Improvement of Cheilitis granulomatosa after Dental Treatment

Association between cheilitis granulomatosa and odontogenic infections: A case-control study

The association between cheilitis granulomatosa and dental infections (dental caries and apical periodontitis) is still not well understood. Herein, we aimed to investigate the association in large hospital cases with cohort controls. Cheilitis granulomatosa cases (n = 181) were retrieved from Peking University Hospital of Stomatology and age- and sex-matched to controls (n = 181). The χ² -test, Student's t-test, and Mann-Whitney U-test were used to compare the differences between groups. The χ² -test and odds ratio were used to verify if there was an association and risk relationship. The results showed that both dental caries and apical periodontitis were associated with cheilitis granulomatosa (p < 0.001). Individuals with cheilitis granulomatosa had approximately a twofold increased frequency of dental caries than those without cheilitis granulomatosa (104/181, 57.5% vs. 53/181, 29.3%) (p < 0.001). The odds ratio of dental caries occurring in the case group compared to the control group was 3.211. The frequency of apical periodontitis in patients with cheilitis granulomatosa was significantly greater than in those without cheilitis granulomatosa (109/181, 60.2% vs. 28/181, 15.5%) (p < 0.001). The odds ratio was 8.272. Moreover, apical periodontitis was also locationally related to cheilitis granulomatosa (p < 0.001). Collectively, our study showed that the foci of dental infections are associated with cheilitis granulomatosa, suggesting that proper treatment of focal teeth may be important in the management of cheilitis granulomatosa.

Characteristics of the salivary microbiota in cheilitis granulomatosa

Background

Cheilitis granulomatosa (CG) is a disturbing and persistent idiopathic lip swelling. The cause and treatment has not been wholly elucidated. Some reports infer that CG is mainly associated with dental infection but no firm or reliable microbiological evidence has been provided for a causative organism. This study aimed to evaluate whether microorganisms contribute to the etiology of CG in order to inform appropriate treatment options in clinic.

Material and Methods

Unstimulated saliva was collected from 15 CG patients who were diagnosed clinically and pathologically and 15 healthy controls (HC). DNA was extracted from the precipitate of the centrifuged saliva for 16s rRNA high-throughput sequencing using the Miseq PE300 platform. The distribution of the microbiome between the two groups was compared.

Results

CG patients had a greater microbial flora that was more diverse than the HC. Prevotella, Alloprevotella, Porphyromonas, Actinomyces, Rothia, Fusobacterium, Haemophilus, and Aggregatibacter had a significantly higher abundance in CG patients. In contrast, Streptococcus and Campylobacter were the most abundant genera in HC with a mean relative abundance of 63% and 2%, respectively. The microbiological network indicated that most of the bacteria that were enriched at greater levels in CG patients were likely to be Prevotella, Actinomyces, and Rothia. These have been shown to co-exist with other bacteria.

Conclusions:

The composition and structure of bacterial communities in CG patients were different from HC. Most of the genera observed in CG patients were associated with periodontitis and pulp infection. These findings might be helpful in understanding the etiology of CG. Further study will be needed to confirm these findings and explore the underlying pathological mechanism.

Key words:Cheilitis granulomatosa, 16s rRNA high-throughput sequencing, salivary microbiota.

A new approach to the management of caliber-persistent artery: A case report and analysis of previously reported cases

A caliber-persistent labial artery (CPLA) is an incipient arterial branch that penetrates near the submucosal tissue of the lip without dividing or reducing in diameter and often appears as a palpable lesion on the lip. It occurs at an incidence of approximately 3%. This study investigated the causes of swelling of the lips, focusing on CPLA, and reviewed the literature for past cases in order to inform the treatment of a 32-year-old man presenting with an asymptomatic, solitary, elevated lesion on the vermilion of the upper lip of seven months duration. Biopsy resulted in abundant bleeding. Histopathology showed fragments of connective tissue composed of spindle-shaped cells, fibroblasts, collagen fibers and sections of small blood vessels with lymphocytic infiltration of chronic inflammatory cells around the small vessels. A thick-walled section reminiscent of a major artery was apparent. In view of the size of the lesion and concern over the functional and esthetic impairment that might result from surgery, the patient was treated with triamcinolone (40 mg/ml) injected at low pressure into the lesion, which caused the formation of deposits of colloidal particles within the lesion. The procedure was repeated twice at 2-week intervals. Subsequently, the lesion was found to have completely regressed. The favorable therapeutic results achieved, and the findings of the present review, support the intralesional injection of triamcinolone as a first-line conservative treatment in CPLA rather than a surgical approach that can result in inordinate hemorrhaging.

Buccal localization of Crohn's disease with long-term infliximab therapy: a case report

INTRODUCTION

Cheilitis granulomatosa causes persistent idiopathic lip swelling and ulceration and it can sometimes be recognized as a unique or early manifestation of Crohn's disease. Spontaneous remission is rare and with the lack of controlled trials, different therapeutic approaches have been used. Some cases have been treated with an exclusion diet in the attempt to rule out diet allergens, while the most popular treatments include antibiotics such as tetracycline and clofazimine tranilast, benzocaine topical or intralesional steroids, and cheiloplasty, with different outcomes.

CASE PRESENTATION

We describe the case of a 23-year-old Caucasian man, primarily diagnosed with cheilitis granulomatosa for a severe lower lip swelling, and then with Crohn's disease of the terminal ileum and anus. Treatment of Crohn's disease with an anti-tumor necrosis factor alpha agent (infliximab) successfully induced remission of both the gastrointestinal disease and the oral lesion.

CONCLUSIONS

Our recommendation is that physicians should be able to recognize cheilitis granulomatosa as a possible marker of a more complex systemic disease and proceed first with an accurate physical examination, and further suggest investigations of the bowel. In cases of Crohn's disease, a therapy with biological agents can be successful.

Intralesional injection of Pingyangmycin plus corticosteroids may be an effective treatment for cheilitis granulomatosa

Cheilitis granulomatosa is a rare disease characterised by the recurrent labial swelling of one or both lips with the possibility of the condition to remain on a permanent basis. This kind of granulomatous, inflammatory disease may appear independently or be linked to a paralysis such as the facial and lingua plicata which then characteristic of the Melkersson-Rosenthal syndrome. Classically, a non-necrotizing granulomatous inflammation is seen at histologic examination. Many treatments have been tried. But as its high recurrence rate, the results were often disappointing. The major active component of Pingyangmycin is bleomycin A5. Currently, bleomycin has been proved to be a widely accepted treatment protocol for hemangiomas and lymphangioma. It has been proved that bleomycin could infiltrate prominently into lymphocytes and other inflammatory cells. Stromal connective tissue would proliferate markedly as the result of sclerotherapy. Oedema, lymphangiectasia and perivascular lymphocytic infiltration are always seen in cheilitis granulomatosa histologically. Therefore, we hypothesize that intralesional injection of Pingyangmycin plus corticosteroids may be a safe and effective treatment for cheilitis granulomatosa. The efficacy of this treatment modality is worthy of further investigation.