para lo que se utilizó la queiloplastia descrita por Castañón, opción útil para lograr el cumplimiento de los principios estéticos y funcionales(AU)

Introduction: For the treatment of labial squamous cell carcinoma there are several therapeutic modalities, but surgery is the first choice. Numerous techniques have been described for the management of lesions affecting more than a third of the lower lip. However, the selection of any particular one depends on the fulfillment of the reconstructive principles of this unit. Objective: Exemplify the benefits of using Castañón cheiloplasty for partial lip reconstruction in a patient with squamous cell carcinoma of the lower lip. Case presentation: A 68-year-old male patient with a history of smoking and alcoholism was presented, who went to the Head and Neck Oncological Surgery consultation for presenting a lesion located in vermilion of the lower lip. An incisional biopsy reported moderately differentiated squamous cell carcinoma. It was studied as a T2N0M0, stage II and was treated surgically by subtotal cheilectomy and reconstruction with Castañón technique. Conclusions: The clinical case of a patient with squamous cell carcinoma of the lower lip, a pathological entity of high incidence, was presented. Surgery was the only treatment modality used. Once the surgical resection of the lesion was performed, the defect was reconstructed, for which the cheiloplasty described by Castañón was used, a useful option to achieve compliance with the aesthetic and functional principles(AU)

Técnica de Kapetansky-Juri modificada para la corrección de defectos labiales en silbido / Modified Kapetansky-Juri technique to correct whistling lip defects

RESUMEN La deformidad en silbido es uno de los defectos residuales más frecuentes entre pacientes operados de hendiduras congénitas del labio superior. La técnica de Kapetansky-Juri ha permitido corregir los defectos en silbido (moderados y graves). Se presentó una paciente de 16 años de edad operada de una hendidura bilateral labio palatina; a causa de esta hipoplasia regional y tras el proceso de crecimiento y desarrollo craneofacial, persistió la insuficiencia del prolabio como un defecto en silbido moderado. La paciente fue tratada con la técnica de Kapetansky-Juri con una pequeña modificación, lo que permitió, no solo dar volumen al prolabio, sino también un intento en la corrección del arco de Cupido. Los resultados alcanzados fueron satisfactorios y se corresponden con los objetivos finales de toda cirugía reparadora de las hendiduras labio alveolo palatinas.

ABSTRACT Whistling deformity is one of the most frequent residual defects in patients operated on for congenital clefts of the upper lip. Kapetansky-Juri technique has made it possible to correct whistling defects (moderate and severe). We present a 16-year-old female patient operated on a bilateral cleft lip and palate; given this regional hypoplasia and after the process of growth and craniofacial development, insufficiency of the prolabium persisted as a moderate whistling defect. She was treated with the Kapetansky-Juri technique with a small modification, allowing us not only to give volume to the prolabium, but also an attempt to correct the Cupid's bow. The achieved results were satisfactory and correspond to the final objectives of all reconstructive surgery of the cleft lip and palate.

Prevalence of Lip and Tongue Squamous Cell Carcinoma (Scc) at a Pathological Anatomy Service in Northeast Brazil

ABSTRACT: The aim of this work was to trace an epidemiological and clinical profile of oral squamous cell carcinoma (SCC) cases diagnosed as lip and tongue SCC from June 2001 to 2018 at a pathology anatomy service located in Northeastern Brazil. Age, sex, duration, location, growth type, staining, metastasis, etiologic agents and lesion size data were obtained fr om patient clinical files and histopathological reports. A total of 124 cases were recorded, with tongue SCC being the most preval ent. The common characteristics of both assessed SCCs included higher frequency in men, mean age of 60 years old, evidence mostly of exophytic lesions and maximum size of 4 cm, predominantly diagnosed after a maximum of 1 year of appearance. Regarding divergent findings, lip SCC occurred mostly in the lower portion of the lip, presenting a predominantly leukoplastic color, with regular smoking habits and sunlight identified as the main etiological agents, and no strong relation to metastasis. On the other hand, tongue SCC mostly exhibiting predominantly erythroleukoplastic staining, with a greater relationship to alcohol - associated smoking and regular smoking habits. The highest percentage of patients with metastasis presented tongue SCC. Although lip and tongue SCC display a male preference, an increasing amount of female involvement has been noted over the years, due to the adoption of deleterious habits such as smoking and alcoholism. Tongue SCC presented a greater relationship with metastasis and clinical leukoeritroplastic evidence. This greater aggressiveness could be related to the unfavorable locat ion of these lesions in relation to lip SCC, sometimes making it difficult to identify in their early development stages.

RESUMEN: El objetivo de este trabajo fue rastrear un perfil epidemiológico y clínico de los casos de carcinoma oral de células escamosas (CCE) diagnosticados como CCE de labios y lengua entre junio de 2001 y 2018 en un servicio de anatomía patológica ubicado en el Noreste de Brasil. Los datos de edad, sexo, duración, ubicación, tipo de crecimiento, tinción, metástasis, agentes etiológicos y tamaño de la lesión se obtuvieron de los archivos clínicos de los pacientes y los informes histopatológicos. Se revisaron un total de 124 casos, siendo el CCE de lengua el más prevalente. Las características comunes de ambos CCE evaluados incluyeron mayor frecuencia en hombres, edad promedio de 60 años, evidencia mayoritariamente de lesiones exofíticas y tamaño máximo de 4 cm, diagnosticado predominantemente después de un máximo de 1 año de aparición. En cuanto a los hallazgos divergentes, el CCE labial se presentó mayoritariamente en la porción inferior del labio, presentando un color predominantemente leucoplásico, con el hábito de fumar habitualmente y la luz solar identificados como los principales agentes etiológicos, sin una fuerte relación con las metástasis. Por otro lado, el CEC de la lengua presenta en su mayoría tinción predominantemente eritroleucoplásica, con una mayor relación con el tabaquismo asociado con el alcohol y con los hábitos habituales de tabaquismo. El mayor porcentaje de pacientes con metástasis presentó CCE de lengua. Aunque el CCE de labios y lengua muestra una preferencia en hombres, se ha observado una cantidad cada vez mayor prevalencia en mujeres a lo largo de los años, debido a la adopción de hábitos nocivos como el tabaquismo y el alcoholismo. El CCE de lengua presentó una mayor relación con la metástasis y la evidencia clínica leucoeritroplásica. Esta mayor agresividad podría estar relacionada con la ubicación desfavorable de estas lesiones en relación al CCE labial, dificultando en ocasiones su identificación en sus primeras etapas de desarrollo.

