Large Lip Research Articles

The nasolabial flap as a one-stage procedure for reconstruction of intermediate-to-large lip defects with functional and aesthetic assessments

The primary function of the lip is oral competence. The lips are also fundamental in facial aesthetics. Thus in lip reconstruction, it is paramount to achieve both good functional and aesthetic outcomes. Local flaps are able to provide the best tissue match in intermediate and large lip defects. Nevertheless, there has been limited literature on using the musculocutaneous nasolabial flap as a one-stage procedure for lip reconstruction. The authors recruited 21 patients who underwent a one-stage nasolabial musculocutaneous flap reconstruction for lip defects for the study. The modiolus at the mouth angle was preserved and the nasolabial flap was de-epithelised and tunnelled subcutaneously in all patients for reconstructing the lips. Electromyography was performed for 14 flaps to detect muscle activity. Oral competency was assessed using the Drooling Rating Scale and aesthetic outcomes were also analysed postoperatively with the Patient and Observer Scar Assessment Scale. All patients successfully underwent lip reconstruction with the musculocutaneous nasolabial flap. There were no flap failures. Electromyographic activity was detected in 10 out of the 14 flaps tested. Oral competencies were well preserved and there were no cases of microstomia. Aesthetic results were also good. The nasolabial flap for one-stage reconstruction of lip defects following lip resection is feasible. Good functional and aesthetic outcome can be achieved.

Outcomes Following V-Y Advancement Flap Reconstruction of Large Upper Lip Defects

Outcomes Following V-Y Advancement Flap Reconstruction of Large Upper Lip Defects

Staged Trilobe Pedicle Flap to Repair a Large Cutaneous Lip and Nasal Vestibule Defect

Staged Trilobe Pedicle Flap to Repair a Large Cutaneous Lip and Nasal Vestibule Defect

Functional Reconstruction of Large Lip Defects with Microsurgical Techniques

Functional Reconstruction of Large Lip Defects with Microsurgical Techniques

Three-dimensional analysis of labial morphology: Effect of sex and age

Morphological changes in the lips during ageing, including labial volume, area and thickness were assessed in healthy individuals. 40 healthy volunteers (20 men and 20 women) were selected and divided into two groups according to age: 21-34 years ('youthful' group) and 45-65 years ('aged' group). Three-dimensional (3D) stone labial models were made, digitized, and 3D virtual reproductions obtained. Labial thickness, vermilion area, and volume of the upper and lower lips were measured from the digital reconstructions. The data were compared using three-way ANOVA. All data were significantly larger in men than in women (p<0.05), the lower lip was thicker than the upper lip (p<0.001). A significant effect of age for labial thickness and area were found (p<0.001 and p=0.014): the youthful group had higher values than the aged group. Upper to lower lip ratios were not significantly different between sexes or ages. Generally, young people have a larger lip area and thickness than aged ones and men had larger lips than women. The upper/lower lip ratios for area and volume were similar in the two genders.

First Report of Parascaris equorum in a White-Tailed Deer, Odocoileus virginianus, from Mansfield, Pennsylvania, U.S.A.

Abstract A gravid adult female nematode recovered from the rumen of a white-tailed deer, Odocoileus virginianus, was identified as Parascaris equorum, a common and cosmopolitan ascaridoid nematode parasite of horses and other equids. The cervine host was a 2-yr-old female that was presented to the Large Animal Soft Tissue Surgery service of the Cornell University Hospital for Animals (Ithaca, New York), with a 3-mo history of right-sided, unilateral, mucopurulent nasal discharge and weight loss. The doe was placed under general anesthesia, and radiographs of the head and thorax were taken. Rhinoscopy of both nasal passages was performed, during which time the rumen became distended, necessitating deflation. An orogastric tube was placed in the rumen and gas was successfully removed. Upon withdrawal of the tube, a 22.9-cm pinkish white ascarid worm was recovered from its lumen. Closer examination of the specimen revealed 3 large prominent ascarid-type lips consistent with P. equorum. The location of the vu...

