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Patel M, Ramamurthi A, Jones K, North P, Lin KYK. Rare Congenital Upper Lip Pit. J Craniofac Surg 2024:00001665-990000000-01706. [PMID: 38861357 DOI: 10.1097/scs.0000000000010403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
Congenital lip pits are characterized by sinuses or fistulas in the lips that can occur in isolation or as part of a genetic disorder. A 6-year-old girl with a right upper lip lesion present at birth presented with recurrent swelling and occasional erythema. Examination revealed a mildly swollen punctum at the right upper wet/dry vermillion with expressible serous drainage. There were no other phenotypic or cognitive concerns. The lesion was surgically excised using vertical wedge resection. The postoperative course showed well well-healed incision. The pathology report confirmed a lip pit. The family was referred to genetics for further evaluation. Van der Woude syndrome (VWS) is a genetic disorder associated with abnormal development of the paramedian lip. Most congenital lip pits are primarily found on the lower lips, with paramedian lip pits being the most common. Upper lateral lip pits with or without accompanying lip pits are considerably rarer. Though VWS is commonly associated with mutations in the interferon regulatory factor 6 or grainyhead-like protein 3 genes, ~25% of affected individuals lack an identified genetic etiology. A high index of suspicion for VWS is warranted if lip pits are present in the absence of other phenotypic abnormalities and should prompt genetic testing for interferon regulatory factor 6 and grainyhead-like protein 3 mutations. Multidisciplinary teams should consider patient self-esteem, quality of life, and potential family planning when deciding on surgical intervention for lip pits. Surgical management of pits should entail tissue-preserving techniques such as vertical wedge resection and inverted T-lip reduction to prevent whistle-lip deformity.
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Affiliation(s)
- Milan Patel
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee
| | - Aishu Ramamurthi
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee
| | - Kelly Jones
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Kant Y K Lin
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee
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Zhang J, Li Z, Pang P. Congenital Upper Lip Sinus. J Craniofac Surg 2024:00001665-990000000-01478. [PMID: 38688013 DOI: 10.1097/scs.0000000000010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 05/02/2024] Open
Abstract
Congenital upper lip sinus (CULS) is an extremely rare anomaly. The aim of the study is to present a new case and compile the present knowledge of CULS to help foster a deeper understanding of this disease. A 9-year-old girl with a midline CULS, a prolonged maxillary labial frenulum, and a palatal epulis is presented. Thirty-nine papers met the eligibility criteria and 45 cases were included in the systematic review. CULS shows typical clinical and pathologic characteristics. It tends to occur at the midline region horizontally (n=35; 78%) and the upper part of the white lip (n=23; 51%) vertically. No ethnic predilection is found, but it tends to show a female predilection (n=28; 62%). Twenty-six cases (58%) are symptomatic. Thirteen cases (29%) are accompanied by other maxillofacial defects. In all cases, the sinus was lined with stratified squamous epithelium. The etiology remains unknown but 3 theories have been put forward: the fusion theory, the merging theory, and the invagination theory. The authors believe that CULS shows homogeneity with cleft lip to some extent and maybe a microform of it. Primary treatment is surgical excision and the prognosis is favorable, with no complications or recurrence.
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Affiliation(s)
- Jiarui Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Liaoning Provincial Key Laboratory of Oral Diseases, China Medical University, Shenyang, China
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Li P, Wang J, Lin L. Congenital Midline Upper Lip Sinus: Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2024:1455613241249052. [PMID: 38646728 DOI: 10.1177/01455613241249052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Congenital midline sinus of the upper lip are rare congenital malformations. We recently identified a case featuring a congenital midline sinus of the upper lip. The punctate opening was positioned at the midline of the philtrum, immediately below the base of the columella. Surgical removal of the sinus tract was conducted through an intraoral approach. Up to now, fewer than 70 cases have been reported. Several postulates, including the fusion theory, merging theory, and invagination theory, have been proposed to explain the formation of the congenital midline sinus of the upper lip. Nevertheless, the etiology of this uncommon abnormality remains unclear. This report details a case of a congenital upper lip sinus presenting as a congenital midline sinus of the upper lip and reviews the current literature on this condition.
