Case and Research Letters
Persistent Labial Edema Secondary to Hemifacial Spasm
Edema labial persistente secundario a espasmo hemifacial
R. Bella-Navarro
, V. Alonso-Usero, E.M. Gutiérrez Paredes, E. Jordá-Cuevas
Corresponding author
Servicio de Dermatología, Hospital Clínico Universitario, Valencia, Spain
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Bella-Navarro, V. Alonso-Usero, E.M. Gutiérrez Paredes, E. Jordá-Cuevas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Bella-Navarro" "email" => array:1 [ 0 => "rbellanavarro@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Alonso-Usero" ] 2 => array:2 [ "nombre" => "E.M." "apellidos" => "Gutiérrez Paredes" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá-Cuevas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema labial persistente secundario a espasmo hemifacial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2002 "Ancho" => 1500 "Tamanyo" => 466406 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealed labial edema with slight ectasia of the lymphatic vessels in the specimen, with no granulomatous lesions or other inflammatory lesions (hematoxylin–eosin, original magnification ×10).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Persistent labial edema is a nonspecific clinical manifestation that can occur in many different diseases, including Melkersson-Rosenthal syndrome or its monosymptomatic form, granulomatous cheilitis or Miescher syndrome.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 76-year-old woman who was referred to our department for acquired edema in the lower left lip. Since its onset about 2 years previously, the lesion had been completely stable and asymptomatic. The patient's personal history included dyslipidemia, treated with atorvastatin, and left hemifacial spasm 8 years earlier. She had also received regular 6-month infiltrations of botulinum toxin in the orbicular muscle of the left eyelid for 4 years.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The examination revealed well-organized, nonpitting, nonpulsatile edema in the lower left lip, of soft, rubbery consistency; the mucous membranes and other oral structures were completely normal. No discoloration or local signs of superinfection were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Additionally, the patient was unable to fully close her left eye and presented muscle twitching on the left hemiface. She reported no surgical operations, local radiotherapy, infiltrations of botulinum toxin or filler material in the area, or prosthetic dental work in contact with the affected area.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Because the lip swelling was accompanied by motor disturbances, the lesion was biopsied to perform a differential diagnosis with granulomatous cheilitis. Histology of the specimen showed lip edema with some ectasia of the lymphatic vessels in the specimen, but no granulomatous lesions or other inflammatory lesions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Hemifacial spasm is an involuntary abnormal movement of the face and is relatively common. The clinical entity is characterized by repeated tonic–clonic twitches of the muscles innervated by the facial nerve (cranial nerve VII). Hemifacial spasm is seen more often in women and in adulthood and usually appears as the sequela of <span class="elsevierStyleItalic">idiopathic</span> peripheral facial paralysis. However, cases secondary to large vascular abnormalities and tumors (e.g., neurinoma or meningioma) have also been reported. The condition typically presents insidiously and affects the orbicular muscles, in the form of eyelid twitching, and extends ipsilaterally to other muscles.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Spasms are initially paroxysmal, but later increase in frequency and severity and then become sustained contractions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These tonic contractions would, in our opinion, hinder venous and lymph return from the affected areas, thus causing an increase in the diameter of the abundant lip vasculature.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis should include conditions such as hereditary and acquired angioedema (in these cases, the lesions disappear within 24 to 48<span class="elsevierStyleHsp" style=""></span>hours), various orofacial granulomatoses such as lymphomatoid granulomatosis, Crohn disease, and Melkerson-Rosenthal syndrome and its monosymptomatic form (granulomatous cheilitis or Miescher syndrome).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> The contractions can be associated with other accompanying manifestations (e.g., pulmonary or intestinal involvement, facial paralysis, or tongue fissures, respectively), and the biopsy tends to provide the diagnosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Likewise, it is necessary to rule out congenital or acquired lip malformations (lymphangioma, hemangioma, and neurofibromatosis), Ascher syndrome (possibly associated with blepharochalasis and thyroid goiter), and cheilitis glandularis, where the increased size of lips is due to secondary inflammation of heterotopic salivary glands in the lips.