Lateral Lip Research Articles

Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.

3D Assessment of Nasolabial Appearance in Patients With Complete Unilateral Cleft Lip and Palate.

Rhinoplasty in patients with complete unilateral cleft lip and palate (UCLP) is challenging, and the surgical outcome of the nose is complicated to evaluate. The aim of this study was to assess the nasolabial appearance of patients with UCLP compared with a control group. Cross-sectional study. Riga Cleft Lip and Palate Centre, Latvia. All consecutive 35 patients born between 1994 and 2004 with nonsyndromic complete UCLP were included. Of 35 patients, 29 came for checkup; the mean age was 14.7 years (range 10-18). In the control group, 35 noncleft participants at 10 years of age were included. Nasolabial appearance was evaluated from 3-dimensional images using a 3-dimensional stereo-photogrammetric camera setup (3dMDface System), the results being analysed statistically. In UCLP group, a statistically significant difference between cleft and noncleft side was found only in alar wing length ( P < .05). The difference of nasolabial anthropometric distances in the control group between the left and right side was not significant. The difference between the UCLP group and the control group was significant in all anthropometric distances except the lateral lip length to cupid's bow. The nasolabial appearance with acceptable symmetry after cleft lip and reconstructive surgery of the nose was achieved. Symmetry of the nasolabial appearance in patients with UCLP differed from those in the control group. The 3D photographs with a proposed set of anthropometric landmarks for evaluation of nasolabial appearance seems to be a convenient, accurate, and noninvasive way to follow and evaluate patients after surgery.

Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections.

The tensor of the vastus intermedius (TVI) is a newly described component of the extensor apparatus of the knee joint. The objective of this study was to evaluate the appearance of the TVI on magnetic resonance (MR) imaging and its association with the adjacent vastus lateralis (VL) and vastus intermedius (VI) muscles and to compare these findings with the corresponding anatomy. MR images were analyzed from a cadaveric thigh where the TVI, as part of the extensor apparatus of the knee joint, had been dissected. The course of the TVI in relation to the adjacent VL and VI was studied. The anatomic dissection and MR imaging revealed a multilayered organization of the lateral extensor apparatus of the knee joint. The TVI is an intervening muscle between the VL and VI that combined into a broad flat aponeurosis in the midthigh and merged into the quadriceps tendon. Dorsally, the muscle fibers of the TVI joined those of the VL and VI and blended into the attachment at the lateral lip of the linea aspera. In this area, distinguishing between these three muscles was not possible macroscopically or virtually by MR imaging. In the dorsal aspect, the onion-like muscle layers of the VL, TVI, and VI fuse to a hardly separable muscle mass indicating that these muscles work in conjunction to produce knee extension torque when knee joint action is performed. Clin. Anat. 30:1096-1102, 2017. © 2017 Wiley Periodicals, Inc.

Micromorphology of egg and larva of Eristalis fratercula, with an updated key of Eristalis species with known third instar larvae (Diptera: Syrphidae)

Abstract The flower- or hoverflies (Syrphidae) and particularly the subfamily Eristalinae, are known by their importance as pollinators in both natural and agro-ecosystems. Similar to other saprophagous eristalines, the larvae of Eristalis Latreille, 1804 are characterized by an elongated anal segment and a telescopic breathing tube. These features have given them the common name of rat-tailed maggots and allow them to develop in liquid or semi-liquid media loaded with decaying organic material. This paper presents the first description of the egg and the third-instar larva of the boreal species Eristalis fratercula (Zetterstedt, 1838). Morphological studies are presented based on cryo-scanning electron microscopy (cryo-SEM). After comparison with all other known species of the genus Eris-talis with described preimaginal morphology, we conclude that main diagnostic character of E. fratercula is the presence of long branched spicules located in the upper margin on the lateral lips. Finally, we provide an updated key that includes the 15 Eristalis species whose third larval stages have already been described.