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Affiliation(s)
- Peng Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Jingyuan Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Liqiang Lin
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
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Congenital midline upper lip sinuses with intracranial extension - A variant of nasal dermoid? An embryology-based concept. Int J Pediatr Otorhinolaryngol 2023; 164:111394. [PMID: 36459726 DOI: 10.1016/j.ijporl.2022.111394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/30/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The study aimed to present the comparative analysis of midline congenital upper lip sinuses (MCULS) and nasal dermoids (NDs). The clinical similarity of congenital midline pathologies of the midface was interesting subject for further studies. Therefore, histopathological, and embryological background were also analyzed to verify a hypothesis that NDs and MCULSs are the different variants of the same entity. MATERIAL AND METHODS The study group included 27 surgically treated pediatric cases with the congenital midline sinus of the nose (n = 25) or upper lip (n = 2). Seven children presented intraoperatively confirmed intracranial extension of the abnormality, 6 in NDs group and 1 in MCULS group. Apart from clinical characteristics also histopathological results were compared in both groups. An analysis of the literature concerning the proposed theories of origin of NDs as well as the current classification systems of MCULSs and NDs were conducted. RESULTS The analysis revealed that MCULSs present the same clinical characteristics as NDs. No differences were noticed in the histopathological results. The embryological theories presented so far are insufficient to convincingly explain the precise process of origin of abnormalities such as ND and MCULS. Nevertheless, the developmental embryological processes of the midface shed a new light on the common origin of NDs and MCULSs. The proposal of an update of the existing classification of midline congenital midface sinuses was presented. CONCLUSIONS The comparative analysis of clinical, histopathological, and embryological characteristics confirms that NDs and MCULSs are different forms of the same entity. Embryological implications result in the possibility of intracranial extension in each case of MCULS. Therefore, CT and MR imaging which provide irreplaceable information are recommended for all patients with MCULS. The updated classification of midline congenital midface sinuses should be taken into consideration.
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Imura H, Chimedtseren I, Furukawa H, Ito M, Natsume N. Upper lip abscess due to congenital sinus infection: A case report. Congenit Anom (Kyoto) 2022; 62:134-135. [PMID: 35137994 DOI: 10.1111/cga.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hideto Imura
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.,Cleft Lip and Palate Center, Aichi Gakuin University Dental Hospital, Nagoya, Japan.,Division of Speech, Hearing, and Language, Aichi Gakuin University Dental Hospital, Nagoya, Japan
| | - Ichinnorov Chimedtseren
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Hiroo Furukawa
- Cleft Lip and Palate Center, Aichi Gakuin University Dental Hospital, Nagoya, Japan
| | - Masaaki Ito
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.,Cleft Lip and Palate Center, Aichi Gakuin University Dental Hospital, Nagoya, Japan
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.,Cleft Lip and Palate Center, Aichi Gakuin University Dental Hospital, Nagoya, Japan.,Division of Speech, Hearing, and Language, Aichi Gakuin University Dental Hospital, Nagoya, Japan
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Hosokawa T, Takahashi H, Miyasaka Y, Ohira K, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Hosokawa M, Oguma E, Yamada Y. Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3107-3122. [PMID: 31063247 DOI: 10.1002/jum.15016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/01/2019] [Accepted: 04/10/2019] [Indexed: 06/09/2023]
Abstract
A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yusuke Miyasaka
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenji Ohira
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Mayumi Hosokawa
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Chowdhary F, Chowdhary A, Chowdhary Z, Chowdhary A. Midline Congenital Upper Lip Sinus: A Rare Case. Indian J Otolaryngol Head Neck Surg 2019; 71:553-557. [DOI: 10.1007/s12070-018-1399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 11/28/2022] Open
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Hamzan I, Ishak A, Basiron B. Lip pits abscess: Isolated congenital midline upper lip sinus. SANAMED 2019. [DOI: 10.24125/sanamed.v14i1.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Congenital midline upper lip sinuses or fistulas are exceptionally uncommon condition following abnormal fusion of embryologic structures. Here, we report a case of congenital upper lip sinus type I presented as upper vestibular fold abscess in a seven year old boy.
