Comprehensive Management of Pediatric Ascher Syndrome: A Case Report and Literature Review.

Abstract

Ascher syndrome is a rare disorder characterized by a triad of upper eyelid ptosis, lip mucosa hypertrophy, and nontoxic thyroid enlargement. Pediatric cases are extremely rare and often underrecognized due to nonspecific symptoms and the lack of standardized diagnostic criteria. We report the case of an 8-year-old boy with incomplete Ascher syndrome who presented with progressive bilateral upper eyelid laxity and thickened, everted lip mucosa. After comprehensive evaluation, surgical correction was planned to address the functional and cosmetic concerns associated with the lip deformity. The patient underwent mucosal excision with a double inverted "W" incision for the upper lip and a horizontal dumbbell-shaped incision for the lower lip. Histopathologic examination revealed characteristic findings, including salivary gland hyperplasia, edema, and reduced elastic fibers. No eyelid surgery was performed due to the absence of visual obstruction. Postoperative follow-up for 3 years demonstrated stable aesthetic results, normal lip function, and no recurrence or visible scarring. This case underscores the importance of early recognition and multidisciplinary planning in pediatric Ascher syndrome. Tailored surgical intervention can yield favorable long-term outcomes, even in young patients. A concise review of the literature is provided to contextualize this rare condition and to inform treatment strategies. Despite limited case volume, this report contributed to the growing clinical understanding of pediatric Ascher syndrome and highlighted the potential of personalized surgical approaches to optimize patient outcomes.