Lip Length Research Articles

Facial Anthropometry Measurements Using Three-Dimensional Stereophotogrammetry Analysis Among Nigerians.

This study aimed to determine the normative facial anthropometry measurement among Nigerians using three-dimensional stereophotogrammetry analysis.This study was carried out in Lagos, Nigeria over a period of 3 years. The sample population was Nigerians of diverse ethnic groups, age 16 and above with no history of congenital or acquired craniofacial deformities.A total of 452 subjects participated in the study with 56.2% males and 43.8% females. Most of the participants were between the ages of 25 to 49 (54.4%), 40.7% were less than 25 years of age and only 4.4% were more than 50 years old. The mean body mass index (BMI) for males was 22.7 and 23.4 for females. Mean values of upper facial height, midfacial height, lower facial height, intercanthal distance, interpupillary distance, upper facial width, and lower facial width are 69.13 ± 5.91, 49.89 ± 3.56, 67.85 ± 6.12, 35.19 ± 3.20, 67.04 ± 3.67, 139.43 ± 7.11, and 124.29 ± 9.72 mm, respectively. The upper facial height, commissure width, upper lip length, and lower jaw width were significantly affected by age, while the BMI of an individual was a determinant of the interpupillary distance, facial width, and lower jaw width.This study demonstrated that there was a statistically significant difference in the facial dimensions of males when compared to females across all ages among the study population. The authors also observed that age and BMI are significant predictors of variations in some of the measurements.

Evaluation of Cephalometric Changes and Its Relation to Changes in Patients' Quality of Life After Mandibular Setback Surgery.

To find out if a relationship exists between the different cephalometric changes and the perception of patients before and after Bilateral Sagittal Split Osteotomy (BSSO) setback surgery. Sample consisted of 28 patients (mean age 23.78 ± 1.36years), Male:Female = 1:1.3, with a median follow-up of 10 ± 1.8months, with skeletal class III malocclusion treated with BSSO setback surgery. Pre- and post-surgery lateral cephalograms were analysed. The Oral Health Impact Profile (OHIP) questionnaire was used to assess the patients' quality of life after surgery. Cephalometric data were then correlated with the questionnaire results. The psychological and social aspects of OHIP questionnaire were most affected. The most significant correlation between OHIP score change and cephalometric parameters was found with reduction of 'lower lip protrusion'; and significantly positive correlations were with increase in ANB angle and reduction in values of SND angle, N-B distance, lower lip length, lower facial height, mentolabial angle and angle of facial convexity. A significant relationship exists between the subjective and objective parameters which should be considered while planning for orthognathic surgery. Results of this study could be beneficial, helping the clinicians, to emphasise on specific cephalometric variable with the patient-specific expectations.

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients.

Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and non-cleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 ± 0.15, and the lateral lip height ratio was 0.91 ± 0.09 (P < 0.001). No significant differences were observed in lip width and vermilion height between the cleft and non-cleft sides of the upper lip of 6-year-olds; the alar base width ratio was 1.22 ± 0.16, medial lip height ratio was 1.11 ± 0.11, and lateral lip height ratio was 0.89 ± 0.09 (P < 0.05). There were no significant differences in the alar projection and nasal dome height on the cleft side of the nose; the nostril height and width ratios were 0.82 ± 0.11 and 1.31 ± 0.21 (P < 0.001), respectively. These consecutively performed lip adhesions for patients with wide unilateral complete cleft lip resulted in excellent long-term results. Therefore, lip adhesion for wide unilateral complete cleft lip is a reasonable alternative to presurgical molding.

Using rotation cross-advancement flap for repairing complete unilateral cleft lip and nasolabial deformity

To evaluate the efficacy of rotation cross-advancement flap method in repairing the nasolabial deformity of complete unilateral cleft lip. A retrospective study was performed to analyze the children who were treated by using the rotating cross-advancement flap for repairing the complete unilateral cleft lip at the Fujian Medical University Union Hospital from October 2018 to July 2019. The clinical data such as patient's lip height, lip length, nostril height, nostril width, nostril area and so on were collected at the pre-operation, post-operation and following-up visits respectively and used to evaluate the efficacy of the treatment. Six children were included in the present study. The ratios of lip height on noncleft side to cleft side were 2∶1 at the pre-operation time. The ratios of nostril height on the noncleft side to the cleft side were about 2∶1. The ratios of the width and the area of the nostril were 1∶2 to 1∶3. At the post-operation time, the ratios of length and height of the lip at the cleft side to the noncleft side were around 1∶1. The shape of the nostrils and nasolabial fold were almost symmetrical between the cleft side and noncleft side. The shapes of the nasal sill were acceptable and the postoperative scars were not obvious. There were no obvious incision healing complications and the treatment effects were satisfactory. Rotation cross-advancement flap method was safe and reliable for repairing the nasolabial deformities in children with complete unilateral cleft lip.