Resolución de hipertrofia de labios menores mediante técnicas simples / Resolution of hypertrophy of the labia minora using simple techniques

Introducción. La hipertrofia de los labios menores se define como tejido labial que sobresale más allá de los labios mayores, puede afectar de manera uni- o bilateral y resultar en dispareunia, interferencia con los deportes, dificultades con la limpieza, irritación e infecciones crónicas del tracto urinario, incomodidad para el uso de prendas ajustadas, además de trastornos psicológicos. Todos estos motivos llevan a las mujeres a la consulta. La reducción de labios menores es el procedimiento estético genital femenino más común. Este trabajo tiene como objetivo presentar técnicas de baja complejidad para resolver diferentes grados de hipertrofia de labios menores. Materiales y métodos. Estudio retrospectivo, observacional que comprendió 3 pacientes entre el periodo de marzo del 2019 a febrero 2020 que Incluyó a pacientes con hipertrofias leves y moderadas. Resultados. En 2 pacientes se realizó escisión directa y en 1, técnica del desepitelizado más lipotransferencia de labios mayores, sin evidenciar complicaciones mayores. Discusión. Si bien en la literatura se han reportado un gran número de técnicas quirúrgicas, cada una de ellas debe adecuarse al tipo de hipertrofia labial. La técnica del desepitelizado permite conservar un borde natural, con conservación de la coloración y textura original de la paciente, aporte neurovascular, pero no es conveniente utilizarla en pacientes de grados mayores de hipertrofia. La escisión directa proporciona una técnica simple para la escisión del exceso de tejido en pacientes con mayor tamaño de sus labios menores, pero elimina el contorno, la coloración y la textura naturales del borde libre, aun así, las pacientes resultan conformes con su nuevo aspecto. Conclusión. La reconstrucción de los labios menores, utilizando las técnicas de desepitelización y escisión directa, es confiable y da un resultado cosmético y funcional exitoso. Estas técnicas son de baja complejidad, tiempo operatorio breve, técnicamente reproducibles, dando gran conformidad y resultando un método seguro

Introduction. Hypertrophy of the labia minora is defined as lip tissue that protrudes beyond the labia majora, can affect unilaterally or bilaterally and result in dyspareunia, interference with sports, difficulties with cleaning, irritation and chronic infections of the urinal tract, discomfort for wearing tight clothes, in addition to psychological disorders. All these reasons lead women to the consultation. Labia minora reduction is the most common female genital cosmetic procedure. This work aims to present low complexity techniques to resolve different degrees of hypertrophy of the labia minora. Materials and methods: retrospective, observational study that comprised 3 patients between the period of March 2019 to February 2020 that included patients with mild and moderate hypertrophy. Results: Direct excision was performed in 2 patients and in 1, de-epithelialization technique plus lipotransference of the labia majora. Without showing major complications. Discussion: Although a large number of surgical techniques have been reported in the literature, each of them must be adapted to the type of lip hypertrophy. The de-epithelialization technique allows a natural border to be preserved, with preservation of the patient's original color and texture, neurovascular supply, but it is not convenient to use it in patients with higher degrees of hypertrophy. Direct excision provides a simple technique for excision of excess tissue in patients with larger labia minora, but removes the natural contour, coloration and texture of the free edge, yet patients are still satisfied with their new appearance. Conclusion. The reconstruction of the labia minora, using de-epithelialization and direct excision techniques is reliable and gives a successful cosmetic and functional result. These are low complexity techniques, short operating time, technically reproducible, giving great conformity and resulting in a safe method

Lifting labial: uma revisão de literatura / Lip Lift: A Literature Review

Introdução: o lifting labial consiste em remover cirurgicamente uma porção do lábio superior caracterizado como longo, achatado, sem definição das colunas filtrais e com diminuição da borda do vermelhão, o que acontece em paralelo ao avanço da idade. Sendo assim, várias técnicas foram criadas ao longo do tempo por cirurgiões a fim de fornecer ao paciente um lábio mais jovem e atraente. Objetivos: explanar as dimensões e características dos lábios, as indicações do lifting labial e as técnicas cirúrgicas. Método: foi realizado um levantamento na literatura científica nas bases de dados PubMed/Medline. O critério de inclusão adotado foi artigos com disponibilidade do texto integral do estudo e clareza no detalhamento metodológico utilizado. Além disso, um livro foi adicionado para comple-mentar informações necessárias. Os descritores utilizados para seleção dos artigos foram: lifting labial (lip lifting); morfologia dos lábios (lip morphology); lábios ideais (ideal lips). Resultados: lábios envelhecidos tendem a perder a sensualidade por consequência de al-guns fatores como o alongamento do lábio branco, a perda das definições do lábio e das co-lunas do filtro, o achatamento do lábio vermelho e o surgimento de rugas, que resultam em buscas por técnicas clínicas que ajudam a amenizar essas condições e melhorar a autoes-tima dos pacientes. Conclusão: para alcançar resultados satisfatórios com essa técnica, é necessário que o profissional domine o conhecimento sobre as dimensões do terço inferior da face de acordo com idade, sexo e raça, que tenha domínio sobre as técnicas cirúrgicas mais eficazes e as indicações de acordo com a individualidade do paciente.