Use of the angularis oris cutaneous flap for repair of a rostral mandibular skin defect in a cat

The angularis oris axial pattern flap is based on the blood supply of the angularis oris artery and vein. While the use of this flap for repair of canine facial wounds is well documented, this technique has not been reported in the cat. This case report presents the reconstruction of a large ventral chin and rostral lip wound with the use of this flap. Complete survival of this flap was observed in this patient.

Disorders of sexual development in genetic pediatrics: Three different ambiguous genitalia cases report from Hospital Para el Nino Poblano, Mexico

Five pediatric patients with three different disorders of sexual development are reported in this study; the first three male patients (16 years, 4 years and 2 months old, respectively) were diagnosed as having diphallia. These 3 patients had real diphallia, well developed penises, urinarious meatus, and both testicles and one of the case, vessel duplication was reported by urology. All the patients have normal cytogenetic analysis, 46XY. The fourth patient was 2 years old, with hyperplasic clitoris, hyperpigmented tissue similar to labia major (large lips) and internal female organs identified as vagina, uterus and both ovaries. A chimera with two different cells lines [46,XX (48%) and 46,XY (52%)] by cytogenetic studies was reported. And the last child was 2 years 8 months old patient with chromosome translocation, between chromosome Y and 7 chromosomes t(7;Y). Hypospadias pene-escrotal, unilateral cryptorchidism, urinary meatus stenosis and malformed scrotum were diagnosed together with vessel duplication. Key words: Ambiguous genitalia, diphallia, hypospadias, cryptorchidism, chromosome translocation and chimera.

Morphology of the infective larval stage of the equid parasite Habronema muscae (Spirurida: Habronematidae), from houseflies (Musca domestica)

The infective larva of the spirurid nematode Habronema muscae, a parasite of houseflies, was measured and specimens fixed in Karnovsky's fluid were examined by scanning electron microscopy. The oral opening contains six teeth and is surrounded by large bilobed dorsal and ventral lips and smaller lateral lips. A pair of amphids lie behind the lateral lips. There are two rows of four cephalic papillae. The body is deeply ridged, both transversely and longitudinally. The caudal end of the worm is studded by small papillae. The position of the anal opening is somewhat ambiguous. These larval morphological features are discussed, as well as the changes which must have occurred in the metamorphosis of the infective larva to the adult in the stomach of horses.

Contribution of Facial Feature Dimensions and Velocity Parameters on Particle Inhalability

To examine whether the actual dimensions of human facial features are important to the development of a low-velocity inhalable particulate mass sampling criterion, this study evaluated the effect of facial feature dimensions (nose and lips) on estimates of aspiration efficiency of inhalable particles using computational fluid dynamics modeling over a range of indoor air and breathing velocities. Fluid flow and particle transport around four humanoid forms with different facial feature dimensions were simulated. All forms were facing the wind (0.2, 0.4 m s(-1)), and breathing was simulated with constant inhalation (1.81, 4.3, 12.11 m s(-1)). The fluid flow field was solved using standard k-epsilon turbulence equations, and laminar particle trajectories were used to determine critical areas defining inhaled particles. The critical areas were then used to compute the aspiration efficiency of the mouth-breathing humanoid. One-tailed t-tests indicated that models with larger nose and lip features resulted in significantly lower aspiration efficiencies than geometries with smaller features, but the shape of the orifice into the mouth (rounded rectangle versus elliptical) had no effect on aspiration efficiency. While statistically significant, the magnitudes of differences were small: on average, the large nose reduced aspiration efficiency by 6.5% and the large lips reduced aspiration efficiency by 3.2%. In comparison, a change in breathing velocity from at-rest to heavy increased aspiration efficiency by an average of 21% over all particle sizes, indicating a much greater impact of aspiration efficiency on breathing rate in the facing-the-wind orientation. Linear regression models confirmed that particle diameter and breathing velocity were significant predictors to the aspiration fraction, while the facial feature dimensions were not significant contributors to a unifying model. While these effects may be less pronounced as the orientation changes from facing-the-wind, their impact confirms the importance of breathing velocity and, to a lesser extent, facial feature dimensions on exposure estimates in low freestream velocities typical of occupational environments.

