Labial Incompetence Research Articles

Oral findings and comprehensive dental management of Moebius syndrome: a systematic review

BackgroundMoebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management.MethodsA digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate.ResultsTwenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%).ConclusionsThis systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.

Rare Disorders: Diagnosis and Therapeutic Planning for Patients Seeking Orthodontic Treatment.

The available literature on the orthodontic treatment of patients with rare disorders is extremely scarce. The aim of this study was to analyze the diagnosis and orthodontic treatment of a group of 94 individuals with rare diseases, referred for orthodontic evaluation to a university special care dentistry center (University of Santiago de Compostela, Spain). We created a control group of 94 systemically healthy individuals, paired by sex and age range. For all participants, we recorded their dental and skeletal abnormalities, oromotor dysfunctions and the characteristics of their orthodontic treatment. Some of the morphological and functional abnormalities were more prevalent in the rare disorders group than in the control group, including dental agenesis, microdontia, enamel defects, maxillary hypoplasia, overbite, cleft lip/palate, mouth breathing, atypical swallowing, lingual/labial interposition, labial incompetence, modified consistency diet, bruxism, and muscle tone abnormalities. Compared with the control group, the 56 patients with rare disorders who underwent orthodontic treatment required more desensitization sessions, used mixed appliances (fixed and removable) more often and for longer periods and had more frequent complications, such as gingivitis, caries, mucosal ulcers and recurrent debonding of the device. In conclusion, for selected patients with rare disorders, it is feasible to perform orthodontic treatment, whose planning will be determined by the dental-skeletal abnormalities and oromotor dysfunctions. Although complications are more frequent, they can typically be solved without having to stop treatment.

Basal Extended Mentoplasty.

The chin is one of the most visible facial structures. Chin surgery, was initially described, for, the treatment of facial abnormalities, advancing the mandibular symphysis; achieved anterior displacement of the base of the tongue showing some value in the treatment of snoring and obstructive sleep apnea, and achieved adequate lip competence. We designed the Basal Extended Mentoplasty (BEM) based on the needs of patients orthodontically compensated, but dissatisfied with the appearance of his face as well as upper airway problems looking for a solution to this, design and planning the advances of the chin. Patients operated in the service of Maxillofacial Surgery, Specialist Hospital, "Dr. Bernardo Sepulveda "XXI Century National Medical Center, during the period of 2015-2019, orthodontically compensated patients, with labial incompetence and Class II skeletal. Sixty-five patients were operated during this period, and eight cases are presented. Lip competition, osseointegration of the segments is observed, with a proper projection of the lower third, no nerve or vascular damage in the area. The design of the osteotomy is for orthodontically compensated patients with labial incompetence and Class II skeletal, giving a result mandibular lengthening. The BEM achieved adequate lip competence demonstrated by an interlabial gap of 0mm, achieved adequate osseous consolidation of the fracture site with a more harmonious facial balance and profile, without nerve or vascular damage with spectacular results.

Short-Term Effects of a Myofunctional Appliance on Atypical Swallowing and Lip Strength: A Prospective Study.

Atypical swallowing needs treatment in order to eliminate harmful interferences of the tongue, which prevent the harmonious growth of the stomatognathic system. The purpose of this study was to assess the effects of a functional appliance on the presence of atypical swallowing, analyzing the lip strength and the altered facial mimics. The effects of a myofunctional appliance (the Froggy Mouth) were evaluated on 40 children (6 males; 24 females; mean age 9.6 ± 2.17) with atypical swallowing—with tongue thrust diagnosed by an expert orthodontist—before and during a 6 month treatment. Data were analyzed over time with a paired samples t-test for normally distributed data. After 6 months of treatment, 33 children out of 40 achieved clinical correction of atypical swallowing due to their good compliance, even at an early stage. Seven children showed low compliance and did not obtain any result. Lip strength in compliant subjects went from 190.30 ± 86.04 cN to 489.39 ± 123.36 cN (t = p < 0.001). Facial mimics improved in 28 out of 33 compliant subjects, and four children with the initial diagnosis of labial incompetence achieved correction. This observational study demonstrates the short-term efficacy of this myofunctional appliance in the treatment of atypical swallowing, achieving correction of the facial mimics and labial incompetence with a significant improvement of the lip strength.

