Lip Sensation Research Articles

Functional role of lingual nerve in breastfeeding

Functional role of lingual nerve in breastfeeding was investigated in rat pups during the suckling period. DiI, a postmortem neuronal tracer, was used to confirm the immature lingual nerve (LN) responsible for tongue sensation and resulted in successful fiber labeling anterogradely to the tongue, which showed different distribution patterns from fiber labeling derived from the hypoglossal nerve. Unilaterally LN-injured pups did not show suckling disturbance with absence of any shortening (P11 pups: 559±16s; 105% of the control value) in nipple attachment time and the survival rate remained high (P11: 100%). Bilaterally LN-injured pups showed suckling disturbance with marked shortening (P11 pups: 220±54s; 42% of the control value) in nipple attachment time and a low survival rate (P1: 33%; P11: 41%). Bilaterally infraorbital nerve-injured or bilaterally bulbectomized pups did not show any nipple attachment at all and there were no survivors, confirming the crucial roles of upper lip sensation and olfaction in suckling. Based on these findings, we conclude that tongue sensation is very important, but not essential for suckling.

Patients’ responses to distraction osteogenesis: a multi-centre study

This investigation aimed to compare and contrast practical difficulties experienced by 54 children from three different centres (Mexico City, New York, Paris) treated with either extra-oral or intra-oral distraction devices. The possible effect of distraction osteogenesis on pain/sleeping difficulty, speech and eating problems and disturbance of recreational activities and alteration in sensation were investigated. It was expected that intra-oral devices would reduce the difficulties associated with the distraction process and their psychological effect on the child. Some benefits resulting from the use of intra-oral devices were identified, these included fewer sleeping problems ( P = 0.006) and less disturbance of recreational activities ( P = 0.002). However, eating and maintaining oral hygiene were more problematic with intra-oral devices the differences between the intra-oral and extra-oral groups was approaching significance at P = 0.07. A major disadvantage of the extra oral device was scarring. In both groups the alteration of lip sensation was temporary, pain was limited to the time of activation of the distraction device. A high level of patients’ cooperation was mandatory for successful completion of the treatment.

Functional lower lip reconstruction with bilateral cheek advancement flaps: revisitation of Webster method with a minor modification in the technique.

Major defects of the lower lip have been repaired in many ways. Of these, some employed flaps from the chin, cheek or upper lip. Some of these procedures employed flaps without regard for the facial grooves or landmarks. Some methods required incisions through nerves supplying the orbicularis oris and the flaps used for the lower lip reconstruction. Of the many methods of reconstruction that have been reported, we believe that the Webster technique should be considered as the first choice for lower lip defects larger than 80% of the total. Because this technique interferes minimally with the sensation of the lower lip and a satisfactory cosmetic outcome with a functional lower lip is achieved, the sensation and muscle function of the upper lip are unaffected. In addition to discussing the advantages of the Webster method, in this paper we present a minor modification in the dissection of the orbicularis oris muscle in an attempt to improve the motor innervation and to provide adequate oral competence and labial functioning in expression and speaking. Motor function and innervation of the lips after reconstruction was documented by clinical findings as well as electrophysiological methods.

Interventions for replacing missing teeth: preprosthetic surgery versus dental implants.

Preprosthetic surgery refers to the surgical procedures that can modify the oral anatomy to facilitate the retention of conventional dentures. Osseointegrated implants offer an alternative treatment to improve denture retention. A denture may be connected by special attachments to implants placed into the jaw. To test the null hypothesis of no difference in the success (patient satisfaction and morbidity) and cost effectiveness between conventional prostheses that require preprosthetic surgery (PPS) and implant retained prostheses (IRO) that do not require preprosthetic surgery, against the alternative hypothesis of a difference. The Cochrane Oral Health Group (OHG) Specialised Register (May 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE and EMBASE (May 2002) were searched. In addition, 55 implant companies were contacted and the bibliographies of review articles were checked for studies outside the hand searched journals and personal references were searched. Randomised controlled trials comparing preprosthetic surgery and implant retained dentures for improving denture retention. Data were independently extracted, in duplicate, by two reviewers (HW, PC). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out (ME, PC). The Cochrane OHG's statistical guidelines were followed. One study, containing 60 participants, reported in four articles was identified for inclusion in this review. No studies were excluded. There was a statistically significant difference between mean patient satisfaction scores with patients in the IRO group being more satisfied in general at both year one (WMD = -0.66(95% CI; -1.28 to -0.04)) and five years (WMD = -0.90(95%CI; -1.74 to -0.06). Altered sensation of the lower lip and chin was measured at one year and five years. There was no statistically significant difference at either time point and no patients had altered sensation at five years. There is weak evidence from the results of one randomised controlled trial including 60 subjects that patients are generally less satisfied with preprosthetic surgery and a conventional denture than with an implant retained denture. There is a need for more well designed trials comparing the success and cost-effectiveness of preprosthetic surgery and implant supported dentures. Such trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/). However, since preprosthetic surgery is considered to be an obsolete treatment nowadays, almost completely replaced by dental implants, it may be that new RCTs on this topic will not be designed.

