Reconstrucción de defectos de labio superior con colgajos locales. Presentación de casos y revisión bibliográfica / Reconstruction of upper lip defects with local flaps. Case presentation and literature review

Introducción. La reconstrucción de lesiones del labio superior supone un reto para lograr conservar la función, la competencia labial y la obtención de resultado estético satisfactorio. Se estudian pacientes con lesiones malignas en labio superior y su respectivo tratamiento resectivo y reconstructivo, y se realiza revisión bibliográfica de los principios del abordaje labial y las técnicas reconstructivas con colgajos locales. Material y métodos. Presentación de cuatro casos de pacientes con carcinoma basocelular en labio superior, en quienes se realiza resección con margen de seguridad y técnicas de reconstrucción en "V", en forma pentagonal, avance en VY, colgajo digital nasogeniano y colgajo de avance de mejilla según el defecto obtenido tras la escisión de la lesión cutánea maligna. Resultados. Adecuada coloración y vitalidad de los colgajos, conservación de competencia labial y función de apertura y cierre bucal, cicatrices emplazadas en pliegues naturales. Discusión. Evaluación de opciones reconstructivas para defectos de labio superior según bibliografía. Conclusión. La reconstrucción de labio mediante las técnicas expuestas constituyen excelentes opciones para el tratamiento de defectos de hasta un tercio de longitud del labio superior, ya que conservan la competencia labial y proveen un resultado estético satisfactorio.

Introduction. The reconstruction of defects of the upper lip is a challenge in order to preserve function, lip competence and obtain a satisfactory aesthetic result. Patients with malignant lesions in the upper lip and their respective resective and reconstructive treatment were studied, and a bibliographic review of the principles of the labial approach and reconstructive techniques with local flaps was carried out. Material and methods. Presentation of four cases of patients with basal cell carcinoma of the upper lip, in whom resection is performed with a safety margin and reconstruction techniques in a "V" shape, in a pentagonal shape, VY advancement flap, nasogenian digital flap and cheek advancement flap. Results. Adequate color and vitality of the flaps, preservation of lip competence and function of mouth, scars located in natural folds. Discussion. Evaluation of reconstructive options for upper lip defects according to bibliography. Conclusion. Lip reconstruction using the exposed techniques are excellent options for the treatment of defects of the upper lip, since they preserve lip competence and provide a satisfactory aesthetic result

Resultados estéticos y funcionales de la reconstrucción de los labios con colgajos / Aesthetic and functional results of the reconstruction of the lips with flaps

Introducción: Los labios representan la unidad anatómica principal del tercio inferior de la cara. Por lo tanto, su reconstrucción quirúrgica representa un desafío para el cirujano, quien busca la excelencia en la restauración de las funciones, la estética y la apariencia facial. Muchas técnicas de reconstrucción han sido descriptas, cada una con sus ventajas y desventajas. Objetivos: evaluar los resultados estéticos y funcionales en todos los pacientes operados por lesiones oncológicas de los labios que requirieron colgajos locales, regionales y libres. Diseño: Observacional retrospectivo Lugar de Aplicación: Hospital público de atención terciaria en tumores. Material y Método: 19 pacientes 11 mujeres y 8 hombres, edad media de 65 años (31-77). Se incluyeron todos los pacientes con patología tumoral de los labios, con defectos mayores a un 1/3 del labio. Fueron 10 carcinomas escamosos, 7 carcinomas basocelulares, 1 hemangioma venoso y 1 queratosis actínica. En la resección un paciente requirió una mandibulectomía marginal y otro una maxilectomía parcial. Se le realizó vaciamiento ganglionar a 2 pacientes. Como reconstrucción se realizaron un colgajo bilobulado, 3 colgajos de avance, 1 comisuroplastia con colgajo romboidal , 2 de Abbe-Esländer, 5 de Karapandzic, 2 de mejilla, 1 Bernard-Burow y otro de Fujimori y 3 libres radiales con palmar largo. Todos los pacientes fueron evaluados en el postoperatorio inmediato, enfatizando la vitalidad de los colgajos y la cicatrización y en el postoperatorio tardío resultados funcionales y estéticos. Resultados: Todos los colgajos sobrevivieron. Sufrieron dehiscencia de la herida quirúrgica 4 pacientes. Con respecto a los resultados funcionales, la continencia oral completa fue obtenida en aquellos defectos , que pudieron reconstruirse con colgajos obtenidos del labio residual. Los defectos mayores reconstruídos con colgajos de mejilla, vecindad o especialmente con colgajo libre radial con tendón del palmar largo, obtuvieron muy buenos resultados. Tres pacientes sufrieron microstomía, La inteligibilidad del habla fue satisfactoria en todos. Los resultados estéticos fueron calificados como excelentes especialmente en los colgajos libres. Conclusión: Se han obtenido resultados satisfactorios, tanto funcionales como estéticos, en las reconstrucciones de grandes defectos de labio, con el colgajo microquirúrgico radial utilizando el tendón de palmar largo como un arnés de tensión logrando continencia oral y suspensión adecuada. La elección de uno u otro colgajo va a depender de cada paciente, edad, factores de riesgo y la elección y experiencia de cada cirujano

