Morsicatio buccarum, morsicatio labiorum, cheek and lip biting, linea alba

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Cheek and lip biting (K13.1)

Gastroenterology, Dentistry

general information

Short description

- a kind of self-induced chronic mechanical injury of the mucous membrane of the cheeks and lips, which occurs when exposed to teeth and / or prostheses due to many reasons.

Notes

Other gingival and edentulous alveolar margins - K06.-

Stomatitis and related lesions - K12.-

Diseases of the tongue - K14.-

If necessary, the following codes can be used to clarify the cause:
- Mental and behavioral disorders due to alcohol use - F10.-

Mental and behavioral disorders due to tobacco use - F17.-

Other codes indicating alcohol consumption, tobacco use or contact (tobacco smoke)
- Neurotic disorder, unspecified - F48.9

Reaction to severe stress and adjustment disorders - F43.-

Classification

There is no single classification.
It is recommended to use general clinical description parameters, including localization, prevalence, number, size and shape of pathomorphological changes, as well as the phase of the course of the disease (exacerbation, remission) and the presence of complications.

Etiology and pathogenesis

Cheek biting
Most common causes:
- anatomical and morphological features of the structure of the dentition (malocclusion - teeth located outside the dentition; expansion of the upper and lower dental arches, buccal or lingual crossbite);

Sharp mounds of chewing teeth;

Sharp edges of carious and decayed teeth;

Poorly placed fillings;

Improperly made prostheses;

A bad habit that manifests itself with nervous tension;
- mental disorders (the question of defining such disorders as obsessive-compulsive is being discussed);
- hereditary sensory and autonomic neuropathy (Riley-Day syndrome Riley-Day syndrome - a hereditary syndrome: a combination of hypersalivation, reduced tearing, erythema, mental lability, hyporeflexia and reduced pain sensitivity; inherited in an autosomal recessive manner
);

Deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (Lesch-Nyhan syndrome Hyperuricemia (syn. Lesch-Nyhan syndrome) is a hereditary metabolic disease caused by a deficiency of the enzyme hypoxanthine phosphoribosyltransferase (EC 2.4.2.8), manifested by mental retardation, choreoathetosis, attacks of aggressive behavior with self-harm, high levels of uric acid in the urine. Inherited in an autosomal recessive manner
).

lip biting
Additional reasons to the reasons given for cheek biting:
- orthodontic pathology (malocclusion): protrusion Protrusion (in dentistry) - 1) Protrusion of the lower jaw; 2) Anomaly of bite, characterized by the location of part of the teeth in front of the rest
anterior teeth, mesial bite Mesial bite - an anomaly characterized by the anterior position of the lower jaw
, distal bite Prognathic bite (syn. distal bite) - a bite in which the incisors and canines of the upper jaw are located in front of the corresponding teeth of the lower jaw
;

Overhanging edges of seals;

Elements of orthopedic structures.

The process of biting is similar to the formation of callus on the skin and refers to the so-called "oral keratoses". Constant mechanical irritation stimulates the production of an excessive amount of keratin, with a subsequent change in the thickness and color of the affected mucosal area.
Histology reveals uneven hyperplasia of the epithelium with foci of proliferation of epithelial cells in the upper layer with focal para- and hyperkeratosis and basophilic infiltration of the surface layer of the epithelium.
Microscopy and bacteriological examination reveal various microorganisms (mainly staphylococcus, streptococcus, much less often candida).

Epidemiology

Age: mostly adult

Prevalence: Very common

Sex ratio (m/f): 0.5

The incidence among women is approximately twice that of men.
Approximately 60-75% of patients are over 35 years of age.
In general, prevalence varies significantly by geography and averages 2.2-5.5% in the adult population, although individual population studies reveal a prevalence of 0.8-1.8% (USA) to 7-8% (Spain, India ).

Factors and risk groups

Risk groups correspond to the etiology and include:
- malocclusion;
- dental prosthetics;
- caries;
- treatment (filling) of teeth;
- piercing.

