Bilateral Lip Research Articles

Cheiloplasty by Pfeifer's Technique

Introduction: Cleft lip repair is done usually between the ages of 3rd–5th month of life. Millard's and Tennison techniques are usually used worldwide which are modified Z-plasty techniques at the superior and inferior ends of the philtrum, respectively. Wave-line incision method was introduced by Pfeifer (1970) and the available literature shows that it is an easy technique, applicable to almost all types of clefts. Hence, the study was undertaken to evaluate the results of this method. Patients and Methods: The study was carried out in a total of 701 patients, of which 572 were unilateral cleft lips and 129 were bilateral lips. According to this method, the lip skin incision modified into a wavy line, thus making it less conspicuous using the concept of “morphological order.” The basis of this is that a skin incision between two points can be lengthened if both points are joined in a curve or wavelike manner rather than in a straight line. Results: The results were evaluated for white roll match, vermilion match, cupids bow, and nasal symmetry after cleft repair and found to be excellent with 93.5%, 92.4%, 94%, and 81%, respectively, in unilateral cleft lip variety, good with 75.9%, 71%, 82%, and 87.5%, in bilateral cleft lip variety. Conclusion: This method is not a new technique, but the literature is not available. The technique is found to be good and useful in all clefts, also in revision surgeries and also found to be clinically as well as statistically significant.

Rare presentation of Van der Woude syndrome in a mother and child: A case report from Sub-Saharan Africa

Van der Woude syndrome (VWS) is a very rare congenital abnormality with high degree of penetrance and variable phenotypic expression. Common phenotypic features reported in the literature include bifid uvula, submucous cleft palate, or cleft palate to incomplete and complete unilateral or bilateral cleft lip and palate with lower lip pits as cardinal feature. Bilateral, single median or paramedian pits have been reported. We present an unusual VWS in both mother and child with the mother presenting with double bilateral (four) lower lip pits.

Airway management with a rigid external distractor in place.

Airway management with a rigid external distractor in place.

Correcting the secondary bilateral cleft lip deformities using an innovative partial-thickness musculomucosal pedicle cross-lip flap

Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip. We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap. Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities. The central defects usually occurred in these patients. The defects were reconstructed partially or completely according to the severities of the defects. The operative procedures were as follows: The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided. Then the partial-thickness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect. Results All 98 musculomucosal pedicle flaps were viable. The upper lips were reconstructed according to the severities. Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity. It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities. Key words: Bilateral clefit lip; Secondary deformity cleft lip; Cross-lip flap; Upper lip deformity

Prevalence of cleft lip and/or palate in children from Lodz between years 1981–2010

Congenital malformations constitute a serious problem of both medical and social nature. Cleft lip and/or palate represent the most common congenital anomaly of the face that is why it is essential to know the real frequency of the described phenomenon. The aim of this paper is to determine the frequency of cleft lip and/or palate and the types of malformations that occurred in Lodz city between the years 1981-2010. Our clinic has been carrying on the studies concerning the incidence of cleft lip and/or palate since 1981. The Polish Registry of Congenital Malformations has been operating in Poland since 1 April 1997. The team has managed to obtain data, from the Registry, concerning the total number of all live born infants and the number of children with cleft lip and/or palate, who were born in Lodz, between 1998 and 2010. In years 1981-2010, 319 children, in 210 952 live born infants, were born with cleft lip and/or palate in Lodz. The isolated cleft palate was observed more frequently in girls and the unilateral cleft of lip and palate in boys. In all three decades palate clefts are more common whereas bilateral lip, alveolus and palate clefts are more infrequent. A small tendency to decrease in actual cleft lip and/or palate frequency among children, in the period of 30 years, is observed in Lodz. Over the years it has still been observed that the isolated cleft palate is the most common type of defect.

Pilot study of pre-maxilla replacement and bone graft in a patient with lip and palate clefts: transforaminal relationship between upper canines and bone graft

Objective: The aim of this study was to assess patients subjected to replacement surgery of the pre maxilla with bone graft, having as donor area the iliac crest and chin, and the relation with upper canines erupted in grafted areas. Materials and Methods: 54 records were evaluated from cleft patients that were under treatment at CAIF - Center of Attention to Clefts in Curitiba, PR, Brazil, both sexes, with unilateral and bilateral lip and palate clefts. Patients younger than fourteen years old, both sexes, that lost the surgical segment or did not continue the treatment at same welcoming institution, were excluded. The surgical segment average was 5.72 years. Results: Using both descriptive and chi-square statistics, we observed a statistically significant distinction regarding the eruption of upper canines in the region of secondary bone grafts when using iliac crest and chin grafts, which 62.8% of the sample that was treated with chin grafts happened to have an eruption of upper canines, and 37.2% were successful with iliac crest grafts (value-p 0.028). Conclusions: It is necessary to carry out a study with a larger sample size and where the samples are paired in order to confirm the superiority the iliac crest donor area as the gold standard for this surgical procedure.