Bloqueo de nervio mentoniano para braquiterapia de carcinoma de labio / Mental nerve block for brachytherapy of lip carcinoma

Introducción: El cáncer de labio es el tumor más frecuente de la cavidad oral que afecta, sobre todo, el labio inferior. La braquiterapia es un tratamiento único eficaz en estadios tempranos y como terapia adyuvante a la cirugía en estadios avanzados. Esta técnica es un proceso doloroso por lo que para su realización se han empleado sedaciones profundas, infiltraciones intramusculares de anestésico local y técnicas de anestesia regional, entre otras. Objetivo: Presentar una técnica anestésica diferente y poco descrita como alternativa para disminuir el dolor de la intervención. Presentación del caso: Paciente con carcinoma de labio programado para braquiterapia. Se realiza bloqueo del nervio mentoniano de manera bilateral para el tratamiento en labio inferior. Conclusiones: Este tipo de bloqueo, por su sencillez y eficacia, es una alternativa útil a la sedación profunda para la realización de braquiterapia en el labio inferior(AU)

Introduction: Lip cancer is the most frequent tumor of the oral cavity that affects, above all, the lower lip. Brachytherapy is a unique treatment which is effective in early stages and, as adjuvant therapy to surgery, it is also effective in advanced stages. This technique is a painful process, a reason why deep sedation, intramuscular infiltrations of local anesthetic, and regional anesthesia techniques, among others, have been used. Objective: To present a different and scarcely described anesthetic technique as an alternative to reduce the pain of this intervention. Case presentation: Patient with lip carcinoma scheduled for brachytherapy. Bilateral mental nerve block is performed in the lower lip. Conclusions: This type of block, due to its simplicity and effectiveness, is a useful alternative to deep sedation for brachytherapy in the lower lip(AU)

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.

Reconstrução de lábio inferior pela w-plastia / Lower lip reconstruction using W-plasty

O CEC do lábio inferior representa entre 20% e 30% de todos os cânceres da cavidade oral. Atinge principalmente homens com mais de 50 anos que têm histórico prévio de tabagismo, etilismo e exposição solar. O diagnóstico é clínico e confirmado pela análise histopatológica. O presente trabalho relata caso de uma paciente que apresentava carcinoma espinocelular acometendo mais de 1/3 do lábio inferior, mas que devido à grande mobilidade apresentada pela região após a ressecção da lesão primária, optou-se por reconstrução conservadora para preservar a funcionalidade sem comprometer o resultado estético.

Lower lip squamous cell carcinomas (SCC) correspond to 20-30% of all oral cavity cancers. It mainly affects men over 50 years of age who have previous history of smoking, alcoholism and exposure to the sunlight. The diagnosis is clinical, confirmed by histological analysis. The present paper describes a case of a patient with a SCC affecting more than 1/3 of the lower lip, who underwent resection of the primary lesion and a conservative reconstruction of the lesion's region, due to the great local mobility, aimed at preserving the functionality without compromising the aesthetic outcome.

Oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip: second case report

Abstract This communication reports the second known case of oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip. The patient, an 82-year-old black woman, a former smoker (for more than 30 years), suffering from an ulcerous vegetative lesion in the middle third of the lower lip for approximately 12 months. The result of the histopathological analysis indicated carcinoma, with well-differentiated keratinized squamous cells and the presence of septate mycelial filaments. In the direct mycological examination, thick and dematiaceous septate mycelial filaments were observed. After the resection surgery, the patient did not need to use an antifungal drug to treat the phaeohyphomycosis, and no follow-up radiotherapy was needed to treat the squamocellular carcinoma. We stress that the presence of the squamocellular lesion of the lip was a possible contributing factor to the infection.

Lower lip reconstruction using a skin-mucosa Abbe-Estlander flap after squamous cell carcinoma excision

Abstract: Lips are structures that play an essential role in aesthetics and in different functions such as nutrition and speech. The complex anatomy of the lips – with three different layers composed of skin, mucosa, and muscles – makes surgical management of this area a therapeutic challenge. The use of flaps for the reconstruction of large defects with low risk of necrosis is possible given the abundant blood supply of the lips. We report a case of surgical reconstruction of the lower lip after the excision of a severe squamous cell carcinoma using a skin-mucosa Abbe-Estlander flap with a satisfactory final outcome.

Lipoma gigante en el labio inferior: Un caso inusual / Giant lipoma on lower lip: an unusual case

Introducción: los lipomas son tumores mesenquimales benignos que consisten esencialmente en adipocitos maduros, poco comunes en la cavidad oral comparada con otras superficies corporales. Lesiones de gran tamaño son relativamente raras y el labio inferior no es un sitio muy habitual. Se caracteriza por ser una lesión de crecimiento lento que puede alcanzar grandes dimensiones y son generalmente asintomáticos. Objetivo: caracterizar un caso de lipoma gigante en el labio inferior con algunas características clínicas e histopatológicas de esta lesión. Presentación del caso: se describe un caso de lipoma gigante que afecta el labio inferior de un paciente de 55 años de edad, de sexo masculino con una evolución asintomática de ocho años. Se realizó una exéresis completa y el examen histopatológico reveló un lipoma. Conclusiones: el paciente está bajo seguimiento y sin signos de recidiva. Las características clínicas y microscópicas fueron de gran importancia para el diagnóstico(AU)

Introduction: lipomas are benign mesenchymal tumors which consist essentially of mature adipocytes, and are relatively uncommon in the oral cavity comparing with other body surfaces. Large lesions are relatively rare and lower lip is not a very usual site. This is characterized as a slow growing lesion which might reach large dimensions and are usually asymptomatic. Objective: to show a case of giant lipoma affecting lower lip and to comment on its clinical and microscopic features. Case report: in this study, we describe a case of giant lipoma affecting lower lip of a 55 years-old male with an asymptomatic evolution of eight years. We performed a complete excision, and the histopathological examination revealed a lipoma. Conclusions: actually, the patient is under follow up without signs of recurrence. The clinical and microscopic characteristics were very important for the diagnosis(AU)

Adenoma pleomórfico em lábio superior: relato de caso / Upper lip pleomorphic adenoma: case report

As glândulas salivares são órgãos anexos de grande importância para o sistema estomatognático. Estão susceptíveis a uma série de patologias benignas e malignas e, dentre as benignas, o tumor mais comum é o adenoma pleomórfico. Tal patologia tem etiologia desconhecida e acomete com mais frequência as glândulas salivares maiores. Em casos mais raros, pode ocorrer em glândulas salivares menores, em variadas regiões na cavidade oral. Possui crescimento lento, e apresenta-se como aumento de volume firme, encapsulado e assintomático. Seu tratamento baseia-se na excisão cirúrgica e apresenta baixas taxas de recidiva. O presente trabalho objetiva relatar um raro caso de adenoma pleomórfico em lábio superior e discutir o tratamento instituído... (AU)

The salivary glands are attached organs of great importance to the stomatognathic system. Are susceptible to a number of benign and malignant disorders, and among the most common benign tumor is the pleomorphic adenoma. This pathology has unknown etiology, affecting more often the major salivary glands. In rare cases, can occur in the minor salivary glands in different sites in the oral cavity. It grows slowly and is presented as increase in firm volume, encapsulated and asymptomatic. Its treatment is based on surgical excision and has a low recurrence rate. This study reports a rare case of pleomorphic adenoma in the upper lip and discuss the treatment instituted... (AU)

