Lip Regions Research Articles

Spotlight in Plastic Surgery: January 2019

Spotlight in Plastic Surgery: January 2019

Facial burn during orthognathic surgery: Case report

Despite the fact that the advances in surgical techniques have contributed to the reduction in the number of complications associated with orthognathic surgery, problems resulting from different phases of treatment, treatment planning, and postoperative period may occur. This paper presents a case of facial soft tissue lesion, burn in the lower lip region, in a patient with Class III malocclusion during orthognathic surgery. A 22-year, 3-month-old male patient with Class III malocclusion was burned in the paramedian region of the lower lip due to unnoticed overheating of the low-speed handpiece during sagittal osteotomy of the left mandibular ramus. The injury to the patient could have resulted in legal repercussions against the dental surgeon. However, that did not occur. The satisfaction with the aesthetic and functional results, from the standpoint of both dental and facial aspects, was more important for the patient than the aesthetics of the burn sequelae. Although orthognathic surgery is a safe and widely used procedure in association with orthodontic treatment, the risk of complications always exists. No matter how skilled and self-confident the surgeon is, careful attention to the variables that can be controlled should be taken into account in order to reduce the chance of complications that may result in irreversible damages.

Chronic oral methylphenidate treatment increases microglial activation in rats.

Methylphenidate (MP) is a widely prescribed psychostimulant used to treat attention deficit hyperactivity disorder. Previously, we established a drinking paradigm to deliver MP to rats at doses that result in pharmacokinetic profiles similar to treated patients. In the present study, adolescent male rats were assigned to one of three groups: control (water), low-dose MP (LD; 4/10mg/kg), and high dose MP (HD; 30/60mg/kg). Following 3months of treatment, half of the rats in each group were euthanized, and the remaining rats received only water throughout a 1-month-long abstinence phase. In vitro autoradiography using [3H] PK 11195 was performed to measure microglial activation. HD MP rats showed increased [3H] PK 11195 binding compared to control rats in several cerebral cortical areas: primary somatosensory cortex including jaw (68.6%), upper lip (80.1%), barrel field (88.9%), and trunk (78%) regions, forelimb sensorimotor area (87.3%), secondary somatosensory cortex (72.5%), motor cortices 1 (73.2%) and 2 (69.3%), insular cortex (59.9%); as well as subcortical regions including the thalamus (62.9%), globus pallidus (79.4%) and substantia nigra (22.7%). Additionally, HD MP rats showed greater binding compared to LD MP rats in the hippocampus (60.6%), thalamus (59.6%), substantia nigra (38.5%), and motor 2 cortex (55.3%). Following abstinence, HD MP rats showed no significant differences compared to water controls; however, LD MP rats showed increased binding in pre-limbic cortex (78.1%) and ventromedial caudate putamen (113.8%). These findings indicate that chronic MP results in widespread microglial activation immediately after treatment and following the cessation of treatment in some brain regions.

Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism.

Both deep understanding and reliable prediction of postoperative soft tissue changes are crucial for planning orthognathic surgery. Instead of estimating soft tissue responses by measuring individual landmark changes, this study aimed to investigate the relationship (ratio) between soft and hard tissue movements in different facial regions through three-dimensional cone-beam computed tomography (CBCT). Preoperative and postoperative CBCT images were superimposed using the surface registration method on the basis of the cranial base, and 10 facial regions of interest were defined. Region-based volumetric subtractions between the preoperative and postoperative segments were performed. The volumetric differences and surface of each region were used to estimate the average movement. Correlation and regression analyses were performed to examine the relationships between the corresponding soft and hard tissue movements. An overall pattern of facial soft tissue movement was observed in patients with prognathism who underwent orthognathic surgery. The experiment results have shown that mean ratios for the average soft-to-hard tissue movements in the facial regions varied, which may not exactly be similar to the published reports because of the population biocharacteristics and study methods, but the trend is in agreement with the previous studies. Additionally, the prediction capability of the regression model was significantly high, ranging from 0.786 to 0.857, in upper lip, upper vermilion, and chin regions, thus demonstrating that the skin outline changes in these critical regions could be reliably predicted from the underlying bone movements. These results could likely be applied in future soft tissue simulation in orthognathic surgery.