Clinical picture

Clinical Criteria for Diagnosis

Change in psychological status; malocclusion; the presence of seals; the presence of prostheses; pain; burning; discomfort; White spots; white stripes; white scales; symmetrical lesion; desquamation of the mucosa; swelling of the lips; swelling of the cheeks; roughness of the lesion; minor erosions of the mucosa

Symptoms, course

Anamnesis. When biting the cheeks and lips in the anamnesis, there is evidence of the corresponding habit. There is a connection with manipulations in the oral cavity, prosthetics, for infants - with increased, difficult sucking.
Lip biting may be a habit that relieves the discomfort of temporomandibular disorder or glossodynia. Glossodynia - paresthesia in the form of sensations of burning, tingling, itching in the tongue and a feeling of dryness in the mouth; observed in diseases of the gastrointestinal tract, some lesions of the nervous system, etc.
.

Complaints. Most patients may not present any complaints. Patients with aggressive cheek and lip biting may complain of pain, burning, or swelling.
Patients may note sensations of thickening or roughness of the lesion. Desquamation of the mucosa from the affected areas causes some patients to often spit, teeth or tongue mechanically remove fragments of the altered mucosa.

On examination of the oral cavity, an inflamed mucous membrane with an uneven surface is revealed. The affected area looks like a spot or plaque with torn, shaggy edges. Sometimes small superficial erosions are noted on the mucosa, alternating with white scales. Most often, such changes are characteristic of the mucosa along the line of closing of the teeth (the so-called "linea alba").
Examination of the lips reveals edematous and hyperemic mucosa, and the lower lip suffers more often. The lesions are usually symmetrical.

Diagnose the presence of hyperkeratosis Hyperkeratosis - excessive thickening of the stratum corneum of the epidermis
allows the absence of changes in the lesion when wiping it with a dry sterile cloth.

A number of patients have changes in psychological status.

Diagnostics

Cheek and lip biting is usually diagnosed clinically.

1. Biopsy indicated in atypical cases, as well as in cases resistant to ongoing therapy for more than 1-3 weeks.
When processing a biopsy, it is mandatory to use PAS (in order to detect fungal infections).
The most acceptable is the collection of a biopsy by excision of the tissue. Brush biopsy and exfoliative biopsy are not adequate methods.

2. For differential diagnosis, some optical devices can be used that allow you to examine and photograph the mucous membrane with high magnification. These devices use various principles preliminary diagnosis of cancerous and other lesions of the oral mucosa. Often, the mucosal area requires pre-treatment with some reagents (for example, acetic acid).

Laboratory diagnostics

There are no specific tests to confirm or refute the diagnosis.
Bacteriological examination of the mucosa is useful due to the high degree of colonization of the damaged mucosa by staphylococcus, streptococcus and candida.

Differential Diagnosis

Cheek and lip biting is differentiated with the following diseases and conditions:
1. Mechanical injuries of a different etiology (for example, improper brushing of teeth).
2. Chemical and thermal burns of the lips.
3. Mucosal tuberculosis. Tuberculous ulcers have undermined edges, there is a sharp pain on palpation, and small yellow dots (Trel grains) are also determined.
4. Cancer. Ulcers seen in cancer have a hard base and hard edges; elements of the lesion may be slightly painful. Such ulcers do not heal long enough (more than 2-3 weeks).
5. Contact stomatitis.
6. Leukoplakia.
7. Candidal lesions of the oral cavity.
8. Stomatitis associated with smoking.
9. Congenital dyskeratosis.
10. Lichen planus.

Clinical features of mechanical hyperkeratosis in comparison with other whitish lesions of the lip mucosa:
1. The resulting spots and plaques are described as "rough, shaggy, often scaly".
2. The defeat of the lips, as a rule, is bilateral. The foci are located in the part of the mucosa that can come into contact with the teeth.
Proliferative leukoplakia can also be bilateral (sometimes symmetrical), but leukoplakia will often affect areas that do not have contact with teeth (such as the gums).