Characterization of the Possible Roles for B Class MADS Box Genes in Regulation of Perianth Formation in Orchid

To investigate sepal/petal/lip formation in Oncidium Gower Ramsey, three paleoAPETALA3 genes, O. Gower Ramsey MADS box gene5 (OMADS5; clade 1), OMADS3 (clade 2), and OMADS9 (clade 3), and one PISTILLATA gene, OMADS8, were characterized. The OMADS8 and OMADS3 mRNAs were expressed in all four floral organs as well as in vegetative leaves. The OMADS9 mRNA was only strongly detected in petals and lips. The mRNA for OMADS5 was only strongly detected in sepals and petals and was significantly down-regulated in lip-like petals and lip-like sepals of peloric mutant flowers. This result revealed a possible negative role for OMADS5 in regulating lip formation. Yeast two-hybrid analysis indicated that OMADS5 formed homodimers and heterodimers with OMADS3 and OMADS9. OMADS8 only formed heterodimers with OMADS3, whereas OMADS3 and OMADS9 formed homodimers and heterodimers with each other. We proposed that sepal/petal/lip formation needs the presence of OMADS3/8 and/or OMADS9. The determination of the final organ identity for the sepal/petal/lip likely depended on the presence or absence of OMADS5. The presence of OMADS5 caused short sepal/petal formation. When OMADS5 was absent, cells could proliferate, resulting in the possible formation of large lips and the conversion of the sepal/petal into lips in peloric mutants. Further analysis indicated that only ectopic expression of OMADS8 but not OMADS5/9 caused the conversion of the sepal into an expanded petal-like structure in transgenic Arabidopsis (Arabidopsis thaliana) plants.

Why Some Women Look Young for Their Age

The desire of many to look young for their age has led to the establishment of a large cosmetics industry. However, the features of appearance that primarily determine how old women look for their age and whether genetic or environmental factors predominately influence such features are largely unknown. We studied the facial appearance of 102 pairs of female Danish twins aged 59 to 81 as well as 162 British females aged 45 to 75. Skin wrinkling, hair graying and lip height were significantly and independently associated with how old the women looked for their age. The appearance of facial sun-damage was also found to be significantly correlated to how old women look for their age and was primarily due to its commonality with the appearance of skin wrinkles. There was also considerable variation in the perceived age data that was unaccounted for. Composite facial images created from women who looked young or old for their age indicated that the structure of subcutaneous tissue was partly responsible. Heritability analyses of the appearance features revealed that perceived age, pigmented age spots, skin wrinkles and the appearance of sun-damage were influenced more or less equally by genetic and environmental factors. Hair graying, recession of hair from the forehead and lip height were influenced mainly by genetic factors whereas environmental factors influenced hair thinning. These findings indicate that women who look young for their age have large lips, avoid sun-exposure and possess genetic factors that protect against the development of gray hair and skin wrinkles. The findings also demonstrate that perceived age is a better biomarker of skin, hair and facial aging than chronological age.

Labial Morphology: A 3-Dimensional Anthropometric Study

To develop a noninvasive 3-dimensional method to evaluate labial morphology and to assess gender-related differences in healthy young adults. Dental and lip impressions of 11 men and 10 women aged 21 to 34 years, with sound, full, permanent dentition were obtained. The models were digitized and 3-dimensional virtual reproductions obtained. The labial thickness, vermilion area, and volume of the upper and lower lips were measured from the digital reconstructions. The male and female data were compared using Student's t test. The mean lip thickness was significantly larger (P = .02) in men (14.3 mm) than in women (12.3 mm). The lower lip was thicker than the upper lip. The vermilion width was larger in men (75 mm) than in women (70 mm), and no differences were found for vermilion height (10 mm). In the upper lip, the height/width ratio was significantly larger in women (14.1%) than in men (12.3%). The vermilion surface area was slightly larger in men than in women (upper lip area: women, 467 mm(2); men, 501 mm(2); lower lip area: women, 491 mm(2); men, 569 mm(2)). The labial volume was significantly larger in men (upper lip, 2,390 mm(3); lower lip, 2,902 mm(3)) than in women (upper lip, 1,743 mm(3); lower lip, 1,764 mm(3); P = .021). The upper/lower lip area and volume ratios were similar in the 2 genders. Overall, men had larger lips than women. The inferior lip height/width ratio was similar in both genders, and men had a relatively thinner upper lip than women.

