The lips. Excision and repair

A series of 33 older patients with lip venous lake treated by sclerotherapy

BACKGROUND

Venous lake lesion is a venous ectasia that can occur on the lips of older people. Although different therapies have been used, there is no guideline for treating this lesion. The purpose of this study was to evaluate whether sclerotherapy is an effective and acceptable option for treatment of venous lake lesions of the lips in older patients.

METHODS

Medical records and images were retrieved from the archives of a geriatric dentistry clinic between 2005 and 2017. A total of 33 older patients treated with 5% ethanolamine oleate were included. Clinical information was selected and described.

RESULTS

The female gender was predominant (64%), and the patients' age ranged from 66 to 90 years. The majority of the patients were Caucasian (91%), and 82% were under treatment for hypertension. In 91% of the cases, the lesions were located on the lower lip and varied from 3 to 10 mm in diameter. A complaint period lasting longer than 2 years was reported by 58% of the patients. Color alteration was the most common type of esthetic complaint. Only one application of sclerotherapy was performed in 85% of the cases. For the remaining patients, two sessions were necessary. The total dose ranged from 0.3 to 0.9 ml. Complete regression of the lesions was observed in all cases. No complications or recurrences were reported.

CONCLUSION

Sclerotherapy with ethanolamine oleate is an effective, affordable, and predictable treatment for venous lake lesions of the lips in older patients.

Verruciform Xanthoma of a Lower Lip Lesion: A New Case and Review of the Literature

A non-smoking man in his seventh decade presented with a lesion he had had for about 5 years on the right external surface of the lip 1 mm from the vermilion border. On physical examination, a yellowish-coloured, non-tender, verrucous mass of 0.5 × 0.7 cm was observed. A histopathological examination of the first 3-mm punch biopsy was non-diagnostic. The histopathological evaluation of a second, 5-mm-deep punch biopsy made by a pathology expert in oral lesions revealed a diagnosis of verruciform xanthoma. The key to the diagnosis of verruciform xanthoma is to recognize xanthoma cells. However, these cells may be insufficient in number in small and superficial biopsy material and overlooked by a pathologist especially when lacking knowledge of this uncommon lesion. Verruciform xanthoma of the lower lip at the vermilion border is an extremely rare entity described in 5 cases worldwide to date. We aimed to bring verruciform xanthoma to readers' attention for a differential diagnosis of lower lip diseases and to prevent overdiagnosis and overtreatment of this lesion unfamiliar to otorhinolaryngologists.

Lip lesions in a Brazilian population

BACKGROUND

The lips represent one of the most important parts of the facial complex because of a large number and variety of injuries that may be related to this anatomic site such as inflammatory processes and benign and malignant tumors. The aim of this study was to describe the pathologic features of the lip lesions seen in a Brazilian outpatient service.

METHODS

Data from 6231 samples of oral biopsies were retrieved from the files of 5 anatomic pathology services in Fortaleza, Brazil. After data have been collected, the lesions were separated in 3 groups: G1 (nonmalignant dysplastic lesions/malignant tumors), G2 (benign neoplasms), and G3 (reactive/inflammatory lesions).

RESULTS

Analysis of the specimens for which an oral biopsy was performed yielded 1034 cases (16.6%) diagnosed on lip during the study period. From this total, 514 cases were in females and 520 were in males. Ages ranged from 2 to 96 years, with a global average of 40.1 years. The peak incidence of lip lesions in this study occurred in the fifth decade of life. The most common lesion in each group was squamous cell carcinoma (G1), hemangioma (G2), and mucocele (G3). Lower lip was the most affected region (65.9%).

CONCLUSIONS

The largest number of cases represented nonmalignant conditions, which occurred mostly in the lower lip. In addition, malignancies increased significantly with the increase in age. Further studies are necessary for a better worldwide epidemiologic understanding about lip diseases.

Treatment of developmental defect of upper lip with carbon dioxide laser radiation (CO2): first surgical time

With the exception of the cleft lip, developmental defects (DD) of the lip are rare. The upper lip originates from the ectomesenchyme and is formed by the merging of the nasal medial and lateral processes with the maxillary process. Disturbances during this formation period can cause DD with functional and/or esthetic repercussions. We present a case of DD of the upper lip in a patient with a history of progressive growth of the left lateral portion of the upper lip that occurred from the time of birth until the age of 22 years. Clinical examination revealed hypertrophy of the area from the left philtral columns to the left commissure of the lip, extending the portion of the surface mucosa creating a flaccid and asymptomatic tissue mass. All other buccal structures appeared to be within normal limits and without any evidence of defects or deformities. In the surgical planning we decided to carry out corrective surgery in two phases. The first phase accomplished a conservative excision of the total abnormal labial tissue mass with a CO2 laser radiation (5 W in continuous mode, bunch diameter Phi = 0.6 mm with a power density of 768 W/cm2 and fluency of 0.231 J/cm2) being careful to preserve the vermilion portion of the lip. Postsurgical clinical evaluations were done every three days until the skin sutures were removed and then every seven days until two months post surgery. While the entire mass of excessive tissue could not be completely removed, the removal of the excessive mucosal tissue produced a very good outcome relative to lip function, with a good esthetic result without scarring, and good tissue mobility. The results showed that the CO2 laser is an extremely useful instrument that can provide excellent control of the surgical field and allow for healing that produces excellent functional and esthetic results.

Venous lakes: a report of 32 cases treated by carbon dioxide laser vaporization

Venous lakes (VL) are acquired venous ectasies of the superficial dermal venules, usually observed in older people. Thirty-two adult patients with VL in several localizations were treated by carbon dioxide laser vaporization. Two passes were performed to each lesion within the same session. A continuous and defocused mode, with a power density of 5 W/cm2, was used in the first pass, and a continuous focused mode with the same power density was in the second pass. Photographic controls were performed before and after treatment. VLs were removed, and the smooth surface of the treated area was re-established by a single laser session. Only one case recurred after the treatment. No significant secondary effects were observed. Carbon dioxide laser is a good and safe method for treatment of skin VL. With adequate cautions, excellent cosmetic results can be obtained with a single session of treatment.