Labial Muscles Research Articles

Primary Rhinoplasty by Open Approach With Repair of Bilateral Complete Cleft Lip

Nasal deformities inherent to a cleft are challenging. A controversy existed regarding the best time to correct these nasal problems. Now, there is a consensus that these nasal deformities are better to be dealt with along with repair of cleft lip.Primary cheilorhinoplasty involves proper reconstruction of clefted musculoaponeurotic complex by placing the muscles in their proper anatomic-physiologic orientation through careful identification, dissection, and mobilization of paranasal and labial musculature. In short, cleft repair is a muscle repair that enhances the establishment of a normal nasolabial complex. Delicate dissection and accurate repositioning of the lower alar cartilages during a primary lip repair will definitely help to establish a normal nasal shape. The nasal tissues must be supported with accurately placed sutures either by an open or a closed approach. The author prefers the open approach as published by Trott and Mohan (Br J Plast Surg 1993;46:215-222) with modifications because it has the added advantage for the identification and proper repositioning of the lower alar cartilages by accurately placed sutures under direct vision and the incisions of this procedure can be carried out through hidden rim incisions without any residual scars even in the colored population who were offered with this technique. Silicone nostril retainers, if available, during the immediate postoperative period will definitely promote the proper contours and the patency of the nostrils.Since 1994, the author has been performing this technique for patients with complete unilateral and bilateral cleft lip, which were presented separately. Patients with incomplete cleft lip were not included in this study because the nasal deformities were minimal, although the technique can be adopted for the correction of incomplete cleft lip nasal deformity also. Till December 2007, a total of 142 children with complete bilateral cleft lip with gross nasal deformities have been operated on and followed up.

S111: Cleft Lip/Nose and Palate: Muscle Surgery and Primary Functional Management

Nasolabial musculature is an important element to address in cleft lip and nose cases for the achievement of a favorable clinical outcome. Disruptions of facial tissues in clefting disorders usually from skin down to bone including muscles in between exhibit an important functional role during facial growth and development. Due to loss of tissue continuity and hence the breakdown of the equilibrium of functional forces acting upon each halves of lips, nose and the entire facial skeleton, stimulation and establishment of normal growth are also affected. Current understanding of surgical treatment of cleft lip and nose entails a reconstructive concept that requires a surgical maneuver by incorporating and taking into consideration of anatomically misaligned and dysfunctional regional muscles and muscle groups. Proper reapproximation and reconstruction of labial and nasal muscles correct the discontinuity and thereby restore transmitting forces through these structures. The prime reason for this surgical step is to restore functional imbalance and hence resultant forces acting upon affected structures of the clefting disorder. The technique requires identification, isolation and reconstruction of these muscles and/or muscle groups that situate around lips and nose. Improved outcome on the basis of this concept requires execution of a proper surgical treatment sequence and protocol. However muscle surgery is not the only disrupted structure to be addressed as all tissues involved either directly or indirectly affected have to be taken into consideration and handled accordingly. Mucocutaneous structures need to be carefully analyzed for their aberrations and displacements from their correct positions in order to place correct incisions and reposition into their correct localizations. This particular issue is usually overlooked and may result in violation of subjacent esthetic units which in turn yield unacceptable clinical esthetic outcomes. Therefore identification of skin of lip and nose and their reconstruction is mandatory. In addition primary septorhinoplasty and nasal floor reconstruction are also important operative phases in the surgical correction of cleft lip and nose. The reconstruction of cleft palate and alveolus regarding timing and surgical technique is still a controversial issue as several regimens have been described to achieve the best functional and esthetic outcome as in cleft lip and nose. Soft palate in cleft patients being the posterior part of the face needs to be addressed just like the anterior face and a meticulous muscle surgery has to be accomplished. In addition a staged closure is generally fol

The Use of Dermal Fat Grafts for the Correction of Secondary Cleft Lip Deformities

