We present a 24 year old female patient who consulted the Maxillofacial Surgery Department of the San José Hospital Complex in October 2006, referred from the Dermatology Department of the same centre with a diagnosis of SMR due to an increase in the volume of the lower lip which had not responded to treatment with intralesional and oral corticoids.
The patient reports that the enlargement of the lower lip dates back to 2004, which was biopsied in the same year and histopathologically diagnosed as a GCS associated with MDS. Initial treatment consisted of intralesional infiltrations performed in the dermatology department with betamethasone 4 mg and prednisone 0.5 mg without positive results.
In her medical history, she reported a history of morbid epilepsy under treatment, mild mental retardation, hypothyroidism, insulin resistance and allergy to iodine. The drugs he uses regularly are Levothyroxine 100 mg 1 tablet/day, Carbamazepine 200 mg 1.5 tablets/day, Metformin 850 mg 1 tablet/day.
Physical examination revealed a large increase in the volume of the lower lip, which was everted, associated with a depapillated tongue and the presence of transverse furrows on the dorsum of the tongue compatible with a fissured tongue, as well as a discrete macroglossia.

Treatment consisted of 3 intralesional infiltrations of 1 ml of Kenacort®-A 40 mg (Triamcinolone acetonide) diluted in 1 ml of 2% lidocaine in the lower lip to control post-infiltration pain, at one-week intervals. The patient was monitored for three months, where a marked reduction in the size of the lower lip was observed, but still without achieving an aesthetic size, so a fourth infiltration was performed without improvement. Then a lower lip reduction cheiloplasty was scheduled under general anaesthesia to improve the aesthetics of the patient's lip, with good results that were controlled at one month postoperatively.