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544

letters to the editor

Mucous Extravasation Phenomenon Following


Vermilionectomy
To the Editor:
Vermilionectomy, a surgical procedure for partial or
total removal of the lip vermilion, commonly the lower
one, is indicated for the treatment of actinic cheilitis
with moderate or severe epithelial dysplasia.1,2 The
surgical technique usually involves removal of the
damaged tissue above the muscle plane, covering the
wound with healthy internal labial mucosa.3,4 The
most common sequelae after vermilionectomies are
mouth opening reduction and paresthesia, but pain,
pruritus, dysesthesia, healing contraction, and difficulties in eating and speaking can occur.1,2,4,5
Mucous extravasation phenomena (mucocele) are
common oral lesions caused by traumatic rupture of
minor salivary gland ducts, causing release of mucous
into the adjacent connective tissue.6 Iatrogenic injury
due to surgical procedures can lead to rupture of the
ductal glandular system, nevertheless, we found no reports of mucoceles arising after vermilionectomies in
the English literature.
A 45-year-old woman was referred to the Oral Pathology Department, University of Campinas Dental
School, in July 2000, complaining about a nodular lesion on the lower lip lasting 15 days. The patient had
a vermilionectomy on the lower lip 2 months before as
treatment for actinic cheilitis. Clinical examination
showed a 1.0 cm  1.0 cm  0.7 cm smooth, soft,
bluish nodule on the left labial mucosa (Figure 3).
Clinical diagnosis was mucocele and the patient was
submitted to excisional biopsy under local anesthesia.
The final diagnosis was mucous extravasation phenomenon and the patient has been followed up for 15
months with no signs of recurrence.

Figure 3. Nodular bluish sessile lesion on the left lower lip vermilion of a 45-year-old woman. Note the discrete postvermilionectomy scar on the lip vermilion/lip skin limit.

Dermatol Surg

28:6:June 2002

Most tissues removed in vermilionectomies are superficial, but minor salivary gland ducts can be ruptured, leading to mucous extravasation in the surrounding tissues. Therefore, as in the case reported
here, mucoceles should also be included as possible
postoperative sequelae after vermilionectomies.
Cludio Maranho Pereira, DDS
Paulo Rogrio Ferreti Bonan, DDS, MSc
Fbio Rama Pires, DDS, MSc
Oslei Paes de Almeida, DDS, PhD
Piracicaba/SP, Brazil

References
1. Kurul S, Uzunismail A, Kizir A. Total vermilionectomy: indications
and technique. Eur J Surg Oncol 1995;21:2013.
2. Spira M, Hardy B. Vermilionectomy: review of cases with variations
in technique. Plast Reconstr Surg 1964;33:3946.
3. Huang CC, Arpey CJ. The lips: excision and repair. Dermatol Clin
1998;16:12742.
4. Kolhe PS, Leonard AG. Reconstruction of the vermilion after lipshave. Br J Plast Surg 1998;41:6873.
5. Sanches-Conejo-Mir J, Bernal AMP, Moreno-Gimenez JC, Camacho-Martinez F. Follow-up of vermilionectomies: evaluation of the
technique. J Dermatol Surg Oncol 1986;12:18084.
6. Oliveira DT, Consolaro A, Freitas FJG. Histopathological spectrum
of 112 cases of mucocele. Braz Dent J 1993;4:2936.

Hematomas are Underrepresented in Studies


on Complications of Ambulatory Phlebectomy
To the Editor:
General complications of varicose vein surgery include
recurrence, hemorrhage and hematoma formation,
damage to deep veins and arteries, nerve damage
(saphenous and sural nerve), wound necrosis, lymphedema and lymphatic pseudocysts, wound necrosis,
and unsightly scars.1 With the use of ambulatory phlebectomy, wound necrosis, unsightly scars, and infection do not occur. In a recent review by Ramelet2 postoperative hemorrhages were reported in 0.34.3% of
cases and major hematomas were reported in 0.1
2.45% of cases. The incidence ofnot further specifiedhematomas was reported in 1 of 1000 cases by
Olivencia.3
In light of our experience with ambulatory phlebectomy, we have serious doubts on the way in which the
occurrence of hemorrhage and hematoma formation is
reported. In our phlebologic practice we notice hemorrhage (escape of blood from a ruptured blood vessel) in
less than 1% of cases, especially when bandages shift
immediately (up to 24 hours) after phlebectomy. Hematomas (extravasation of blood), however, seems to
occur much more often than reported in the literature. This is why we addressed this problem for both
sclerotherapy 4 and ambulatory phlebectomy.5 Recently we examined 100 cases of ambulatory phlebec-

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