Maxillary Reconstruction Using Submental Artery Island Flap and Sagittal Mandibular Ramus/Coronoid Process Graft Pedicled With Temporalis Muscle

The purpose of this study is to describe maxillary reconstruction using the submental artery island flap and the sagittal mandibular ramus and coronoid process graft pedicled with the temporalis muscle through the modified lateral lip and submandibular approach. From May 2013 to September 2016, 11 patients with maxillary defects secondary to maxillary cancer ablation who underwent maxillary reconstruction using a submental artery island flap and a sagittal mandibular ramus and coronoid process graft pedicled with the temporalis muscle through the modified lateral lip and submandibular approach were enrolled in this prospective study. All submental artery island flaps and sagittal mandibular ramus and coronoid process grafts were successful, with satisfactory functional and esthetic outcomes. No functional impairment at the donor site occurred in any case. The submental artery island flap combined with the sagittal mandibular ramus and coronoid process graft is a feasible and acceptable technique for maxillary reconstruction in older patients because it is safe, quick, and straightforward to harvest and it offers a very acceptable esthetic and satisfactory outcome, with the advantage of low morbidity of the donor site. When combined with the 3-dimensional virtual operative method, the technique can improve postoperative outcomes.

Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique

One hundred and one patients with complete or incomplete cleft lip underwent the anatomical subunit approximation technique for repair. The patients were followed up prospectively for 1year. The objective of this study was to determine the outcomes for the nasolabial area through anthropometric measurements and assessment of the Asher-McDade Aesthetic Index and Steffensen’s criteria at 1year after surgery. Six assessors (three cleft surgeons and three non-surgeon medical professionals) examined cropped images; reliability was assessed using Cronbach’s alpha. The difference in lip length between the healthy and operated sides was 0.61mm and the difference in nostril diameter was 0.37mm (differences not significant). The average scar width was 2.78±1.35mm. Hypertrophic scars were observed in 9.9% of cases. The average Asher-McDade Aesthetic Index rating varied between 1.35 and 1.98 for all parameters. Cronbach’s alpha coefficient was 0.83, 0.89, 0.98, and 0.89 for nasal form, nasal symmetry, vermilion border, and nasolabial profile, respectively. Steffensen’s criteria rated appearance as ‘good’ in 69.3% to 91.1% of cases. The anatomical subunit approximation technique can be performed in Sub-Saharan Africans for all types of unilateral cleft lip. It significantly improves the length of the medial and lateral lips, leaving an acceptable scar. A study with a larger sample size and longer follow-up is warranted.

A Quadrangular Flap Technique for Vermilion Repair in Unilateral Cleft Lip.

In unilateral cleft lip repair, the vermilion triangular flap technique reported by Noordhoff1 and its modification are widely accepted for the augmentation of the vermilion height on the medial side of the cleft; however, these techniques do not focus on the deformity of the labial tubercle. In this article, we herein report a modified technique for vermilion repair that is focused on the labial tubercle. The muco-vermilion quadrangular flap was elevated from the lateral lip to augment the labial tubercle. As a result, the amount of labial tubercle is appropriate. Fifty-three consecutive unilateral cleft lip repairs were performed. In most cases, the amount of the labial tubercle was appropriate, and the curvature of free margin was preferable. The technique could reduce the number of scars on the vermilion by placing some of the suture lines on the oral surface and enabled the augmentation of the labial tubercle. In conclusion, the quadrangular flap can be considered an ideal flap for the construction of the vermilion.

Morphological and molecular identification of Habronema spp. (Nematoda: Habronematidae) from donkeys in Xinjiang, China, and notes on the taxonomical status of Habronema majus (Creplin, 1849) and H. microstoma (Schneider, 1866).

Habronematid nematodes were collected from the stomachs of donkeys, Equus asinus L., in the Tarim Basin, Xinjiang, China. After examination by light and scanning electron microscopy, Habronema muscae (Carter, 1861) and H. majus (Creplin, 1849) were identified. The morphology of our specimens representing H. muscae (Carter, 1861) agreed well with previous redescriptions in the shape of the lateral lips, origin of the lateral alae, ratio of left and right spicules, and number and arrangement of caudal papillae. However, H. majus (Creplin, 1849) differs from H. microstoma (Schneider, 1866) in the arrangement of the caudal papillae in the male. Moreover, molecular analysis also showed interspecific differences of 26.2-28.2% in ITS2 and 8.6-8.9% in cox1 between H. majus and H. microstoma, a divergence much higher than the known intraspecific variation of Habronema spp. (6.6-8.7% in ITS2; 0.2-2.2% in cox1). The results indicate that both H. microstoma (Schneider, 1866) and H. majus (Creplin, 1849) are valid species.