Complications

Cheek and lip biting has a benign course.
Complications include the formation of decubitus ulcers and their infection with the development of stomatitis.
risk of developing leukoplakia Leukoplakia is a dystrophic change in the mucous membrane, accompanied to some extent by keratinization of the epithelium; refers to precancer
discussed and does not yet have a good evidence base.

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Diet. No special diet is required if the condition of the teeth and the absence of pain allow chewing of sufficiently coarse food. Reasonable limits include avoiding irritating ingredients and overly rough foods that can increase pain and/or discomfort during chewing.

The most important therapy is establishment and elimination of the traumatic factor:
- bite correction;
- correction of new dentures or replacement of old ones;
- replacement of seals;
- grinding of the cutting edges of teeth that injure the mucous membrane.

Of particular importance is the manufacture and installation of acrylic prostheses (kappa), which cover the teeth and protect the buccal mucosa from injury. At a minimum, wearing them is indicated during sleep, when the patient does not control the movement of the jaws.

There is no unequivocal evidence of the effectiveness of psychological correction methods in the treatment of biting of the cheeks and lips, however, several studies show their effectiveness within 3 months in the treatment of such conditions.

In the case of bacteriological confirmation of colonization of damaged areas, local antiseptics are indicated.

Forecast

The prognosis is favorable. Changes disappear or decrease within 1-3 weeks from the start of full therapy. In the absence of dynamics, a set of measures is shown to exclude a malignant neoplasm (biopsy) or other causes of parakeratosis Parakeratosis is a violation of the process of keratinization of epidermal cells, characterized by the presence of cells containing nuclei in the stratum corneum and the absence of a granular layer.
and ulceration (eg, infection, AIDS).

Hospitalization

Hospitalization is not required.

Prevention

Getting rid of the habit of biting lips or cheeks.

Information

Sources and literature

1. "Morsicatio buccarum et labiorum (excessive cheek and lip biting)" Glass LF, Maize JC, The American Journal of Dermatopathology, no. 13(3), 1991
2. "Oral Frictional Hyperkeratosis" Catherine M Flaitz, Chief Editor: William D James, 2012
   1. http://emedicine.medscape.com -
3. "Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions" Cam K, Santoro A, Lee JB, Skinmed journal, no. 10(2), 2012
4. "Three cases of "morsicatio labiorum" Kang HS, Lee HE, Ro YS, Lee CW., Annals of Dermatology journal, No. 24(4), 2012
5. http://o-stom.ru
6. wikipedia.org (Wikipedia)

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Cheek biting is a fairly common occurrence, which is rarely considered a disease. It not only causes pain and discomfort, but also lowers the patient's quality of life. They equally affect both children and adults.

Note:regular traumatization of the mucous membrane of the cheeks in a dream, while eating or talking can have serious causes and consequences.

Table of contents:

Reasons for biting the cheek from the inside

A number of factors contribute to the development of this pathology. It should be noted that in the absence of treatment and the transition of the disease to a chronic form, the risk of developing precancerous conditions and even cancer of the oral cavity increases.

Injury to the mucous membrane of the cheek is possible as a result of such reasons:

The features of the anatomical and morphological structure of the teeth and jaws, leading to cheek biting, include:

• incorrectly set with overhanging edges;
• sharp bumps on the chewing surfaces of the teeth;
• dystopian teeth, which are located in the mouth outside the dentition;
• expansion of dental arches (lower, upper);
• poorly made;
• (congenital, acquired, lingual, buccal);
• tilted to the side;
• sharp edges of decayed teeth.

Symptoms when biting the cheek

On examination, the patient will present the following complaints:

• pain at the site of biting of the cheek mucosa;
• difficulty in daily oral hygiene;
• wound formation;
• pain when eating;
• pain while talking.