Introduction: the lip lift consists of surgically removing a portion of the upper lip when it is characterized as long, flat, with no definition of the filter columns, and with a reduction in the vermilion border, which happens in parallel with advancing age. Therefore, surgeons have created several techniques to provide the patient with a younger and more attractive lip. Objectives: explain the dimensions and characteristics of the lips, the indications for lip lifting, and some surgical techniques. Method: a survey was carried out in the scientific literature on the PubMed/Medline databases. The inclusion criterion adopted was articles with the full text of the study and clarity in the methodological details used. Also, a book was added to complement necessary information. The descriptors to select articles were lip lifting, lip morphology, and ideal lips. Results: aged lips tend to lose their sensuality with the lengthening of the white lip, the loss of definitions, thinning of the red lip, and the appearance of wrinkles, which demand searches for techniques that help soften these con-ditions and improve the patient's self-esteem. Conclusion: to achieve satisfactory results with this technique, the professional needs to master the knowledge about the dimensions of the lower third of the face according to age, sex, and race. Also, the professional needs to master the most effective surgical techniques and the indications according to the patient's individuality. Keywords: Lip lift. Morphology of the lips. Characteristics of young lips. Lip aging.

Orofacial functions and forces in male and female healthy young and adults

ABSTRACT Purpose: To determine reference values of orofacial myofunctional condition and orofacial forces in healthy young and adults. Methods: Fifty young and adults were selected from a total of 316 voluntaries. Participants were assessed with the Orofacial Myofunctional Evaluation with Scores (OMES) for the investigation of orofacial myofunctional condition. The maximum forces of bite, cheeks, tongue (anterior and posterior regions), and lips were assessed with an electronic dynamometer (values expressed in Newtons). Force values were obtained by average of three repeated measurement. The technical error of measurements was calculated for all variables. Results: There were no differences in orofacial myofunctional condition between men and women. Men presented higher values of orofacial forces compared to women. Conclusion: The normal values of orofacial myofunctional condition and orofacial forces were determined in healthy and adults Brazilian men and women. The values obtained in this study from healthy Brazilian may help in the diagnosis of alterations in orofacial motor function and contribute for their therapeutic management.

RESUMO Objetivo: determinar valores de referência da condição miofuncional orofacial e forças orofaciais em adultos jovens saudáveis. Método: foram selecionados 50 jovens e adultos de um total de 316 voluntários. Os participantes foram avaliados pelo protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE) para a investigação da condição miofuncional orofacial. As forças de mordida, bochechas, língua (regiões anterior e posterior) e lábios foram avaliadas por um dinamômetro eletrônico e os valores foram registrados em Newtons. Os valores de força foram obtidos pela média de três medidas repetidas. O erro técnico do método foi calculado para todas as variáveis. Resultado: Não houve diferenças na condição miofuncional orofacial entre homens e mulheres. Homens apresentaram maiores valores de forças orofaciais em relação às mulheres. Conclusões: Os valores normais da condição miofuncional orofacial e das forças orofaciais foram determinados em homens e mulheres brasileiros saudáveis e adultos. Os valores obtidos neste estudo de brasileiros saudáveis podem auxiliar no diagnóstico de alterações na função motora orofacial e contribuir para o seu manejo terapêutico.

A capillary angioma of the lips: an extremely rare situation in the oral cavity / Angioma capilar de los labios: una situación extremadamente rara en la cavidad oral

Hemangiomas are tumors identified by rapid endothelial cell proliferation in early infancy, followed mostly by involution over the time. However, 10-12 % of true hemangiomas don't involute and require surgical treatment. Hemangiomas are classified on the basis of their histological appearance as capillary, mixed and cavernous. We report a case of capillary angioma in a 13-year old boy who presented with a budding into the lower lip. The lesion was excised and histopathological report confirmed the diagnosis.

Los hemangiomas son tumores identificados por la rápida proliferación de células endoteliales en la primera infancia, seguidos principalmente por involución a lo largo del tiempo. Sin embargo, entre el 10 y el 12 % de los hemangiomas no intervienen y no requieren tratamiento quirúrgico. Los hemangiomas se clasifican en función de su aspecto histológico como capilares, mixtos y cavernosos. Reportamos un caso de angioma capilar en un niño de 13 años que presentó un brote en el labio inferior. La lesión fue extirpada y el informe histopatológico confirmó el diagnóstico.

Tratamiento quirúrgico del carcinoma epidermoide de un 40 % del labio inferior. Reporte de caso / Surgical treatment of squamous cell carcinoma of 40 % of the lower lip. Case report

RESUMEN Fundamento: La técnica del tonel de Schuchardt, está indicada cuando el defecto en el labio compromete del 30-75 % del labio, de localización central y paramedial que afecta bermellón y piel; en este caso se usó el colgajo para reconstruir una lesión tumoral más lateral. La técnica aparece descrita para extraer el tonel de espesor parcial, sin embargo, teniendo en cuenta el margen oncológico recomendado en este caso la excéresis abarcó todo el espesor del labio. Objetivo: Presentar un caso de un paciente con un carcinoma epidermoide del 40 % en el labio inferior intervenido en el Hospital General Camilo Cienfuegos. Presentación del caso: Paciente masculino de 43 años de edad tratado durante un año por queilitis actínica, portador de una lesión exofítica, infiltrante que ocupaba el 40 % del labio inferior. Se estableció como impresión diagnóstica un carcinoma epidermoide y se decidió el tratamiento quirúrgico. Atendiendo a las características individuales del paciente y a las de la lesión, se eligió la técnica del tonel descrita por Schuchardt. Conclusiones: Las lesiones malignas de los labios pueden incidir enmascaradas por el cuadro clínico de lesiones premalignas como la queilitis actínica por lo que es importante mantener un seguimiento estrecho de estos casos. Al aplicar el método clínico puede decidirse la intervención quirúrgica con diagnóstico presuntivo de carcinoma epidermoide, deben respetarse entonces los márgenes oncológicos recomendados. La técnica del tonel inicialmente descrita para pérdidas de tejidos mediales y paramediales del labio, de espesor parcial puede emplearse en defectos de localización más lateral y de espesor total con resultados satisfactorios.