Analyzing on the location of the bicipital groove for alignment in shoulder arthroplasty of Chinese.

Many anthropometric studies of the normal glenohumeral relationship have been performed for the implant design and to identify reference points for the correct placement of the prosthesis in glenohumeral joint replacement. However, whether those implantation marks, which adopted from European or American, can achieve the same precision to Eastern Asian, specifically Chinese is still unknown. One hundred eighty healthy were scanned using CT. Their humeri were measured to determine humeral head retroversion and its relation to the location of the bicipital groove. The angle between the transepicondylar axis and the line connected the centre of the head sphere and the lateral lip point of the bicipital groove, and the plane through the humerus shaft axis and the lateral lip of the bicipital groove in the horizontal plane were measured and denoted by angle-α and angle-β, respectively. The biceps distance (BD) from the lateral lip of the bicipital groove proximally to the axis of humeral head in the horizontal plane was also measured. The average angle α and β was 40.08° (±11.15°) and 42.19° (±12.64°). The average BD was 7.15mm (range 0.87-13.94mm; SD 2.55mm). The linear relationship between humeral head retroversion and the bicipital groove angle α can expressed as α=0.7125×retroversion+24.8128 (R2=0.5956). If the centre of the lateral aspect of the stem has a posteriorly offset of 20° from the lateral lip of the bicipital groove, the component would have a proximal 20° of retroversion. The results indicate that the bicipital groove can be used as a landmark for prosthetic stem positioning in shoulder arthroplasty. Moreover, it is different from the current standard technique of cutting the proximal humerus at 30° of retroversion with the epicondyles or forearm used as a guide.

First record of the root knot nematode, Meloidogyne minor in New Zealand with description, sequencing information and key to known species of Meloidogyne in New Zealand.

Meloidogyne minor Karssen et al. 2004 was collected from perennial ryegrass (Lolium perenne L.) growing in a sports ground in Christchurch, New Zealand. This is a new record for M. minor, the first report of this nematode occurring in New Zealand, and the second report from the southern hemisphere (after Chile). In general, the New Zealand isolate of M. minor corresponds well to the descriptions of M. minor given by Karssen et al. (2004). The New Zealand isolate is characterized by having a female with dorsally curved stylet, 13-14 μm long, with transversely ovoid knobs slightly sloping backwards from shaft; rounded perineal pattern; and male with stylet 16-19 μm long, large transversely ovoid knobs sloping slightly backwards from shaft; head region not set off, labial disc elevated, lateral lips prominent; and second stage juvenile 370-390 μm long, with hemizonid posterior but adjacent to excretory pore; tail 53-63 μm long; and a distinct hyaline tail terminus 14-18 μm long. In addition, molecular phylogeny using near full length small subunit (SSU), D2/D3 expansion segments of the large subunit (LSU), the internal transcribed spacer region (ITS1 and 2), and the intergenic spacer (IGS2) of the ribosomal rDNA supports the identification.

Characterisation of some Scutellonema species (Tylenchida: Hoplolaimidae) occurring in Botswana, South Africa, Costa Rica and the USA, with description of S. clavicaudatum sp. n. and a molecular phylogeny of the genus