Assessing Attentional Bias in Secondary Cleft Lip Deformities: An Eye-Tracking Study.

Using a well-established measure of attention, we aimed to objectively identify differences in severity between types of simulated secondary cleft lip deformities. Volunteer participants viewed a series of images of a child digitally modified to simulate different secondary unilateral cleft lip deformities (long lip, short lip, white roll/vermilion disjunction, and vermilion excess), a lip scar with no secondary deformity, or a normal lip. Eye movements were recorded using a table-mounted eye-tracking device. Dwell times for 7 facial regions (eyes, nose, mouth, left ear, right ear, scar, and entire face) were compared. Forty-six naive adults (25 male; mean age 25.5 years) were recruited from our local university community. The primary outcome of the study was cumulative dwell time between facial regions (eyes, nose, mouth, left ear, right ear, scar, and entire face). Participants spent significantly more time focused on the upper lip regions in patients with simulated secondary deformities relative to those who did not ( P < .01). Severe short lip deformities resulted in longer fixation times than severe long lips ( P < .05). Participants spent less time focused on the eye region in the presence of a secondary lip deformity ( P < .05). When total facial fixation time was assessed, short lip deformities resulted in the greatest duration dwell time ( P < .001). This study presents objective data to support the concept that observers show varying degrees of attentional bias to the lip region depending on the type and severity of the simulated secondary cleft lip deformity.

The effect of a stepped lip piston design on performance and emissions from a high-speed diesel engine

Understanding engine-out NOx and soot emissions from light-duty diesel engines is vital for improving combustion system design and ultimately for reducing aftertreatment requirements. In this work two piston bowl shapes, a standard re-entrant bowl and a bowl with a stepped lip, are tested experimentally and numerically at two part-load operating points (1500 rpm/6.8 bar net IMEP and 1750 rpm/13.5 bar net IMEP), and four full-load operating points (1500, 2000, 3000, and 4000 rpm). The results show that the stepped lip design consistently increases the 50–90% MFB duration across all operating conditions due to the trapping of the flame in the region of the stepped lip. Use of the stepped bowl allowed injection timing to be advanced at full load, a condition constrained, in this work, by strict limits of cylinder pressure and exhaust temperature. However, despite these changes in combustion behavior engine out emissions were found to be largely insensitive to the bowl shape. No statistical difference in NOx and soot emissions between the two bowl geometries was observed at part load. A minor penalty in NOx emissions, statistically significant at ∼67% CI, is reported for the stepped bowl design at some full load points.

Incidence of inferior alveolar nerve affection with and without nerve exposure during bilateral sagittal split osteotomy

Objective: The aim of this study was to determine the presence and severity of inferior alveolar nerve (IAN) affection during bilateral sagittal split osteotomy (BSSO) in two groups of patients with and without direct exposure and visualization of the nerve during surgical procedure.Patients and Methods: In this prospective randomized clinical study, 14 patients (28 sides) indicated for BSSO were included. The sides were randomly divided into two groups with equal number of sides (14 sides). Group I with wide soft tissue dissection of the medial side of the ramus and exposure of IAN above the ligula and group II with minimal soft tissue dissection of the medial side of the ramus without exposure of IAN. For evaluation of neurosensory function of IAN, two methods were used including subjective evaluation and two-point discrimination test.Results: According to the subjective evaluation, there was a statistically significant difference between both groups in favor of group II in all follow-up recalls except in the final one at 12 months postoperatively. Considering the results of two-point discrimination test, the improvement obviously continued during the successive follow-up periods in both groups, with a statistically significant difference in favor of group II until the ninth month, and then in the last follow-up at the 12th month, the records were almost equal.Conclusion: To markedly reduce the postoperative neurosensory disturbances of IAV and to accelerate the full recovery of sensation of the lower lip and chin regions following BSSO, limited exposure and dissection of the medial soft tissues of the ramus should be practiced with avoidance of direct exposure and manipulation of IAN.

