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Photobiomodulation and Miescher’s cheilitis granulomatosa: case report

Porrini Massimo, Garagiola Umberto, Rossi Margherita, Bosotti Moreno, Marino Sonia, Gianni Aldo Bruno, Runza Letterio, Spadari Francesco,
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 ( Porrini Massimo ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Garagiola Umberto ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Rossi Margherita ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Bosotti Moreno ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Marino Sonia ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Gianni Aldo Bruno ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit
 ( Runza Letterio ) - University of Milan Fondazione IRCCS Ca’ Granda Division of Pathology
 ( Spadari Francesco ) - University of Milan Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico Maxillo-Facial and Dental Unit

Abstract


Background: Miescher’s cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip.

Case presentation: The patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Ca Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T1?T12). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T10?T12 was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T7). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period.

Conclusions: Our experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.

키워드

Diode laser; Photobiomodulation; Miescher granulomatous cheilitis; Orofacial granulomatosis

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