Sir: Surgeons who treat patients with cleft lip deformities face a wide array of challenges, both in the initial repair of the distorted anatomy and in the frequent “touch-up” procedures to improve secondary deformities. Common local techniques include V-Y vermilion advancement, Z-plasties, elliptical excision, Abbé flaps, and Kapetansky flaps.1,2 When local tissues are inadequate for volumetric correction, a wide range of grafting material is frequently used with variable results.3,4 Eight patients underwent cleft lip revision performed by a single surgeon using our dermal fat grafting technique at our facility between 1997 and 2001. The defect was outlined with a surgical marker, and the vertical incision placed on the posterior (oral) aspect of the marking. A subcutaneous pocket was dissected while staying within the markings of the defect, and the dermal graft was harvested. The size and shape of the graft were slightly larger than those of the outlined lip defect, to allow for trimming and slight overcorrection of the defect, since 10 to 15 percent resorption is expected (Fig. 1). The skin to be used was de-epithelialized in situ and excised full thickness with a thin layer of fat on the undersurface of the dermis. The graft was placed on the lip externally and trimmed to fit the defect optimally (Fig. 2). The graft was then drawn inside the pocket using two U stitches of 5-0 chromic gut suture, with the dermis side inward and the mucosal incision closed.Fig. 1.: Defect outlined on lip.Fig. 2.: Dermal fat graft overlying defect, trimmed to fit defect optimally with slight overcorrection.The charts were reviewed along with the standardized preoperative and postoperative photographs. Of the eight patients who underwent cleft lip revision, five had unilateral cleft deformities and three had bilateral deformities. All but one of the patients had a concomitant cleft palate. The average follow-up was 22 months. The average age at the time of operation was 12 years. Two of the patients, both with unilateral deformities, were noted to have a “slight excess fullness” on the grafted side but did not require a repeated operation. The initial patient in the series developed a palpable nodule of fat necrosis that required removal in addition to excision of excess vermilion. No other patients required repeated procedures for their cleft lip deformities (Table 1).Table 1: Patient DataThe method we have described has yielded consistent and durable results. The technical aspect of harvesting and placing the graft is straightforward and has a shallow learning curve. Our method differs from that reported in another recently published article5 and features a precisely dissected pocket to define the deficit to be augmented. We prefer to place our grafts with the dermis side down, believing the outwardly placed fat has a softer feel and graft take is better with the dermis adjacent to the labial muscle layer. Grafting can be combined with other procedures, such as V-Y advancement. In addition, the majority of these patients do not require the creation of any other scars, due to the harvest of tissue in the iliac region from bone-graft-harvest donor sites. In the event of incomplete correction, the procedure can be easily repeated for further focused augmentation. Craig Staebel, M.D. Charles N. Verheyden, M.D., Ph.D. Department of Surgery Division of Plastic Surgery Scott & White Memorial Hospital and Clinic The Scott, Sherwood, and Brindley Foundation The Texas A & M Health Science Center College of Medicine Temple, Texas DISCLOSURES There were no sources of funding supporting the work, and there is no financial interest to declare on behalf of either author.

Long-term Results After Using Dynamic Presurgical Nasoalveolar Remodeling Technique in Patients With Unilateral and Bilateral Cleft Lips and Palates

To evaluate the effects and durability of results after using dynamic presurgical nasoalveolar remodeling in patients with unilateral and bilateral cleft lips and palates. Dynamic presurgical nasoalveolar remodeling technique does not rely on the relatively static force exerted by the orthopedic plate held in place by means of tape or adhesives. The principle behind this procedure is the use of the force generated during suction and swallowing to produce the remodeling effects on the nasal structures. The nasal component acts not only on the nasal structures but also in the lip function by stimulating labial muscle contraction. Direct anthropometry performed before primary reconstruction of the lip and nose and 1 year later posterior to surgery suggests that results are permanent. When the dynamic presurgical nasoalveolar remodeling protocol is instituted early, it can avoid memory cartilage fixation. Changes incorporated to the nasal extension allowed us to obtain better results, elevating the nasal tip, remodeling the depressed cleft side alar cartilages in unilateral cases, and repositioning and correcting the positional alteration of the nasal cartilages building a new columella in bilateral cases. In addition, comfort and tolerance of patients has been improved, and adjustments needed during follow-up have been simplified, significantly reducing the consultation time and increasing the interval between appointments. The obtained outcome facilitates primary surgical cleft lip and nose reconstruction and improves surgical results.

