|Year : 2015 | Volume
| Issue : 2 | Page : 150-152
A rare case report: Non-syndromic double, double lip!!
Vela D Desai, Sudakshina Das
Department of Oral Medicine and Radiology, Jaipur Dental College, Jaipur, Rajasthan, India
|Date of Web Publication||16-Mar-2015|
Vela D Desai
B-4O6, Trimurthy Apartment, Opposite BSNL Telecom Colony, Malviya Nagar - 302 017 Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Double lip is a rare developmental oral anomaly, affecting the lips. It is also referred to as "macrocheilia," in which a fold of excess or redundant labial tissue is apparent at rest or on smiling. It usually involves the upper lip, less frequently the lower lip either unilaterally or bilaterally, but rarely both the lips are affected as in the presented case. It may interfere with speech and esthetics; surgery may be indicated for cosmetic reasons only. In this article, the authors report a rare case of non-syndromic congenital double upper and lower lip in a 70-year-old male patient, with a brief review of literature.
Keywords: Congenital, double lip, macrocheilia
|How to cite this article:|
Desai VD, Das S. A rare case report: Non-syndromic double, double lip!!. CHRISMED J Health Res 2015;2:150-2
| Introduction|| |
Double lip is a rare anomaly of the lips that is characterized by a fold of excess mucosal tissue situated proximal to the vermillion border. A double vermilion with a transverse furrow between the two borders appears when the orbicularis oris muscle contracts during a smile. Etiology is not much understood. It may be either congenital or acquired secondary to trauma. Also chronic lip sucking habit may give rise to double lip. Male gender predilection of 7:1  with no racial variation reported in the studies. Double lip may present clinically as a single distinct entity or in conjugation with other manifestations like bifid uvula and cleft palate.  The authors here report a unique case of congenital double, double lip affecting both upper and lower lips in a 70-year-old male patient, which is seldom reported in the English literature.
| Case Report|| |
A 70-year-old male patient [Figure 1] reported to the Department of Oral Medicine and Radiology with the chief complaint of pain in the upper right back teeth region for the last 4-5 days. Patient did not report any relevant medical/family history, and it was his first dental visit. Negative history of allergy and drug intake was elucidated. His general physical examination was not contributory with normal extra-oral features. The routine clinical examination revealed a mass of extra tissue in both the upper and lower lips [Figure 2]. On further evaluation for the excess tissue on the lips, the patient did not report any habit of lip sucking in the past or present. Also gave a negative history of trauma to the lips. The hyperplasic tissue was present since birth, with no change in appearance since then.
On examination, the extra fold of labial tissue extended bilaterally, on inner aspect of both the upper and lower lips almost, from the midline to 2 cm laterally up to the corner of the mouth when the mouth was opened. At rest, the double lip was not evident. Midline constriction was appreciable in both the lips due to the attachment of the frenulum. The overlying as well as the surrounding mucosa was normal except for heavy melanin pigmentation due to his adverse smoking habit. On palpation the texture was smooth, non-tender and soft in consistency. His oral hygiene status was fair with generalized periodontitis and attrition. Based on the clinical presentation, a provisional diagnosis of double lip was made. Blood picture was normal without any evidence of thyroid enlargement. His other dental problems were attended to, and habit counseling was done to quit the smoking habit and was followed-up.
| Discussion|| |
The double lip may be present as a single entity or as a feature of syndrome, e.g. Ascher's syndrome, which is characterized by a triad of non-toxic thyroid enlargement, double lip and blepharochalasis. ,
Usually double lip is present at birth but it becomes more prominent after eruption of permanent dentition.  On smiling, it gives the characteristic Cupid's bow appearance.  Double lip can be distinguished from other lip swellings due to this particular "Cupid's bow" appearance or midline constriction.
Histologically the upper lip can be divided into two zones-an outer smooth zone (the pars glabrosa) and an inner zone (the pars villosa).  The congenital form of double lip is considered to develop during the 8 th and 12 th weeks of intrauterine life and may be attributed to the persistence of the horizontal sulcus in between the pars glabrosa and the pars villosa. , The submucosal tissue is always in excess and the labial glands are enlarged.  Constant sucking by the teeth might also lead to gradual enlargement of this hyperplastic tissue. ,
The incidence of congenital double lip is not well-documented. Prevalence of this rare oral anomaly is approximately 1 in 480 Chileans and 1 in 200 white persons in Utah. 
Double lip is a clinical diagnosis, and no laborious investigations are required. Surgical treatment is required if it pose cosmetic or functional problems, or may have serious impact on psychological well-being. Lasers can be used for the cosmetic correction. As our patient was an elderly patient of 70 years and was not esthetically worried about his appearance, he was only kept under observation.
This sporadic oral anomaly is of special interest for a reason that it is a very very rare finding to involve both lips and only a few cases have been reported till date in the literature.
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[Figure 1], [Figure 2]