Upper lip fistulas: three new cases

Rare Congenital Upper Lip Pit

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.

Congenital Upper Lip Sinus

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.

Congenital Midline Upper Lip Sinus: Case Report and Review of the Literature

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.

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients

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.

Congenital midline sinus of the upper lip: A case report and review of literature

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Very rare case report, isolated congenital upper lip midline sinus.

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Surgical excision is curative, no recurrence.

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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.

Congenital Midline Upper Lip Sinuses

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.

Median philtrum sinus: a rare presentation and review of management options

Nasal dermoids are rare congenital abnormalities, and there is only one previously reported case of a philtrum sinus tract extending to the skull base. A 2-month-old boy was presented with an incidental finding of a median philtrum sinus with no infective features and no other abnormal clinical findings. MRI demonstrated a sinus tract extending from the philtrum to the crista galli. On multidisciplinary review, a conservative approach was taken due to the asymptomatic nature of the patient. Given the rarity of nasal dermoids, diagnosis requires precise clinical examination and MRI to identify the extent of the tract. Management options require a multidisciplinary case-specific approach and include non-surgical as well as surgical approaches.

Congenital Midline Sinus of the Upper Lip

An extremely rare patient of congenital midline sinus of the upper lip in a 2-year-old boy is presented. The sinus was located on the midline of the philtrum just below the base of the columella. Surgical removal of the sinus was performed via an extra- and inraoral approach. Histopathological examination of the resected sinus revealed it to be lined by keratinized stratified squamous epithelium with sebaceous glands and hair follicles. Three postulates can account for the formation of the congenital midline sinus of the upper lip: the fusion theory, the merging theory, and the invagination theory. However, the etiology of this rare abnormality remains obscure.

Congenital midline sinus of the upper lip

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.

Classification of Congenital Midline Upper Lip Sinuses: A Case Report and Review of the Literature

Background

We recently encountered a case of a midline upper lip sinus, one of the rarest congenital lip sinuses. Several embryological hypotheses have been proposed regarding the etiology of this rare disease, but it remains obscure.

Methods

We reviewed all cases of upper lip sinus reported in the English language through 2011, and classified them into three types according to accompanying anomalies and the site of the fistula.

Results

Twenty-eight studies involving 31 cases were reviewed and classified. A type I sinus was a midline sinus without accompanying anomalies. There were 13 such cases, with a female predilection. Type II sinuses were midline sinuses with accompanying anomalies, and there were nine such cases. Type III sinuses were lateral sinuses with or without accompanying anomalies; there were nine cases.

Conclusions

Our classification scheme is not only convenient for clinical application, but also reflects the embryological process responsible for congenital lip sinuses.

A case of congenital midline fistula of the upper lip

Congenital fistulas of the lip are commonly found in the lower lip and accompany cleft lip. They are seen as a symptom of Van der Woude syndrome, which is predominantly hereditary. In contrast, congenital fistulas of the upper lip are rare. A number of hypotheses have been proposed to explain the pathogenesis of fistulas of the upper lip, including fusion failure of facial prominences and absence of mesoblasts, suggesting a relationship between this condition and the development of cleft lip. The pathogenesis of this disorder has been attracting attention. We report the case of a 5-year-old girl with congenital fistula of the upper lip.

Congenital isolated midline sinus of the upper lip: clinical and embryological approaches

OBJECTIVES

Congenital sinuses or fistulas of the lip are uncommon malformations, yet true medial upper-lip fistulas (MULFs) are extremely rare. We present a new case of congenital upper-lip fistula located in the midline of the philtrum of an 8-month-old girl.

INTERVENTION

Complete surgical removal was performed with a combined extra- and intraoral approach. Histological examination revealed that the fistula was lined by squamous epithelium with sebaceous and mucous glands and hair follicles.

RESULTS

Several embryological hypotheses have been proposed concerning these anomalies. This article reexamines and discusses major embryological theories on pathogenesis of sinuses or fistulas of the upper lip. We propose that early ectodermal inclusion events may occur in the medial fusion area during formation of the intermaxillary process. This embryological approach is highly concordant with our recent hypothesis on nasal dermoid sinus cysts (NDSCs) pathogenesis, in which we proposed an embryological hypothesis with early ectodermal inclusion phenomenon in the midline suture area to explain NDSCs pathogenesis.

CONCLUSIONS

Common early ectodermal inclusion phenomena could be involved in both NDSCs and MULFs pathogenesis.

The developmental relationship between the deciduous dentition and the oral vestibule in human embryos

In humans, there is no consensus about the developmental relationship between the deciduous dentition and the oral vestibule separating the teeth from the lips and cheeks. The classical concept assumes that two horseshoe-shaped epithelial structures exist: the dental lamina, giving rise to single tooth primordia, and the vestibular lamina running parallel and externally to it, giving rise to the oral vestibule. The aim of this study was to investigate the development of the dental and vestibular laminae in the upper jaw and to determine their developmental relationship in humans from embryonic week 6 to 9. Although a thickening of the vestibular epithelium was always present on serial histological sections, computer-aided three-dimensional reconstructions did not show any continuous vestibular lamina. Several discontinuous epithelial structures (bulges and ridges) occurred transiently at different stages of oral vestibule development. Along the mesiodistal axis, the dental and vestibular epithelia were regionalized in parallel: in the incisive, canine, and 1st and 2nd molar regions. The vestibular ridges fused with the dental lamina distally to the deciduous canine, 1st molar and 2nd molar. These interactions between the developing teeth and vestibular structures are reminiscent of the situation in some reptiles, where single teeth are paired one-to-one with single tooth glands.