ABSTRACT Background: The barrel of Schuchardt technique, is indicated when the defect in the lip compromises 30-75 % of it, from central to paramedial location which affects both, vermilion and skin; in this case, the flap was used for rebuilding a more lateral tumor lesion. The technique is described to extract the partial thickness barrel; however, taking into account the oncological margin recommended in this case, the hysteresis covered the entire thickness of the lip. Objective: To present a case of a patient with 40 % squamous cell carcinoma in the lower lip intervened at Camilo Cienfuegos General Hospital. Case report: A 43-year-old male patient treated for a year having actinic cheilitis, with an infiltrated exophytic lesion, occupying 40 % of the lower lip. A squamous cell carcinoma was diagnosed, so surgical treatment. Based on the individual characteristics of the patient and those of the lesion, the barrel technique described by Schuchardt was chosen. Conclusions: Malignant lesions of the lips can affect masked by the clinical picture of premalignant lesions such as actinic cheilitis, so it is important to keep a close follow-up of these cases. When applying the clinical method, the surgical intervention with presumptive diagnosis of squamous cell carcinoma can be decided, then the recommended oncological margins must be respected. The barrel technique initially described for losses of medial and paramedial tissues of the lip, of partial thickness can be used in defects of more lateral location and of total thickness with satisfactory results.

Carcinoma epidermoide de lábio inferior: análise da incidência e mortalidade no Brasil / Lower lip epidermoid carcinoma: analysis of incidence and mortality in Brazil

O carcinoma epidermoide de lábios tem suas manifestações clínicas iniciais como atrofia, ressecamento e fissuras do vermelhão do lábio inferior com margem indefinida entre o vermelhão e a pele. O diagnóstico precoce é de fundamental relevância nos casos dessa patologia. O cirurgião dentista tem um papel extremamente importante neste caso. Objetivo: Realizar uma revisão da literatura pertinente sobre o carcinoma epidermoide oral. Metodologia: Essa revisão foi realizada empregando a base de dados do SCIELO, LALICS e BBO - Odontologia, foram pesquisados artigos da literatura com língua inglesa e portuguesa publicados no período de 2013 a 2018 com auxílio dos termos: câncer oral, diagnóstico e fatores associados. Foram excluídos os artigos cujas abordagens antes de 2013, outras línguas as não citadas, teses, projetos e produções não relacionadas a temática. Resultados: Os métodos tradicionais de tratamento oncológico são: cirurgia, radioterapia e a quimioterapia. O tratamento a ser estabelecido estará na dependência da localização, grau histológico de malignidade, estadiamento do tumor e da condição de saúde do indivíduo. Conclusões: O cirurgião-dentista deve estar preparado para diagnosticar e lidar com pacientes que apresentam lesões cancerizáveis com o propósito de diminuir as taxas de incidência e mortalidade e, então, melhorar a qualidade de vida das pessoas(AU)

Cancer is a cellular modification that is related to the loss of its metabolic regulation and intercellular control in which it differs depending on its type and behaves, biologically, different from a normal cell. From this point of view, lower lip cancer is one of the most frequent manifestations of oral cancer. The most frequent risk factors are stimulated from the practice of harmful habits such as: exposure to sunlight, alcohol consumption and smoking. Squamous cell carcinoma of the lips has its initial clinical manifestations such as atrophy, dryness and fissures of vermilion of the lower lip with indefinite margin between the vermilion and the skin. Early diagnosis is of fundamental relevance in cases of this pathology. The dentist surgeon plays an extremely important role in this case. The traditional methods of cancer treatment are: surgery, radiotherapy and chemotherapy. The treatment to be established will depend on the location, histological grade of malignancy, tumor staging and the individual's health condition. Therefore, the dental surgeon must be prepared to diagnose and deal with patients who have cancerous lesions in order to reduce incidence and mortality rates and thus improve people's quality of life(AU)

Programa educativo para la prevención del cáncer bucal desde la adolescencia / Educational program for the prevention of oral cancer since adolescence

RESUMEN Fundamento: el cáncer bucal aporta un número considerable en las cifras de morbilidad las que aumentarán en los decenios venideros. Informar sobre el tema pudiera ser el punto de partida si se pretende combatir este flagelo de la vida moderna. Objetivo: diseñar un programa educativo sobre cáncer bucal para adolescentes según necesidades identificadas. Métodos: se realizó una investigación de desarrollo con enfoque mixto, de intervención educativa, prexperimental, prospectiva y de corte longitudinal en el municipio de Santa Clara en el período comprendido entre febrero/2016 a noviembre/2017. Se utilizaron métodos teóricos y empíricos que permitieron la fundamentación bibliográfica y la recogida de información. Resultados: en el diagnóstico aplicado predominaron factores de riesgos como mala higiene bucal, consumo de dieta no protectora e insuficiencias de conocimientos sobre el cáncer bucal entre los adolescentes; y práctica de hábitos tóxicos por padres u otros familiares, por lo que se diseñó un programa educativo el cual fue valorado por criterio de especialistas y aplicado con resultados muy favorables en la solución de los problemas detectados. Conclusiones: los especialistas lo consideraron pertinente, factible, útil, con adecuada estructura y valor científico y pedagógico, y se comprobó su efectividad a partir de su aplicación en el grupo de adolescentes para el cual fue diseñado.

ABSTRACT Background: oral cancer contributes with a considerable number in the morbidity figures which will increase in the coming decades. Reporting on this issue could be the starting point in the battle against this scourge of modern life. Objective: to design an educational program on oral cancer for adolescents according to identified needs. Methods: a development research was carried out with a mixed approach, educational intervention, pre-experimental, prospective and longitudinal study in the municipality of Santa Clara in the period from February/ 2016 to November / 2017. Theoretical and empirical methods were used that allowed the bibliographic foundation and the collection of information. Results: in the applied diagnosis, risk factors predominated, such as poor oral hygiene, non-protective diet consumption and insufficiency of knowledge about oral cancer among adolescents; and practice of toxic habits by parents or other family members, that´s why an educational program was designed, which was assessed by specialists and applied with very favorable results in the solution of the problems detected. Conclusions: the specialists considered it pertinent, feasible, useful, with adequate structure and with scientific and pedagogical values, and its effectiveness was proven from its application in the adolescent group for which it was designed.