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> All these conditions have a well-established histologic diagnosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A final hypothesis to consider is the effect of regular botulinum toxin infiltration. Although cases of local edema secondary to botulinum toxin infiltrations have been described,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in our patient this treatment was never administered in the circumoral region, and edema severity was unchanged long after injections, when the drug would have been expected to have a lower therapeutic effect.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, although hemifacial spasm is not rare, there are no published reports in the literature that associate it with persistent labial edema. This phenomenon could be explained by the fact that the condition is asymptomatic and mundane. Therefore, the patient is unlikely to be referred to a specialist unless the clinical picture is noteworthy, hence the condition is underdiagnosed. Because both manifestations can appear together, they should be taken into account in the differential diagnosis of persistent lip swelling.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Bella-Navarro R, et al. Edema labial persistente secundario a espasmo hemifacial. Actas Dermosifiliogr. 2012;103:157–158.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1093 "Ancho" => 1587 "Tamanyo" => 156160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Soft edema in the lower left lip.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2002 "Ancho" => 1500 "Tamanyo" => 466406 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealed labial edema with slight ectasia of the lymphatic vessels in the specimen, with no granulomatous lesions or other inflammatory lesions (hematoxylin–eosin, original magnification ×10).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemifacial spasm: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.H. Wilkins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surg Neurol" "fecha" => "1991" "volumen" => "36" "paginaInicial" => "251" "paginaFinal" => "277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1948626" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Espasmo hemifacial. Consideraciones clínico-epidemiológicas a propósito de 188 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Torres" 1 => "C. Cosentino" 2 => "D. Zevallos" 3 => "G. Mendoza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Per Neurol" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "4" "paginaFinal" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bolognia" 1 => "J.L. Jorizzo" 2 => "R.P. Rapini" 3 => "T.D. Horn" 4 => "J.M. Mascaró" 5 => "A.J. Mancini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "paginaInicial" => "1088" "paginaFinal" => "1089" "serieVolumen" => "vol. 1" "serieTitulo" => "Dermatología" "serieFecha" => "2004" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study of the oral manifestations of Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Harty" 1 => "P. Fleming" 2 => "M. Rowland" 3 => "E. Crushell" 4 => "M. McDermott" 5 => "B. Drumm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2005" "volumen" => "3" "paginaInicial" => "886" "paginaFinal" => "891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16234026" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melkersson-Rosenthal syndrome: a neuro-muco-cutaneous disease of complex origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O.P. Hornstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Probl Dermatol" "fecha" => "1973" "volumen" => "5" "paginaInicial" => "117" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4595076" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent upper lip swelling caused by foreign body infection: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Patel" 1 => "L. Bhatia" 2 => "G. McQueen" 3 => "J. Moorman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SMJ.0b013e31816f85fa" "Revista" => array:6 [ "tituloSerie" => "South Med J" "fecha" => "2008" "volumen" => "101" "paginaInicial" => "651" "paginaFinal" => "653" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18475243" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1,678 participants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.F. Brin" 1 => "T.I. Boodhoo" 2 => "J.M. Pogoda" 3 => "L.M. James" 4 => "G. Demos" 5 => "Y. Terashima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.06.040" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2009" "volumen" => "61" "paginaInicial" => "961" "paginaFinal" => "970" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19744746" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000686/v1_201304241253/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000002/v1_201304241253/S1578219012000686/v1_201304241253/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000686?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 9 | 21 |
