Caliber-Persistent Artery |
||
|
||
|
Thick walled artery is found just beneath the
surface of the |
||
Quick Review for Patients
Note: click on underlined words for more detail or photos.
Miko et al first described, in 1980, a developmental anomaly referred to by them as persistent caliber artery of the lower lip. Also called, retained caliber labial artery and caliber-persistent labial artery, the lesion is exactly what the name implies. The inferior alveolar artery retains its large size and thickened walls even after it leaves the bone through the mental foramen and travels through the orbicularis oris muscle to supply the mucosal aspects of the lower lip. The artery becomes superficial toward the midline of the lower lip, and the persistent size makes it palpable, usually a few millimeters inferior to the vermilion border. This is also a phenomenon of the lower gastrointestinal tract, specifically of the gastric and jejunal mucosa, where it has produced lethal hemorrhage.
Clinical Features
Of the few examples of oral persistent
caliber artery reported to date, more than 80% have been on the lower lip
and a few have been on the upper lip and hard palate. Patients
have been 40-88 years at diagnosis, but lesions are present for months and
years prior to diagnosis. The artery typically presents as a sessile, elongated
nodule which may be pulsatile (Figure 1). It may be tender or ulcerated
as a result of recurrent trauma or irritation from the anterior teeth, and
this has led some to confuse the lesions clinically with ulcerative lip
carcinoma. Multiple lesions have been
reported.
Pathology and Differential Diagnosis
A large artery with thick smooth muscle walls (Figure 2) is separated from the overlying stratified squamous epithelium by a variable amount of routine fibrovascular connective tissue in this lesion. The "retained caliber" of this artery is obvious and the vessel is typically somewhat parallel to the surface. Excess keratin on the surface and scattered chronic inflammatory cells in the stroma are evidence of chronic trauma.
This lesion is easily distinguished from its venous counterpart, the traumatic angiomatous lesion (venous pool,
venous
lake, venous aneurysm) by the thickness of its muscled walls.
It may, at times, be difficult to differentiate caliber-persistent artery
from arteriovenous malformation (A-V shunt), but typically
the latter entity involves multiple intertwining arterioles rather than a
single large artery. The A-V shunt also has a greater admixture of arteriole
and venous vessels. There is no encapsulation of either lesion.
Treatment and Prognosis
No treatment is necessary for
caliber-persistent labial artery unless it becomes tender or excessively
enlarged from recurring trauma. Simple surgical removal
of the offending vessel will provide cure, although excessive hemorrhage
may be a surgical problem. The suggestion by Miko et al that
chronic ulceration of such a lesion may lead to malignant transformation
has not been substantiated by others.
References (Chronologic Order)
Note: General references can be found by clicking on that topic to the left.
Miko TL, Adler P, Endes P. Simulated cancer of the lower lip attributed to a "caliber persistent" artery. J Oral Pathol 1980; 9:137-144.
Miko TL, Molnar P, Verseckei L. Interrelationship of caliber persistent artery, chronic ulcer and squamous cancer of the lower lip. Histopathol 1983; 7:595-599.
Lovas JGL, Rodu B, Hammond HL, Allen CM, et al. Caliber-persistent labial artery: a common vascular anomaly. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86:308-312.
Manganaro AM. Caliber-persistent artery
of the lip: case report. J Oral Maxillofac Surg 1998; 56:895-897.
