RESUMO
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.
Assuntos
Neoplasias Labiais/cirurgia , Carcinoma de Células Escamosas/cirurgia , Queilite/cirurgiaRESUMO
BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and W-plasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.
Assuntos
Queilite/cirurgia , Cicatriz/cirurgia , Lábio/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Fatores Etários , Idoso , Carcinoma de Células Escamosas/prevenção & controle , Distribuição de Qui-Quadrado , Feminino , Humanos , Neoplasias Labiais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Lesões Pré-Cancerosas/prevenção & controle , Fatores de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
FUNDAMENTO: A queilite actínica crônica é a ceratose actínica localizada no vermelhão labial. O tratamento é de crucial importância, devido ao potencial de transformação maligna. OBJETIVO: Avaliar os resultados estéticos e funcionais das vermelhectomias clássica e em W-plastia na queilite actínica. Na técnica clássica, a cicatriz é linear; na W-plastia, em linha quebrada. MÉTODOS: Foram tratados 32 pacientes com diagnóstico clínico e histopatológico de queilite actínica. Quinze deles foram submetidos à técnica em W-plastia e 17, à técnica clássica. Avaliaram-se parâmetros como retração cicatricial e alterações funcionais. RESULTADOS: Houve associação estatisticamente significativa entre a técnica utilizada e a presença de retração cicatricial, sendo a associação positiva com a clássica (p=0,01 com correção de Yates). O risco relativo (odds ratio - OR) calculado foi de 11,25, ou seja, houve maior chance de retração nos pacientes submetidos à técnica clássica. Nenhuma das técnicas apresentou alterações funcionais. Avaliaram-se complicações pós-operatórias como presença de crostas, lábios secos, parestesia e deiscência de sutura. Não houve associação estatisticamente significante entre as complicações e a técnica utilizada (p=0,69). CONCLUSÃO: Concluiu-se que a vermelhectomia em W-plastia oferece melhores resultados estéticos e índices de complicações semelhantes.
BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and Wplasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Queilite/cirurgia , Cicatriz/cirurgia , Lábio/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Fatores Etários , Distribuição de Qui-Quadrado , Carcinoma de Células Escamosas/prevenção & controle , Neoplasias Labiais/prevenção & controle , Complicações Pós-Operatórias , Lesões Pré-Cancerosas/prevenção & controle , Fatores de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
A queilite actínica é uma alteração dos lábios causada pela exposição crônica aos raios solares ultravioleta. É comum em indivíduos idosos de pele clara e que mantêm hábitos ocupacionais ou de lazer ao ar livre, expondo-se à radiação actínica. Este trabalho comenta as características clínicas e a relação com os achados microscópicos, assim como o diagnóstico e formas de tratamento da queilose actínica. É ressaltada a importância de sua detecção precoce, da instituição de medidas preventivas e do controle clínico dos pacientes visando evitar o desenvolvimento do câncer de lábio inferior. O presente estudo buscou demonstrar um caso clínico de queilose actínica no qual serão observadas fotos de todo o tratamento, desde sua detecção clínica (observação da lesão difusa, em placa, com bordos levemente eritematosos e pequenos pontos de solução de continuidade), comprovação histopatológica através de biópsia incisional, etapas cirúrgicas até o pós-operatório de 3 meses, observando-se cicatrização total e ausência da lesão pré-existente. Logo, torna-se de grande importância o conhecimento deste tipo de lesão já que seu alto potencial de malignização para carcinoma de células escamosas apresenta grande risco à saúde geral do paciente, levando-o a posteriores mutilações ou até mesmo ao óbito por metástase, caso haja a instalação e progressão do carcinoma epidermóide.
Actinic cheilitis is a change in the lips caused by chronic exposure to ultraviolet sun rays. It is common in older, fair skin individuals who work outdoors or have outdoor leisure activities and are constantly exposed to actinic radiation. This work discusses the clinical characteristics and their relationship with the microscopic findings, as well as diagnosis and treatment options for actinic cheilitis. The importance of early detection, implementation of preventive measures and clinical control of the patients to avoid lower lip cancer is emphasized. The present study presents a clinical case of actinic cheilitis with pictures taken during the entire treatment, including clinical detection (diffuse lesion, in plaque, with slightly erythematous borders and some loss of the sharp border between lip and skin), histopathological confirmation by incisional biopsy, surgical stages and 3 months after surgery, showing complete healing and absence of the preexisting lesion. This, knowledge of this type of lesion is critical because of its potential to develop into squamous cell carcinoma, which would represent a great risk for the general health of the patient who would later need to be mutilated or even die due to metastases if carcinoma develops and progresses.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Queilite/cirurgia , Queilite/diagnósticoRESUMO
BACKGROUND: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation. METHODS: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere. RESULTS: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures. CONCLUSIONS: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.