A Syndrome with Coarse Face, Mental Retardation and Unusual Stereotyped Movements

We describe a mentally retarded 24-year-old man followed by our group since age 18 months who exhibited nearly continuous stereotypic movements while awake. These movements, which have persisted over many years, consist of synchronous lateral flexion at the neck and waist. Movements could be partially voluntarily suppressed and disappeared in sleep. The patient has drug-resistant seizures and a constellation of dysmorphic features, including coarse face, large nose, large thin lips, brachicephaly, marked hirsutism on the face, and limbs proportionally smaller than the trunk, which suggests that the unusual stereotypic movements described may be part of a syndrome. Routine and full metabolic serum and urine analyses, full ophthalmological examination, internal organs ultrasound examination, full skeletal survey, standard karyotype and array-CGH analysis yielded normal results.

A study of disrupted carotid plaque using high-resolution MRI

Objective To evaluate distribution features of disrupted carotid plaque. Methods Forty-three subjects with duplex ultrasound evidence of 50% to 99% stenosis were retrospectively analyzed. Plaques were categorized as disrupted if there was MRI evidence of fibrous cap rupture. Quantity measured areas of the lumen (LA), wall (WA), and plaque components. The morphological parameters used were total vessel area, vessel burden index, eccentricity index. Mann-Whitney test and Chi-square test appropriate used SPSS (v. 12.0 ). Results There were 17 disrupted and 26 undisrupted lesions identified for comparison. Disrupted plaques showed a predominance of longer longitudinal length of large lip nucleus along the vessel wall (6 mm vs. 0 mm, U = 126, P <0.05 ), a large vessel burden (0.67 vs. 0.59, U =105, P <0.05), and high prevalence of thrombus (82.4% vs. 42.3 %, U = 132,P <0.05). In addition, disrupted plaques showed a different pattern of plaque distribution, having a more eccentric position of the lumen (3.68 vs. 2.79, U = 126, P < 0.05 ), a smaller lumen area (23.97 mm2 vs. 30. 18 mm2, U = 138, P<0.05) and a longer segment of stenosis when compared with the intact plaques. Conclusions Disrupted plaques have significantly different characteristics in terms of both axial and longitudinal distribution. A combination of multi-plane and multi-contrast high resolution MRI may provide valuable information about overall lesion morphology and its association to vulnerability. Key words: Carotid stenosis; Magnetic resonance imaging; Imaging process, computer-assisted