Dental trauma in the anterior sector: an analysis of the predisposing factors in a group of orthodontic patients.

The aim of this study was to analyze the predisposing factors of upper incisal trauma in children candidates for orthodontic treatment. This is a retrospective study involving 102 consecutive patients who requested orthodontic therapy at Pediatric Dentistry Clinic of Bari University's Dental School during the time frame 2012-2019. The distribution of reported dental trauma was analyzed according to gender, type of trauma, etiology, overjet and labial competence. No substantial association between gender and trauma emerged from our study. Patients between the age range of 11-15 years appear to be at increased risk. A statistically significant correlation between increase in overjet and traumatic events was found. A link was discovered between labial incompetence and trauma, since this condition increases the risk of trauma by exposing part of the surface of the upper incisors. A correlation also emerged between Skeletal Class II and the increased risk of traumatic injury. Dental trauma, especially in the anterior sector, is a fairly frequent occurrence in pediatric and adolescent patients and is linked to several factors. In our study subjects with Skeletal Class II division I malocclusion with elevated overjet are more predisposed to dental trauma. The limitations of our study are the low number of subjects in the examined sample, and the heterogeneity of the trauma presentation.

Correction of whistle deformity using the myomucosal vertical Z-plasty technique

Background: Bilateral cleft lip repair can result in various secondary deformities. The whistle deformity is a common sequel of unilateral or bilateral cleft lip repair, which involves a soft tissue deficiency in the central portion of the lip. This defect causes labial incompetence, which results in speech difficulties as well as compromised oral function.

Fente labiale inférieure para-commissurale : stratégie thérapeutique

We report the first case described in the literature of lateral, paracommissural cleft of the lower lip in a 2-year-old child. This anomaly caused labial incompetence requiring surgical correction. Different surgical techniques have been described for the treatment of the cleft of the upper lip. We studied each of them, analyzed the advantages and disadvantages of these techniques by inverting them and adapting them for the lower lip. We opted for the double "Z" plasty of Malek because the difference in height between the cleft side and the healthy side was important. In addition, this plasty hides part of the scar in the labiomental groove. The functional and aesthetic result at 6 months after surgery is satisfactory.

Tratamiento de las discrepancias dento maxilares en paciente Clase II esqueletal. Reporte de Caso

Class II skeletal is one of the major challenges to be treated by the orthodontist. This occurs when there is a discrepancy between the maxilla and mandible, ie may have an overgrowth of the maxilla accompanied by a retrusion of the mandible. This causes both skeletal and dental alterations, presenting crowding, labial incompetence or convex profile and may be strictly orthodontic treatment or in certain cases require maxillo facial surgeries. The objective of this research was to improve the patient's profile, achieving Class I molar and canine, correct lip incompetence and improve occlusion. The treatment plan included tooth extraction first upper and lower premolars and thanks to the implementation of the ROTH technique using elastic chains and arches retraction could meet the initial objective, improving the aesthetics and function of the dento structures facial.

Impact of genioplasty during puberty on the upper airways.