Assuntos
Materiais Biocompatíveis/efeitos adversos , Reação a Corpo Estranho/etiologia , Granuloma de Corpo Estranho/etiologia , Polimetil Metacrilato/efeitos adversos , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Ritidoplastia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Materiais Biocompatíveis/administração & dosagem , Brasil , Queilite/epidemiologia , Queilite/etiologia , Queilite/cirurgia , Doença Crônica , Estudos Transversais , Feminino , Reação a Corpo Estranho/epidemiologia , Reação a Corpo Estranho/cirurgia , Granuloma de Corpo Estranho/epidemiologia , Granuloma de Corpo Estranho/cirurgia , Humanos , Injeções Intradérmicas , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/cirurgiaRESUMO
PURPOSE: The purpose of this study was to analyze the clinical and histological features of actinic cheilitis (AC). PATIENTS AND METHODS: A total of 29 patients with AC were clinically evaluated, and incisional biopsies were performed to confirm the clinical diagnosis. Histological features were analyzed, and dysplasia was classified as mild, moderate, or severe. The chi(2) test was used for the following variables: gender, age, race, and smoking habits. The degree of dysplasia was related to these variables (Fisher's test) to test for independence between them (P < .05). RESULTS: Of the patient group, 72.41% were male, 75.86% were over age 40 years, 93.10% were white, and 72.41% were nonsmokers. Clinically, all patients presented with multifocal lesions. The following manifestations were seen: dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor. Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia were found in the epithelial tissue; elastosis, inflammatory infiltrate, and vasodilatation were found in the connective tissue. Dysplasia was mild in 10.34% of the patients, moderate in 27.59%, and severe in 62.07%. Absence of sample homogeneity was observed in regard to gender, age, race, and smoking habits. It was not possible to reject the hypothesis of independence between mild, moderate, or severe dysplasia and gender, age, race, and smoking habits. CONCLUSIONS: Dryness, atrophy, and scaly lesions were the most common clinical findings observed. Dysplasia, inflammatory infiltrate, and vasodilatation, as well as elastosis, were the most common histological findings observed. Gender, age, race, or smoking habits were not related to the degree of dysplasia in the sample.
Assuntos
Queilite/patologia , Transtornos de Fotossensibilidade/patologia , Adulto , Fatores Etários , Queilite/etiologia , Queilite/cirurgia , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Masculino , Transtornos de Fotossensibilidade/etiologia , Transtornos de Fotossensibilidade/cirurgia , Grupos Raciais , Estudos Retrospectivos , Fatores Sexuais , Fumar/efeitos adversosRESUMO
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.
Assuntos
Humanos , Masculino , Adulto , Lábio/patologia , Neoplasias Labiais/cirurgia , Queilite/cirurgiaRESUMO
Vinte casos de queilite actínica com alterações clínicas difusas foram inicialmente submetidos a uma biopsia e posteriormente `a vermelhonectomia. As peças cirúrgicas foram secionadas a cada 3 mm e os achados histopatológicos da biopsia foram comparados aos dos cortes seriados. As alterações epiteliais não ocorreram uniformemente ao longo do vermelhão; a biopsia freqüentemente não representou a área de maior gravidade histológica. Foram detectados focos de carcinoma superficialmente invasivo em áreas descontínuas ao longo do vermelhão em 4 casos. Os achados sugerem que casos de queilite actínica com alterações clínicas difusas possam se tratar de casos mais graves à histopatologia. / Twenty cases of actinic cheilitis with diffuse clinical changes were initially biopsied; a vermilionectomy was then performed. Surgical specimens were sectioned every 3mm; histopathological findings from biopsies were compared with the sections from vermilionectomies. Epithelial changes were not uniform along the vermilion; biopsies did not reveal the most severe area in many cases. Foci of non-continuous areas of superficially invasive carcinoma were detected in 4 cases. These findings suggest that cases of actinic cheilitis presenting with diffuse and poorly demarcated clinical lesions...
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Lábio/patologia , Neoplasias Labiais/diagnóstico , Queilite/diagnóstico , Biópsia , Diagnóstico Diferencial , Queilite/cirurgia , Queilite/patologiaRESUMO
BACKGROUND: Cryosurgery is a therapeutical method successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity. METHODS: Liquid nitrogen spray or cryoprobe have been used alone or associated with other surgical methods in various types of oral lesions, such as pyogenic granuloma, angioma, actinic cheilitis, keratoacantoma, fibroma, HPV lesions in HIV and non-HIV patients, hypertrophic lichen planus, leukoplakia and erythroplakia, verrucous carcinoma, mucous cysts, and papillary hyperplasia of the palate, among others. RESULTS: Our experience and the literature have shown that cryosurgery is a very useful technique for treatment of oral lesions. The oral mucosa, because of its characteristics of humidity and smoothness, is an ideal site for this technique. It shows a very good esthetic result and it may be either the first choice or an alternative option to conventional surgery. CONCLUSIONS: Cryosurgery is a very safe, easy to perform, and relatively inexpensive technique for treating various oral lesions in an out-patient clinic.
Assuntos
Criocirurgia/métodos , Doenças da Boca/cirurgia , Queilite/cirurgia , Humanos , Ceratoacantoma/cirurgia , Doenças Labiais/cirurgia , Mucosa Bucal/cirurgiaRESUMO
Os autores estudam uma anomalia de desenvolvimento - leptoqueilia ou lábios finos - de apariçäo pouco frequente, mas que coercitivamente leva as suas portadoras, jovens ou näo, a procurarem os cirurgiöes plásticos para a sua correçäo. Atribuem a anomalia ao desenvolvimento insuficiente da borda vermelha do lábio superior. Justificam a denominaçäo "bardotizaçäo" e indicam o tratamento, bastante simples - excisäo de fuso cutâneo adjacente ao limite mucocutâneo do lábio superior