The “Bikini” Lip Reduction: An Approach to Oversized Lips

Sir: Greatly hypertrophic or oversized lips are an occasionally encountered aesthetic problem, particularly in the black and Asian populations. The reduction of very large lips is not a new procedure but remains a relatively unused one and has received little attention in the literature.1–4 The following presents a modified method for lip reduction referred to as the “bikini” reduction, consisting of excising a “bikini top” (two cups and a middle strap) from the upper lip, and a “bikini bottom” (a triangle) from the lower lip. This technique is unique in that it focuses not only on lip reduction but also on labial contouring and volume balance. Aesthetic analysis of the lips has been described in detail by the author5 and may be reviewed in Figure 1, above.Fig. 1.: (Above) Aesthetic analysis of attractive lips. (Center) The “bikini” incision, consisting of a “bikini top” (two cups and middle strap) from the upper lip, and a “bikini bottom” (a triangle) from the lower lip. (Below) The expected result, showing the proper reductions, contouring, and relative volumes of the upper and lower lips.The patient is asked to close the lips gently. A marker is used to place a dot in the midline between both upper and lower lips at the actual dry/wet junction (Fig. 1, center, points a and a′). The patient is then asked to open the lips slightly, as the surgeon manipulates the lips with his or her fingers by rotating them inward, attempting to make them appear smaller. The patient then closes the lips. This is repeated until the size of the showing vermilion is adequately reduced, ensuring the lower lip remains roughly 40 to 50 percent more voluminous than the upper one. Then, another dot is made in the midline on the newly created dry/wet interface (Fig. 1, center, points b and b′). The patient then opens the lips, revealing four central dots (a, a′, b, and b′). The bikini design is now implemented (Fig. 1, center). The bikini top is marked by drawing the central strap as two parallel lines between a and b for a distance of approximately 1 cm, then diverging to form two oval cups bilaterally. The cups’ anteroposterior dimension (c to d) should be approximately double that of a to b and should end in a tapered manner a few millimeters before the commissures. The bikini bottom is drawn as a triangle (e to b′ to f), with points e and f stopping a few millimeters from the commissures. Infiltration of the operative field is performed using 5 to 8 cc of lidocaine 1% with epinephrine 1:100,000. While squeezing the upper lip between the fingers of the left hand to limit bleeding, a no. 15 blade is used to excise the bikini top from the upper lip, with the blade beveled slightly to excise a triangular wedge of tissue. The bikini bottom is excised in a similar way and hemostasis is achieved using fine needle tip electrocautery. Defects are closed with a deep layer of interrupted 4-0 chromic sutures, followed by a superficial layer of interrupted 4-0 chromic. No dressing is necessary. Figure 1, below shows the expected result. Nabil Fanous, M.D. Valérie J. Brousseau, B.Sc.H., M.D.C.M. Adi Yoskovitch, M.D. Institute of Cosmetic Surgery Department of Otolaryngology–Head and Neck Surgery McGill University Montreal, Quebec, Canada DISCLOSURE None of the authors has any disclosures to make.

The ‘Bikini Lip Reduction’: A Detailed Approach to Hypertrophic Lips

Excessively large lips represent an occasional but significant challenge in aesthetic surgery. Previously described techniques focus largely on the simple excision of a strip of tissue to reduce the lips, without specific attention to the resultant lip contour or to the volume relationship between the lips. The present paper describes a new technique for lip reduction, called the 'bikini lip reduction'. This technique not only reduces the volume of the lips, but also restores an attractive labial contour, as well as an ideal volume relationship between the upper and lower lips. Because it is based on aesthetic analysis, this technique consistently yields both smaller and more aesthetically appealing lips. Simply stated, the bikini lip reduction consists of excision of a 'bikini top' (two cups and a middle strap) from the upper lip and a 'bikini bottom' (a triangle) from the lower lip. The aesthetic results and the patient satisfaction achieved through the bikini lip reduction technique have been very satisfactory.

New species of terebellid polychaetes (Polychaeta: Terebellidae) from Australia

Four new species of terebellid polychaetes were found among unidentified or misidentified material deposited at the Australian Museum, Sydney while a study on the phylogenetic relationships among terebelliform polychaetes was being carried out. These new species are herein described and compared with the most similar congeners and, in cases of Amphitritides and Spinosphaera, comparative tables for all known species of these genera are provided. Amphitritides carawa sp. nov., is characterized by having 19–22 pairs of notopodia and nephridial papillae on segments 3 and 6–19, inserted anteriorly at base of notopodia and vertically aligned with them. Spinosphaera barega sp. nov., is characterized by having eyespots arranged in a circular patch on the lateral areas of the prostomium, 23 pairs of notopodia, characteristic “spinosphaera chaeta” present from segment 10–11 and nephridial papillae absent or not visible. Decathelepus wambira sp. nov., is distinguished from D. ocellatus, the only other known species of the genus, by lacking a tongue-like process originating from the distal part of the prostomium and by the morphology of notochaetae. Streblosoma bingarra sp. nov., is distinguished from other species of the genus by the presence of a large lower lip, arrangement of branchial filaments and the ventral surface on anterior body being tessellated and highly glandular.