The genusScutellonemacontains more than 40 species of spiral nematodes with enlarged phasmids called scutella. In this study, we provide morphological and molecular characterisation ofS. clavicaudatumsp. n.,S. brachyurus,S. bradys,S. cavenessi,S. transvaalense,S. truncatumandScutellonemasp. A. from North and Central America, and Africa. The new species,S. clavicaudatumsp. n., was found on sugarcane in South Africa and is characterised by a lack of lip annuli as inS. africanum,S. siamenseandS. truncatum. The lip region, in both males and females, is conical and marked by six large rectangular blocks separated or fused with the submedian and lateral lip sectors, which surround a round and distinct labial disc. Females of this new species also have large vaginal glands, a functional spermatheca, the lateral field posterior to the scutellum ending in a bluntly pointed shape and a clavate tail. Morphological descriptions, measurements, light and scanning electron microscopic photos and drawings are also given forS. bradys,S. cavenessi,S. transvaalenseandS. truncatum. The study of spiral nematode samples from Florida, USA, confirmed the presence of a morphologically and genetically atypical populations ofS. bradys. The morphology of theS. bradyspopulation from Bermuda grass in pasture land from central Florida fits that of type specimens of this species, but differs in having a truncate tail terminus rather than round and also a prominent spermatheca filled with flagellate spermatozoa. Other FloridaScutellonemasamples analysed in this study belonged toS. cavenessi, a species native to West Africa. This is the first report ofS. cavenessiin Florida, where it parasitises the ornamental plantSansevieria trifasciata. Our study showed a high level of intraspecific variation forScutellonemarRNA and mtDNA genes, which can reach 5.6% for the D2-D3 of 28S rRNA, 12.9% for the ITS rRNA genes and 14.4% for theCOIgene. Phylogenetic relationships withinScutellonemaare given as inferred from the analyses of the D2-D3 of 28S rRNA, ITS rRNA and theCOImtDNA gene sequences.

The versatility of the Karapandzic flap: A review of 65 cases with patient-reported outcomes

ObjectiveThe Karapandzic flap is an established technique for reconstruction of large lip defects and in our experience is particularly valuable in repair of the upper lateral lip and the commissures as well. We present our experience in a case series of 65 patients under one consultant. MethodThis is a retrospective study of patients who underwent Karapandzic flap repair for lip defects following cancer resection from 2007 to 2014 in North Yorkshire. A data collection tool was used which incorporated patient demographics, tumour location, histology, complications, resection margins and recurrence including functional and aesthetic outcomes. The Patient and Observer Scar Assessment Scale (POSAS) was used to assess postoperative outcome at more than 1 year. ResultsThe clearance rate was 98.4%. For those with a follow-up greater than 1 year, there was no recurrence or surgical revision, whilst the most common concern was temporary lip paraesthesia. The mean POSAS scores were low for both patients and observers reflecting a high satisfaction rate. ConclusionThe technique of Karapandzic flap reconstruction for defects in both upper and lower lip allows adequate margin clearance with a low level of complications. The advantages of this technique include preservation of both function and sensation utilising local tissue to allow successful aesthetic outcomes.

Experimental study on premixed flame propagation of hydrogen/methane/air deflagration in closed ducts

Experimental investigations of premixed hydrogen/methane/air flame propagation in closed ducts were conducted in six ducts for stoichiometric mixtures with five hydrogen fractions (i.e., 0%, 25%, 50%, 75%, and 100%). In the experiments, the flame propagation behavior associated with the pressure dynamic was studied, and the results show that the flame shape changes as the aspect ratio and hydrogen fraction vary. In the duct with the smallest aspect ratio, only the first four stages of the “tulip” flame were observed. As the aspect ratio increased, the flame structure evolved differently. In cases with lower hydrogen fractions, the flame front became asymmetric, and the lower lateral lip propagated slower than the upper one in a classic “tulip” flame inversion. As the hydrogen fraction increased but before reaching pure hydrogen, the flame propagated while maintaining its tulip shape, accompanied by small oscillations; furthermore, a cellular flame appeared in the duct with the largest aspect ratio before the end of propagation. In those ducts, a distorted “tulip” flame with indented tulip lips was observed for pure hydrogen. For all configurations, the flame speed dynamic is closely related to the pressure, and they both significantly increase with increasing hydrogen.

Preoperative Cleft Lip Measurements and Maxillary Growth in Patients With Unilateral Cleft Lip and Palate.