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

BackgroundThe authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero-premaxillary suture.Material and Methods4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla.ResultsThe follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars.ConclusionsTo our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are required. Key words: Protruding premaxilla, bilateral cleft lip, vomerine ostectomy, one stage surgery, Millard II technique.

A method for reconstruction of vermilion tubercle.

Background:This article reports on the bilateral lip mucosa flaps (BLMFs) for reconstruction of the vermilion tubercle of the corrected cleft lip deformity.Methods:From 2005 to 2013, the bilateral mucosa flaps procedures were performed on 34 secondary cleft lip patients (bilateral, n = 25; unilateral, n = 9). We retrospectively reviewed the pre-, intra-, and postoperative data of these 34 cases receiving BLMFs.Results:Satisfactory results were obtained, both cosmetically and functionally, in all 34 patients. Lateral projection measurements of the reconstructive vermilion tubercle showed a mean increase of 151%. There were minimal perioperative complications. The color and texture matched well with the surrounding tissue. The postoperative scars are not remarkable at all.Conclusions:The technique is relatively simple. The BLMFs provided a versatile and reliable option for the reconstruction of the vermilion tubercle from secondary cleft lip deformities.

Van der woude syndrome with short review of the literature.

Van der Woude syndrome (VWS) is a rare autosomal dominant condition with high penetrance and variable expression. Clinical manifestation of this autosomal dominant clefting syndrome includes bilateral midline lower lip pits, cleft lip, and cleft palate along with hypodontia. These congenital lip pits appear as a malformation in the vermilion border of the lip, with or without excretion. Discomfort caused by spontaneous or induced drainage of saliva/mucus when pressure is applied or during a meal as well as poor aesthetic match is one of the main complaints of patients with congenital lip fistula. The pits are treated by surgical resection. Dentists should be aware of the congenital lip pits as in Van der Woude syndrome because they have been reported to be associated with a variety of malformations or other congenital disorders. Here, the authors report a rare case of Van der Woude syndrome with short review of the literature.

Syphilis related to atypical oral lesions affecting an elderly man. a case report

To present a case of oral syphilis in an old patient. Syphilis seems to be resurging mainly in the young. However, in the last twenty years, the elderly have become more susceptive to infectious diseases due to a more frequent use of sildenafil. An 83-year-old man was referred to our clinic complaining of burning mouth. His medical history revealed papular lesions on chest and penis glans, which had been diagnosed and treated as scabiosis 2 months prior to our assessment. The intra-oral examination showed erosive and patch lesions on the bilateral lip commissures, the palate and the border of the tongue. Initially, oral herpes was suspected. However, both the serological test and the cytology were negative. Therefore, syphilis was hypothesised. Non-treponemic (VDRL) and treponemic tests (FTA-ABS) were reagent and secondary syphilis was confirmed. The treatment consisted of penicillin G benzathine 2.4 million IU/IM for 4 weeks. Both oral and skin lesions had complete remission. The present case illustrates that syphilis should be suspected in old patients with oral atypical lesions.

The Application of Bilateral Lip Mucosa Flaps in Repairing Upper Vermilion Defects

The lip is a primary aesthetic feature of the human face. Repair of vermilion defects represents a unique challenge to the reconstructive surgeon. The methods of repair are various and have both advantages and disadvantages. Bilateral lip mucosa flaps were applied to the repair of upper vermilion defects, and the effects were observed and reported in this article. The bilateral lip mucosa flaps were designed. Two reverse triangular flaps were designed on both sides of the upper vermilion defect. These 2 flaps have the common pedicle in the vermilion depression site. Alternatively, a "λ" incision may be used in the wet vermilion. Then, the mucosa flaps were raised, and the dissection was performed between the orbicularis oris muscles and oral mucosa glands. Next, the bilateral mucosa flaps were rotated down 90° and inserted into the "λ" incision to increase the tissue volume of the middle upper lip and deepen the labiogingival sulcus. The common pedicle of the mucosa flaps was formed to the vermilion tubercle, and the incisions were sutured layer by layer. From 2005 to 2010, the bilateral mucosa flaps procedures were performed on 30 secondary cleft lip patients (bilateral, n=22; unilateral, n=8). Lateral projection measurements of the reconstructive vermilion tubercle showed a mean increase of 149%. Satisfactory results were obtained, both cosmetically and functionally, in all 30 patients. There were minimal perioperative complications. The postoperative scars are not remarkable at all. The technique is relatively simple. The bilateral lip mucosa flaps provided a versatile and reliable option for the correction of vermilion defects from secondary cleft lip deformities.

