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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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ORIGINAL ARTICLE  
Year : 2018  |  Volume : 22  |  Issue : 1  |  Page : 144
 

Prevalence of commissural lip pits in population of central Gujarat: A hospital-based study


Department of Oral Medicine and Radiology, Manubhai Patel Dental College and ORI, Vadodara, Gujarat, India

Date of Submission25-Jun-2016
Date of Acceptance22-Dec-2017
Date of Web Publication13-Apr-2018

Correspondence Address:
Mansi Narendra Tailor
Department of Oral Medicine and Radiology, Manubhai Patel Dental College and ORI, Munjmahuda, Vadodara - 390 020, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_126_15

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   Abstract 

Background: Commissural lip pits (CLPs) fall among the rare congenital deformities recorded. CLP usually follows dominant hereditary pattern and may be associated with other congenital defects. CLP can appear as unilateral depression or bilateral depression.
Objective: To assess the prevalence, age distribution, site and gender predilection of CLP in a central Gujarat population.
Materials and Methods: Outdoor patients over a period of 6 months were examined for clinical evidence of CLPs.
Results: A total of 14,403 patients were examined for the presence of CLP. CLP was identified in 381 patients with a prevalence of 2.65%. The occurrence of CLP was more in male patients. The maximum number of patients was in the age groups of 20–29 years. No significant statistical difference was observed in the distribution of CLP. Unilaterally distributed CLP was more common on the left side.
Conclusion: Our study showed 2.65% prevalence of isolated CLPs with a male predilection. There was almost equal distribution of unilateral and bilateral CLP. In unilateral cases, the left side was affected the most. Although literature says lip pits can be an associated feature of certain syndromes, there were no syndromic patients in our study.


Keywords: Commissural lip pits, Gujarat, malformation


How to cite this article:
Tailor MN, Joshi MU. Prevalence of commissural lip pits in population of central Gujarat: A hospital-based study. J Oral Maxillofac Pathol 2018;22:144

How to cite this URL:
Tailor MN, Joshi MU. Prevalence of commissural lip pits in population of central Gujarat: A hospital-based study. J Oral Maxillofac Pathol [serial online] 2018 [cited 2020 May 27];22:144. Available from: http://www.jomfp.in/text.asp?2018/22/1/144/230019



   Introduction Top


Lip pits are malformations of lips, often following hereditary pattern, possibly a dominant characteristic and may be associated with other congenital defects.[1] Lip pits can be of three types according to their location: commissural, median upper and median lower. Median lower lip pits are the most common among all.[2] Commissural lip pits (CLP) are small mucosal invaginations that occur at the corner of the mouth on the vermilion border.[3] CLP can appear as unilateral depression or more frequently as bilateral depression.[1],[3],[4] Prevalence rates of CLP in adults range from 0.3% to 21.1%[4],[5],[6],[7],[8],[9],[10],[11] [Table 1]. Prevalence studies of CLP in the Indian population are lacking. The purpose of this hospital-based study was to report the frequency of occurrence of CLPs among patients in central Gujarat state region.
Table 1: Prevalence of commissural lip pits in different population

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   Materials and Methods Top


Permission to undertake the study was obtained from institutional ethics committee. A total of 14,403 patients over a period of 6 months, from June 2014 to December 2014, were examined for clinical evidence of CLPs. Diagnosis of CLPs was made on the basis of clinical examination. Study variables included age, gender and site of malformation.

Statistical analysis

Statistical analysis was done using STATA 13.1 Software by Stata Corp Ltd India Continent by applying Pearson Chi-square test and Fisher's exact test.


   Results Top


Out of 14,403 patients, 381 patients had CLP, with 2.65% prevalence. Age of the patients ranged from 4 to 81 years. Out of 381 patients, 135 (35.4%) were females and 246 (64.6%) were males [Graph 1]. Male: female ratio was 1.8:1. The maximum number of patients was in the age groups of 20–29 years (24.9%) [Graph 2]. Out of 381 patients having CLP, 188 (49.3%) patients had unilateral CLP [Figure 1] while 193 (50.7%) patients had bilateral CLP [Figure 2]. No significant statistical difference was observed in the distribution of CLP. Out of 188 patients having unilateral lip pits, 147 patients had CLP on the left side and 41 patients had CLP on the right side [Table 2]. No significant correlation was observed between unilateral/bilateral distribution as well as site-wise distribution of CLP with the gender (P > 0.05) [Graph 3] and [Graph 4].

Figure 1: Unilateral commissural lip pit on the left side

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Figure 2: Commissural lip pit bilaterally

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Table 2: Site-wise distribution

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   Discussion Top


Lip pits may result from notching of the lip at an early stage of development, with fixation of the tissue at the base of the notch or from the failure of complete union of the embryonic lateral sulci of the lip.[1] Their location suggests that they may represent a failure of normal fusion of maxillary and mandibular process.[3]

CLPs occur on the lip commissure lateral to the typical lip pits.[4] Lip pits can occur either as an isolated defect or in association with other developmental disturbances as popliteal pterygium syndrome,[12] Van der Woude syndrome,[13] oral-facial-digital syndrome and Marves and Cremer's syndrome.[14] CLP can be seen unilaterally or bilaterally on the corner of the mouth.[2],[3],[4]

CLP is a congenital malformation which may be misdiagnosed with lesions such as chronic angular cheilitis (CAC). CAC is a fungal infection of acquired origin. Reduced vertical dimensions lead to accentuated folds at the corner of mouth, thus favoring saliva pooling and fungal infections. Furthermore, in special children like Down syndrome, there is greater evidence of CAC because of continuous drooling of saliva because of muscle hypotonia. CAC can be differentiated from CLP on the basis of history.[15],[16]

In the present study, we found 2.65% overall prevalence of CLP. Our results were almost similar with the results of Sawyer et al.[5] and Ambika et al.[6] who found 2.9% and 3.5% prevalence of CLP, respectively. Our results showed disparity with results of Premakumar et al.,[4] Gorsky et al.,[7] Schaumann et al.,[8] and Freudenberger et al.[9] who found 0.3%, 17.4%, 21.13% and 8% overall prevalence of CLP, respectively.