Maxillary growth in patients with cleft lip and palate is highly variable. The authors' aim was to investigate associations between preoperative cleft lip measurements and maxillary growth determined cephalometrically in patients with complete unilateral cleft lip and palate (cUCLP). Retrospective cross-sectional study. Children with cUCLP. Preoperative cleft lip measurements were made at the time of primary cheiloplasty and available for each patient. Maxillary growth was evaluated on lateral cephalometric radiographs taken prior to any orthodontic treatment and alveolar bone grafting (8.5 ± 0.7 years). The presence of associations between preoperative cleft lip measurements and cephalometric measures of maxillary growth was determined using regression analyses. In the 58 patients included in the study, the cleft lateral lip element was deficient in height in 90% and in transverse width in 81% of patients. There was an inverse correlation between cleft lateral lip height and transverse width with a β coefficient of -0.382 (P = .003). Patients with a more deficient cleft lateral lip height displayed a shorter maxillary length (β coefficient = 0.336; P = .010), a less protruded maxilla (β coefficient = .334; P = .008), and a shorter anterior maxillary height (β coefficient = 0.306; P = .020) than those with a less deficient cleft lateral lip height. Patients with cUCLP present with varying degrees of lateral lip hypoplasia. Preoperative measures of lateral lip deficiency are related to later observed deficiencies of maxillary length, protrusion, and height.

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re- exploration in situation of any suspected failing free flap. Keywords: Free Radial Artery Forearm Flap (FRAFF), Squamous cell carcinoma (SCC), Supra Omohyoid Neck Dissection (SOND), Lymph Nodes (LN), Internal Jugular Vein (IJV)

Structural diversity of the vastus intermedius origin revealed by analysis of isolated muscle specimens.

The quadriceps femoris (QF), a major extensor of the knee joint, plays an important role in human movement. However, descriptions of the three vastus muscles of the QF in anatomy textbooks remain confusing. We analyzed 33 QFs by a novel approach, using isolated muscle specimens to clarify the structures of the vastus lateralis (VL), vastus medialis (VM), and vastus intermedius (VI) origins. The origins of the VL and VM were quite constant in shape and location, but the VI was much more structurally diverse. In typical cases (23 of 33), the origin of the VI attached muscularly to the anterior and lateral surface of the femoral shaft. It adjoined the origin of the VL at the lateral lip (LL) of the linea aspera to form a common origin. In some cases (10 of 33), the muscle belly and origin of the VI were much smaller than those in the typical cases; the origin of the VI attached only to the anterior surface of the femur and did not contact the LL. In addition, the muscle belly of the VI was narrow and almost corresponded to the width of the femoral shaft. The isolated muscle specimen is a useful tool for analyzing individual muscle structures, which can be difficult to observe by routine dissection. Using this method, it became clear that the VI is more structurally diverse in its origin than the VL and VM. Clin. Anat. 30:98-105, 2017. © 2016 Wiley Periodicals, Inc.

Description of two equine nematodes, Parascaris equorum Goeze 1782 and Habronema microstoma Schneider 1866 from the domestic horse Equus ferus caballus (Famisly: Equidae) in Egypt

Parasitic gastroenteritis (PGE) caused by infection of the gut with parasitic nematodes is one of the most important diseases of livestock animals from both financial and welfare perspectives. Parascaris equorum and Habronema microstoma are of the most endemic nematodes of the world which are currently the major cause of PGE of the domestic horses in Egypt. The present investigation introduced the first morphological description of these nematodes recovered from the domestic horse, Equus ferus caballus (Equidae), in Egypt by light and scanning electron microscopy. Seven P. equorum (fifth stage) and 18 adults of H. microstoma were recovered from the gastrointestinal tracts of four young domestic horses collected during the year of 2015. Microscopic examination of the isolated fifth stage P. equorum revealed that it possessed a long body with a broad anterior end equipped by large shamrock-like lips with deep transverse groove on medial surface set off from the rest of the body by a deep post-labial constriction giving the body a shouldered appearance. The total body length was 12-15 (14 ± 2) cm for males and 13-18 (16 ± 2) cm for females. Lips were three in number in the form of one dorsal and two sub-ventral surrounding the central stoma. The isolated adult worms of H. microstoma were whitish in color narrowed slightly at the anterior end. Single lateral ala in the cephalic region in both sexes was observed. The buccal vestibule was markedly thickened and equipped by two tridentate teeth. The adult worms had two bilobed lateral lips surrounding the mouth with four sub-median cephalic papillae and two amphids. The males were 14.5-18.0 (17.2 ± 0.3) mm long and 1.23-1.57 (1.42 ± 0.3) mm wide. The posterior end was spirally coiled and had wide caudal alae. The spicules were unequal. The females were 13.5-21.0 (16.2 ± 0.3) mm long and 1.55-1.75 (1.69 ± 0.3) mm wide. The anal pore had a thin upper rim and was located 177.0μm from the posterior end.