Interlabial gap and freeway space at rest position: a cephalometric study

Abstract Objectives The aim of this prospective study was to assess the amount of interlabial gap (ILG) and freeway space (FWS) at rest position (RP) according to gender, age, and skeletal pattern, and to evaluate the cephalometric measurements at maximum intercuspal position (MIP) and at RP to define the cephalometric changes from MIP to RP related to the amount of ILG and FWS. Methods Lateral cephalograms and photographs of selected subjects (47 females, 57 males) were obtained at MIP and RP. Cephalometric measurements at MIP and RP and their differences were measured and compared. Results ILG (P &gt; 0.05) and FWS (P &lt; 0.01) were greater in males than in females. ILG (P &lt; 0.05) and FWS (P &gt; 0.05) were greater in adolescents than in adults. ILG and FWS were not significantly related with the vertical skeletal pattern (FHR, facial height ratio). ILG was the greatest in Class II cases but without significance. FWS was significantly greater in Class III than in Class I and Class II cases (P &lt; 0.05). At MIP, the ILG at RP increased as overjet (P &lt; 0.05) and upper lip to the aesthetic line (P &lt; 0.01) increased. At RP, the ILG increased as upper incisor exposure and the lips to the aesthetic line increased (P &lt; 0.001), and FWS decreased as overbite decreased (P &lt; 0.001). From MIP to RP, lip length showed the greatest decrease (P &lt; 0.001) in the large ILG group. Additionally, Bjork sum (the sum of the saddle, articular, and gonial angles), mandibular plane angle, anterior facial height, and ANB (P &lt; 0.001) showed the greatest increase, while OB (P &lt; 0.001) showed the greatest decrease in the large FWS group. The lip competent group showed the largest frequency distribution in the small ILG and FWS groups, while smile line frequency distribution showed no relationship with the level of ILG and FWS. Conclusions Taking cephalometric measurements at RP would be helpful to evaluate the ILG and FWS more accurately, and to provide a more accurate diagnosis and treatment plan.

3D-reconstructions of Bast's Valve and Membranous Labyrinth: Insights for Vestibular Implantation and Meniere's Disease.

Bast's valve is a poorly understood inner ear structure located at the junction between pars superior and inferior in the membranous labyrinth. Anatomically precise three-dimensional reconstructions (3D-reconstructions) of Bast's valve can help illuminate the morphology of the valve, and point toward its role in normal physiology and pathological states such as endolymphatic hydrops. This is of particular relevance to the development of a vestibular implant, a device intended to rehabilitate deficits in the vestibular system. Six postmortem human temporal bones from healthy donors were scanned using a micro-computed tomography (microCT) scanner. The microCT data allowed 3D-reconstructions of the membranous labyrinth, with a particular focus on Bast's valve, vestibule, and cochlear duct. The microCT images of Bast's valve showed a rigid lip containing a core of soft tissue, opposing the thin membranous wall of the utricle. The maximum recorded length and width of the rigid lip were 440.4 μm and 88 μm, respectively. The 3D-reconstructions illustrated the slit-like opening of Bast's valve into the utricle, the twisting course of the basal turn of the cochlear duct, and the spatial orientation of utricle and saccule with respect to the stapes footplate. The present study provided a novel anatomical perspective on the microscopic structure of Bast's valve. The interplay between endolymphatic hydrops and Bast's valve is an ongoing area of research, but defining this anatomy in 3D will play a key role in furthering our understanding of the disease process. Implications for vestibular implantation are explored through the various 3D-reconstructions.

Tooth-borne versus tooth-bone-borne rapid maxillary expanders according to a stereophotogrammetric evaluation of facial soft tissues: A randomized clinical trial.