Comparative study of larval head structures of Megaloptera (Hexapoda)

External and internal head structures of the larva of Neohermes are described in detail. The results are compared to conditions found in other representatives of Corydalidae, in Sialidae, and in Raphidioptera and Neuroptera. Corydalidae and Sialidae are mainly characterised by plesiomorphic features such as distinct frontal and coronal sutures, six stemmata, a movable labrum with a full set of muscles, a thin tentoriomandibular muscle, a distinct maxillary groove, 4-segmented maxillary palps, an oblique arrangement of the extrinsic maxillary muscles, a labium with all components except for the glossae and paraglossae, 3-segmented labial palps, and a largely complete muscle system. The partly reduced maxillary groove, the strongly elongated stipes, the apical membranous stipital collar, the close connection of the palp and galea, the subdivision of the galea, the strongly shortened palp, the bipartite tentoriocardinal and tentoriostipital muscles, the anterolateral submental notch, the lateral tentoriopharyngeal muscle, and the postgular plate are autapomorphies of Corydalidae. An additional antennomere is present in large corydalid species. The monophyly of the subfamilies Corydalinae and Chauliodinae is not supported by features of the larval head. The reduced condition of the anterior and dorsal tentorial arms and the antennal muscles, the transverse labial muscle, the loss of muscles of the salivary duct, and possibly the lateral origin of M. frontopharyngalis posterior are autapomorphies of Sialidae. The monophyly of Megaloptera is suggested by the insertion of a peg-like or spine-shaped sensillum on the antepenultimate antennomere, the vestigial salivary duct, and a verticopharyngeal muscle composed of several bundles. The distinct neck region, the parietal ridge, and the anterior position of the posterior tentorial grooves are features shared by Corydalidae and Raphidioptera. Arguments in favour of a clade comprising Megaloptera and Raphidioptera are the presence of a circular ridge anterad of the neck region, an increased number of Semper cells and retinula cells in the stemmata, the presence of a gula in adults, a similar cleaning behaviour, and molecular data. Potential autapomorphies of Neuropterida are the prognathism of the larvae and the absence of a mandibular mola. However, the polarity of these characters is unclear. A derived condition found in most groups of Endopterygota, but not in Hymenoptera, is the presence of one or two sensorial appendages on one of the intermediate antennomeres, usually the penultimate. Larval autapomorphies of Endopterygota suggested in earlier studies are confirmed for Corydalidae.

Histological structure of the mouthparts, clypeo-cibarial system, and cephalic foregut in Philoliche rondani (Diptera, Tabanidae, Pangoniinae)

The leading factor responsible for the evolution of Philoliche rondani mouthparts, as well as those of the other long-proboscid Pangoniinae, appears to be adaptation to the intake of nectar from concealed sources (flowers with elongated floral tube). Adaptations to blood-sucking, inherent only in females, have morphogenetic and behavioral aspects. Philoliche rondani males, as compared to males of Tabanus-like species, have better developed clypeus, labrum, and labium. The presence of a long proboscis has led to transformation of the labial musculature and complication of the food canal structure. During the intake of nectar, the distalmost portion of this canal is formed only by the labium. The lateral labial folds form a peculiar closing apparatus. The cibarial and pharyngeal pumps of Philoliche rondani are similar to those of other tabanids investigated.

Head morphology of Caurinus (Boreidae, Mecoptera) and its phylogenetic implications

