Abstract
Oral and maxillofacial trauma frequently results in both hard and soft tissue injuries. This case report presents a 3-year-old patient who developed a lower-lip abscess due to foreign bodies two months post-trauma. Clinical examination revealed swollen masses in the skin and mucosa of the lower lip. After diagnosing the abscess, the foreign body was removed, leading to full recovery. This case emphasizes the importance of thorough clinical examination, detailed medical history, appropriate paraclinical testing, and the use of ultrasound as a superior diagnostic tool, given its safety, non-invasiveness, and diagnostic efficacy, especially when X-rays are inconclusive.
1
Introduction
Oral and maxillofacial traumas are common emergencies, often damaging teeth and supporting structures, including alveolar bone fractures, tooth loss, and soft-tissue laceration [ ]. In cases of orofacial trauma with soft-tissue lacerations, foreign bodies like tooth fragments may penetrate soft tissues, leading to complications such as infection and bleeding. If undiagnosed during emergency treatment, these fragments can cause medico-legal issues and inflammatory conditions, including painful swollen masses [ ], disfiguring fibrosis, extraoral scars, and fistulas [ ] ( Table 1 ).
| Authors/Year | Patient age (Years)/Gender | Causes of trauma | Involved soft tissue | Foreign bodies | Complications |
|---|---|---|---|---|---|
| Hill F.J., Picton JF (1981) [ ] | 9/M | Bicycle fall | Tongue | Tooth 11 fragment | Painful swollen mass, laceration in tongue |
| Da Silva A.C. et al. (2004) [ ] | 10/M | Bicycle fall | Lower lip | Tooth 11 fragment | Lower lip firm mass, lacerations |
| Da Silva A.C. et al. (2004) [ ] | 17/M | Bicycle accident | Lower lip | Tooth 11 fragment | Swollen mass, lacerations in mental region |
| Cetinkaya R. et al. (2005) [ ] | 29/F | – | Lower lip | Anterior teeth fragments | Hard swelling in the lower lip |
| Rao D. et al. (2006) [ ] | 14/F | – | Lower lip | Tooth 21 fragment | Lower lip swelling with intermittent discharge |
| Al-Jundi S.H. et al. (2010) [ ] | 13/F | Fall | Lower lip | Tooth 21 fragment | Bleeding, laceration, scar, hard mass in lower lip |
| Cubukcu C.E. et al. (2011) [ ] | 4/M | Fall | Upper lip | Tooth 51 fragments | Upper lip swollen mass, laceration |
| Barua P. et al. (2013) [ ] | 12/F | Fall | Lower lip | Teeth 11,21 fragments | Lower lip swollen mass, infection, bleeding |
| Agarwal A. et al. (2013) [ ] | 12/F | Fall | Upper lip | Teeth 11,12 fragments | Lacerations, upper lip swollen mass |
This case report presents a pediatric patient with a chronic and severe orofacial infection caused by a foreign body embedded in the lower lip for 2 months. It emphasizes the importance of appropriate paraclinical testing for accurate diagnosis and timely treatment, particularly highlighting the role of ultrasound in improving diagnostic accuracy for this condition.
2
Case report
A 3-year-old Vietnamese male presented with swollen masses on the lower lip’s skin and mucosa. Two months earlier, he sustained trauma to the lip after a fall, causing initial swelling and bleeding, which resolved without treatment. A week later, a small, non-fluid-filled mass appeared at the trauma site. Despite a diagnosis of labial gland damage at a private hospital, no treatment was provided. As the masses enlarged, he was examined at the School of Dentistry. His medical history included a lingual frenectomy under general anesthesia five months prior, along with behavioral interventions. Extraoral examination revealed a red, firm, painless mass (3 × 4 mm) on the lower lip, oozing pink fluid on pressure, along with decayed primary upper incisors with significant hard tissue loss ( Fig. 1 ). Intraoral examination showed a white, firm, painless mass (2 × 2 mm) with undefined boundaries (2 × 2 mm) ( Fig. 2 ).
The tentative diagnosis is a lower lip abscess caused by a foreign body. An intraoral periapical radiograph (IOPAR) was ordered to detect a radiopaque foreign body, but due to the patient’s poor cooperation, two attempts were unsuccessful ( Figs. 3 and 4 ).
A Doppler ultrasound was then requested to examine the lower lip and detect any radiolucent foreign bodies. The ultrasound revealed a 2.5 mm hyperechoic structure in the soft tissue, corresponding to the site of clinical injury, with mild surrounding edema and a 1.8 mm hypoechoic fluid connecting the structure to the skin ( Fig. 5 ).