Objectively, the doctor detects a local inflammatory process at the site of injury and an uneven surface of the mucous membrane. The characteristic location of the wound is the line of closing of the teeth from the side of the cheek. If biting is permanent and does not have time to heal, then the disease becomes chronic. As a result, ulcerative and erosive processes are formed.

Important:one of the long-term consequences of biting the cheeks is a decubitus (decubitus) ulcer and leukoplakia.

A decubital ulcer is formed at the site of regular injury to the buccal mucosa. It requires a mandatory consultation with a dentist and the selection of treatment. L leukoplakia is a chronic pathology in which there is keratinization of the oral mucosa and inflammation in the stroma against the background of exogenous irritation.

Diagnostics

The main attention is paid to differential diagnosis. The wound surface as a result of biting the cheek should be distinguished from tuberculous ulcer, leukoplakia and cancer.

A tuberculous ulcer is very painful if touched.. It has jagged undermined edges and yellow grain. A cancerous ulcer does not heal for a long time, more than a month. It is distinguished by the presence of a seal in the center and along the edges. in this case allows you to accurately determine the diagnosis.

Note:in any case, if a wound appears as a result of biting the cheek, you should first of all seek medical help from a dentist.

Cheek biting treatment

To eliminate cheek biting, both as a physiological problem and as a bad habit, the patient should first of all consult a professional dentist. The doctor selects the treatment taking into account the cause, if necessary, refers to other specialists (oncologist, neurologist, otolaryngologist, psychotherapist).

First aid

Before visiting a doctor, you can rinse your mouth at home cold water . This will help eliminate bleeding, if any, and relieve soreness. It is also allowed to rinse with decoctions of St. John's wort. Painkillers can be taken for pain.

Basic principles of treatment for biting the cheek:

If the patient is in constant, experiencing negative emotions and bites his cheek because of this, then therapy must necessarily include psychological help as well.

If the cause of the pathology is improper prosthetics, filling, teething, then you should visit a dentist. He will eliminate the bite of the cheek when the jaws are closed by grinding sharp bumps or removing a tooth, making new dentures, fillings.

In case of malocclusion of the congenital type, it is necessary to consult an orthodontist. He will select the right treatment, if necessary, put braces that will help change the position of the teeth.

With bruxism, the manufacture of protective mouthguards on the teeth, which are used only at night, is sometimes indicated.. Such devices do not allow the patient to compress the jaws very strongly during sleep and bite the mucous membrane.

Note:when biting the cheek, you can not lubricate the wound in the mouth with brilliant green or iodine, touch it with dirty hands, drink hot, self-medicate in the form without a doctor's prescription.

If healing of the mucosa is not observed during the treatment, the wound increases in size, a hematoma has appeared, the pathological process has spread to the tongue, then an additional examination should be carried out and an oncologist should be visited.

Betsik Julia, medical consultant

"White line" cheeks- a common white wavy line protruding above the level of the buccal mucosa at the level of the bite plane, it is due to a pronounced tendency of the epithelium to keratinize. The "white line" of the cheek has a width of 1-2 mm, stretches in a horizontal direction from the second molar to the area where the canine is located, does not separate from the mucous membrane when rubbed with a spatula, and is usually located on both sides. Often associated with scalloped tongue and seen in bruxism and in patients who have a habit of clenching their teeth or sticking their tongue to their teeth, creating negative pressure in the mouth; does not cause any pain. Does not require treatment.