External and internal head structures of Caurinus dectes were examined and described in detail. The features are compared to conditions found in other groups of Antliophora. Caurinus is obviously crucial for the reconstruction of the mecopteran and antliophoran groundplan. It displays a remarkable series of plesiomorphic character states such as a complete clypeolabral suture, the presence of M. hypopharyngomandibularis (M. 13) and M. frontohypopharyngalis (M. 41), a subdivided clypeus, a short head without rostrum, a dorsal tentorial arm attached to the head capsule, the absence of a cranial dilator of the antenna, and large mandibles with a well developed apical tooth, two distinct subapical teeth, and a basal molar part. The first three plesiomorphic features render potential autapomorphies of Mecoptera in the traditional sense invalid. Autapomorphies of Caurinus are the distinctly flattened labrum, the absence of the labroepipharyngeal muscle, the very large size of M. 13, the strongly enlarged penultimate palpomeres, the partition of M. 41, the very strongly developed precerebral sucking chamber, strongly curved optic lobes, the presence of a large protocerebral extension in the genal region and deep posterior excavations of the protocerebrum. The maxillolabial plate, the absence of cardines as separate structures, the reduction of ocelli, and the origin of maxillary palp muscles on a median ridge or area of the maxillolabial plate are likely autapomorphies of Boreidae. Another potential autapomorphy of the family is the presence of longitudinal furrows on the mandibles. However, they are absent in Boreus. The thick strongly sclerotised, median ridge of the maxillolabial plate, the missing retractibility of the prementum, the absence of extrinsic labial muscles, and the presence of a median ridge on the prepharyngeal roof suggest a clade Boreus + Hesperoboreus. The origin of extrinsic maxillary muscles from the clypeus has probably evolved independently in Boreus and Hesperoboreus, and in Panorpa, respectively. The absence of M. craniolacinialis and the presence of a row of several subapical mandibular teeth are autapomorphies of Boreus. The presence of a specific intrinsic muscle of the salivary duct and a membranous galea enclosing the labrum and mandibular base are derived features shared by Boreidae and Pistillifera (galea absent in Nannochorista, Siphonaptera and Diptera). The loss of M. frontolabralis (M. 8) is a potential apomorphy of Mecoptera incl. Siphonaptera. A sister group relationship between Boreidae and Siphonaptera is not supported by characters of the adult head. Head structures of Siphonaptera are extremely modified in correlation with ectoparasitic habits.

The larval head of Raphidia (Raphidioptera, Insecta) and its phylogenetic significance

External and internal head structures of larval representatives of Raphidiidae are described. The obtained data were compared to characters of other neuropterid larvae and to larval characters of representatives of other endopterygote lineages. Characters potentially relevant for phylogenetic reconstruction are listed and discussed. The larvae of Raphidioptera differ distinctly from other neuropterid larvae in their morphology. They are mainly characterised by autapomorphic and plesiomorphic character states and few features indicate systematic affinities with other groups. Endopterygote groundplan features maintained in Raphidioptera are the complete tentorium, the free labrum, the full set of labral muscles, the presence of four extrinsic antennal muscles, the three-segmented labial palpi, the presence of a full set of extrinsic maxillary and labial muscles, the presence of a salivarium, and possibly the high number of stemmata. Apomorphies likely correlated with predaceous habits are the long gula, the protracted maxillae, the longitudinal arrangement of extrinsic maxillary muscles, and the elongated prepharyngeal tube. Highly unusual, potentially autapomorphic features are the presence of a dorsal ligament of the tentorium and paired gland-like structures below the pharynx. A prognathous or very slightly inclined head and slender mandibles without mola are features shared by larvae of all orders of Neuropterida. The parallel-sided head is a potential synapomorphy of Raphidioptera and Megaloptera. A fully prognathous head with anteriorly shifted posterior tentorial grooves and the presence of a parietal ridge and a distinct neck region are features shared with Corydalidae. Characters of the larval head are not sufficient for a reliable placement of Raphidioptera.

Embryonic expression of Tbx1, a DiGeorge syndrome candidate gene, in the lamprey Lampetrafluviatilis

We report the embryonic expression in the lamprey Lampetrafluviatilis of Tbx1, the main candidate gene involved in DiGeorge/velo-cardio-facial syndrome (DGS/VCFS). From the end of neurulation to stage 26, Tbx1 becomes progressively expressed in all developing pharyngeal arches, as they form. Transcripts are mainly restricted to the mesodermal core and to the posterior pharyngeal endoderm, excluding ingressing neural crest cells. They are also present in the otic vesicle, in a ventral and posterior location. From a later stage (stage 27) onwards, additional expression domains in the head mesenchyme, later contributing to labial muscle precursors, and in the cloacal region, become visible. The comparison of these data with those reported in the chick and the mouse indicates a high conservation of Tbx1 expression in the pharyngeal arches among vertebrates.