Lower lip reconstruction with nasolabial flap - going back to basics

Squamous cell carcinoma of the lower lip is frequent, and radical excision sometimes leads to complex defects. Many lip repair techniques are aggressive requiring general anesthesia and a prolonged post-operative period. The nasolabial flap, while a common flap for the repair of other facial defects, is an under-recognized option for the reconstruction of the lower lip. We describe the use of nasolabial flap for the repair of a large defect of the lower lip in a ninety year-old male, with good functional results and acceptable cosmetic outcome. We believe the nasolabial flap is a good alternative for intermediate-to-large lower lip defects in patients with impaired general condition.

Adenoma de células basales en el labio superior: reporte de un caso / Basal cell adenoma in upper lip: case report

Basal cell adenoma is a rare benign salivary gland neoplasm that accounts for 1 to 3 percent of all salivary gland tumors. Most cases occur in major salivary glands and are rare in minor salivary glands. Describe a clinical case of basal cell adenoma. A 76-year-old Caucasian Brazilian woman presents with a slow-growing asymptomatic lesion of the upper lip. Physical examination revealed a nodular lesion 1.1 cm in size. The lesion was firm to palpation and the surrounding mucosa had normal color and appearance, without any ulceration. The tumor was surgically removed by excisional biopsy. Biopsy confirmed basal cell adenoma. A systematic literature review was carried out in PubMed, Lilacs and SciELO databases. The review included all articles published before 1992. Until 1991 no differentiation was made between basal cell adenoma and canalicular adenoma. Both pathologies were classified as monomorphic adenoma. This is the seventh case of upper lip basal cell adenoma reported in the literature between 1992 and 2014. Three of the seven cases reported were from Brazil(AU)

El adenoma de células basales es una neoplasia de la glándula salival raro benigno que representa a 1 a 3 por ciento de todos los tumores de las glándulas salivales. La mayoría de los casos ocurren en las glándulas salivales mayores, siendo poco frecuente en las glándulas salivales menores. El objetivo de este estudio fue describir un caso clínico de adenoma de células basales. Una mujer brasileña de raza caucásica de 76 años de edad, quien se queja de un crecimiento lento y asintomático de una lesión en el labio superior. El examen físico reveló una lesión nodular de 1,1 cm de tamaño. La lesión era firme a la palpación y la mucosa circundante tenía color normal y la apariencia, sin ulceración. El tumor fue extirpado quirúrgicamente mediante una biopsia por escisión. La biopsia confirmó adenoma de células basales. Se realizó una revisión sistemática de la literatura se en las bases de datos PubMed, Lilacs y SciELO. Incluimos en esta revisión todos los artículos publicados antes de 1992. Hasta 1991, no se hizo la diferenciación entre adenoma de células basales y adenoma canalicular. Ambas patologías fueron clasificadas como adenoma monomórfico. Este es el séptimo caso de adenoma de células basales de labio superior reportado en la literatura entre 1992 y 2014. Tres de los siete casos reportados provinieron de Brasil(AU)

Surgical options for treatment of lip and perioral tumors: report of 5 cases

Basal cell and squamous cell carcinomas are the main neoplasms of lip and perioral location. We describe different techniques of successful surgical reconstruction, including flaps or simple incision and suture. Using the latter technique satisfactory results were demonstrated, although the incision made removed more than a third of the lip, contrary to the literature. Our goal is to emphasize that the common sense and experience of the surgeon should prevail in the choice of reconstructive method. Moreover, even if the priority is complete excision of the lesion, we cannot ignore the aesthetic and functional recovery objective.

