A one-year-old patient presented with progressive swelling of the right cheek, facial hair loss, decreased right oral commissure, without skeletal involvement, whose clinical and radiological findings were consistent with
Facial ultrasound at 18 months of age, performed with high resolution linear transducer, showed predominantly microcystic lesion, with some cysts that exceeded 15 mm in diameter.
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Serial mapping of the lesion was planned and used twice + OK-432 and in the following two Bleomycin.
All procedures were performed 6-8 weeks apart under general anesthesia.
The procedure consisted of aspirating the contents of larger cysts and injecting OK 432, at a dose of 0.1 mg dissolved in 10 cc of total volume.
During the first procedure, on the 4th day, there was a significant increase in volume and scarlet fever began, evolving with a decrease in honeycombing and local induration.
Similar procedure was performed with Bleomycin whose doses did not exceed 0.3-1 mg/kg per session.
Posterior fixations showed a slighter volume increase and less local reaction.
At the age of 2 years 4 months, with the most circumscribed lesion, it was considered that there was no greater benefit to continue with the lesions and intralesional surgical excision was planned.
A right submandibular external approach was used, with partial resection of the lesion, which compromised complete thickness of the cheek including facial muscles and vestibular mucosa.
An elastic compression and massage therapy was started 15 days after surgery, attempting to external compression with an acrylic mask but which was bad for the patient.
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The biopsy confirmed the diagnosis of microcystic LM with fibrous interstitium and inflammatory lymphocytic infiltration.
Six months later, a new resection was planned using the same approach and removing a remaining lesion towards the rectum.
Postoperative facial compression measures were maintained before surgery.
After several years he began to present discomfort in relation to vesicular lesions in the oral vestibule that he often died, being interpreted as local recurrence of his LM.
At 9 years of age, an intraoral excision of the lesion was performed, and the biopsy showed a LM with diffuse fibrosis.
Given the difficult management of intraoral healing since the patient was often bitten presenting bleeding and local inflammation, she was referred to orthodontics for management of her dentomaxilal anomaly and intraoral support.
An intraoral appliance with complete vestibular prolongation was designed, which provided a good intraoral support plan that enhanced external compression. An orthodlinear narrowing appliance was installed at the anterior superior level in the area of the mental sector.
The internal/external compression was indicated for 15 h daily, with equipment controls and acrylic overrun according to the space that was taking place in the vestibule.
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Since the follow-up of the last 4 years showed no local recurrence and the right oral commissure was descending and inanimate, a new surgery was programmed to suspend the right intraoral commissure by adding the material weekly.