A clinically validated prediction method for facial soft-tissue changes following double-jaw surgery.

It is clinically important to accurately predict facial soft-tissue changes prior to orthognathic surgery. However, the current simulation methods are problematic, especially in anatomic regions of clinical significance, e.g., the nose, lips, and chin. We developed a new 3-stage finite element method (FEM) approach that incorporates realistic tissue sliding to improve such prediction. In Stage One, soft-tissue change was simulated, using FEM with patient-specific mesh models generated from our previously developed eFace template. Postoperative bone movement was applied on the patient mesh model with standard FEM boundary conditions. In Stage Two, the simulation was improved by implementing sliding effects between gum tissue and teeth using a nodal force constraint scheme. In Stage Three, the result of the tissue sliding effect was further enhanced by reassigning the soft-tissue-bone mapping and boundary conditions using nodal spatial constraint. Finally, our methods have been quantitatively and qualitatively validated using 40 retrospectively evaluated patient cases by comparing it to the traditional FEM method and the FEM with sliding effect, using a nodal force constraint method. The results showed that our method was better than the other two methods. Using our method, the quantitative distance errors between predicted and actual patient surfaces for the entire face and any subregions thereof were below 1.5 mm. The overall soft-tissue change prediction was accurate to within 1.1 ± 0.3 mm, with the accuracy around the upper and lower lip regions of 1.2 ± 0.7 mm and 1.5 ± 0.7 mm, respectively. The results of qualitative evaluation completed by clinical experts showed an improvement of 46% in acceptance rate compared to the traditional FEM simulation. More than 80% of the result of our approach was considered acceptable in comparison with 55% and 50% following the other two methods. The FEM simulation method with improved sliding effect showed significant accuracy improvement in the whole face and the clinically significant regions (i.e., nose and lips) in comparison with the other published FEM methods, with or without sliding effect using a nodal force constraint. The qualitative validation also proved the clinical feasibility of the developed approach.

Early treatment of symphysis mandibular fracture in 12 years old children using erich arch bar: a case report

Objective: To explain the management of symphysis mandibular fracture in pediatric using erich arch bar.Methods: A 12 years old boy has fracture in mandible due to the accident occurred when his chin hit the touching motorcycle tank. Clinically a deformity at the anterior of mandible and malocclusion has occurred. Patient also complained a pain with swelling and bleeding at the region of fracture and lip. Suturing had been done in wound area for both intra and extra oral area followed by the application of arch bar in maxilla and mandible. Doing evaluation at the third day, a vague fracture line was found in panoramic radiograph.Results: The following treatment done was the application of erich arch bar for mobility reducing the fracture of mandibular symphysis. A good healing act management to symphysis mandibular fracture of 12 years old children with full eruption of teeth has been given to the teeth to develop retention and to stabilize the erich arch bar.Conclusion: Management of pediatric symphysis mandibular fracture for 12 years old children with full eruption of teeth using erich bar revealed a healed fracture.

The combined effects of reduced pH and elevated temperature on the shell density of two gastropod species measured using micro-CT imaging