| 2024 October | 99 | 53 | 152 |
| 2024 September | 138 | 40 | 178 |
| 2024 August | 164 | 55 | 219 |
| 2024 July | 169 | 42 | 211 |
| 2024 June | 148 | 43 | 191 |
| 2024 May | 124 | 39 | 163 |
| 2024 April | 146 | 28 | 174 |
| 2024 March | 146 | 36 | 182 |
| 2024 February | 144 | 30 | 174 |
| 2024 January | 127 | 49 | 176 |
| 2023 December | 149 | 24 | 173 |
| 2023 November | 182 | 31 | 213 |
| 2023 October | 107 | 26 | 133 |
| 2023 September | 117 | 36 | 153 |
| 2023 August | 84 | 30 | 114 |
| 2023 July | 77 | 55 | 132 |
| 2023 June | 105 | 35 | 140 |
| 2023 May | 86 | 47 | 133 |
| 2023 April | 63 | 37 | 100 |
| 2023 March | 113 | 41 | 154 |
| 2023 February | 83 | 29 | 112 |
| 2023 January | 61 | 33 | 94 |
| 2022 December | 70 | 41 | 111 |
| 2022 November | 56 | 23 | 79 |
| 2022 October | 42 | 25 | 67 |
| 2022 September | 30 | 25 | 55 |
| 2022 August | 26 | 27 | 53 |
| 2022 July | 39 | 35 | 74 |
| 2022 June | 27 | 36 | 63 |
| 2022 May | 79 | 34 | 113 |
| 2022 April | 61 | 34 | 95 |
| 2022 March | 73 | 49 | 122 |
| 2022 February | 51 | 36 | 87 |
| 2022 January | 55 | 44 | 99 |
| 2021 December | 43 | 37 | 80 |
| 2021 November | 73 | 45 | 118 |
| 2021 October | 137 | 56 | 193 |
| 2021 September | 92 | 46 | 138 |
| 2021 August | 72 | 34 | 106 |
| 2021 July | 48 | 33 | 81 |
| 2021 June | 61 | 39 | 100 |
| 2021 May | 70 | 41 | 111 |
| 2021 April | 111 | 66 | 177 |
| 2021 March | 99 | 33 | 132 |
| 2021 February | 75 | 31 | 106 |
| 2021 January | 50 | 13 | 63 |
| 2020 December | 34 | 17 | 51 |
| 2020 November | 43 | 18 | 61 |
| 2020 October | 23 | 7 | 30 |
| 2020 September | 30 | 11 | 41 |
| 2020 August | 32 | 13 | 45 |
| 2020 July | 19 | 17 | 36 |
| 2020 June | 61 | 35 | 96 |
| 2020 May | 26 | 25 | 51 |
| 2020 April | 37 | 23 | 60 |
| 2020 March | 35 | 20 | 55 |
| 2020 February | 2 | 9 | 11 |
| 2020 January | 1 | 11 | 12 |
| 2019 December | 4 | 3 | 7 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 3 | 7 |
| 2019 August | 0 | 10 | 10 |
| 2019 July | 0 | 12 | 12 |
| 2019 June | 2 | 17 | 19 |
| 2019 May | 2 | 35 | 37 |
| 2019 April | 1 | 19 | 20 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 0 | 2 | 2 |
| 2019 January | 2 | 6 | 8 |
| 2018 December | 2 | 1 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 1 | 0 | 1 |
| 2018 August | 0 | 7 | 7 |
| 2018 July | 0 | 8 | 8 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 7 | 7 |
| 2018 April | 0 | 9 | 9 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 53 | 6 | 59 |
| 2018 January | 66 | 11 | 77 |
| 2017 December | 72 | 8 | 80 |
| 2017 November | 54 | 6 | 60 |
| 2017 October | 65 | 5 | 70 |
| 2017 September | 65 | 2 | 67 |
| 2017 August | 126 | 7 | 133 |
| 2017 July | 98 | 9 | 107 |
| 2017 June | 118 | 9 | 127 |
| 2017 May | 108 | 7 | 115 |
| 2017 April | 92 | 7 | 99 |
| 2017 March | 61 | 7 | 68 |
| 2017 February | 47 | 9 | 56 |
| 2017 January | 44 | 12 | 56 |
| 2016 December | 69 | 16 | 85 |
| 2016 November | 120 | 18 | 138 |
| 2016 October | 98 | 21 | 119 |
| 2016 September | 111 | 10 | 121 |
| 2016 August | 95 | 13 | 108 |
| 2016 July | 68 | 9 | 77 |
| 2016 June | 5 | 8 | 13 |
| 2016 May | 12 | 9 | 21 |
| 2016 April | 14 | 19 | 33 |
| 2016 March | 9 | 7 | 16 |
| 2016 February | 5 | 10 | 15 |
| 2016 January | 12 | 17 | 29 |
| 2015 December | 10 | 5 | 15 |
| 2015 November | 16 | 10 | 26 |
| 2015 October | 12 | 7 | 19 |
| 2015 September | 9 | 0 | 9 |
| 2015 August | 19 | 1 | 20 |
| 2015 July | 76 | 12 | 88 |
| 2015 June | 48 | 6 | 54 |
| 2015 May | 105 | 13 | 118 |
| 2015 April | 107 | 4 | 111 |
| 2015 March | 75 | 10 | 85 |
| 2015 February | 44 | 11 | 55 |
| 2015 January | 43 | 14 | 57 |
| 2014 December | 44 | 9 | 53 |
| 2014 November | 36 | 15 | 51 |
| 2014 October | 54 | 15 | 69 |
| 2014 September | 44 | 10 | 54 |
| 2014 August | 69 | 16 | 85 |
| 2014 July | 60 | 18 | 78 |
| 2014 June | 81 | 14 | 95 |
| 2014 May | 78 | 20 | 98 |
| 2014 April | 63 | 10 | 73 |
| 2014 March | 73 | 16 | 89 |
| 2014 February | 18 | 8 | 26 |
| 2014 January | 23 | 11 | 34 |
| 2013 December | 20 | 6 | 26 |
| 2013 November | 16 | 12 | 28 |
| 2013 October | 15 | 3 | 18 |
| 2013 September | 13 | 9 | 22 |
| 2013 August | 18 | 9 | 27 |
| 2013 July | 11 | 7 | 18 |
| 2013 June | 11 | 13 | 24 |
| 2013 May | 14 | 14 | 28 |
| 2013 April | 18 | 18 | 36 |
| 2013 March | 17 | 8 | 25 |
| 2013 February | 39 | 8 | 47 |
| 2013 January | 45 | 4 | 49 |
| 2012 December | 28 | 4 | 32 |
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