Leukedem.

leukedem- change in the buccal mucosa in the form of an opalescent area of ​​milky white or gray color. Usually observed in individuals with dark skin, represents a variant of the normal structure of the mucous membrane, less common in people with fair skin. The incidence of leukedema increases with age, reaching 50% in African American children and 92% in adults. Localization of leukedema on the mucous membrane of the lip, soft palate and floor of the mouth is less common.

leukedem usually has bilateral localization. A close examination of the oral cavity reveals white lines and folds. With prolonged existence, these folds can find one on top of the other. Changes in leukedema depend on the degree of pigmentation of the mucous membrane, the quality of oral care and the intensity of smoking. The boundaries of the altered area of ​​the mucous membrane are uneven and blurred. A characteristic sign of leukedema is a pronounced decrease or disappearance of the whiteness of the affected area when the mucous membrane is stretched. When rubbing with a spatula, the changed mucous membrane is not removed. The cause of leukedema has not been established, however, it has been noted that it is more pronounced in smokers, and when quitting smoking, it tends to reverse development. Histological examination of the biopsy material shows a thickening of the epithelium, a pronounced swelling of the cells of the spiny layer without signs of inflammation. Leukedema does not pose any danger. Does not require treatment.

Biting or chewing on the buccal mucosa.

Cheek biting- a bad habit, more common in mentally unbalanced individuals. Chronic traumatization of the mucous membrane leads to a hyperplastic reaction with the formation of irregularly shaped white plaques, sometimes lines or stripes. With continued trauma, there is an increase in plaque, the appearance of erythema and ulceration.

Chewing of the buccal mucosa observed at any age, regardless of race and gender of patients. Persons with this bad habit usually chew the mucous membrane of the anterior cheek, less often - the lips. The diagnosis is based on the clinical picture and history. Despite the fact that the injured mucosa is usually not prone to malignant transformation, patients should be warned about the changes to which it undergoes. In the differential diagnosis, patchy leukoplakia and candidiasis should be included, given the similarity of mucosal changes caused by chewing with these diseases. Histological examination reveals areas of both normal and wrinkled epithelium with signs of parakeratosis and mild subepithelial inflammation.

At a dental appointment, the diagnosis of diseases of the oral mucosa is often carried out. Often lesions of the oral mucosa are localized on the lateral surface of the tongue and the distal cheeks.

Most dental patients have cheeks. Cheeks have functional, anatomical and social significance. Functionally, cheek owners use them to retain food and liquids while eating, to aid in the production of speech sounds and to moisten the mouth, and as a sucking membrane. Anatomical cheeks consist of buccal muscles covered on the outside with skin and mucous membrane on the inside. Within these layers are numerous minor salivary glands, sebaceous glands, neurovascular structures, buccal fatty lumps, and the duct of the major salivary gland opens. Socially, a cheeky person can be said to have "big cheeks".

This article discusses several common benign lesions that occur on the intraoral surfaces and subsurfaces of the cheeks. The cheeks are also a site of potential intraoral malignancy. The purpose of the presented material is to raise the awareness of dentists and dental hygienists regarding the manifestation of selected benign, precancerous and cancerous lesions of the cheeks.

Chemical burns

Chemical burns of the buccal mucosa often occur after the application of local anesthetics in an attempt to relieve toothache. Aspirin (aspirin), acetaminophen (acetaminophen) and various medicinal mixtures can initiate chemical burns. Chemical burns can be classified by severity depending on the area of ​​edema and redness in relation to a dense white scab, sloughing off the necrotic mucosal surface (Fig. 1).

Rice. 1. Chemical burn.

Most chemical burns heal without sequelae.

Tobacco spot (leukoplakia)

Tobacco spot or tobacco descending lesion is a wrinkled, white or pink, diffuse lesion of the vestibule of the mouth. These lesions are often seen in the mandibular transitional fold, the site where smokeless tobacco is commonly placed (Figure 2).

Rice. 2 Tobacco stain.

Nitrosonornicotine in snuff or chewing tobacco has been declared carcinogenic. Thus, the use of a local carcinogen predisposes to the appearance of squamous cell carcinoma at the site of tobacco application, especially in the transitional fold of the mandible. (Fig. 3).

Rice. 3. Tobacco stain.