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Salah BI, Al-Rawashdeh B, Al-Ali ZR, Mahseeri M, Al-Zu'bi Z. Congenital midline sinus of the upper lip: A case report and review of literature. Int J Surg Case Rep 2018; 51:41-44. [PMID: 30138869 PMCID: PMC6104629 DOI: 10.1016/j.ijscr.2018.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022] Open
Abstract
Very rare case report, isolated congenital upper lip midline sinus. Surgical excision is curative, no recurrence. Upper lip midline sinus can be associated with syndromes or conditions.
Introduction Congenital pits of the lip are uncommon and may be associated with conditions such as Van der Woude syndrome. Isolated lip pits are extremely rare developmental defects. Presentation of case A 7 year old Caucasian girl presented to plastic surgery clinic in Jordan University academic hospital complaining of an upper lip pit that has been present since birth. It was associated with a single episode of whitish discharge. On examination, an isolated upper lip midline sinus was found. She is otherwise fit and healthy. Surgical excision was curative with good cosmetic outcome. Discussion The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas. A total of 55 cases was found upon reviewing the English literature. No similar cases were reported in Jordan. Different presentations are mentioned in this review. Several embryologic theories are presented. Conclusion Upper lip sinus formations are rare developmental events, and the pathogenesis of these lesions still needs further evaluation. Simple surgical excision is the treatment of choice.
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Affiliation(s)
- Bareqa I Salah
- Jordan University Hospital, Department of General Surgery, P.O. Box 755, Tla-Ali, Jordan.
| | - Baeth Al-Rawashdeh
- Jordan University Hospital, Department of Special Surgery, 11942, P.O. Box 13046, Amman, Jordan.
| | - Zaid R Al-Ali
- Jordan University Hospital, Department of Oral and Maxillofacial Surgery, Jordan.
| | - Mohamad Mahseeri
- Jordan University Hospital, Department of General Surgery, Jordan.
| | - Zayed Al-Zu'bi
- Jordan University Hospital, Department of Oral and Maxillofacial Surgery, Jordan.
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Kün-Darbois JD, Chatellier A, Paré A, Caillot A, Ambroise B, Bénateau H, Veyssière A. Congenital Midline Upper Lip Sinuses. Cleft Palate Craniofac J 2017; 55:292-295. [DOI: 10.1177/1055665617723635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital sinuses of the upper lip are rare congenital malformations. There have been only 40 cases described in the literature. We report 3 cases of congenital midline upper lip sinus in Caucasian children. Two of those lesions were associated with other anomalies (complete cleft palate and hemifacial macrosomia or submucous cleft palate with bifid uvula). The pathophysiology remains unexplained yet. Congenital upper lip sinuses can be considered as possible microforms of cleft-lips. Associated anomalies are frequent and must be sought. The treatment is a full excision of the sinus tract and of the skin around the punctum in order to avoid risks of recurrence.
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Affiliation(s)
- Jean-Daniel Kün-Darbois
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
- GEROM research unit, Angers, University Hospital, Angers, France
| | - Anne Chatellier
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
| | - Arnaud Paré
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Tours, France
| | - Aude Caillot
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
| | - Béatrice Ambroise
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
| | - Hervé Bénateau
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
- Maxillo-facial surgery, Medecine faculty of Caen, University of Caen Basse-Normandie, Caen, France
| | - Alexis Veyssière
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France
- Laboratory EA 4652 Microenvironnement Cellulaire et Pathologies, BioconnecT team, Medecine faculty of Caen, University of Caen Basse-Normandie, Caen, France
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Isolated Congenital Midline Upper Lip Sinus in A 5-year Old Child: A Rarity. Indian J Otolaryngol Head Neck Surg 2017; 69:568-570. [DOI: 10.1007/s12070-016-1044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022] Open
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Rullo R, Addabbo F, Femiano F, Di Domenico M, Rullo F, Festa VM. Congenital midline fistula of the upper lip: Embryological aspects of a rare malformation. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
A congenital lip sinus is a rare condition that has been reported to occur in both the upper and lower lips, either in isolation or in association with congenital deformities such as a cleft lip and palate in Van der Woude syndrome. The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas, but no similar cases have been described in Singapore. We herein report a case of congenital upper lip sinus presenting as a recurring upper lip abscess and review the current literature on this condition.
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Affiliation(s)
- Denise Fok
- Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Ee Hsiang Jonah Kua
- Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | - Yong Chen Por
- Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
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