Authors: Santosh Patil(Senior Lecturer), Dr. Nitin Kalla ,Dept. of oral medicine and radiology, Jodhpur Dental College, Jodhpur National University, Jodhpur, India INTRODUCTION

Lips are not only the site of a variety of local lesions, but they also reflect the presence of a number of systemic diseases. Because the dentist will most often be the first person to observe these conditions, it is essential that he or she should be familiar with their diagnosis. This is particularly important because some of these conditions can have serious consequences, and the prognosis is greatly improved by early recognition and treatment. Swelling of the upper lip can result from various diseases such as salivary tumors, infectious and inflammatory diseases, hemangoimas, arteriovenous malformations and cysts1. Along with these causes, trauma and iatrogenic injuries can also lead to lip swelling. The aim of this article is to report a case of young girl who reported with a lip swelling secondary to an unusual cause.

CASE HISTORY

An eighteen year girl reported with a chief complaint of swelling over the upper lip since two years. The swelling was associated with dull aching, localized, intermittent pain. There was no history of discharge from the swelling, or regression of the swelling. Patient gave history of trauma to that region during her childhood days which led to exfoliation of a deciduous incisor from that site. Extaoral examination revealed a diffuse swelling over the left side of upper lip which was firm, non-tender and non-pulsatile on palpation (Figure1) . Intraorally a solitary well defined swelling seen over the upper labial mucosa extending to the maxillary facial gingiva in the region of missing maxillary left central incisor causing obliteration of the vestibule, the color of the swelling was same as that of adjacent mucosa (Figure2) . On palpation the swelling was soft superficially and hard in the deeper side.
Intraoral periapical and maxillary occlusal radiograph revealed deformed crown and root of maxillary left central incisor with no other findings (Figure3, 4).
Surgically the swelling was explored and found that maxillary left central incisor was displaced labially (Figure5). The tooth was extracted and patient was planned for fixed prosthesis.















DISCUSSION

In the above reported case, because of trauma in the younger age to the patient there was exfoliation of deciduous central incisor .As a result of this there was injury to the developing permanent central incisor leading to its malformation and it was displaced labially perforating the upper lip causing a hematoma.
The various differential diagnoses to be considered are mucocele, ranula, benign or malignant salivary gland neoplasms, oral hemangiomas. Mucocele may be occasionally seen on the lips, they appear as dome shaped swelling, which has bluish fluid filled appearance when located superficially and they appear normal in color when deeply located. A history of paroxysmal swelling and collapse is common, which was absent in our case2. Scolozzi et al reported a rare case of a large dentigerous cyst associated with an impacted mesiodens in a 42-year-old male who presented with a slow-growing swelling in the upper lip1. Five percent of minor salivary gland tumors are reported to occur in the upper lip, so these tumors should also be considered in the differential diagnosis of the swelling of upper lip. These tumors appear as soft or firm masses which may later ulcerate. Most of minor salivary gland tumors grow slowly and often exist for years before treatment is sought. Seventy five percent of canalicular adenomas are thought to occur in upper lip, and the majority of these lesions are seen near midline3.   Minicucci et al reported a case of basal cell adenoma from labial salivary gland origin in a Caucasian woman which presented as painless slow growing swelling in the upper lip. The case was diagnosed by means of histopathological evaluation and confirmed by immunohistochemistry4. Similiar case of basal cell adenomatosis affecting the upper lip in a seventy one year old male patient was reported by Mair et al5. A case of Mucinous cystadenocarcinoma arising from a minor salivary gland in the upper lip of an eighty year old patient was reported by Aydin et al6.
Hemangiomas are the most common benign tumors of infancy7. The incidence of hemangiomas at birth has been reported to be 1-2.6%, rising to 10- 12% by the first year of age. 80% of hemangiomas are noted in the first month of life8. Sixty percent of all hemangiomas are located on the head and neck area. These Lesions are soft, nonfluctuant, dome shaped and bluish in color and will blanch on pressure9. The swelling noted in our patient was fluctuant and was non blanching, so hemangioma was ruled out.

CONCLUSION

Although it is rare in routine practice to see a malformed tooth causing a swelling in upper lip because of altered eruption path, the dentist should keep in mind about this possibility when examining a case of upper lip swelling.

REFERENCES

1. Scolozzi P, Lombard T, Richter M. Upper lip swelling caused by a large dentigerous cyst. Eur Arch Otorhinolaryngol 2005; 262: 246–249.
2. Gupta B, Anegundi R, Sudha P, Gupta M. Mucocele: Two Case Reports. J Oral Health Comm Dent 2007; 1(3):56-58.
3. Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions. In: Lesions of the lips. 5th ed.Mosby; 1997. Pp 574-575.
4. Minicucci EM, Campos E, Weber S, Domingues M, Ribeiro D. Basal Cell Adenoma of the Upper Lip from Minor Salivary Gland Origin. Eur J Dent. 2008; 2: 213–216.
5. Mair WS, Stalsberg H. Basal cell adenomatosis of minor salivary glands of the upper lip. Arch Otorhinolaryngol 1988; 245(3):191-195.
6. Aydın E, Turkoglu S, Ozen O, Akkuzu B. Mucinous cystadenocarcinoma of a minor salivary gland in the upper lip: Case report. Auris Nasus Larynx2009; 32(3):301-304.
7. Daley T. Acquired Tufted Angioma of the Lower Lip Mucosa. J Can Dent Assoc 2000; 66:137.
8. Magee WP, Ajkay N, Rosenblum RS. Surgical Treatment of Lip Hemangiomas. Int Pediatr. 2003; 18(1):49-54.
9. Seltzer A. Cavernous Hemangioma of the Lip. Arch Otolaryngol. 1960; 72(3):363-365.