We managed four patients who had neoplastic, posttraumatic, atrophic and postoperative lip deformity, respectively. Case 1: The patient had a hemangioma (17 × 14 mm) confined to the vermilion part of the lower lip. We performed the wedge excision of the tumor and labioplasty. The postoperative appearance and function of the lip were satisfactory. Case 2: The patient had posttraumatic deformity of the upper lip. We performed correction by Cronin's triangular flap method. The postoperative appearance of the lip was satisfactory. Case 3: The patient had severe atrophy of the upper lip and difficulty closing mouth due to progressive hemifacial atrophy. We performed reconstruction of the upper lip on the atrophic side with a cross-lip vermilion flap from the non-atrophic lower lip. The postoperative appearance and function of the lip were satisfactory. Case 4: The patient had postoperative lower lip deformity and difficulty closing mouth after tumor resection and reconstruction with a myocutaneous pectoralis major flap. We performed debulking of the bulky flap and covered the raw surface with a local rotation flap. The postoperative lip closure was satisfactory. In patients with lip deformity, it is important to perform appropriate correction or reconstruction according to each patient's clinical features in order to achieve satisfactory cosmetic and functional outcomes.

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SHIMOIDE Takeshi ・ ENOMOTO Akifumi ・ MATSUNAGA Kazuhide IWASAKI Sanae ・ OKAMOTO Reiko ・ HAMADA Suguru : Diffuse sclerosing osteomyelitis of the mandible (DSO) is a non-bacterial osteomyelitis that has been considered one of the symptoms of chronic recurrent multifocal osteomyelitis or synovitis, acne, pustulosis, hyperostosis and osteitis syndrome, which are autoinflammatory diseases. DSO is clinically difficult to diagnose, and no clear consensus has been established regarding its management. We herein present a pediatric case of DSO successfully treated by anti-TNF-α therapy. A 13-year-old Japanese child was referred to our clinic because of swelling of the right mandibular gingiva. Antibiotics were administered as an initial treatment, but were ineffective. We used hyperbaric oxygen therapy and performed mandibular corticotomy; however, these treatments were also ineffective. Incisional biopsy of the mandible region was performed, revealing DSO. Treatment with a corticosteroid was begun, and clinical symptoms dramatically decreased. However, we could not decrease the corticosteroid dose owing to the recurrence of inflammatory symptoms. Bisphosphonate or disease-modifying antirheumatic drug treatment was also effective but was stopped owing to adverse reactions. Then, the patient was treated with anti-TNF-α antibody. After administration, remarkable improvement of inflammatory findings was confirmed. In addition, no major side effect or complication was encountered, and a complete response has been achieved for 2 years. This case provides a basis for the future appropriate management of DSO using anti-TNF-α antibody in pediatric patients. : DSO (慢性び漫性硬化性下顎骨骨髄炎) SAPHO syndrome (SAPHO 症候群) CRMO (慢性再発性多発性骨 髄炎) autoinflammatory disease (自己炎症性疾患) anti-TNF-α antibody (抗 TNF-α 抗体) 近畿大学医学部附属病院歯科口腔外科 (主任：濱田 傑教授