The increased absorption of atmospheric CO2 by the ocean affects carbonate chemistry and calcification rates of marine organisms. The impacts of low pH and seawater warming were investigated for the intertidal gastropods Nassarius nitidus and Columbella rustica. The combined effect of reduced pH (7.6) and increased temperature (25 °C) was studied at intermediate time intervals for a total period of 3 months in order to investigate variability and fluctuations of the shell structure and density over time. The pH and temperature conditions used for the experiment were selected according to the predictions of the Intergovernmental Panel on Climate Change. Deterioration of the external surface structure and reduction of shell density of the gastropods were confirmed using an innovative imaging and analysis method based on micro-computed tomography. The effect of low pH at ambient temperature was detrimental for N. nitidus with a 38.1% reduction of density in the shell lip and a 47.7% decrease in the apex, which is the oldest shell region. C. rustica was also affected, although to a much lesser degree (the maximum reduction observed was 8% at the apex). The negative effects of reduced pH were further reinforced for C. rustica when the temperature was increased, while N. nitidus was not affected significantly by the combination of the two factors. Increased temperature at ambient pH had an inhibitory effect on the shell density of N. nitidus causing a reduction of about 40%, whereas the shell density of the widest and lip regions of the C. rustica were increased under the same conditions. Different species are characterised by different vulnerability and tolerance responses regarding ocean acidification and warming, and this variability may affect ecological interactions and marine biodiversity.

Prediction of Binding Site in Eight Protein Molecules of Begomovirus and its Satellite Components i.e. Betasatellite and Alphasatellite Isolated from Infected Ornamental Plant

The production of soybean cyst nematode (SCN), Heterodera glycines, including female formation and fecundity was much higher in SCN race 14 (R14) than in race 3 (R3) in susceptible soybean cultivars Bragg (intolerant), Lee74 (moderately tolerant), and PI 97100 (highly tolerant). The nematode body was also significantly larger in R14 than in R3 at 20 days after inoculation, but the further nematode growth appeared to be slower in R14 than in R3, resulting in no significant difference between the two races at 30 days after inoculation. Within each race, no significant difference was observed in the growth and reproduction among the soybean cultivars tested. Syncytial areas near the nematode lip regions (infection sites) were measured for each soybean cultivar-SCN race combination. R14 induced significantly larger syncytia than R3. Bragg had relatively larger syncytia than Lee74 and PI 97100, but the difference among the soybean cultivars was minimal or not significantly different. Syncytium occupation in the stelar region differed only between PI 97100 and the other two cultivars, which may be somewhat, but not exactly, related to tolerance levels. Syncytial cytomplasm was degenerated more with R14 and in Bragg than with R3 and in Lee74 and PI 97100, respectively. In light microscopy, degenerated syncytia were characterized by depleted and loose cytoplasm with less plastids than normal-looking (intact) syncytia which had dense syncytial cytoplasm. Electron microscopy revealed that degenerated syncytia contained highly vacuolated cytoplasm with degenerated plastids. The above results suggest that structural characteristics of syncytia may match the nematode growth and reproduction.

Morphological Simulation of Different Incisal Embrasures: Perception of Laypersons, Orthodontic Patients, General Dentists and Orthodontists

This study aimed to evaluate how different forms of incisal embrasures influence the esthetic perception of the smile, the preferences of each group of evaluators, and the influence of gingival display. Two photographs of a broad male and female smiles were digitally manipulated to remove imperfections and asymmetries. A second manipulation was performed on the four maxillary incisors, creating 3 different forms of incisal embrasures: rounded, semi-rounded and squared. The lower region of the upper lip was shifted down to simulate a smile with and without gingival display, resulting in a total of 12 photos. A presentation in digital media was structured with instructions and the photos to be studied by 240 evaluators, who were divided into four groups: laypersons, patients undergoing orthodontic treatment, general dentists and orthodontists. The statistical analysis comprised the Multiple Factor ANOVA (SPANOVA), and the Tukey's post-test was applied at a 5% significance level. The semi-rounded form was generally preferred, with a score of 70.83 for the male smile, and 77.26 for the female smile. Gingival display generated a statistically significant influence on how the embrasures were perceived, with the semi-rounded being preferred when associated with gingival display. Orthodontists were the most stringent in their evaluations. Patients and laypersons exhibited different patterns of esthetic perception. The form of the incisal embrasures associated with gingival display influenced the evaluators' esthetic perception. There was a statistically significant difference between the groups of patients and orthodontists. Incisal embrasures play an important role in smile esthetics and influence the attractiveness perception. In general, the semi-rounded embrasure form is the most preferred. Different groups' perceptions on tooth morphology reinforce the importance of patient participation in treatment planning. (J Esthet Restor Dent 29:68-78, 2017).