Análisis de huellas labiales en una muestra de estudiantes de odontología de la Universidad de Costa Rica mediante la clasificación de Renaud: estudio piloto / Lip prints analysis in a sample of dentistry students of the University of Costa Rica based in Renaud's classification: pilot study

Resumen El presente estudio, tuvo como objetivo, analizar los distintos patrones morfológicos presentes en las huellas labiales de una determinada población costarricense y su correlación con las variables, sexo, edad y afinidad biológica. Se analizaron 105 huellas labiales pertenecientes a estudiantes de quinto y sexto año de la carrera de odontología de la Universidad de Costa Rica durante el II semestre del 2016. De las 105 huellas labiales analizadas mediante el método de Renaud, el patrón más prevalente fue el tipo C de manera general, mientras que, de manera individual, en labio superior predomina el patrón tipo A y en labio inferior predomina el patrón tipo C. De la totalidad de muestras analizadas, se destaca que todas revelaron patrones distintos y la correlación estadística entre las variables, sexo, edad y afinidad biológica, permitió conocer la existencia de elementos que podrían ser útiles para identificación de individuos en el ámbito forense. Los resultados demuestran que, con la aplicación de las técnicas adecuadas en la toma de muestras y un análisis estandarizado, las huellas labiales pueden ser utilizadas en el ámbito forense como método de identificación de individuos. Este estudio, además, pone en evidencia la necesidad de realizar más investigación sobre huellas labiales en Costa Rica, no sólo por la necesidad de un aumento en el número de muestras y así obtener mayores resultados estadísticos, si no también, para desarrollar las herramientas necesarias en la toma, revelado y análisis de huellas labiales, así como su aplicabilidad al servicio de la justicia costarricense.

Abstract The objective of this study was to analyze the different morphological patterns present in the lip prints of a certain Costa Rican population and its correlation with the variables, sex, age and biological affinity. 105 lip prints were analyzed belonging to fifth and sixth year students of the dental career of the University of Costa Rica during the second semester of 2016. Of the 105 labials analyzed by the Renaud method, the most prevalent pattern was type C in general, while, individually, in the upper lip, predominantly, the type of pattern, A and the lower lip, predominantly the type C pattern. Of the total of the analyzed samples, the different patterns and the statistical correlation between the variables, sex, age and biological affinity, remarks information that can be useful to identify individuals in the forensic field. The results show that, with the application of the appropriate techniques in the taking of samples and a standardized analysis, the lip prints can be used in the field of forensic science as a method of identification of individuals. This study also highlights the need to conduct more research on lip prints in Costa Rica, not only to increase the number of samples, but also to obtain more extended statistical results. Besides, this research can be used to develop the necessary tools in the taking, development and analysis of lip print. Moreover, the results obtained may be taken into consideration in order to improve forensic research in the Costa Rican justice system.

Lesiones premalignas y malignas en el complejo bucal en La Palma, Pinar del Río / Premalignant and malignant lesions in the oral cavity, La Palma municipality, Pinar del Río

RESUMEN Introducción: actualmente se considera que el cáncer bucal es un conjunto de enfermedades con gran variación de factores predisponentes. La única medida que puede aumentar los índices de curabilidad es el diagnóstico en una etapa inicial de cualquiera de los tipos histopatológicos que se desarrollan en el área bucal. Objetivo: caracterizar clínico-epidemiológica los pacientes portadores de las lesiones premalignas y malignas en el complejo bucal en el municipio La Palma, Pinar del Río entre los años 2015 a 2016. Métodos: se realizó un estudio observacional, transversal y descriptivo cuyo universo quedó constituido por los pacientes que acudieron a los servicios estomatológicos de la clínica estomatológica "10 de Octubre", remitidos a la interconsulta de Cirugía Maxilofacial, de la que se obtuvo una muestra de 102, de ellos, portadores de entidades premalignas y malignas de la mucosa bucal en ese período. Se utilizaron las frecuencias absolutas y relativas para el análisis e interpretación de las variables. Resultados: resultó más frecuente el sexo masculino, y el grupo de edad de más de 60 años. Los labios y carrillos fueron las localizaciones anatómicas más afectadas, y los factores de riesgo que prevalecieron fueron el tabaquismo y los bordes filosos. Se empleó, fundamentalmente, la modalidad de tratamiento conservadora. Conclusiones: el conocimiento en la población sobre el Programa de Detección Precoz de Cáncer Bucal fue muy bajo.

ABSTRACT Introduction: nowadays oral cancer is considered a set of diseases with a large variation of predisposing factors. The only measure that can increase the indexes of its cure is the diagnosis in the early stages of any of the histopathological types that develop in the oral cavity. Objective: to characterize clinical and epidemiologically the patients with premalignant and malignant lesions in the oral cavity in La Palma municipality, Pinar del Río between 2015 and 2016. Methods: an observational, cross-sectional and descriptive study was carried out; the target group was constituted by the patients who attended the dentistry services at 10 de Octubre dentistry clinic, and transferred to the oral office of Maxillofacial Surgery, where a sample of 102 was taken, among them, carriers of premalignant and malignant lesions of the oral mucous membrane in that period. Absolute and relative frequencies were used for the analysis and interpretation of the variables. Results: male gender predominated, and the age group was over 60 years old. The lips and cheeks were the most affected anatomical sites, and the prevailing risk factors were smoking and sharp edges. The conservative modality of treatment was mostly used. Conclusions: knowledge concerning the Program of Early Detection of Oral Cancer in the population was very low.