The initial lesions from topical tobacco use can be eradicated in most cases by stopping the use of tobacco products. It is possible to achieve the disappearance of clinical lesions by stopping tobacco use for about two weeks. If, however, lesions persist after the two-week tobacco-free period, the remaining lesions should be completely removed and presented to a pathologist for microscopic evaluation.

Squamous cell carcinoma

Squamous cell carcinoma is the most common malignant tumor that occurs in the oral cavity. The buccal mucosa is where cancer can be found relatively easily. Squamous cell lesions are usually painless, however, the patient may be aware of a persistent ulcer, cheek fullness, or a patch that ulcerates repeatedly.

Squamous cell carcinoma may present as a flat area; in the form of an ulcerated surface; in the form of a hardened (like a donut) area; surface, like a washboard or as an exophytic swelling (Fig. 4).

Rice. 4. Squamous cell carcinoma.

Most dentists, dental hygienists, and physicians are more suspicious of cancer if the lesion has White color. For many years, practitioners have been trained to examine the mucosa for leukoplakia (white plaques). In fact, redness (erythroplasia) is the earliest clinical manifestation of squamous cell carcinoma 2 . Reddened tissue should dramatically raise the level of suspicion of cancer (Fig. 5).

Rice. 5. Squamous cell carcinoma.

Squamous cell carcinoma of the cheek is more easily seen than malignant tumors of many other anatomical regions of the mouth and upper pharynx. The buccal mucosa is easily examined, especially when a standard examination of the oral cavity and teeth is performed. It is necessary to carefully evaluate all anomalies of the tissues of the cheeks. When a malignant tumor of the buccal mucosa occurs, the disease is very aggressive and difficult to control. Approximately half of all cases of squamous cell carcinoma of the cheeks metastasize to the regional lymph nodes of the neck. The cure prognosis for cheek cancer is poor.

Lichen planus

Most pathologists will agree that lichen planus (LP) and lesions that look like lichen planus (lichenoids) are common diseases of the oral mucosa. Despite this, oral pathologists express different opinions relative to lichen planus and lichen planus-like lesions.

The most important points of view are the following:

Lichen planus should not be ignored; and it is extremely difficult to make a definitive diagnosis of lichen planus by clinical examination. Lichen planus is most commonly found on the buccal mucosa (Figure 6), but may also be found on the gums, tongue, palate, lips, floor of the mouth, or skin.

Rice. 6. Lichen planus.

This chronic process is characteristic of women, especially after 40. Lichen planus can be exclusively on the skin, exclusively on the mucous membrane, or simultaneously on both tissues. Lichen planus lesions may be due to past trauma to the site of the lesion, such as a scratch on the skin or an injection to numb the teeth. This observation is known as the "Koebner Phenomenon".

Typical lesions occur bilaterally on buccal mucosa or gingival lace-like, white streaks, or keratotic rings on an erythematous base (Figure 7).

Rice. 7. Lichen planus.

These lesions are usually asymptomatic, with the exception of ulcerative and bullous lichen planus (Figure 8).

Rice. 8. Erosive lichen planus.

Symptomatic lesions cycle between asymptomatic periods and painful episodes lasting several weeks. Lesions, according to established practice, respond symptomatically to the application of topical steroids, especially 0.05% fluocinonide (Lidex).

Some researchers consider lichen planus to be a precancerous disease.4 Other researchers question the relationship between lichen planus and oral cancer.5 However, other scientists suggest that in patients with long-term lichen planus, both lichen planus and malignancy may occur at the same time. , especially in cases of erosive lichen planus.6 In addition, the dysplastic process, clinically mistaken for "lichenoid dysplasia", has similarities with lichen planus. But in contrast to lichen planus, lichenoid dysplasia tends to occur in those areas of the oral cavity that are the most common localization of oral cancer: the floor of the mouth, the ventrolateral region of the tongue, the lingual mucosa of the alveolar ridge, the tonsil folds and the soft palate.