To evaluate the effects of tooth-borne and tooth-bone-borne rapid maxillary expansion (RME) on soft tissue with stereophotogrammetry. Thirty two patients (15 males and 17 females) who met inclusion criteria were divided into two groups. In the first group, tooth-borne RME appliance (hyrax) was applied to 16 patients (9 males and 7 females mean age 13.4±1.3years), and in the second group, tooth-bone-borne RME appliance (hybrid hyrax) was applied to 16 patients (6 males and 10 females, mean age 13.05±1.24years). Changes in soft tissues before RME (T0) and post-retention (T1) period were evaluated by stereophotogrammetry. Linear and angular measurements were performed. Independent- and dependent-sample t tests were used to compare intra- and inter-group differences at P<.05 significance level. The data revealed statistically significant changes in nasal width, mid-face width, upper lip vermillion length/lower lip vermillion length ratio and upper lip angle in hyrax group. (P<.05) Also nasal width, lower lip length, lower lip vermillion length, anterior face height, lower face height, convexity angle and mandibular angle showed statistically significant changes in hybrid hyrax group. (P<.05) In the inter-group evaluation, no significant differences were found except upper lip and mandible angle. (P<.05). Both hyrax and hybrid hyrax expanders had effects on soft tissue profile. Anterior face height and lower face height increased in both groups. Upper lip length increased by 0.36mm in the hybrid group and 0.10mm in the hyrax group. This trial was registered at Clinicaltrials.gov (Identifier: NCT04828213).

Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip

We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery. Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019. We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P=.012, r=0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P=.00074, r=0.57); thus, the shorter the red lip, the higher was the oral commissure. The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.

Bending-Induced Cross-Sectional Deformation of Cold-Formed Steel Channel-Section Beams

In practice, the cold-formed steel structures are widely used, and their geometrical nonlinearity is of great significance in structural design. However, the current analytical solutions are only applied to linear problems, and the nonlinear problems are mostly considered by commercial finite element software. This paper presents an analytical model to describe the bending-induced cross-sectional deformation in cold-formed steel channel-section beams when subjected to transverse bending loads. The nonlinear effect of cross-sectional deformation on the relationship between the overall bending curvature and applied moment is examined. A parametric study is also carried out to examine how the flange width, lip length, and thickness of the section affect the cross-sectional deformation and corresponding nonlinear bending behavior of the beams.

Dynamic esthetic analysis of the anterior teeth in normal occlusion in individuals aged 18-49 years

Objective: To investigate the relationship between age, sex, length of upper lip and the exposure of maxillary central incisor. Methods: A total of 304 participants in normal occlusion (154 males, 150 females, aged 18-49 years) were recruited in this study from patients, visited the Medical Examination Center, Affiliated People's Hospital, Shanxi Medical University from January 2019 to August 2020. Participants were divided into 18-29 years old group (104, 53 males, 51 females), 30-39 years old group (110, 56 males, 54 females) and 40-49 years old group (90, 45 males, 45 females). Facial photography was used to record the facial state during the mandibular postural position, "che" pronunciation position and posed smile. The upper lip length, upper lip thickness and the exposure of maxillary central incisor were measured by ImageJ. The differences of measurement items in each group and the gender differences of each measurement item were analyzed. The length of upper lip and the exposure of upper central incisor in the mandibular postural position were analyzed by Pearson correlation. Results: In the mandibular postural position, the length of upper lip was (21.9±2.2), (22.5±2.5) and (23.1±2.2) mm in the 18-29 years old, 30-39 years old and 40-49 years old groups, and the length of upper lip in the 40-49 years old group was significantly larger than that in the 18-29 years old group (P<0.05). The exposure of upper central incisor in the 40-49 years old group during the mandibular postural position, "che" pronunciation position and posed smile [(1.4±1.2), (4.7±2.4), (7.7±2.4) mm, respectively] were significantly lower than those in the 18-29 years old group [(2.3±1.4), (5.5±2.2) and (8.8±2.0) mm] (P<0.05). The exposure of upper central incisor in the 30-39 years old group during the mandibular postural position and posed smile [(1.8±1.4), (8.2±2.0) mm, respectively] was significantly lower than those in the 18-29 years old group (P<0.05). With the increase of age, the exposure of upper central incisor decreased gradually. In the same group, the exposure of upper central incisor in the female during the mandibular postural position and "che" pronunciation position (except 40 to 49 years old group) were significantly larger than those in the male (P<0.05), and there was no statistically significant difference between the sexes in the posed smile (P>0.05). There was a significant linear correlation between the exposure of upper central incisor and the length of upper lip at the mandibular postural position in normal occlusion aged 18-49 (r=-0.325, P<0.01). Conclusions: Gender factor should be considered in the esthetic design of anterior teeth. The exposure of anterior teeth in the mandibular postural position and "che" pronunciation position is more valuable than that in the posed smile. The length of upper lip in normal occlusion aged 40-49 was significantly shorter than that aged 18-29, and the exposure of upper central incisors was significantly reduced.