Queilite esfoliativa: diagnóstico diferencial e tratamento / Queilitis exfoliativa: diagnóstico diferencial y tratamiento / Exfoliative cheilitis: differential diagnosis and treatment

Introdução: a queilite esfoliativa é uma condição dermatológica incomum que ocorre principalmente em mulheres jovens e que afeta o vermelhão dos lábios. Embora a doença seja de etiologia desconhecida, ela tem sido associada a períodos de estresse e ansiedade, como também a hábitos parafuncionais. O seu diagnóstico e manejo constituem um desafio devido à semelhança clínica entre a queilite esfoliativa e outras lesões labiais, o que muitas vezes resulta em recorrência. Objetivo: relatar dois casos clínicos de queilite esfoliativa enfatizando o diagnóstico diferencial com outras lesões que podem acometer os lábios. Relato de Casos: O primeiro caso ocorreu em um paciente do sexo masculino, 21 anos, leucoderma, com queixa de que há dois anos sentia ardência e coceira nos lábios associada a formação de crostas. Ele relatou ter realizado tratamento prévio e possuir problemas de saúde de ordem geral. Exames complementares foram realizados e não mostraram alterações. Assim, a hipótese de queilite esfoliativa foi estabelecida. O paciente foi submetido à biópsia incisional, sob anestesia local, no qual o exame histopatológico confirmou o diagnóstico clínico de queilite esfoliativa, sendo tratado com laserterapia, porém não houve sucesso no tratamento. No segundo caso, uma paciente do sexo feminino, 43 anos, melanoderma, exibindo manchas, fissuras e crostas nos lábios, além de prurido como sintomatologia. Foram solicitados exames complementares que apresentaram padrões de normalidade, assim, o diagnóstico clínico foi de prurigo actínico. Após a realização de biópsia incisional, sob anestesia local, o diagnóstico de queilite esfoliativa foi estabelecido. A paciente foi tratada com corticosteroide tópico, havendo regressão da lesão. Conclusão: o diagnóstico e manejo clínico da queilite esfoliativa é um desafio, deste modo, se faz necessário o estabelecimento de um diagnóstico correto, descartando a hipótese de outras doenças com o auxílio de exames complementares(AU)

Introducción: la queilitis exfoliativa es una condición dermatológica inusual que ocurre principalmente en mujeres y que afecta la superfície de los labios. Aunque es una enfermedad de causa desconocida, ha sido asociada a estrés y ansiedad, así como a hábitos parafuncionales. Su diagnóstico y manejo es un desafío debido a la similitud clínica entre la queilitis exfoliativa y otras lesiones labiales, ya que a menudo estas lesiones tienen recurrencia. Objetivo: describir dos casos clínicos de queilitis exfoliativa enfatizando en el diagnóstico diferencial. Presentación de casos: el primer caso ocurrió en un paciente del sexo masculino de 21 años, raza blanca. Relató que hace dos años sentía ardor en los lábios asociado a la formación de costras. Afirma haber realizado tratamiento previo y no presentar ningún problema de salud. Se realizaron exámenes complementarios y no mostraron ninguna alteración. Así, se estableció la hipótesis de queilitis exfoliativa. El paciente fue sometido a biopsia incisional, bajo anestesia local, en el cual el examen histopatológico confirmó el diagnóstico clínico de queilitis exfoliativa, siendo tratado con laserterapia, sin embargo, no hubo éxito en el tratamiento. En el segundo caso, una paciente de sexo femenino, 43 años, raza negra, exhibiendo manchas, fisuras en los labios, además de prurito como sintomatología. Se solicitaron exámenes complementarios que presentaron valores dentro de la normalidad, por lo que el diagnóstico clínico fue de prurito actínico. Después de la realización de la biopsia incisional, bajo anestesia local, fue establecido el diagnóstico de queilitis exfoliativa. La paciente fue tratada con corticoesteroides tópicos, habiendo regresión de la lesión. Conclusiones: el diagnóstico y manejo clínico de la queilitis exfoliativa es un desafío, por lo que se hace necesario el establecimiento de un diagnóstico correcto, excluyendo otras afecciones con el apoyo de exámenes complementarios(AU)

Introduction: exfoliative cheilitis is an infrequent skin condition that occurs mostly in women, affecting the skin of the lips. Though its etiology is unknown, it has been associated to stress and anxiety, as well as to parafunctional habits. Diagnosis and management are challenging, due to the clinical similarity between exfoliative cheilitis and other lesions of the lips, since these are often recurrent. Objective: describe two clinical cases of exfoliative cheilitis, focusing on the differential diagnosis. Case presentation: the first case was a white male 21-year-old patient who reported having had a burning sensation on his lips associated to crust formation for two years. The patient stated having been under treatment and being in good general health. Complementary tests were indicated which did not reveal any alteration. Thus, the hypothesis of exfoliative cheilitis was put forth. Incisional biopsy was performed under local anesthesia, histopathological examination confirming the clinical diagnosis of exfoliative cheilitis. Laser therapy was indicated, but the treatment was not successful. The second case was a black female 43-year-old patient presenting with spots and fissures on her lips, as well as itching. Complementary tests were indicated which yielded normal values, and thus the clinical diagnosis was actinic prurigo. Incisional biopsy performed under local anesthesia led to the diagnosis of exfoliative cheilitis. The patient was treated with topical corticosteroids, with regression of the lesion. Conclusions: exfoliative cheilitis diagnosis and clinical management are challenging, hence the need to make an accurate diagnosis, excluding other conditions with the aid of complementary tests(AU)

Agenesia congénita de clítoris y labios menores en una niña de 8 años / Congenital agensis of clitoris and labia minora in 8-year-old girl

Resumen Antecedentes: La agenesia congénita del clítoris y los labios menores es una malformación poco común y los casos clínicos reportados en la bibliografía son escasos. Caso clínico: Paciente de ocho años llevada al pediatra por probable infección de vías urinarias por leucocituria. Le prescribieron un antibiótico y debido a que persistió la leucocituria le revisaron los genitales externos que se encontraron con enrojecimiento de los labios mayores y del vestíbulo vaginal, con leucorrea, sin clítoris ni labios menores. Conclusiones: Se trata de un caso de agenesia congénita de clítoris y labios menores que se suma a los escasos reportes de esta malformación.