Somewhere between lichen planus of unknown origin and lichenoid dysplasia (with its malignant potential), there is another group of lichenoid lesions. Nonspecific lichenoid reactions - microscopic varieties - also have an unknown etiology. Similar to lichen planus, drug reactions are fairly common. Especially in patients taking phenothiazines, angiotensin converting enzyme inhibitors and thriazides, lichen planus-like reactions most frequently occur with respect to other drugs. Lichenoid oral mucositis can also occur secondary to consumption of foods containing cinnamon, such as cinnamon sweets, chewing gum, mouth rinses, and toothpastes. Systemic or discoid lupus erythematosus may also be accompanied by oral lesions similar to lichen planus.

When a patient has any type of lichen planus lesion, it is important to make a specific diagnosis. A complete medical history of this lesion should include its onset, symptoms, medications, consumption of products containing cinnamon, tobacco use, alcohol use, history of trauma (such as dental treatment), and known systemic diseases. The most useful diagnostic tool is the microscopic examination of biopsy tissues.

Once the diagnosis is established, lichen planus can be treated with a topical corticosteroid, which often reduces symptoms. Although clinical symptoms can be controlled, lichen planus lesions can persist for a long time. It is the duty of the dentist, dental hygienist, and dental surgeon: those who can diagnose lichen planus to carefully examine the mucosa of patients with lichen planus for suspicious lesions. Despite the controversy among pathologists, it is true that cancer occurs at the same time as lichen planus, and lichen planus is potentially malignant.

Fibroma

Fibroma from irritation is a common benign lesion that occurs on the mucous membranes of the cheeks, tongue, lips and other parts of the oral cavity. Fibromas are raised nodules that are about the same color as the surrounding tissue, or slightly paler (Figure 9).

Rice. 9. Fibroids.

Most fibromas are a few millimeters in size but can become quite large (Fig. 10).

Rice. 10. Fibroma.

They may be single, or may appear as a group of lesions. Fibromas can be surgically removed and presented for histological examination. Typically, lesions do not recur if the cause of irritation has been removed and the lesion has been completely resected.

Hemangioma

Blood vessels can form tumor-like lesions, especially in the cheeks, tongue, and lips. These benign lesions are often blue, ovoid, soft nodules (Figure 11).

Rice. 11. Hemangioma.

These shrinking nodules may pale on palpation due to a temporary interruption in blood flow to the affected area. Hemangiomas can be removed surgically and presented for histological examination, especially if they are large or their localization causes functional problems (Fig. 12).

Rice. 12. Hemangioma.

Recurrence of hemangioma is possible, and depends on the configuration of the lesion and the completeness of the removal.

Hematoma

Hematomas are a secondary, in relation to trauma, accumulation of blood in soft tissues (Fig. 13).

Rice. 13. Hematoma.

On the buccal mucosa, traces of spontaneous biting are often found, leading to the formation of a hematoma (Fig. 14).

Rice. 14. Hematoma.

These lesions are usually self-limiting, self-heal, and rarely require treatment.

This article presents several buccal mucosal lesions that are common in dentistry. Because the cheeks are a potential site of aggressive oral malignancy, all lesions should be investigated with suspicion until a definitive diagnosis is made. Lichen planus-like lesions should also not be casually overlooked, as cancer may arise or already exist, at least in conjunction with lichenoid dysplasia or lichen planus lesions. It must be emphasized that a visual examination is not sufficient to make a diagnosis and / or plan a treatment plan for lichen planus or lichenoid dysplasia.

Dentists and dental hygienists are the only and most competent of their kind who can detect cheek lesions at an early, treatable stage. Every visit to the dentist should include a cheek check.

Bibliography:

1. Silverman, Sol, Jr. Oral Cancer Third Edition. The American Cancer Society. 1990. P. 10.

2. Mashburg, A., Samit, A. "Early Diagnosis of Asymptomatic Oral and Oropharyngeal Squamous Cancers." CA: A Journal of Clinicians. Vol. 45, No.6.,pp. 328-51.