Effects of different surgical techniques and displacement distances on the soft tissue profile via orthodontic-orthognathic treatment of class II and class III malocclusions

BackgroundOrthognathic surgery can be carried out using isolated mandibular or maxillary movement and bimaxillary procedures. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile.MethodsThe changes in the soft tissue profile of 187 patients (Class II: 53, Class III: 134) were investigated. The treatment approaches were differentiated as follows: Class II: mandible advancement (MnA), bimaxillary surgery (MxS/MnA), upper extraction (UpEX), or Class III: maxillary advancement (MxA), mandible setback (MnS), bimaxillary surgery (MxA/MnS), and lower extraction (LowEX) as well as the extent of skeletal deviation (moderate Wits appraisal: − 7 mm to 7 mm, pronounced: Wits <− 7 mm, > 7 mm, respectively). This resulted in five groups for Class II treatment and seven groups for Class III treatment.ResultsIn the Class II patients, a statistically significant difference (p ≤ 0.05) between UpEX and moderate MnA was found for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), and mentolabial angle (Pog’-B′-Li). In the Class III patients, a statistically significant differences (p ≤ 0.05) occurred between LowEX and moderate MxA for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), upper and lower lip distacne to esthetic line (Ls/Li-E-line), and lower lip length (Sto-Gn’). Only isolated significant differences (p < 0.05) were recognized between the moderate surgical Class II and III treatments as well between the pronounced Class III surgeries. No statistical differences were noticed between moderate and pronounced orthognathic surgery.ConclusionsWhen surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. However, it must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment. In contrast, moderate maxillary advancement in Class III therapy led to a significantly more convex facial and soft tissue profile by decreasing distances of the lips to the E-Line as well as the lower lip length.

The Rhino-Lip-Lifting: A Novel Proposal for Midface Profileplasty Performed as a Single Surgical Procedure.

As facial aging occurs, aesthetic changes of the nasal tip and the senile upper lip include tip ptosis, increase in skin length, loss of vermillion height and Cupid's bow, and vertical wrinkles.Regardless of the rejuvenation procedure, the lips are not to be considered as a single anatomical entity, instead they should be placed in a strong correlation with the nose. The aim of this study is therefore to demonstrate the effectiveness of the association of primary closed rhinoplasty together with indirect subnasal lip-lifting technique.A total of 45 patients were enrolled in this study and underwent primary closed rhinoplasty with indirect subnasal lip-lifting. The result showed an overall average nasolabial angle width reduction of 10.9% and lip length shortening of 23.5%, as assessed 1 year after the surgical procedure. When comparing before and after photographs and using the Subjective Global Aesthetic Improvement Scale (sGAIS), the overall satisfaction was rated 4.4 on 5, as "much improved."The authors show that lips should not be considered as a single anatomical entity but that they indeed must be placed in a strong correlation with the nose since a droopy nasal tip is likely to be considered unattractive and is often associated with the appearance of a long nose with covered philtrum and upper lip.Tip rotation to a normal nasolabial angle width could grant a beneficial impact on overall nose aesthetics; however, it may not fully balance the midface profile as it is the "lip position-to-incisal show" ratio that defines beauty, whereas the balance among forehead, nasal tip, upper lip, and chin is what defines the contour of harmonious profiles.This is the first patient series to show that the combination of closed rhinoplasty and indirect lip-lifting is a highly effective, safe, and reliable procedure to address profile rejuvenation.