Flies and concealed nectar sources: morphological innovations in the proboscis of Bombyliidae (Diptera)

AbstractBee‐flies (Bombyliidae) have morphological adaptations of the mouthparts to particular floral traits. To investigate this the short, plesiomorphic proboscis of Hemipenthes morio was compared with the long, apomorphic proboscis of Bombylius major. A novel feeding position enables B. major to use flowers that open to the side as additional nectar sources. The new horizontal feeding position is enabled by the prolonged ventral base of the proboscis. Bombylius major exploits deep corolla tubes with an elongate proboscis, and an increased efficiency in both the suction pumps and the sealing mechanisms of the proboscis. The exploitation of narrow corolla tubes is made possible by the shift from a sponging feeding mode, exhibited by H. morio, to the exclusively sucking mode in B. major. Besides quantitative changes in the proportions of the different proboscis components, labellar movements as well as the structures of saliva distribution are changed along with this shift. The labial musculature of B. major does not significantly differ from the plesiomorphic state, since both examined species do not only feed on nectar, but also on pollen.

Subvocal speech, reading rate, and comprehension.

The relationship of subvocal speech and reading rate to comprehension of 25 children, ranging from 8 to 15 years of age, was investigated by means of electromyographic (EMG) recordings taken while the subjects silently read two meaningful passages. The first was orthographically regular, and the second was composed of approximately sixty percent homophones, Labial muscle action recordings, latencies, and comprehension measures were obtained. Variables derived from these measures were used to predict reading age. Profiles derived from the EMGs provided information about how each reader processed the information from the reading passages. The empirical results of the study provide strong support for the valuable role of subvocal speech in the extraction of information and the importance of readers demonstrating the ability to use flexibility of the reading process when reading for meaning.

Physiology of the lips and modelingof lip gestures

The lips are one of the articulators for producing speech sounds, and also contribute to the generation of phonetic information to be visually perceived by the listeners. For this reason, lip gestures for speech provide a useful research topic for investigating multimodal aspects of speech production and perception. As a device for studying these issues, a computational model has been developed to represent the time-varying lip contour controlled by the contraction pattern of labial musculature. Data from simultaneous measurements of lip contour shapes and perioral muscle EMG have been analyzed to build a model of lip contour in the frontal view. The modeling principle is a linear mapping from muscle contraction pattern to lip contour deformation. A multiple linear regression analysis is employed to estimate each x- and y-coordinate for seven measured points on the lip contour from the integrated EMG signals. The analysis of EMG signals indicates a pattern of muscle group selection for typical lip gestures. The orbicularis oris inferior (OOI) and the depressor labii inferior (DLI) co-contract for lip rounding. The peripheral layer of the OOI shows an increased activity for lip protrusion. The model as well as the preliminary data appear promising for our research goal of understanding the organization of speech production and perception.

Variability of motor strategies

The capability of the speech motor system to be adjustable is shown through the investigation of activity patterns of the mandibular and labial muscle systems, respectively. Different individuals use individual motor strategies for the production of jaw and lip movements, different patterns of muscle activity producing the same speech motor objective.

Aphemia after a penetrating brain wound: A case study

The speech of a patient with aphemia (pure anarthria) resulting from a penetrating brain wound was studied using linguistic and acoustic observations as well as electromyographic recordings from four labial muscles. The results are discussed in relation to phonetic disintegration's syndrome and apraxia of speech which, respectively, enhance linguistic disorders and motor programming disturbance.

Variability of motor strategies

The activity patterns of the mandibular and labial muscle systems, respectively, were investigated for the purpose of determining whether the functions of the jaw and lips are based on a set of universal neuromotor rules. In the first experiment, intramuscular wire electrodes were placed into the eight muscles of the jaw. The activity of these muscles was recorded along with the displacement of the jaw in two-dimensional space, from three American subjects, during the production of speech at different rates. In the second experiment, intramuscular wire electrodes were placed into seven perioral muscles. EMG activity was recorded along with two-dimensional upper and lower lip movements from three French subjects during labial closure associated with speech production. Results indicated that different individuals use individual motor strategies for the production of the jaw and lip movements, and that the same motor objective can be accomplished by the nervous system in many different ways.

Reconstruction of the Oral Commissure After an Electrical Burn

A burn of the oral commissure is one of the most common types of electrical injury in children. To minimize postoperative wound contracture in late reconstructive surgery, a functional reconstruction that combines excision of the burn scar with lateral advancement of the orbicularis oris muscle, re-creation of the modiolus labii, and reestablishment of vermilion continuity has been developed. Functional restoration of the labial musculature to the preinjury position with re-creation of the modiolus labii and reestablishment of vermilion continuity appears to significantly decrease the amount of postoperative wound contracture (p less than 0.025).

