Combination of phototherapy for treatment of labial necrotizing lesion: case report

Lip necrotizing lesions are painful, complex to heal, and negatively impact the patient's orofacial condition. The present study reports a clinical case of a necrotizing lesion on the lower lip in a 38-year-old male patient, previously healthy, five days after receiving the first dose of the SARS-COV-2 vaccine, with an initial diagnosis of labial herpes zoster, with secondary infection and unsatisfactory response to clinical treatment. After debridement of the necrotic tissue, followed by a combination of antimicrobial photodynamic therapy (aPDT), photobiomodulation therapy (PBMT) and hydrofiber dressing with silver, the patient evolved with complete healing of the lip lesion and satisfactory restoration of orofacial functions after 7 days. According to the present case report, this combination of phototherapy modalities suggests to be a promising tool for the treatment of necrotizing labial lesions.

Caliber-persistent labial artery: report of 3 cases

Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

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.

Abordagens terapêuticas não-cirúrgicas para a queilite actínica / Non-surgical therapeutics approaches for actinic cheilitis

A queilite actínica (QA) é uma desordem potencialmente maligna que se desenvolve principalmente no lábio inferior, decorrente da exposição crônica a luz solar. O objetivo desse estudo é elucidar, a partir de uma revisão da literatura, as abordagens não cirúrgicas mais atuais para o tratamento da QA. Foi realizada uma busca nas bases de dados PubMed, Scielo e Cochrane, sendo obtidos 280 artigos e após aplicação dos critérios de elegibilidade, foram utilizados no presente traba lho 16 estudos. Várias abordagens, como, diclofenaco sódico, mebutato de ingenol, imiquimode, 5-fluorouracil, fludroxicortida e terapia fotodinâmica, são apontadas e estudadas como forma de tratamento para a QA. Entretanto, faltam trabalhos para que se estabeleça um consenso sobre a terapêutica não-cirúrgica mais adequada... (AU)

Actinic cheilitis (AC) is a potentially malignant disorder that develops mainly on the lower lip, result ing from a chronic exposure to sunlight. The objective of this study is to elucidate, from a literature review, the most current non-surgical approaches for the treatment of AC. A search was performed in the PubMed, Scielo and Cochrane databases, obtaining 280 papers and after applying the eligibility cri teria, 16 studies were used in the present study. Various approaches, such as diclofenac sodium, ingenol mebutate, imiquimod, 5-fluorouracil, fludroxycortide and photodynamic therapy are pointed out and studied as a form of treatment for AC. However, there is a lack of work to establish a consensus on the most appropriate non-surgical therapy... (AU)

EBV-negative lymphoepithelial-like carcinoma of the lower lip

Lymphoepithelial-like carcinoma (LEC) is a rare malignant neoplasm, which can be associated with Epstein-Barr virus (EBV) infection. Histologically, LEC is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. LEC appears to be an uncommon tumor type of lip carcinoma. An 82-year-old white woman presented a lesion on her lower lip that developed over the last year. The lesion was characterized by ulceration with flat edges, hardened base, painful, and absence of regional lymphadenopathy. Microscopical analysis evidenced an intense inflammatory infiltrate, composed of lymphoplasmacytic cells, associated with scarce pleomorphic epithelial cells. Immunohistochemistry highlighted the LEC cells with strong expression of pan-CK AE1/AE3, EMA, p63, and p53. CD138 was also faintly positive. Ki-67 was >85%. In situ hybridization analysis did not show evidence of EBV. A diagnostic of EBV-negative LEC was made. We present an uncommon type of lip carcinoma, which can represent a diagnostic challenge for clinicians and pathologists.

Tratamento cirúrgico do lábio duplo: relato de caso / Surgical treatment of the double lip: case report

Introdução: O lábio duplo é caracterizado por excesso de tecido na mucosa labial, de aspecto normal, podendo acometer o lábio superior, inferior ou ambos. Ocorre com maior incidência no lábio superior, de forma uni ou bilateral, podendo ser congênito ou adquirido. A alteração geralmente é perceptível em repouso, durante a fala ou sorriso. O tratamento cirúrgico pode ser necessário, caso o paciente apresente comprometimento estético e/ou funcional. Relato de caso: Neste trabalho, é descrito um caso clínico de lábio duplo, adquirido em paciente do sexo masculino de 40 anos de idade cujas queixas eram estéticas e funcionais. Considerações Finais: Foi realizada cirurgia para remoção do excesso tecidual com incisão por planos em forma de elipse, solucionando, assim, a deformidade... (AU)