Independent Component Analysis of Localized Resting-State Functional Magnetic Resonance Imaging Reveals Specific Motor Subnetworks

Recent studies have shown that blood oxygen level-dependent low-frequency (<0.1 Hz) fluctuations (LFFs) during a resting-state exhibit a high degree of correlation with other regions that share cognitive function. Initial studies of resting-state network mapping have focused primarily on major networks such as the default mode network, primary motor, somatosensory, visual, and auditory networks. However, more specific or subnetworks, including those associated with specific motor functions, have yet to be properly addressed. We performed independent component analysis (ICA) in a specific target region of the brain, a process we name, "localized ICA." We demonstrated that when ICA is applied to localized fMRI data, it can be used to distinguish resting-state LFFs associated with specific motor functions (e.g., finger tapping, foot movement, or bilateral lip pulsing) in the primary motor cortex. These ICA components generated from localized data can then be used as functional regions of interest to map whole-brain connectivity. In addition, this method can be used to visualize inter-regional connectivity by expanding the localized region and identifying components that show connectivity between the two regions.

Surgical technique for mucosal closure of retro pre maxillo-palatine cleft in childrens and adults with bilateral lip cleft

Surgical technique for mucosal closure of retro pre maxillo-palatine cleft in childrens and adults with bilateral lip cleft

Correction of Secondary Bilateral Complete Cleft Lip and Whistling Deformities: The Advance and Rearrangement of the Bilateral Lip Tissues

This report introduces a new method for correcting secondary deformities of bilateral complete cleft lip (BCCL) and assesses its short-term results. In this series, 30 patients (21 males and 9 females) ages 4-27years (mean age 14years, 2months) who had previously undergone surgery to correct BCCL using the lateral columellar flap method or the straight-line method were treated using the authors' new curved-line method. Points were marked, and curved lines were used to link the points, with subsequent rearrangement of the lip tissues. Photographic documentation of lip heights was obtained before and after surgery, and short-term patient satisfaction was evaluated using a questionnaire. At 6months, the mean increases in central upper vermilion height and the vermilion heights of Cupid's bow points were 152±20% (central upper vermilion), 87±34% (left Cupid's bow point), and 91±5% (right Cupid's bow point) (P≤0.05). Of the 30 patients, 21 were very satisfied with their results, whereas seven patients graded their results as good. The technique of advancing and rearranging the bilateral lip tissues is a simple and effective method for correcting secondary deformities of BCCL.

P02 - 362 - Schizencephaly and psychosis

Schizencephaly is an uncommon congenital disorder of cerebral cortical development, defined as a gray matter-lined cleft extending from the pial surface to the ventricle. It is a neuronal migration anomaly, caused by insults to migrating neuroblasts during 3rd to 5th gestational months.Ischemia, germline mutations, intrauterine infections and exposure to drugs have been implicated in its etiology. The outcome relates with the severity of pathology. Unilateral closed lip schizencephaly has the mildest clinical picture and bilateral open lip the most severe. The most prominent manifestations are motor deficits and seizures.Schizencephaly has been related with psychosis. However, there is paucity of literature exploring this relation. Pubmed search with “Schizencephaly AND Psychotic disorders OR Bipolar Disorders” as Mesh terms resulted in 9 results. Of these four discussed Schizencephaly. Rest five reports were related to other disorders of cortical malformation. We present an interesting case of schizencephaly associated with psychosis and congenital hemiparesis. We also present a review of literature available for this rare association.This case points towards the role of neurodevelopmental abnormalities in the manifestation of psychosis and bipolar affective disorder. It indicates that presence of neurodevelopmental anomalies may have pathoplastic effects on the presentation of psychosis and may also influence treatment response adversely. A possible mechanism explaining the development of psychosis in schizencephaly is the disruption in intracortical connections. There is also a possibility of underlying ictal phenomenon leading to psychosis. The above case provides support to the neurodevelopmental theory of Schizophrenia.