Abstract Background: Congenital agenesis of clitoris and labia minora is a rare malformation, and clinical cases reported in the medical literature are scares. Clinical case: Female from 8 years of age, with suspicion of urinary tract infection by leucocyturia, before the failure of treatment with antibiotic and persistence of the leukocyturia, the external genital review, finding redness of labia majora and the vaginal vestibule and leukorrhea, but there no clitoris or labia minora. Conclusions: This clinical case of congenital and labia minora, joins the few scientific reports of malformation. Embryological review of how this anomaly is carried out is done.

Muscle Activity and Muscle Strength in Atypical Swallowing / Actividad Muscular y Fuerza Muscular en la Deglución Atípica

Abstract Objective: To characterize muscle activity and muscle strength in patients with atypical swallowing (AS; n = 88) and competent lips (CL) or incompetent lips (IL) versus a control group (Ctrl; n = 90) Methods and materials: An analytical case-control study was conducted using surface electromyography (sEMG) of the orbicularis oris, mentalis and masseter muscles. Compression forces of the orbicularis oris, right and left masseters muscle (Cfrmm, Cflmm)), tongue tensile strength (Tts) via myoscan analysis and resistance of the orbicularis oris (Roo) via dynamo-metry were determined. Comparisons were made with the Mann-Whitney U test under a 95% confidence interval. Results: The amplitude of the sEMG record of the orbicularis oris muscle, in maximal contraction, was lower (p<0.01) in the atypical swallowing group (596.40 ± 175.83) compared to controls (659.83 ± 203.79). The muscle strength studied in the experimental group was lower (p<0.01) than in controls (CFo: AS: 0.31 ± 0.13; Ctrl: 0.38 ± 0,11; Cfrmm: AS: 0.40 ± 0.08; Ctrl: 0.50 ± 0.11; Cflmm: AS: 0.41 ± 0.08; Ctrl: 0.58 ± 0.59; Tts, AS: 0.52 ± 0.14, Ctrl: 0.65 ± 0.14, and Roo: AS: 2.47 ± 0.61; Ctrl: 2.73 ± 0.60). Patients with incompetent lips had a greater muscle activity of the orbicularis oris in swallowing (AS of IL: 197.01 ± 85.84; AS of CL: 160.54 ± 97.03; Ctrl: 147.18 ± 80.10). Conclusion: Patients with atypical swallowing showed differences in the strength of studied muscles and the muscle activity of the orbicular oris muscle compared to controls.

Resumen Objetivo: Caracterizar la actividad y fuerza muscular de pacientes con deglución atípica (DA; N=88) con competencia labial (CL) o incompetencia labial (IL) vs un grupo control (Ctrl; N=90). Materiales y métodos: Estudio analítico de casos y controles se realizó una electromiografía de superficie (sEMG) de los músculos orbicular, mental y maseteros; se determinaron las fuerzas compresiva del orbicular de los labios (FCo), contráctil del masetero derecho (FCmd) e izquierdo (FCmi), extensora del músculo lingual (FEl) por mioescanografía y la fuerza de resistencia del orbicular de los labios (FRo) por dinamometría. Resultados: La amplitud del registro sEMG del músculo orbicular de los labios, en contracción máxima, fue menor (p<0.01) en el grupo DA(596,40±175,83) con respecto a los controles(659,83±203,79); la fuerza de los músculos estudiados en el grupo experimental fue menor (p<0,01) que en los controles (FCo: DA: 0,31±0,13; Ctrl: 0,38±0,11; FCmd: DA: 0,40±0,08; Ctrl: 0,50±0,11; FCmi: DA: 0,41±0,08; Ctrl: 0,58±0,59; FEl; DA: 0,52±0,14; Ctrl: 0,65±0,14; y FRo: DA: 2,47±0,61; Ctrl: 2,73±0,60). Los pacientes con DA-IL presentaron mayor actividad muscular del orbicular en deglución (DA-IL: 197,01±85,84; DA-CL: 160,54±97,03; Ctrl: 147,18±80,10). Conclusiones: Los pacientes con DA difieren en la fuerza de los músculos estudiados y en la actividad muscular del orbicular con respecto a los controles. Los pacientes con DA-CL y DA-IL difieren en la actividad y fuerza muscular del orbicular.

Hiperplasia Endotelial Papilífera Intravascular Oral: relato de dois casos / Oral intravascular papillary endothelial hyperplasia: two cases report

A hiperplasia endotelial papilífera intravascular (HEPI) é uma lesão vascular não neoplásica, benigna e rara, especialmente em cavidade bucal. O presente artigo relata dois casos com diferentes apresentações clínicas de HEPI, envolvendo o lábio inferior. O primeiro caso se refere a um paciente que apresentava nódulo único submucoso, endurecido, arroxeado e assintomático em mucosa labial inferior. E o segundo se reporta a uma paciente que apresentava aumento de volume assintomático em lábio inferior com a mucosa entumecida e arroxeada desde o fundo de sulco. O exame histológico revelou vasos dilatados com proliferação de células endoteliais arredondadas, associadas a estruturas papilares, de tecido conjuntivo projetadas para o lúmen vascular, associadas a um trombo organizado, no primeiro caso, e a um hemangioma, no segundo. A ausência de células inflamatórias, atipia e necrose celular excluíram outras lesões vasculares, sendo o diagnóstico final de HEPI. O prognóstico da HEPI é excelente, uma vez que recidivas são raramente relatadas. A HEPI pode ser incluída no diagnóstico diferencial clínico de lesões labiais únicas, arroxeadas e endurecidas. E por caracterizarse histologicamente por uma proliferação de células endoteliais, é importante estabelecer o diagnóstico diferencial com o angiossarcoma, uma lesão de tratamento mais agressivo e pior prognóstico... (AU)