Effects of Superpulsed, Low-Level Laser Therapy on Neurosensory Recovery of the Inferior Alveolar Nerve.

The purpose of this investigation was to evaluate the therapeutic efficacy of superpulsed, low-level laser therapy (SLLLT) on neurosensory recovery of the inferior alveolar nerve (IAN) after oral surgical injury. A survey of the literature reveals the uncertainty of outcomes for the surgical management of IAN injury and the efficacy of low-level laser therapy in the treatment of IAN injury. In this study, the authors report the results for SLLLT in 57 patients affected by paresthesia of the lip, chin, gingival, and buccal regions. Each patient was subjected to 10 laser treatments, once a week, with a GaAs diode laser. Clinical neurosensory tests (soft touch, 2-point discrimination, pin prick, thermal test) and the visual analogue scale were used before every treatment to evaluate the extent of neurosensory recovery. The authors' results demonstrate that 83.3% of the patients had a significant neurosensory recovery, as evident in the objective and subjective tests. The results reported in this study indicate that SLLLT has the potential to improve neurosensory recovery in patients with IAN paresthesia.

Effects of rapid maxillary expansion on facial soft tissues

Changes in soft tissue in various morphological regions of the face immediately after rapid maxillary expansion (RME) were examined using three-dimensional (3D) deviation analyses. A total of 50 patients were included in the study; 25 patients (11 female and 14 male) presented with a unilateral or bilateral posterior crossbite malocclusion requiring RME. In addition, 25 patients (13 female and 12 male) were included as a control group. The mean ages of the study group and control group were 9.8 years (range 8.1-12.6 years) and 9.6 years (range 8.3-12.2years), respectively. The 3D stereophotogrammetric images acquired immediately before the appliance was cemented and after expansion had been completed in the treatment group were compared using Rapidform software. The 3D deviation analyses were made for the complete face and in the upper and lower face, upper and lower lips and nose regions. The amount of negative and positive deviations and the mean deviations were examined on the facial meshes for the 95th percentiles. Immediately after RME, the mean absolute deviation over the complete face was 0.54±0.16mm. The mean change for the upper face was 0.42±0.17mm (mean positive deviation: 0.37±0.17mm; mean negative deviation: -0.48±0.18mm). The mean absolute deviation was 0.62±0.28mm in the upper lip and 0.60±0.34mm in the lower lip. In the nose area, the absolute deviation was 0.41±0.21mm (mean positive deviation: 0.39±0.16mm; mean negative deviation: -0.43±0.26mm). Changes in facial soft tissues in the upper face, lower face, nasal soft tissues, and lower and upper lip regions were observed after RME.

Three-Dimensional Upper Lip and Nostril Sill Changes After Cleft Alveolus Reconstruction Using Autologous Bone Grafting Versus Recombinant Human Bone Morphogenetic Protein-2

Cleft alveolus in patients with unilateral complete cleft lip and palate has been alternatively reconstructed with recombinant human bone morphogenetic protein (rhBMP)-2. However, its effects on upper lip and nostril sill anatomy are not known. Thus, the objective of this investigation was to assess and compare upper lip and nostril sill changes after cleft alveolus reconstruction with autologous bone from the iliac crest region and rhBMP-2. Patients were randomly allocated into 2 groups. In group 1, autologous bone from the iliac crest region was used to fill the cleft alveolus (n = 4), and in group 2, rhBMP-2 was used to fill the cleft alveolus (n = 8). Preoperatively and at one after the surgery, computerized tomography (CT) was performed. Reformatted CT imaging was used to perform cephalometric linear measurements of the upper lip and nostril sill regions. Inter- and intragroup data of the pre and postoperative reformatted CT measurements of the upper lip and nostril sill regions did not show differences (P >0.05) in cutaneous upper lip height and projection, nostril sill elevation, and subnasale projection. There were no significant upper lip and nostril sill anatomical changes after cleft alveolus reconstruction using autologous bone grafting and rhBMP-2.

