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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 33  |  Issue : 2  |  Page : 142-144

Mucosal reduction for the correction of congenital maxillary double lip


Department of General Surgery, Reconstructive and Plastic Surgery Division, Faculty of Medicine, Al-Azher University Hospital, Damietta, Egypt

Date of Submission09-Mar-2016
Date of Acceptance17-May-2016
Date of Web Publication1-Mar-2017

Correspondence Address:
Ahmed S Hassen
Algawashina, Diarb Nigm, Sharkia, 055
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-208X.201284

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  Abstract 

Congenital double lip is rare and usually involves the upper lip. Apart from a deformity that interferes with speech and mastication, operation may also be indicated for cosmetic reasons. The purpose of this study was to evaluate the results of the operative treatment of congenital maxillary double lip during the period from July 2008 to October 2010. All patients were treated surgically in our hospital. We used an elliptical excision of the mucosal excess. The results were esthetically satisfactory.

Keywords: congenital anomaly, double lip, aesthetic


How to cite this article:
Hassen AS. Mucosal reduction for the correction of congenital maxillary double lip. Benha Med J 2016;33:142-4

How to cite this URL:
Hassen AS. Mucosal reduction for the correction of congenital maxillary double lip. Benha Med J [serial online] 2016 [cited 2021 Dec 5];33:142-4. Available from: http://www.bmfj.eg.net/text.asp?2016/33/2/142/201284


  Introduction Top


Congenital double lip is rare and generally involves the upper lip [1]. A double vermilion with a transverse furrow between the two borders appears when the orbicularis oris muscle contracts during a smile. Double lip occurs most often bilaterally ([Figure 1]a and [Figure 2] [Figure 1] and [Figure 2]) on the upper lip but may be unilateral and can affect both upper and lower lips [2]. Typical appearance of lip is seen when the lip is tensed during smiling. It consists of a fold of excess or redundant tissue on the mucosal side of the lip [3]. Congenital double lip is a developmental anomaly. During fetal development the upper lip mucosa consists of two transverse zones: an outer zone, which is smooth and similar to the skin, and the inner zone, which is villous and similar to the oral mucosa. The furrow dividing the double lip represents an exaggerated boundary line between the two zones. In the double lip, the buccal villous part becomes hypertrophic. In some patients the midline constriction is characterized by its ‘cupid bow’ appearance or constriction ([Figure 1]a and [Figure 2]a [Figure 1] and [Figure 2]); in other cases, the central constriction ([Figure 3]) is apparently due to the attachment of the upper frenulum [2],[4]. Usually, double lip is present at birth but it becomes more prominent after the eruption of permanent dentition [5].
Figure 1 A 21-year-old man with the deformity of congenital double lip. Note the excess of mucosa in the upper lip. (a) Preoperative view. (b) Postoperative view.

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Figure 2 A 21-year-old man with the deformity of congenital double lip. Note the excess of mucosa in the upper lip. (a) Preoperative view. (b) Postoperative view.

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Figure 3 A 68-year-old man with the deformity of congenital double lip. Note the excess of mucosa in the upper lip with a typical midline constriction.

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  Patients and methods Top


Between July 2008 and October 2010, 10 patients – nine males and one female – were enrolled for this study ([Figure 4]a). All patients were thoroughly assessed for their general physical status (hematological assessment) and mental development.
Figure 4 A 18-year-old female with the deformity of congenital double lip. Note the excess of mucosa in the upper lip. (a) Intraoperative view. (b) Early postoperative view.

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Operative interferences were done under local anesthesia. Bilateral infraorbital blocks were administered for all patients except in the case of the female patient, in which general anesthesia was used. The accessory labial tissue was marked and excised by transverse elliptical incision from one commissure to another ([Figure 5]). The primary closure of the wound was carried out using a 4–0 vicryl suture, and then a light-pressure dressing was placed over the upper lip for the first 24 h. Then, the patients were reviewed after 1 week for suture removal, and then after 3 months.
Figure 5 Showing excision of the redundant tissue of the upper lip.

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No postoperative complications were encountered, and the results were esthetically satisfactory.

Histopathology of the specimen showed normal labial mucosa. The connective tissue revealed minor mucosal glands and bands of skeletal muscles.