LIPs on Venus

Venus, a planet similar to Earth in heat budget lacks plate tectonics, yet displays ample evidence of extensive volcanic and tectonomagmatic processes, including regions large enough to be considered LIPs. Thus Venus provides an excellent opportunity to examine large-scale magmatic processes outside a plate tectonic framework. I discuss four groups of Venus’ largest tectonomagmatic provinces: volcanic rises, large coronae (Artemis, Heng-O, Quetzalpetlatl, Atahensik), crustal plateaus, and ‘plains with wrinkle ridges’, unit pwr. Unit pwr, widely interpreted as representing catastrophic resurfacing, has been suggested to be the solar system's largest LIP. I argue herein that these features, each covering ∼ 1 million km 2 or more, and recording extensive volcanic activity, record different evolutionary processes, including both endogenic and exogenic processes. Volcanic rises represent surface manifestations of deep-mantle plumes on thick lithosphere. Large coronae may record different evolutionary paths. Artemis represents a plume signature on thin lithosphere. More mapping is required to determine if Heng-O formed by endogenic or exogenic processes. Preliminary mapping suggests Quetzalpetlatl represents a young mantle plume; Atahensik marks a diapiric structure, though buoyancy mode is unconstrained. Crustal plateaus record solidification of huge lava ponds formed by massive partial mantle melting caused by large bolide impact on thin lithosphere. The status of unit pwr as the largest LIP within the solar system is challenged based on geological considerations, and results of a growing body of geologic mapping.

Adding Versatility to the Reconstruction of Intraoral Lining

Reconstruction of a full-thickness cheek defect, especially one associated with a large lip and oral commissure defect, remains a challenge. After tumor excision, replacement of the oral mucosa is often necessary. The oral mucosa is a thin, pliable lining. Because the skin of the forearm is ideally suited for replacement of oral lining, being thin, pliable, and predominantly hairless, the radial forearm flap is the most frequently used soft-tissue flap for this purpose. In addition, the vascularity of the area allows substantial variation in the design of the flap, both in relation to its site and size. On the other hand, the radial forearm flap might be unusable in some occasions, such as in the case presented here. Thus, a search for an alternative free flap is required. We used a prefabricated scapular free flap to reconstruct a large concomitant lip and full-thickness cheek defect resulting from perioral cancer ablation. We introduce a new "opened pocket" method for reconstruction of the intra-oral lining without folding the flap. Resection of the tumor resulted in a defect including 45% of the upper lip, 50% of the lower lip, and a large, full-thickness defect of the cheek. The resultant defect was temporarily closed with a split-thickness skin graft. Meanwhile, the left scapular fasciocutaneous flap was prefabricated for permanent closure of the defect. The left scapular flap was outlined horizontally, and the flap orientation for the defect was estimated. Then, the distal portion of the flap was harvested and incised to create lips and oral commissure. Afterward, the raw surface under the neo-lip regions and the base where the flap was raised was grafted with one piece from a thick, split-thickness skin graft. Fourteen days later, the patient was taken back to the operating room for reconstruction of the defect with free transfer of a prefabricated scapular fascia-cutaneous flap. The grafted distal region of the flap was raised with the deep fascia located under the graft. Thus, a pocket was obtained. The flap was placed in the defect for final tailoring. Mucosal defect was evaluated to decide where the pocket was to be opened. Then, the grafted fascial portion of the flap was incised from the free edge to the neocommissure. Consequently, lower and upper lip mucosa were achieved by opening the pocket. The prefabricated flap was adapted to the defect with the appropriate sutures. The superior thyroid artery and internal jugular vein were used as recipient vessels. The postoperative period was uneventful. There were no healing problems of the suture lines of the opened pocket, and both labial sulci were quite adequate. The patient was able to resume a soft diet 10 days after the operation. She also had a satisfactory oral competence and an acceptable appearance, without microstomia. Despite its disadvantages, prefabrication can make the scapular fascia-cutaneous flap suitable for reconstruction of a large, concomitant lip and full-thickness cheek defect when other more appropriate flaps are not available. The opened pocket method appears not only to add flexibility to the restoration of the intra-oral lining but also reduces the stress resulting from free flap adaptation.