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.

The study on facial soft tissue thickness using Han population in Xinjiang

Facial profile is an important aspect in physical anthropology, forensic science, and cosmetic research. Thus, facial soft tissue measurement technology plays a significant role in facial restoration. A considerable amount of work has investigated facial soft tissue thickness, which significantly varies according to gender, age, and race. However, only few studies have considered the nutritional status of the investigated individuals. Moreover, no sufficient research among Chinese ethnic groups, particularly Xinjiang population in China, is currently available. Hence, the current study investigated the adaptability of facial soft tissue to the underlying hard tissue among young adults of Han population in Xinjiang, China; the analysis was performed on the basis of gender, skeletal class, and body mass index (BMI). Measurements were obtained from the lateral cephalometric radiographs of 256 adults aged 18–26 years old. Differences in soft tissue thickness were observed between genders and among skeletal classes. With regard to gender, significant differences in soft tissue thickness were found at rhinion, glabella, subnasale, stomion, labrale superius, pogonion, and gnathion among different BMI groups. Thus, nutritional status should be considered when reconstructing an individual's facial profile. Results showed that the thinnest and thickest craniofacial soft tissues existed in rhinion and lip regions, respectively. Overall, this research provides valuable data for forensic facial reconstruction and identification of young adults in Xinjiang, China.

Daily Thermal Fluctuations Experienced by Pupae via Rhythmic Nursing Behavior Increase Numbers of Mushroom Body Microglomeruli in the Adult Ant Brain.

Social insects control brood development by using different thermoregulatory strategies. Camponotus mus ants expose their brood to daily temperature fluctuations by translocating them inside the nest following a circadian rhythm of thermal preferences. At the middle of the photophase brood is moved to locations at 30.8°C; 8 h later, during the night, the brood is transferred back to locations at 27.5°C. We investigated whether daily thermal fluctuations experienced by developing pupae affect the neuroarchitecture in the adult brain, in particular in sensory input regions of the mushroom bodies (MB calyces). The complexity of synaptic microcircuits was estimated by quantifying MB-calyx volumes together with densities of presynaptic boutons of microglomeruli (MG) in the olfactory lip and visual collar regions. We compared young adult workers that were reared either under controlled daily thermal fluctuations of different amplitudes, or at different constant temperatures. Thermal regimes significantly affected the large (non-dense) olfactory lip region of the adult MB calyx, while changes in the dense lip and the visual collar were less evident. Thermal fluctuations mimicking the amplitudes of natural temperature fluctuations via circadian rhythmic translocation of pupae by nurses (amplitude 3.3°C) lead to higher numbers of MG in the MB calyces compared to those in pupae reared at smaller or larger thermal amplitudes (0.0, 1.5, 9.6°C), or at constant temperatures (25.4, 35.0°C). We conclude that rhythmic control of brood temperature by nursing ants optimizes brain development by increasing MG densities and numbers in specific brain areas. Resulting differences in synaptic microcircuits are expected to affect sensory processing and learning abilities in adult ants, and may also promote interindividual behavioral variability within colonies.

Feeding considerations in infants born with cleft lip and palate

Infants born with the congenital deformity of cleft lip and or palate suffer from varieties of complications since the day 1 of their life. The most important of which is the feeding difficulty which leads to insufficient food intake and thereby causing deleterious effects on their overall development leading to malnutrition and death in some cases. However, research into the anatomical variations of these infants in the region of lip and palate has led to the development of several types of feeders and their modifications which would help them thrive well in the initial days and also for later. Hence, it is worth important to know about them in detail and help these infants and their families psychologically so that the infants do not suffer from feeding difficulties anymore.

下唇粘膜下に発生した滑膜肉腫の1例

下唇粘膜下に発生した滑膜肉腫の1例