Suboral fork: a newly discerned gnathosomal structure from the proboscis of eriophyoid mites (Acari, Eriophyoidea).

The infracapitulum of eriophyoid mites comprises a cone-like basal infracapitulum, containing a pharynx, and a distal infracapitulum, forming a proboscis ensheathing a bunch of stylets. A well-developed basal labral section was observed in all studied specimens. A newly discerned structure, the suboral fork, situated in the ventral part of the proboscis was discovered. It is larger in diptilomiopids and Nalepella and notably smaller in eriophyids and phytoptids. This structure presumably determines the site of piercing and functions in a similar way to the pressure foot of a sewing machine which controls the movements of a needle. In diptilomiopids the suboral fork might have an additional function: it is a stopper which prevents the proboscis from further penetrating into plant tissues. It is possible that the suboral fork is homologous with the labium of early derivative acariform mites. The proboscis might be a fusion product of the infracapitular lateral lips, malapophyses and the labium. The proboscis serves as a feeding structure in eriophyoids; two ways of sucking plant cell sap, depending on shapes of proboscis and labrum, are hypothesized. Further work is needed to draw conclusions on homologies and the function of all gnathosomal structures in eriophyoids.

Morphology of the Bearded Seal (Erignathus barbatus) Muscular-Vibrissal Complex: A Functional Model for Phocid Subambient Pressure Generation.

Bearded seals possess a broad muscular snout with large mystacial vibrissal fields that are involved in tactile sensation and prey identification. Although the microstructure of bearded seal vibrissae and their feeding performance have been investigated their orofacial morphology has not. Such morphological studies are important to understand the underlying mechanisms of feeding performance and to test proposed functional hypotheses. Therefore, the facial musculature was examined in bearded seals to test functional hypotheses regarding feeding performance. The orofacial musculature is composed primarily of three enlarged muscular layers, the M. levator nasolabialis, M. orbicularis oris, and M. buccinatorius (superficial), M. maxillonasolabialis (intermediate), and the M. lateralis nasi and M. dilator nasi (deep). The expansion of these muscles, the three dimensionality of the entire muscular array, the soft tissue insertions, and constant volume fit the model of a muscular hydrostat, and explains the detailed and varied mobility of their snout. An anastomosing network of CN VII innervates these facial muscles. The disproportionately large infraorbital nerve of CN V courses toward the snout and divides into numerous branches that penetrate the external capsule of every Follicle Sinus-Complex. The anatomical evidence support that the M. orbicularis oris, M. buccinatorius, and M. maxillonasolabialis form a robust lateral lip complex that can occluded lateral gape during subambient pressure generation. The rostral portion of the M. orbicularis oris, M. dilator nasi, and M. mentalis function to pursue the rostral lips to form a circular aperture important for projecting steep pressure gradients rostral to the lips for prey acquisition. Anat Rec, 299:1043-1053, 2016. © 2016 Wiley Periodicals, Inc.

A Modified Single-Step Method to Repair a Central Defect of the Upper Lip.

Defects in the central region of the upper lip are difficult to repair. Several techniques have been described, many of them requiring a second surgical procedure to obtain acceptable aesthetic results. A patient with a soft defect in the central region of the upper lip following aggression by human bite is presented. To repair the defect, the principles described by Goldstein for lateral lip defects were used (Goldstein in Plast Reconstr Surg 85(3):446-452, 1990; Robotti et al. in J Plast Reconstr Aesthet Surg 63:431-439, 2010). In this particular case, two full-thickness advancing miomucosal flaps from the vermilion of the upper lip were used with predictable aesthetic results.