Introduction: The double lip is characterized by excess of tissue in the labial mucosa, of normal aspect, being able to affect the upper lip, inferior or both. Occurring with greater incidence in the upper lip of uni or bilateral form, being able to be congenital or acquired. The change is usually noticeable at rest, during speech or smile. Surgical treatment may be necessary if the patient presents with aesthetic and/ or functional impairment. Case report: This paper describes a clinical case of double lip acquired in a 40-year-old male patient, whose complaints were aesthetic and functional. Final considerations: Surgery was performed to remove tissue excess with incision through ellipse-shaped planes, thus solving the deformity... (AU)

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown etiology that affects the lip. It is characterized histologically by a dense infiltrate of plasma cells with a variety of clinical features. The response to different therapeutic modalities is controversial, especially regarding the effectiveness of corticosteroids. We present a case of a 56-year-old Caucasian man with a painful ulcerated and crusted area in the lower lip, resembling a squamous cell carcinoma or actinic cheilitis. Topical corticosteroid was used for one week, which resulted in partial regression and motivated a biopsy. The histological examination provided the diagnosis of PCC. The patient has been disease-free for six months. We also provide a discussion on the criteria of differential diagnosis and management of this rare condition.

Prevalence of and factors associated with actinic cheilitis in extractive mining workers

Abstract The objective of the present study was to determine the prevalence of actinic cheilitis among extractive mining workers and factors associated with the condition, especially the relationship between clinical appearance and the length of occupational exposure to sunlight. A cross-sectional study was performed in Dona Inês, Paraíba, Brazil between 2014 and 2015. A clinical examination, clinical photography and a questionnaire were applied to 201 extractive mining workers. The T-student's, ANOVA one-way, Fisher's exact and Pearson chi-squared tests were performed and the significance level was set at 5%. A high prevalence of actinic cheilitis was observed (38.8%). Length of occupational exposure to sunlight in months (169.63±112.68, p=0.002) was associated with actinic cheilitis. Most workers were Caucasian (p<0.001) and aged 37.41±12.15 years (p=0.004). The time of occupational exposure to sunlight was significant in relation to the following clinical features: atrophy (225.75±97.31; p=0.024); blurred demarcation between the vermilion border of the lip and the skin (186.68±113.15; p=0.032); vertical fissures (210.09±123.07; p=0.046); white and red spotting (199.51±91.80; p=0.004); hard consistency of the lip (225.81±122.34; p=0.012). A high prevalence of actinic cheilitis was found. Age and ethnicity were associated with the presence of AC. Severe clinical presentations of actinic cheilitis were found among participants who had worked for at least 185 months (approximately 15 years) exposed to the sun.

Resumo O objetivo foi determinar a prevalência de queilite actínica entre os trabalhadores extrativistas minerais e os fatores associados a esta lesão, principalmente a relação da aparência clínica da lesão com o tempo de exposição ocupacional à luz solar. Foi realizado um estudo transversal, entre 2014 e 2015, em Dona Inês / PB, localizado no Nordeste do Brasil. Foram aplicados um exame clínico, registro fotográfico e um questionário a 201 trabalhadores extrativistas minerais. Realizaram-se os testes "t" student, ANOVA, Exato de Fisher e Qui-quadrado de Pearson, o nível de significância foi de 5%. Observou-se alta prevalência de queilite actínica (38,8%). A duração da exposição ocupacional à luz solar, em meses, (169,63 ± 112,68, p = 0,002) foi associada à presença de queilite actínica. Estes trabalhadores eram, em sua maioria, brancos (p<0.001) com idade média de 37.41±12.15 anos (p=0.004). O tempo de exposição ocupacional à luz solar foi significativo em relação às seguintes características clínicas: atrofia (225,75 ± 97,31; p = 0,024); perda da demarcação entre o vermelhão do lábio e a borda da pele (186,68 ± 113,15; p = 0,032); Fissuras verticais (210,09 ± 123,07; p = 0,046); Manchas brancas e vermelhas (199,51 ± 91,80; p = 0,004); Consistência dura do lábio (225,81 ± 122,34; p = 0,012). Conclui-se que a prevalência de queilite actínica foi alta. A idade e a etnia foram fatores associados a presença de queilite actinica. Os participantes que haviam trabalhado pelo menos 185 meses (aproximadamente 15 anos) sob exposição ao sol, apresentaram manifestações clínicas graves da queilite actínica.