Maxillary hollow denture: A literature review

Severely resorbed ridges and increased lip length provides challenge to achieve adequate retention, stability and support for the success of complete denture. In such cases Implant supported dentures can be promising alternative to conventional dentures. However, it is not always possible to provide patients with implant treatment as geriatric patients with systemic illness and economic constrains, possess reluctance for a long duration of treatment procedure and unwillingness for any kind of surgical procedure. Hence the best way is to rehabilitate them in conventional way. Light weight hollow dentures can prove to be an effective alternative to conventional denture for achieving optimum results. The aim of this review is to assess the role of maxillary hollow denture in improving the retention and stability in compromised cases based on the data published in the literature.

The Evolution of Unilateral Cleft Lip Repair.

The understanding of cleft lip etiology and approaches for surgical repair have evolved over time, allowing for improved ability to restore form and function. The variability of cleft lip presentations has necessitated a nuanced surgical approach with multidisciplinary cleft care. The earliest documentation of unilateral cleft lip repair predates the 19th century, with crude outcomes observed before the advent of curved incisions and advancement flaps. In the 20th century, straight line, quadrilateral flap, and triangular flap repairs were introduced to mitigate post-repair surgical scarring, increase lip length, and restore the symmetry of the Cupid's bow. Towards the latter part of the century, the development of rotation-advancement principles allowed for improved functional and aesthetic outcomes. Future technical improvements will continue to address the goals of lip and nasal symmetry, muscular continuity, precise scar concealment, and improved patient satisfaction in an increasing range of cleft phenotypes and during subsequent years of growth.

Lip repositioning surgery for gummy smile: 6-month clinical and radiographic lip dimensional changes.

The present case series aimed to examine lip repositioning surgery (LRS) outcomes related to changes in external and internal upper lip (UL) dimensions, utilizing both conventional clinical and novel radiographic approaches. Patients (n = 13) diagnosed with hypermobile UL (>8-mm mobility during smile) and excessive gingival display (≥4-mm) were included and assessed at baseline and 6 months postoperatively. Clinical parameters at rest included total lip and internal lip length (vestibular depth). At maximum smile included total lip, philtrum (ergotrid), and vermilion lengths. Cephalometric parameters included anterior maxillary height; lip length; nasolabial angle; anteroposterior lip thickness; internal lip length (vestibular depth); and vestibular fornix position (using novel approach employing radiopaque marker). Linear mixed-effect models, Pearson's correlation, and linear regression were used for statistical analyses. LRS did not affect total UL length at rest (p = 0.418). It resulted in significant internal UL length decrease (-3.8 ± 2.1 mm, p < 0.001) and significant increases of vermilion length (1.9 ± 1.0 mm, p < 0.001) and anteroposterior lip thickness (0.7 ± 0.7 mm, p = 0.002). The clinical and radiographic measurements of total UL length at rest (r ≥ 0.734) and of internal UL length (r ≥ 0.737), and the two radiographic assessments of vestibular depth (r = 0.842), were strongly correlated. LRS resulted in significant decrease of vestibular depth/internal UL length and in significant increases of UL vertical vermilion length and UL anteroposterior thickness, without affecting total UL length at rest. The documented lip dimensional outcomes should help practitioners when treatment-planning LRS and counseling patients seeking treatment for hypermobile UL.

노화에 따른 발화 시 입술움직임의 변화: 이중모음을 중심으로*

This study investigated the change in lip movement during speech according to aging. For the study, 15 elderly women with an average of 69 years and 15 young women with an average of 22 years were selected. To measure the movement of the lips, the ratio between the minimum point and the maximum point of movement when pronouncing a double vowel was analyzed in pixel units using image analysis software. For clinical utility, the software was produced by applying an automated algorithm and compared with the results of handwork. This study found that the range of the width and length of lips in double vowel tasks was smaller for the elderly than that of the young. A strong positive correlation was found between manual and automated methods, indicating that both methods are useful for extracting lip contours. Based on the above results, it was found that the range of the lips decreased when ignited as aging progressed. Therefore, monitoring the condition of lip performance by simply measuring the movement of lips before aging progresses, and performing exercises to maintain lip range, will prevent pronunciation problems caused by aging.