Mouth breathing is a functional disorder that affects craniofacial and dento-alveolar growth and also upper airway (UA) anatomy. This is apparent mainly in dimensional abnormalities of the UA caused by hypertrophy of Waldeyer's ring and excessive vertical development of the lower part, giving rise to labial incompetence that perpetuates the functional disorder. The main aim of this study was to evaluate the development of the oropharyngeal structures in young hyperdivergent patients who had undergone functional genioplasty in the context of orthodontic treatment. This is a comparative retrospective study performed on 47 adolescents who were hyperdivergent, non-obese and exclusive or diurnal mouth breathers, treated at the Centre de soins, d'enseignement et de recherche dentaires (CSERD) in Montpellier, France. All were candidates for early genioplasty for vertical reduction, and were undergoing or at the end of treatment: 23 had been treated surgically (functional genioplasty), and 24 controls had received orthodontic treatment alone. Inter-group comparison of the changes in cephalometric measurements of the oro- and nasopharyngeal zones and maxillomandibular measurements was performed using covariance analysis (ANCOVA) to adjust for confounding factors. Concerning the skeletal structures: in the sagittal dimension, genioplasty led to significantly greater projection of the symphysis in the surgical group than in the control group (P<0.001). However, the sagittal position of the hyoid bone was unchanged. Similarly, in the vertical dimension, the reduction in divergence of the bony base was significantly greater in the surgical group (P<0.001), but with no change in the vertical position of the hyoid bone. Concerning the upper airways: at the level of the nasopharynx, there was a significantly greater increase in the velopharyngeal space in the surgical group (P<0.033). The same observation can be made on the level of the oropharynx, where there was a significant increase in the linguopharyngeal space in the surgical group (P<0.05), which was not the case in the control group. The change in the depth of the pharynx did not differ significantly between the two groups. Early genioplasty performed on adolescents during the growth phase helps to recalibrate the UA by encouraging spontaneous lip closure.

Assessment of orofacial characteristics and oral pathology associated with cri‐du‐chat syndrome

To obtain a deeper insight into the difficulties individuals with cri-du-chat syndrome experience by means of the analysis of the most common features and oral pathology observed in the subjects enrolled in the study. Intra-oral and extra-oral features of a total of 33 patients with cri-du-chat syndrome (the larger sample so far analyzed) through their clinical and photographic examination. Models, orthopantomographies, and teleradiographies have been collected to establish a pattern as accurate as possible of the oral pathology associated with these patients. The present descriptive study shows that patients with cri-du-chat syndrome present with a series of orofacial features such as mandibular retrognathism, high palate, and variable malocclusion, more commonly anterior open-bite. Most patients also present with perioral muscle relaxation with labial incompetence and short philtrum. As regards oral pathology, these patients suffer dental erosions provoked by gastroesophageal reflux and attritions because of intense day-and-night bruxism. The odontologists' familiarity with the orofacial pathology associated with cri-du-chat syndrome and with the specific needs such disorder conveys should improve the quality of the buccodental treatment these professionals may offer to these patients.

Effects of interceptive orthodontics on orbicular muscle activity: A surface electromyographic study in children

The purpose of this study was to assess by surface electromyography (sEMG) the changes in upper and lower orbicular oris (OO) muscles produced by a preformed functional device in subjects with Class II, division 1 malocclusion, deep bite, and labial incompetence. Twenty-eight subjects were selected: 13 subjects (mean age 9 ± 1.5 years) with Class II malocclusion, deep bite, and labial incompetence were treated with a preformed functional device, while 15 subjects (mean age 9.5 ± 0.8 years) with normal occlusion were used as control. Inclusion criteria for both groups were: presence of mixed dentition, no previous orthodontic treatment, and absence of speech disturbance. sEMG recordings were taken at the time of the first visit (T0), and after 3 (T1) and 6 months (T2) for the treated group, and at T0 and T2 for the control group. The sEMG recording was performed at rest, and while kissing, swallowing, opening the mouth, clenching the teeth, and during protrusion of the mandible, by placing electrodes at the area of muscle contraction. At T0, except during swallowing, the treated group always showed a lower sEMG activity of the lower OO muscle with respect to the control group, with significant differences at rest and during mandibular protrusion ( p < 0.05). In the treated group, a significant increase in muscle tone was observed for the lower OO muscle from T0 to T1, but only at rest. The upper OO muscle showed a significant increase during the protrusion of the mandible from T1 to T2. No significant change was observed in the control group during the follow-up. Muscular contractility of treated patients at T2 reached the same values as that of the control group at T2. Interceptive orthodontics seems to improve the form and function of the orofacial muscle structure. Improvement in muscle contraction after treatment was demonstrated by sEMG.