Queiloplastia primária unilateral através da técnica de Fisher / Unilateral primary lip repair by Fisher technique

Introdução: As fissuras labiais são alterações congênitas que decorrem da não fusão dos processos nasais medianos com os processos nasais laterais, sendo sua ocorrência em aproximadamente 1:550 nascidos vivos. Essas fissuras podem apresentar-se bilaterais ou unilaterais nos lábios e acompanhadas ou não de fenda palatina. A cirurgia primária para reparação do lábio fissurado unilateral vem sendo descrita por diversas técnicas na literatura e geralmente envolve rotações de retalho e deixam cicatrizes visíveis bem como encurtamento do vermelhão do lábio. A técnica de Fisher foi proposta para resultar em uma cicatriz menos visível, em linha reta na região do filtro labial, colocando-a em uma região mais anatômica e simplificando a cirurgia. O objetivo deste artigo é mostrar um caso clínico de queiloplastia primária unilateral, utilizando a técnica de Fisher. Relado de Caso: Paciente CDSS, 8 meses de idade, portador de fissura lábio-palatina unilateral do lado esquerdo. A cirurgia do lábio foi realizada em ambiente hospitalar sob anestesia geral e a técnica utilizada foi a de Fisher. No acompanhamento de 30 dias o paciente apresentou-se com uma cicatriz bastante discreta, posicionada simetricamente em relação ao filtro labial do lado oposto. Conclusão: A técnica de Fisher mostrase como ótima opção para o tratamento de fissuras labiais unilaterais, pois proporciona uma excelente estética, a técnica cirúrgica é relativamente simples e acompanhada de bons resultados funcionais

Introduction: Cleft lip is a congenital abnormality arising from no merger of the median nasal processes with the lateral nasal processes, and their occurrence is approximately 1 in 550 live births. These clefts may present bilateral or unilateral lips and with or without cleft palate. The primary surgery for repair of unilateral cleft lip has been described by several techniques in literature and usually involves retail rotations and leave visible scars and lip vermilion shortening. Fisher technique has been proposed to result in a less visible scar, straight in the philtrum region placing it in a more anatomical region and simplifying the surgery. The purpose of this article is to show a case of unilateral primary lip repair using the Fisher technique. Case Report: Patient CDSS 8 months old has an unilateral cleft lip and palate on the left side. The lip surgery was performed in a hospital under general anesthesia and the technique used was Fisher. In the following 30 days, the patient is presented with a very slight scar, positioned symmetrically in relation to the philtrum of the opposite side. Conclusion: Fisher technique is shown as great option for the treatment of unilateral cleft lip, it provides an excellent aesthetic, the surgery technique is relatively simple and accompanied by good functional results

Histopatologia da forma labial cicatricial de Keith / Histopathology of Keith`s lip scar

O estudo da etiologia das formas congênitas ditas cicatriciais, que incluem bandas cicatriciais congênitas e formas cicatriciais das fissuras labiais, apresenta diversas teorias, que fundamentam seu aparecimento, porém não justificam todos os aspectos envolvidos nessas malformações. Neste artigo são apresentados 4 casos de pacientes portadores da forma cicatricial de Keith, submetidos à realização de queiloplastia pela técnica de Spina, comparados a 1 caso de paciente portador de cicatriz traumática. Todos os pacientes tiveram amostra de tecido enviada para estudo histopatológico, com coloração com hematoxilina-eosina. Os casos estudados apresentaram semelhanças entre a pele embrionária e a cicatriz comum.

Examinations of the etiology of congenital cicatricial presentations, which include congenital constriction bands and cicatricial presentations of cleft lip, have provided several theories that explain their development; however, they do not explain all the aspects involved in these malformations. In the present article, we present the cases of 4 patients with Keith's lip scar who underwent cheiloplasty using the spina technique. These cases were compared with 1 case of a patient with a traumatic scar. Tissue samples were obtained from all the patients for histopathological examination using hematoxylin-eosin staining. The cases under study exhibited similarities in embryonic skin and common scar tissue.