3. Weigand, D.A., Zeigler, T.R. Lichen Planus. In Jordan, R.E. (Editor) "Immunologic Diseases of the Skin." Norwalk: Appleton and Lange, 1991, pp. 623-629.

4. Holmstrup, P. "The Controversy of a Premalignant Potential of Lichen Planus is Over." OralSurg, OralMed, OralPath, 1992. 73:704-706.

5. Eisenberg, E. "Clinicopathologic Patterns of Oral Lichoid Lesions." Oral and Maxillofacial Surgery Clinics of North America. August 1994. Vol.6

The article is based on a translation of the original article A check of cheeks. Rothstein J. Dent Today. 1996 Aug;15(8):60, 62, 64-5. PMID: 9567793 - Translation: Ukhanov M.M. Save to social networks:

Excision of mucous membranes occupies a significant place in the plastic correction of the face. This is a complex of surgical interventions that allow you to significantly adjust facial features. The operation consists in removing part of the fatty and mucous tissues, followed by tightening and correcting the shape of the cheek. Depending on individual characteristics. The operation can be performed both externally and in the oral cavity, which guarantees the absence of scars and other postoperative formations on the patient's face.

We are also happy to advise you on new technology SLIM cheeks - this is an improved author's technique for removing Bish's lumps with excision of the mucosa , in which the rehabilitation process is reduced due to a new method of excision of the mucosa. This technique was developed by the leading plastic surgeons of the Center for Laser Medicine "Correct", the main contribution to which was made by the candidate of medical sciences

Indications for surgery

• A large accumulation of adipose tissue, forming a lump of Bish.
• Sagging or age-related sagging of the cheeks (complex surgery with a lift is recommended).
• Deep or uneven nasolabial folds.
• Plastic surgery on the face.
• Rounded or irregular face shape.
• Other indications for reducing the volume of the cheekbones and cheeks.

Operation steps

The operation is carried out in several stages. Initially, the plastic surgeon examines the patient, outlines rough plan works and discusses with the patient the course of the surgical intervention. Depending on the plan proposed by the specialist, a decision is made on what part of the tissues will be removed, whether a facelift will be performed, whether other work will be carried out, for example, the removal of Bish's lumps or the author's operation "French cheeks". This is the preparatory stage.

The main stage is the operation stage. Depending on the characteristics of the patient, it includes certain components.

• The operation is performed under general or local anesthesia. 1-2 minutes after anesthesia in the patient's oral cavity, an incision of 1.5 - 2.5 cm is made on the outer or inner side of the cheek. Then the connective and muscle tissues are moved apart to provide free access to Bish's lumps. Then the fat body is pulled outward, detachment and partial or complete removal of adipose tissue occurs. The first stitches are applied.
• During the operation, a part of the mucous tissue is excised in order to give the patient's face the planned shape. Correction and partial lifting is carried out.
• At the end of the operation, postoperative sutures are applied to the dissected mucosa.

Stage of rehabilitation

Depending on the complexity of the work performed, the time for the patient's rehabilitation and the period of postoperative support are set. Usually, the healing of the mucous membrane takes place in a period of 2-3 days; discomfort and pain can persist for 4-7 days; complete recovery of the patient occurs by the end of 2 weeks.

Contraindications

• Blood cancer and other blood diseases.
• Systemic diseases.
• Viral and infectious diseases.
• Inflammatory processes in the area of ​​operation.
• Diabetes.
• Chronic diseases.
• Mental illness.
• Age up to 25 years.

results

The first results become visible by the end of 2 weeks. By week 3, postoperative symptoms almost completely subside, and the patient already looks noticeably better. However, some swelling may persist for more than a month. After the rehabilitation period, the oval of the face becomes a given shape, and the cheeks become slightly retracted.

The provision of plastic surgery services is carried out in the scope of consultative and diagnostic measures, referral for surgical treatment in a hospital, postoperative monitoring and rehabilitation.