Lip Analysis and Macrocheilia in Young Jewish Israeli Men

Sir: With the growing ease and popularity of lip rejuvenation and augmentation surgery,1 the establishment of norms of lip and lower face parameters has become particularly important for plastic surgeons. Macrocheilia, or excessively prominent lips, is not only considered unaesthetic, it may also interfere with oral function. The objectives of this study were to develop norms for lips and lower face parameters in relation to ethnic origin, and to numerically define macrocheilia. The study population consisted of a random sample of 403 men aged 18 to 19 years of Jewish Israeli origin undergoing dental screening after high school graduation. Participants completed a questionnaire on background data, including ethnic origin of both parents, and their lip and lower face parameters were measured. Lip incompetence was defined as unconsciously fully parted ptotic lips in rest position.2 Mean lip length at rest and while smiling was 3.15 ± 0.29 cm and 4.04 ± 0.32 cm, respectively. Mean upper and lower maximal lip thickness was 0.64 ± 0.13 cm and 0.98 ± 0.16 cm, respectively. Lower lip mucosal exposure was observed in 80 patients (20 percent) and lip incompetence was observed in 62 (15.4 percent). Lower lip thickness was significantly related to labial incompetence and mucosal exposure (p < 0.0001). Mucosal exposure was significantly related to lip incompetence (p < 0.0001). Six types of profiles were defined according to the most prominent feature in the lower third of the face. In most cases (63.8 percent), the upper lip was the most prominent feature, followed by the lower lip and chin (Fig. 1, left). In 29.3 percent of cases, the lower lip was the most prominent feature, followed by the upper lip and chin (Fig. 1, right). Five ethnicities were identified in the sample: Ashkenazi, Sephardic, Ethiopian, former Union of Soviet Socialist Republics, and mixed. None of the lip parameters was associated with ethnic origin except for upper lip thickness, which was significantly greater in the Ethiopian subgroup (p < 0.05). The lip and lower face norms in the sample of young Israeli men were close to Caucasian norms described in previous studies. Considering that 95 percent of the study population had a lower labial thickness of 0.66 to 1.3 cm (mean ± 2 SD) and an upper labial thickness of 0.38 to 0.9 cm, we defined macrocheilia as a lower vermilion thickness of more than 1.3 cm and an upper vermilion thickness of more than 0.9 cm, accompanied by mucosal exposure and incompetent lip.Fig. 1.: (Left) The upper lip is the most prominent feature, followed by the lower lip and chin. (Right) The lower lip is the most prominent feature, followed by the upper lip and chin.There may be a common Jewish norm for lip parameters, resembling the norm for Caucasians. Lower lip incompetence and mucosal exposure are not as rare as we assumed. Vermilion thickness of more than 1.3 cm for the lower lip and 0.9 cm for the upper lip accompanied by mucosal exposure and incompetent lip might serve as a definition of macrocheilia. Sagit Meshulam-Derazon, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqva and Sackler Faculty of Medicine Tel Aviv University Liran Levin, D.M.D. Department of Restorative Dentistry Maurice and Gabriela Goldschleger School of Dental Medicine Neta Adler, M.D. Dean Ad-El, M.D. Daniel J. Hauben, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqva and Sackler Faculty of Medicine Tel Aviv University Tel Aviv, Israel

Labial incompetence: a marker for progressive bone resorption in silastic chin augmentation: an update.

Bone erosion below silicone rubber implants is a wellknown sequela, occurring in a majority of patients undergoing augmentation genioplasty. It is generally considered to be self-limiting and with minimal adverse consequences. However, if bone erosion progresses to the extent to which teeth are jeopardized or alterations in sensibility of the mental nerve occur, removal of the implant is indicated. Osteoplastic genioplasty may be required to restore aesthetic contour to the chin and to avoid functional anomalies that may occur from explantation. A number of factors have been identified that contribute to this phenomenon; however, speculation regarding its etiology has not acknowledged the functional aberration of a tensed mentalis muscle. A study of six patients with aesthetically positioned and appropriately sized Silastic implants revealed a correlation between preoperative baseline labial incompetence and mentalis muscle hyperactivity and progressive bony erosion. One patient had grade II erosion and four patients had grade III erosion, one with the exposure of dental roots. The sixth patient with mentalis muscle strain, subsequent to attempts to contain her lower denture, also had severe resorption. Such findings suggest that attention should be paid to an alternative approach in microgenic patients presenting with lip strain, since labial incompetence appears to be a reliable marker for ongoing mandibular resorption following Silastic augmentation. Furthermore, since most patients are asymptomatic until significant erosion occurs or are satisfied and do not return, in those individuals with labial incompetence who have already had Silastic chin implants, consideration should be given to routine follow-up examination and radiographs.