Prevalência de lesões labiais em trabalhadores de praia e fatores associados / Prevalence and factors associated with orolabial lesions in beach workers / Prevalencia de lesiones labiales en trabajadores de playa y factores asociados

OBJETIVO: Analisar a prevalência de lesões labiais decorrentes da exposição solar e potenciais associações em trabalhadores de praia. MÉTODOS: Estudo transversal com 362 trabalhadores de cinco praias urbanas em Natal, RN, de agosto a dezembro de 2010. Os participantes responderam um questionário validado com dados pessoais, de ocupação e de saúde e passaram por exame clínico dos lábios feito por pesquisadores calibrados. As possíveis associações das variáveis sociodemográficas, ocupacionais e de saúde geral com a presença de lesões labiais foram avaliadas pelo teste do qui-quadrado para um nível de significância de 5%. A análise multivariada foi feita utilizando-se a regressão robusta de Poisson. RESULTADOS: Dos trabalhadores examinados, 27,1% apresentavam lesões labiais. Desses, 76,8% eram do sexo masculino; 61,6% tinham pele morena ou negra; 94,5% trabalhavam informalmente; e 85,4% trabalhavam expostos ao sol. A maioria (81,1%) relatou uso de algum tipo de fotoproteção: protetor solar (38,7%); protetor labial (15,3%); boné/chapéu (72,4%). Aproximadamente 28% eram fumantes e 48% consumiam álcool regularmente. A fotoproteção com uso de boné/chapéu foi associada à presença de lesões labiais decorrentes da exposição solar. CONCLUSÕES: Observou-se alta prevalência de lesões labiais nos indivíduos expostos ao sol, a qual foi associada ao uso de boné/chapéu como forma de fotoproteção.

OBJECTIVE: To assess the prevalence and factors associated with orolabial lesions caused by sun exposure in beach workers. METHODS: Cross-sectional study with 362 beach workers from five urban beaches in the city of Natal, northeastern Brazil, from August to December 2010. All subjects completed a validated questionnaire to collect personal, occupational, and health-related information and underwent an orolabial clinical examination by trained examiners. Potential associations between sociodemographic, occupational, and health-related variables and the presence of orolabial lesions were assessed using the chi-square test at a 5% significance level. The multivariate analysis was performed using Poisson regression. RESULTS: Of the 362 workers examined, 27.1% had orolabial lesions. Of these, 76.8% were males, 61.6% dark or black skinned, 94.5% informal workers, and 85.4% reported sun exposure. Most (81.1%) reported using sun protection methods including sunscreen (38.7%), lip balm (15.3%), and cap/hat (72.4%). Twenty-eight percent reported smoking and 48% regular drinking. Sun protection with cap/hat was associated with orolabial lesions caused by sun exposure. CONCLUSIONS: There was found a high prevalence of orolabial lesions in workers exposed to sunlight that was associated with the use of a cap/hat as a sun protection method.

OBJETIVO: Analizar la prevalencia de lesiones labiales productos de la exposición solar y potenciales asociaciones en trabajadores de playa. MÉTODOS: Estudio transversal con 362 trabajadores de cinco playas urbanas en Natal, RN, Brasil, de agosto a diciembre de 2010. Los participantes respondieron un cuestionario validado con datos personales, de ocupación y de salud y se evaluaron a través de exámenes clínicos realizados por investigadores calibrados. Las posibles asociaciones de las variables sociodemográficas, ocupacionales y de salud general con la presencia de lesiones labiales se evaluaron por medio de la prueba de Chi-cuadrado para un nivel de significancia de 5%. El análisis multivariado fue realizado utilizándose la regresión robusta de Poisson. RESULTADOS: De los trabajadores examinados, 27,1% presentaban lesiones labiales. De estos, 76,8% eran del sexo masculino; 61,6% tenían piel morena o negra; 94,5% trabajaban informalmente y 85,4%, expuestos al sol. La mayoría (81,1%) relató uso de algún tipo de fotoprotección: protector solar (38,7%); protector labial (15,3%); gorra/sombrero (72,4%). Aproximadamente 28% eran fumadores y 48% consumían alcohol regularmente. La fotoprotección con uso de gorra/sombrero fue asociada a la presencia de lesiones labiales productos de la exposición solar. CONCLUSIONES: Se observó alta prevalencia de lesiones labiales en los individuos expuestos al sol y esta se asoció al uso de gorra/sombrero como forma de fotoprotección.