Intravascular papillary endothelial hyperplasia (IPEH) is a nonneoplastic vascular benign and rare lesion, especially in oral cavity. This article reports two cases of IPEH, with different clinical presentation, involving the inferior lip. The first case refers to a patient presenting a single submucosal indurated purplish and asymptomatic nodule in the lower labial mucosa. And the second, to a patient presenting an asymptomatic increase in the lower lip associated with a swelling and purplish oral mucosa. Histological examination showed dilated vessels with rounded endothelial cells proliferation associated with papillary structures of connective tissue projected to vascular lumen, associated with an organized thrombus in first case and a hemangioma in the second. The absence of inflammatory cells, cytologic atypia and necrosis excluded other vascular lesions, being the final diagnosis of IPEH. The prognosis of IPEH is excellent since recurrences are rarely reported. Isolated purplish and indurated labial lesions can include the IPEH as a possible clinical hypothesis. And, since is histologically characterized by a proliferation of endothelial cells, is crucial the establishment of the histological differential diagnosis with angiosarcoma, which requires a more aggressive treatment and has worse prognosis... (AU)

Reação de corpo estranho a material de preenchimento estético: relato de quatro casos / Foreign body reaction due to aesthetic filling materials: report of four cases

Objetivo: o objetivo deste trabalho é relatar quatro casos de reações de corpo estranho a material de preenchimento estético acometendo a cavidade oral. Relato dos casos: quatro pacientes adultas do sexo feminino compareceram à consulta apresentando nódulos submucosos localizados nos lábios e sulcos nasogenianos com histórico prévio de injeção de materiais de preenchimento estético (ácido hialurônico em duas pacientes e polimetilmetacrilato em duas pacientes). O diagnóstico em três dos quatro casos foi baseado nos achados clínicos e histológicos e apenas nos achados clínicos em um caso. O tratamento consistiu de manejo cirúrgico em três pacientes e corticoterapia em uma paciente e todas se encontram bem e em acompanhamento clínico. Conclusão: os cirurgiões-dentistas devem estar atentos aos efeitos adversos provocados por materiais de preenchimento estético, considerando seus diagnósticos diferenciais e as formas mais adequadas de tratamento.

Objective: The aim of the present study is to report 4 cases of foreign body reactions to dermal fillers affecting the oral cavity. Cases report: Four adult females were referred for evaluation of submerse nodules on the lips and nasolabial folds with a previous history of injection of dermal fillers (hyaluronic acid in two cases and polymethylmethacrylate in two cases). Diagnosis was based on clinical and histological aspects in three cases and solely on clinical aspect in one case. Management consisted in surgical excision in three cases and corticosteroid therapy in one and all 4 patients are well, with no signs of recurrence and remain in clinical follow-up. Conclusion: Dental professionals should be aware of the side effects associated with the use of aesthetic fillers, considering their main differential diagnosis and the most adequate management strategy for each individual case.

Quince años de estudio sobre las adherencias de labios menores / Fifteen-Year Study on the Labial Adhesions

Introducción: las adherencias de labios menores es un problema ginecológico frecuente en niñas prepuberales. De las niñas que lo padecen en algún momento de su vida (1,8 por ciento), el pico de mayor incidencia está entre los 13 y 23 meses de edad. Objetivo: mostrar los resultados de esta experiencia en el diagnóstico y manejo de esta entidad. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo. Se revisó la totalidad de las historias clínicas de 804 niñas atendidas desde el 1º de enero de 1998 hasta el 31 de diciembre de 2012. La muestra quedó integrada por 54 casos con diagnóstico de adherencias de labios menores. Las variables estudiadas fueron: edad al diagnóstico, motivo de consulta, hallazgos clínicos, tipo de sinequia, tratamiento impuesto, entre otras. Resultados: hubo mayor incidencia de sinequias en niñas entre 3 meses y 3 años (74 por ciento), con predominio de la variedad incompleta y dentro de esta la del tercio inferior (66,6 por ciento). La distorsión anatómica de los genitales externos resultó el principal motivo de consulta (42,6 por ciento). Los mejores resultados del tratamiento se lograron con la combinación de medidas higiénicas y ejercicios de tracción lateral vulvar con el uso tópico de estrógenos. Las recidivas se presentaron en 12,9 por ciento de los casos a los seis meses de edad. Conclusiones: la adherencia de labios menores es una causa importante de consulta ginecológica en niñas. Se asocia a una gran ansiedad en padres y familiares. Se obtuvo buenos resultados con el tratamiento médico, sobre todo cuando se empleó estrógenos localmente(AU)

Introduction: Labial adhesions is a common gynecological problem in prepubertal adolescents. The highest peak incidence is between 13 and 23 months old of those girls sufferingfrom this problem at some point in their life (1.8 percent). Objective: Show the results of this experience in the diagnosis and management of this condition. Methods: A descriptive, longitudinal and retrospective study was conducted at revising all the medical records of 804 girls assisted from 1st January 1998 to 31st December, 2012. The sample was composed of 54 cases diagnosed with labial adhesions. The variables studied were age at diagnosis, presenting complaint, clinical findings, type of synechia, treatment, among others. Results: There was higher incidence of synechiae in children between 3 months and 3 years (74 percent), predominantly incomplete, andin the lower third (66.6 percent). The anatomical distortion of the external genitalia was the main reason for consultation (42.6 percent). Best treatment results were achieved with the combination of hygienic measures and vulvar lateral traction exercises with topical estrogen use. Recurrences occurred in 12.9 percent of cases at six months of age. Conclusions: Labialadhesion is a major cause of gynecological consultation in girls. It is associated with great anxiety in parents and relatives. Good results were obtainedwith medical treatment, especially when the topical use of estrogen(AU)