Our study showed male predilection for CLP. Our results were consistent with Premakumar et al.[4] and Sedano et al.[10] Male:female ratio in the present study was 1.8:1 which was similar with results obtained by Premakumar et al.[4] but was not consistent with results of Sedano et al.[10] which was 1.05:1.

The maximum numbers of patients in the present study were in the age groups of 20–29 years. Our results were not in harmony with results of Premakumar et al.[4]

There was no significant statistical correlation observed in the distribution of CLP in the present study. Our results contradicted with the results of Premakumar et al.[4] and Gorsky et al.[7] who found the unilateral distribution of CLP to be more common.

In the present study, in the unilateral distribution of CLP, the left side was more commonly involved than the right side. Our results were in accordance with the results of Premakumar et al.[4]


   Conclusion Top


This study provides prevalence of CLP in central Gujarat state population for the first time. Some similarities were observed between the present study and previous studies. The variation in frequency among studies reported in the literature can be attributed to racial or ethnic differences. Our study showed 2.65% prevalence of isolated CLPs with a male predilection. There was almost equal distribution of unilateral and bilateral CLP. In unilateral cases, the left side was affected the most. Though literature says lip pits can be an associated feature of certain syndromes, there were no syndromic patients in our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rajendran R, Sivapathasundaram B. Shafer's Textbook of Oral Pathology. 6th ed. India: Elsevier; 2009. p. 1-80.  Back to cited text no. 1
    
2.
Rizos M, Spyropoulos MN. Van der Woude syndrome: A review. Cardinal signs, epidemiology, associated features, differential diagnosis, expressivity, genetic counselling and treatment. Eur J Orthod 2004;26:17-24.  Back to cited text no. 2
    
3.
Neville WB, Damm DD, Allen MC, Bouquot JE. Developmental Defects of the Oral and Maxillofacial Region. India: Elsevier; 2002. p. 5.  Back to cited text no. 3
    
4.
Premakumar P, Thomas J, Rani P, Vineet D, Thomas S, Vivek V. Prevalence of commissural lip pits in patients visiting a dental college in a rural area of South Kerala: A Pilot study. IOSR J Dent Med Sci 2013;10:59-61.  Back to cited text no. 4
    
5.
Sawyer DR, Taiwo EO, Mosadomi A. Oral anomalies in Nigerian children. Community Dent Oral Epidemiol 1984;12:269-73.  Back to cited text no. 5
    
6.
Ambika L, Keluskar V, Hugar S, Patil S. Prevalence of oral mucosal lesions and variations in Indian public school children. Braz J Oral Sci 2011;10:288-93.  Back to cited text no. 6
    
7.
Gorsky M, Buchner A, Cohen C. Commissural lip pits in Israeli Jews of different ethnic origin. Community Dent Oral Epidemiol 1985;13:195-6.  Back to cited text no. 7
    
8.
Schaumann BF, Peagler FD, Gorlin RJ. Minor craniofacial anomalies among a Negro population. I. Prevalence of cleft uvula, commissural lip pits, preauricular pits, torus palatinus, and torus mandibularis. Oral Surg Oral Med Oral Pathol 1970;29:566-75.  Back to cited text no. 8
    
9.
Freudenberger S, Santos Díaz MA, Bravo JM, Sedano HO. Intraoral findings and other developmental conditions in Mexican neonates. J Dent Child (Chic) 2008;75:280-6.  Back to cited text no. 9
    
10.
Sedano HO, Carreon Freyre I, Garza de la Garza ML, Gomar Franco CM, Grimaldo Hernandez C, Hernandez Montoya ME, et al. Clinical orodental abnormalities in Mexican children. Oral Surg Oral Med Oral Pathol 1989;68:300-11.  Back to cited text no. 10
    
11.
Bouquot JE, Gundlach KK. Odd lips: The prevalence of common lip lesions in 23,616 white Americans over 35 years of age. Quintessence Int 1987;18:277-84.  Back to cited text no. 11
    
12.
Spencer L, Gondim D, Alves R, Silva C, Lopes V. Popliteal pterygium syndrome: Case report and literature review. Rev Bras Cir Plást 2012;27:482-6.  Back to cited text no. 12
    
13.
More CB, Varma S, Tailor M, Bhavsar K. Van der Woude syndrome: Report of two cases with supplementary findings. Indian J Dent Res 2013;24:387-9.  Back to cited text no. 13
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14.
Marres HA, Cremers CW. Congenital conductive or mixed deafness, preauricular sinus, external ear anomaly, and commissural lip pits: An autosomal dominant inherited syndrome. Ann Otol Rhinol Laryngol 1991;100:928-32.  Back to cited text no. 14
    
15.
Neville BW, Damn DD, Allen CM, Bouquot JE. Textbook of Oral and Maxillofacial Pathology. 2nd ed., Ch. 1., WB Saunders company; Philadelphia, Pennsylvania: 2002. p. 5.  Back to cited text no. 15
    
16.
Al-Maweri SA, Tarakji B, Al-Sufyani GA, Al-Shamiri HM, Gazal G. Lip and oral lesions in children with Down syndrome. A controlled study. J Clin Exp Dent 2015;7:e284-8.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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