Interactions in the labial musculature during speech.

Interactions in electromyographic activity of the upper and lower lips during speech were studied by manipulating the magnitude of bursts of activity related to bilabial closure. Four pairs of electrodes were placed in the labial musculature in each of four normal-speaking young adults. Manipulation of muscle activity usually resulted in positively correlated changes in activity recorded from the other three electrode pairs. Similar effects were found when lower lip muscle activity was manipulated and when upper lip muscle activity was manipulated, suggesting there is no asymmetry in the interactions between lips. Measurements of lower lip closing movement often correlated with the modulated muscle activity, suggesting that the size of lip opening was varied to accommodate different closing forces. The flexibility of a system producing positive correlations in the activity of different labial regions is discussed and contrasted with the suggestions that there are complementary variations, producing negative correlations, in the activity of different labial muscles during speech.

Upper lip, lower lip, and jaw interactions during speech: comments on evidence from repetition-to-repetition variability.

Six studies purporting to demonstrate complementary covariation in lip and jaw activity during speech are reviewed. The statistical procedures used to assess interactions among the upper lip, lower lip, and jaw movements are discussed for four different experiments analyzing repetition-to-repetition movement variation. The findings from two studies analyzing repetition-to-repetition variation for interactions in electromyographic activity recorded from either the jaw musculature or the labial musculature also are evaluated. It is concluded that these studies do not provide convincing evidence of complementary covariation among the articulators or the muscles.

Der einfluß der lippenplastik auf die dentofaziale entwicklung be! patienten mit Lippen-Kiefer-Gaumen-Spalten: I. Jonas, H. IF. Kappert, E. Raider, T. Rakosi, W. Schilli, and U. Joos Fortschr. Kiefenorthop. 1986:400–411

The effect of primary lip repair on the dentofacial morphology was analyzed in 25 adolescents with cleft lip and palate by means of (a) upper lip pressure measurement, (b) electromyography of the labial musculature, (c) roentgenocephalometric and soft-tissue analyses of the lateral head plate, and (d) plaster model analysis. The results were compared with those of 15 patients presenting with normal occlusal and functional relationships. Only the resting pressure of the upper lip correlated with the vertical and sagittal dentofacial morphology in patients with cleft lip and palate. This relation is attributed to the unbalanced and unfavorable functional-mechanical strain of the perioral muscles in these cases. The strain of the repaired upper lip on the underlying skeletal structures correlated with (a) the resting activity of the upper lip and (b) the strain direction being determined by the length and thickness of the labial sofit tissue. The results were specific for patients with cleft lip and palate, and were not correlated to the patient’s age and sex. Contrary to the dental parameters, the skeletal disturbances as a consequence of the muscular imbalance could not be significantly altered by orthodontic treatment. The choice of technique of primaIy upper lip repair in patients with cleft lip and palate is important both for their dentofacial development and for their possible orthodontic Weatment result. Theoretically, from the functionalmechanical aspect, their results indicate that Delaire’s method of primary functional upper lip repair is the most suitable technique. Alex Jacobson Reviews and abstracts 447

Labial kinematics during speech in patients with parkinsonian rigidity.

Studies of orofacial motor control in Parkinson's disease (PD) have demonstrated that these subjects may exhibit hypokinesia and bradykinesia, as well as increased muscle tone. Yet the relationship between aberrations of orofacial movement and muscle rigidity remains unclear. Measures of labial muscle rigidity and movement were made for 12 parkinsonian and 9 age-matched control subjects. Displacement amplitude, peak instantaneous velocity, and movement time were evaluated during repetitive syllable productions. The results showed that while mean parkinsonian displacement amplitudes and velocities were lower than the normal control subjects, there was no statistical relationship between labial rigidity and the degree of movement abnormality. It is concluded that while rigidity may play a part in the overall disability, it does not sufficiently explain the labial articulatory difficulties associated with parkinsonism. This is in agreement with the literature on limb rigidity and movement aberrations in PD, suggesting that rigidity and bradykinesia may represent independent pathophysiological phenomena.