Clinical and Histological Features of Multifocal Canalicular Adenomas of the Upper Lip

Canalicular adenoma (CA) is an uncommon benign salivary gland tumor that mostly occurs in the upper lip. Despite its benign nature, some patients may present multiple nodules and also microscopic growth that can be multifocal with foci of tumor within the adjacent gland. Microscopically, CA can be mistaken for a polymorphous low-grade adenocarcinoma (PLGA) or basal cell adenoma (BCA), and immunohistochemistry can be helpful in differentiating them. Two cases of canalicular adenoma showing tumor foci within the adjacent gland are described. Both cases occurred in the upper lip of white females aged 72 and 79 years. In addition to the histological multifocal aspect, one of the patients presented bi-lateral nodules. Histological examination of both lesions revealed interconnecting and branching canal-like structures composed by uniform columnar and sometimes cuboidal cells, partially encapsulated. Immunohistochemical analysis showed intense expression of cytokeratins (CK) 7, a weak reaction to CK14 and a negative reaction to vimentin. Upon the diagnosis of CA the lesions were excised. In conclusion, it is important to properly diagnose CA and differentiate its multifocal aspect from a malignant behavior.

O adenoma canalicular (AC) é uma rara neoplasia benigna de glândula salivar que ocorre com maior frequência em lábio superior. Apesar de sua natureza benigna, alguns pacientes podem apresentar múltiplos nódulos, além de apresentar microscopicamente um crescimento multifocal com focos de neoplasia na glândula adjacente. Microscopicamente, AC pode ser confundido com adenocarcinoma polimorfo de baixo grau ou adenoma de células basais, sendo a imunohistoquímica útil na diferenciação entre eles. Dois casos de AC com focos de neoplasia dentro da glândula são descritos. Ambos os casos ocorreram em lábio superior de dois indivíduos do sexo feminino com 72 e 79 anos de idade. Além do aspecto histológico multifocal, um dos pacientes apresentou nódulos bilaterais. A análise histológica dos dois casos revelou estruturas canaliculares interligadas, compostas por células colunares uniformes e cuboidais, parcialmente encapsuladas. A análise imunohistoquímica mostrou intensa marcação de citoqueratina (CK) 7, uma fraca expressão para CK14, e reação negativa para vmentina. Após o diagnóstico as lesões foram excisionadas. Conclusão: É importante o correto diagnóstico do AC e a diferenciação do aspecto multifocal de um comportamento maligno.

Retalho de Karapandzic e retalho de Bernard-Burrow-Webster na reconstrução do lábio inferior / Karapandzic flap and Bernard-Burrow-Webster flap for reconstruction of the lower lip

O carcinoma de células escamosas é a neoplasia maligna mais frequente dos lábios, e em cerca de 90 por cento dos casos, localiza-se no lábio inferior, por causa da maior exposição cumulativa à radiação ultravioleta. Os autores apresentam duas técnicas cirúrgicas para a reconstrução de grandes defeitos do lábio inferior, resultantes da excisão cirúrgica tumoral, exemplificando-as e comparando-as através de dois casos clínicos.

Squamous cell carcinoma is the most common malignant neoplasm of the lips, and in about 90 percent of cases it is located on the lower lip due to higher cumulative exposure to ultraviolet radiation. The authors present two surgical techniques for reconstruction of large lower lip defects, resulting from surgical excision of tumors, exemplifying and comparing them with two clinical cases.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

OBJECTIVE: This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma. MATERIAL AND METHODS: Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings. RESULTS: 1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95 percent confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95 percentCI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7). CONCLUSIONS: The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Surgical treatment of oral lymphangiomas with CO2 laser: report of two uncommon cases

This paper reports the treatment of oral lymphangiomas with carbon dioxide CO2 Laser. Lymphangiomas are rare congenital lymphatic malformations. These lesions are most frequently diagnosed during childhood, are most commonly located in the head and neck region, and are extremely rare in the oral cavity. Oral lymphangiomas are of complex treatment due to the difficulty in performing a complete excision. CO2 laser is the most often used laser in the oral cavity due to its affinity with water and high absorption by the oral mucosa. Several benefits of the use of CO2 laser have been reported for surgical oral procedures. The cases reported herein were biopsy-proven lymphangiomas of the oral cavity. The surgical procedures were carried out under local anesthesia and a focused CO2 laser beam (l10.600 nm, f ~2 mm, CW/RSP) was used. At the end of the surgery, the laser beam was used on a defocused mode to promote better hemostasis. Neither sutures nor dressings were used after surgery. No medication and only mouthwashes were prescribed to all patients on the postoperative period. There were no postsurgical complaints from the patients and no relapses of the conditions were observed after follow-up periods of 12 and 18 months. The use of CO2 laser was practical, easy to carry out and effective on the treatment of oral lymphangiomas, with no lesion recurrence.