  Results Top


Postoperative results are presented in [Figure 1]b, [Figure 2]b, and [Figure 4]b [Figure 1], [Figure 2], and [Figure 4]. Patients were followed up for 2 years, and no surgical complications or recurrences occurred.


  Discussion Top


The treatment of congenital double lip is indicated for esthetic concern as in our study or when excess tissue interferes with mastication or speech or leads to habits such as sucking or biting the redundant tissue [6].

In their study on congenital double chin, Palma and Taub [5] reported a higher male incidence, with a male to female ratio of 7: 1, but in our study the ratio was 9: 1.

We reported 10 cases of double upper lip in which only six patients presented with a central constriction. In their study, Eski et al.[7] reported five cases of double upper lip in which only one patient presented with a central constriction.

Various operations to correct a double lip have been described in the literature. Guerrero-Santos and Altamirano [8] described the use of a W-plasty, electrosurgical excision [9], and triangular excision [10]. Simple excision through an elliptical incision was advocated by Reddy and Roa [11]. In patients with a short central constriction band as in our study, the use of two elliptical incisions combined with a vertical Z-plasty results in a satisfactory appearance of the upper lip with a natural-looking tubercle. The upper lip may be present with central constriction due to attachment of the upper labial frenulum, which was the case in our study, but cases without central constriction have also been reported [7]. In a study, the double lip was corrected surgically through a transverse elliptical incision [12].

Similar to the study by Mago [13], treatment can either be carried out under general or local anesthesia, but in our study treatment was carried out under local anesthesia. In our study, the local anesthetic was infiltrated through the infraorbital route to prevent distortion of the tissues, but in a study by Bhatia [12], the local anesthetic was infiltrated through the boundary of the lesion.


  Conclusion Top


Congenital double lip is a rare oral anomaly. Surgical treatment is indicated when the excess tissue interferes with mastication or speech, or more often for esthetic reasons. The results are generally very good and complications extremely rare.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Alkan A, Metin M. Maxillary double lip: report of two cases. J Oral Sci 2001; 43:69–72.  Back to cited text no. 1
    
2.
Barnett ML, Bosshardt LL, Morgan AF. Double lip and double lip with blepharochalasis (Ascher's syndrome). Oral Surg Oral Med Oral Pathol 1972; 34:727–733.  Back to cited text no. 2
    
3.
Kara CO, Kara IG. Double lip. Internet J Plast Surg 2001; 1:X–X.  Back to cited text no. 3
    
4.
Kara CO. Two cases with rare anomaly of upper lip: congenital double lip. Kulak Burun Bogaz Ihtis Derg 1999; 6:234–236.  Back to cited text no. 4
    
5.
Palma MC, Taub DI. Recurrent double lip: literature review and report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:e20–e23.  Back to cited text no. 5
    
6.
Bakshi PS, Jindal NL, Kaushik A, Leekha S. An appraisal of congenital maxillary double lip with a case report. Saudi J Oral Sci 2015; 2:35–38.  Back to cited text no. 6
  Medknow Journal  
7.
2007; Eski M, Nisanci M, Aktas A, Sengezer M. Br J Oral Maxillofac Surg. 45:68–70.  Back to cited text no. 7
    
8.
Guerrero-Santos J, Altamirano JT. The use of W-plasty for the correction of double lip deformity. Plast Reconstr Surg 1967; 39:478–481.  Back to cited text no. 8
    
9.
Peterson A. Electrosurgical correction of maxillary double lip. Dent Dig 1972; 78:182–188.  Back to cited text no. 9
    
10.
Lamster IB. Mucosal reduction for correction of a maxillary double lip. Report of a case. Oral Surg Oral Med Oral Pathol 1983; 55:457–458.  Back to cited text no. 10
    
11.
Reddy KA, Roa AK. Congenital double lip: a review of seven cases. Plast Reconstr Surg 1989; 84:420–423.  Back to cited text no. 11
    
12.
Bhatia V. Unilateral maxillary double lip. A rare case report. Adv Med Dent Sci Res 2014; 2:89–92.  Back to cited text no. 12
    
13.
Mago V. Congenital double lip. Ind J Med Case Rep 2012; 1:13–14.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Abstract
Introduction
Patients and methods
Results
Discussion
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