Qualification of a patient with obsessive–compulsive disorder for lower lip reconstruction

We present a case of an emotionally unstable 20-year-old man with sadomasochistic inclinations, suffering from obsessive–compulsive disorder. In the years 2007 through 2010 the patient was brought to or arrived at our Outpatient Clinic at different time spans amounting to a total of 21 appointments during 3 years. The main signs were severe wounds in the perioral region, which the patient continued to self-inflict for over 10 years. He was suspected of self-extraction of mandibular teeth. Clinical and radiological exams confirmed absence of eight mandibular teeth and chronic inflammatory condition of the mandibular bone in the area of multiple tooth self-extraction. In August 2008 the patient was discharged from the Psychiatric Department and continued treatment as an outpatient. During his visits at the Outpatient Clinic of the Cranio-Maxillofacial Surgery Department in years from 2011 to 2013, the patient declared he would like to undergo lower lip reconstruction and prosthetic rehabilitation. Prosthetic rehabilitation, recommended by the attending psychiatrist and the team of the Outpatient Clinic of the Cranio-Maxillofacial Department, might serve as a test of the patient's adherence to his decisions.