Évolution des idées dans la réparation des lèvres

The history of lip repair shows significant parallelism with the evaluation of ideas in plastic and reconstructive surgery. The first attempts were addressed mainly to full-thickness lower lip repair as the resulting labial incompetence was more handicapping. However, techniques and knowledge evolved rapidly to the modern state of the art. Almost all the procedures used today were already described in the early 20 th century and their progress based on a profound knowledge of functional anatomy established the principles of labial sphincter dynamic repair by tissue redistribution.

Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case-control study.

Habitual snoring and obstructive sleep apnoea in children, which are frequently associated with adenotonsillar hypertrophy, may begin early in life and in relation with orocraniofacial features. The aim of this study was to detect the presence of early bone craniofacial modifications in young children with a long history of habitual snoring. Twenty-six habitually snoring children (mean age 4.6 yrs) were studied by nocturnal portable recording or diurnal polysomnography, cephalometry and orthodontic evaluation. A comparison of cephalometric findings was made between the studied group and 26 age-matched children (mean age 5.1 yrs) with no history of snoring or respiratory problems during sleep. The cephalometric analyses showed a significant increase in craniomandibular intermaxillar, lower and upper goniac angles with a retroposition and posterior rotation of the mandible (high angle face) and a reduction in the rhinopharynx space caused by higher thickness of adenoids in habitually snoring children compared with controls. Cross-bites and labial incompetence as well as daytime symptoms and familiarity for habitual snoring were found in most of the studied group of snorers compared with controls. The results indicate that upper airway obstruction during sleep is associated with mild but significant cephalometric and craniofacial modifications in children complaining of habitual snoring. Whether this skeletal conformation is genetically determined or influenced by the early onset of habitual snoring remains to be assessed.

Aesthetic lip contouring

Barry A. Davidson, MD W. Earle Matory, Jr., MD Sheldon A. Rosenthal, MD Edward O. Terino, MD Dr. Davidson: The first patient (Figure 1) is a 21-year-old woman who seeks volume reduction in the lower lip and volume augmentation in the upper lip. Figure 1 Twenty-one-year-old-woman seeks augmentation of the upper lip and reduced volume in the lower lip. She would also like increased prominence of the philtral column. Dr. Matory, what procedures would you suggest for this patient? Dr. Matory: I'm a little concerned that she may have some lip incompetence. If that were the case, reducing her lower lip volume might exaggerate any existing deformity. Even if she does not have a full lip incompetence and is able to approximate her lip voluntarily, thinning the lower lip would exacerbate any deficit that she has. Dr. Davidson: That's an excellent point. How would you reduce this patient's lower lip if she didn't have incompetence? Dr. Matory: I would use an alveolar sulcus incision and undermine the mucosa. I could then adjust the lip height before actually resecting mucosa. This maneuver lessens the potential for exaggerated labial incompetence. The goal in reducing the lower lip is to bring it up to at least 1 to 2 mm above the medial incisors. If the lower lip falls below the medial incisors, unattractive incisal show will develop. Dr. Davidson: What would be your approach to giving this patient a fuller upper lip? Dr. Matory: Several options are available for augmentation. My primary goal would be to give her a mucosal enlargement as opposed to reducing what seems to be a slightly elongated upper lip. For mucosal enlargement, I prefer autologous tissue. I typically perform a mucosal advancement along with some form of soft tissue augmentation—for example, a fat graft, dermal fat graft, or temporalis …