Correction of complete bilateral cleft lip by using post nasal septal arterie's flap

Objective To develop a new method for correction of the deformity of the complete bilateral cleft lip with short pre-lip. Methods Two specimens with the complete bilateral cleft lip was chosen to investigate the arterial supply to the pre-lip. The arteries were observed by radiography when the specimen was infused with lead oxide. 16 patients with the complete bilateral cleft lip and shortage in the length of pre-lip were enrolled in this study. Taking advantage of the unique character of arterial supply of complete bilateral cleft lip, those with short pre-lip were corrected. Photos of them were taken when preand post-operation for further measurement. And more than 1 year following-up was conducted to judge if the results were good enough or not. 30 babies were chosen as a control group to confirm the results of surgury objectively. Results Post nasal septal arteries were found to supply the pre-lip of the bilateral complete cleft lip. Appearance of 16 patients was good after surgery or 1 years later. There was no statistical significant difference between the patients and control group in the measurement data but nasal-lip angle. Conclusion It is an effective way to correct deformity of the bilateral cleft lip with short pre-lip by taking advantage of post nasal septal arterie's flap. Key words: Bilateral compelet cleft lip with short pre-lip; Surgical correction; Post nasal septal arteries; Short pre-lip

Strange occurrence of lip indentation

From m Fund Conf no Corre D 80 J Am 0190 a 20 doi:1 A 24-year-old white man presented for a vascular malformation of the right forearm that had been present since birth. He had bilateral symmetrical lip indentations (Fig 1). The lip indentations were asymptomatic other than the rare drainage of clear fluid. A careful examination of his mucous membranes, head, and neck was otherwise normal. The rest of his cutaneous examination revealed the vascular anomaly of his forearm and was otherwise normal.

Van der woude syndrome - case report

Genes contains the blue prints for human growth and development. Van der Woude syndrome is a developmental disorder characterized by lip pits on lower lip, cleft palate alone or with cleft lip in some cases & missing teeth. The features of VWS are discussed here with a case report. Bilateral lip pits with submucous cleft palate and bifid uvula were appreciated in the case.

PC-based asymmetry analyzer for facial palsy study in uncontrolled environment: A preliminary study

We develop a PC-based quantitative asymmetry analyzing system for facial palsy patients. To collect frequent data, the system is designed to maximize the chance of measure and minimize the variation of measuring. The system is based on the DirectX technology adopting white balance correction, lip segmentation, point-tracking techniques. The degree and pattern of asymmetry is estimated by tracking the bi-lateral lip points. Tracking performance is tuned up by changing the configuration of tracking compared to previous study. All data are able to be sent via FTP and reviewed by clinician. DirectX technology makes it measure anywhere. White balance correction is effective in restoring color distortion and lip segmentation by region growing is effective in finding bi-lateral lip points but not in all environments. Point-tracking is a good method to provide the temporal movement of lip. A larger searching window of tracking points shows an improved performance in point of variation and robustness at fast movements. Transferring via Internet makes monitor the patient frequently. PC-based analyzing system is able to use not just in clinic but also at home. The system makes it possible to measure frequently and objectively and leads to diagnose exact conditions of patient.

Combined early cleft lip and palate repair in children under 10 months – a series of 106 patients

This article reviews a series of 106 patients presenting with cleft lip and palate who underwent a simultaneous combined cleft lip and palate repair under the age of 10 months. The technique is described together with the early postoperative results. A single surgeon (the author) operated on the 106 patients. The youngest patient was 6 weeks old, and the smallest weighed 2.3 kg. All patients underwent palate repair, followed by lip repair, at a single sitting. The palate repair used the Sommerlad technique with radical muscle repositioning and bilateral lateral Langenbeck-type releasing incisions when indicated. Of the total, 71 patients (67%) had a unilateral lip and palate cleft and underwent a modified Millard repair; 34 (32%) had a bilateral lip defect and underwent a modified Mulliken repair; and one (1%) had a midline cleft lip. Ten patients were excluded from the study, as their palate was deemed too wide to close. Instead, they underwent cleft lip repair and vomer flap to the anterior palate alone. The mean duration of the procedure was 97 min. There was neither mortality, nor significant anaesthetic complications. Two patients who had low oxygen saturation postoperatively were taken back to the theatre. In both cases, the soft palate sutures were removed and the airway improved to a safe degree, permitting return to the ward for subsequent final repair. All patients were discharged home without any ongoing problems. One patient subsequently developed a unilateral dehiscence of a bilateral lip, and seven patients underwent a second procedure to close a palatal fistula. Early follow-up results are encouraging, with only 8% of patients to date requiring a second procedure. Although technically challenging, cleft lip and palate repair in a single simultaneous procedure is a successful and, most importantly, a safe procedure, which enables the complete clefting condition to be repaired early and in a single operation.