O objetivo deste trabalho é relatar o tratamento de linfangiomas orais com o laser de CO2. Os linfangiomas são raras malformações linfáticas congênitas que geralmente são diagnosticados na infância. São localizados preferencialmente na região de cabeça e pescoço, mas são extremamente raros na cavidade oral. As lesões da cavidade oral são de tratamento complexo, devido à dificuldade em exercer uma completa remoção. O laser de CO2 é o laser mais usado na cavidade oral devido à sua afinidade com a água e alta absorção pela mucosa oral. Diversos benefícios da utilização deste aparelho são relatados na literatura sobre a relação de procedimentos cirúrgicos realizados na cavidade oral. Os casos relatados são de linfangiomas comprovados por biópsia prévia. Os procedimentos cirúrgicos foram realizados sob anestesia local com um feixe de laser de CO2 no modo focado (20C Sharplan Laser Indústrias Israel, l10.600 nm, f ~2 mm, CW/RSP). Ao final da cirurgia foi utilizado um feixe de laser no modo desfocado, para promover uma melhor hemostasia. Nem suturas e curativos foram realizados após a cirurgia. Nenhuma medicação foi utilizada, somente anti-sépticos bucais foram prescritos para os pacientes no período pós-operatório. Não houve queixas no pós-operatório dos pacientes e nem recidivas após acompanhamentos de 12 e 18 meses. A utilização do laser de CO2 é um método prático, fácil e eficaz no tratamento de linfangiomas orais, sem recidiva nos períodos de acompanhamento.

Reconstrucción de labio con colgajos combinados: a propósito de un caso / Reconstruction of lip flap combined: a proposal of a case

Los labios comprenden una estructura móvil, formada por una capa muscular cubierta externamente por piel, internamente por mucosa y entre ambas una zona de transición, el bermellón. Debido a su ubicación, el labio inferior recibe radiaciones actínicas directamente, y ésta es la causa por la cual la incidencia de tumores es mayor que en el labio superior. Los labios desempeñan importantes funciones, por lo que la reconstrucción ofrece un gran desafío al cirujano plástico, el cual debe conservar tanto la función como el aspecto estético. Se presenta paciente de sexo masculino, 62 años, que presentaba carcinoma espinocelular de labio inferior, ulcerado, fondo granulante, bordes evertidos, duropétrea, de 3 cm, que afectaba el 70 % del labio e incluía la comisura derecha, sin adenopatías palpables, de 3 años de evolución.

Lips comprise a mobile structure, composed by a muscular layer covered by skin in the outside and mucous in the inside. Between covers there is a transition zone, the vermillion. Due to its localization, the lower lips is exposed to direct sunlinght radiation, and that is the main reason why it has a higher incidence in skin malignancies than the upper lip. Lip reconstruction after excision of malignancies is a challenge for the Plastic Surgeon, mainly because of the important functions of the mouth. The goal is to remain the preservation of those functions as well as restorting the aesthetic unit aspect. A 62 years old male is presented. The patient acussed a history of the tumor, a squamus cell carcinoma of the lower lip, of 3 years. At the admission, the patient showed a 3 cm. firm tumor involving 70 % of the lower lip, including the right commissure. An ulcer with granulation tissue and raised outlining was evident. No local or regional adhenopathies were found at the moment of the admission.

Queilite actínica: relato de caso com características clínicas não usuais / Actinic cheilitis: case report with unusual clinical characteristics

A queilite actínica é uma lesão pré-maligna dos lábios. Geralmente, é causada por uma exposição prolongada do paciente aos raios solares. O presente estudo relata um caso, atendido na Clínica Integrada de Odontologia da Universidade Estadual da Paraíba, com características fora do usual, onde se diagnosticou uma queilose localizada no lábio superior e que, ao exame clínico, não apresentava descamação, sangramento, aspereza ou ressecamento, fugindo, portanto, das características clínicas esperadas de queilose actínica.