The Impact of Mandibular Advancement Surgery on Upper Lip Length in Class II Patients

Introduction: One of the most common maxillofacial malformations is mandibular advancement, a class II malformation or malocclusion. One treatment is mandibular advancement surgery. This research aimed to investigate the effect of mandibular advancement surgery on upper lip length in class II patients. Methods: This retrospective study was conducted with 16 patients having class II malformations who underwent mandibular advancement surgery. Data analysis was conducted using SPSS 19. Results: Results showed that although height of philtrum increased after surgery, there was no significant difference in the height of the philtrum from before to after the mandibular advancement surgery (p > 0.05). Evaluation of the patients showed that although commissure height and vermilion height decreased after surgery, this difference was not statistically different(p > 0.05). However, there was a statistically significant difference between before and after commissure height (p <0.05) at camouflage in patients. There was also a statistically significant difference in height of philtrum and vermilion between before and after camouflage in patients (p <0.05). Conclusions: The results of this study suggest that mandibular advancement surgery plays a serious role in the clinical appearance of lip soft tissue, which can be used as a predictor of patient profile prior to surgery.

Working in Peru: A 25-Year Experience With Voluntary Cleft Missions, and a Technique for the Primary Repair of the Unilateral Cleft Lip and Nasal Deformity.

CIRPLAST is a nonprofit volunteer plastic surgery program that has provided free surgery for patients with cleft lip and palate deformities in different parts of Peru since 1995. In 2015, the author reported 6,108 patients that had been successfully operated on by the CIRPLAST team over a 20-year period. A technique, developed by the author, for the straight-line vertical cleft lip closure without skin flaps of the unilateral cleft lip, was mentioned in that publication but it was not described. 1 The purpose of this article is to present the technique, which has been successfully employed in all the CIRPLAST cleft missions in Peru, for the past 25 years. The straight-line vertical cleft closure does not rely on measurements or skin flaps, and it can be used to close any degree of unilateral cleft lip cleft. The procedure is simple and dependable. After incising the cleft borders on both sides of the cleft, the orbicularis oris muscle is liberated from the surrounding tissues, segmented, and then moved down toward the free border of the lip, so that the cupid's bows can be placed in its normal horizontal position, together with the philtrum on the medial lip, providing normal fullness and pouting of the lower part of the upper lip. Lip length results from the orbicularis oris muscle repair and not from skin flaps. The associated nasal deformity is addressed at the same time as the lip repair, by freeing on the cleft side, the lower lateral cartilage (alar cartilage) from the external nasal skin through a rim incision, and then elevating the cartilage together with its vestibular skin, to place it in its normal position at the tip of the nose, and fixing it there with sutures. The anatomic, functional, and esthetic results of the lip closure together with the correction of the associated nasal deformity have been satisfactory, when comparing the repaired cleft side with the normal side, for symmetry. The straight-line vertical cleft lip closure, based on the orbicularis oris muscle repair, can be used to close any degree of lip clefting, including very wide clefts, without skin flaps. The associated cleft nasal deformity is corrected before the lip closure. The procedure has been used in all the CIRPLAST cleft missions in Peru for the past 25 years, and the outcomes of the repair over time have been satisfactory and stable.

Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis.

This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.

Diced costal cartilage graft combined with muscle repositioning improves Cleft-Side Alar asymmetry in Asian secondary unilateral cleft rhinoplasty: A three-dimensional evaluation

Asymmetry in a retrusive cleft-side ala situated posterior, lateral, and/or inferior to the non-cleft ala is aggravated by ipsilateral defect of the pyriform aperture. This study assessed diced costal cartilage graft combined with muscle repositioning in enhancing structural base and alar symmetry in secondary cleft rhinoplasty. From 2016 to 2019, 20 consecutive patients who underwent pyriform aperture paranasal augmentation combined with muscle repair secondary unilateral cleft rhinoplasty were reviewed retrospectively. Clinical three-dimensional (3D) photos were analyzed pre- and postoperatively, and the augmentation method and muscle repositioning were described detailedly. Twenty cases aged 22.2 ± 3.9 years were submitted to secondary cleft rhinoplasty with diced costal cartilage graft to the pyriform rim. They were followed up for 6.2-26.2 months, with postsurgical time averaging 10.3 ± 3.4 months. After total lip takedown by anatomic muscle re-approximation, the cleft to non-cleft side showed enhanced alar symmetry (p<0.001) and heightened vertical lip length (p<0.001). Additionally, the alar base inclination was improved toward the horizontal plane (p<0.001). The cleft-side ala was anatomically ameliorated after muscle repositioning combined with diced costal cartilage graft to the pyriform rim, improving alar symmetry. Complications were minimal, indicating the safety of this method.