Clinical function after primary surgery for oral and oropharyngealcancer: an 11-item examination

The aim of this study was to record clinical function using an 11-item clinical examination and identify the main postoperative functional deficits.Of 132 consecutive patients undergoing surgery for previously untreated disease between January 1995 and June 1997, 130 were recruited in the study. An 11-domain clinical examination was made on the day before operation, and at 6 and 12 months afterwards. This examination assessed lip competence, tongue movement, oral mucosa, dental state, mouth opening, speech, drooling, diet, appearance, oral sensation and shoulder movement.Preoperatively there were deficits in natural dentition, consistency of diet and tongue protrusion. Postoperatively functional scores fell particularly for tongue movements, mouth opening, mucosa, dentition, speech, diet, appearance, lip sensation and tongue sensation. At 1 year, dental status, sensation and oral mucosa were particularly defective. Patients with large tumours, free tissue transfer, or adjuvant radiotherapy had the worst levels of function.A simple clinical examination provides a rapid assessment of function that can be used in conjunction with validated questionnaires to provide a more comprehensive evaluation of outcome.

Dental evaluation of scuba diving mouthpieces using a subject assessment index and radiological analysis of jaw position

Objective—To compare two experimental scuba mouthpieces with a commercially available design. Methods—A laboratory study using six men to assess effort, muscle pain, muscle fatigue, facial discomfort, tooth discomfort, and loss...

Patients' perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients

In a randomized controlled clinical trial 110 edentulous patients with severe mandibular bone loss have been treated with ITI-dental implants using three different treatment strategies: (1) a mandibular overdenture supported by two implants with ball attachments, (2) two implants with an interconnecting bar or (3) by four interconnected implants. As implant surgery involves elevation of the mucoperiosteum, bone remodelling at the implant site and insertion of implants close to the mental foramen, altered sensations of the mental nerve caused by the surgery are to be expected. An altered sensation of the lower lip can also be caused by pressure of an ill-fitting lower denture on the mental foramen, or in the case of severe bone loss of the alveolar ridge, on the alveolar nerve itself. This article presents the results of the patients' perception of the sensation of their lower lip before, 10 days after and 16 months after implant surgery in the mandible. It shows that 25% of the patients describe a sensory disturbance before treatment. This 25% also showed high scores on the Hopkins Symptoms Check List indicating a tendency to somatize complaints. Eleven percent of the patients report a sensory disturbance in the lower lip 10 days after surgery. Ten percent report a sensory disturbance 16 months after surgery of which one third also reported a disturbance before the treatment. This implies the risk of a sensory disturbance of the lower lip to be a possible complication after implant surgery. Therefore patients must be informed about this phenomenon before treatment.

The Role of Distraction Osteogenesis in the Reconstruction of the Mandible in Unilateral Craniofacial Microsomia

Laboratory and clinical studies have shown that mandibular distraction is an effective and powerful reconstructive surgical technique. It is safely performed without the need for blood transfusion or bone graft. Because of concomitant expansion of the functional matrix (the associated skin, subcutaneous fat, and muscles of mastication), there is a multidimensional expansion of the lower jaw with minimal, if any, evidence of relapse. Moreover, the surgical reconstruction can be commenced by 2 years of age, and the vector of distraction can be controlled by preoperative design. Finally, the increase in resulting mandibular bone stock will provide more reconstructive options in the future for traditional orthognathic surgical techniques. The technique has been criticized, either for the cutaneous incision for the approach to the mandible or for the scar resulting from the path of the distracting screws. However, with careful placement of the device, the resulting scar can be placed in the lines of minimal tension with a resulting satisfactory scar. It has been assumed that the osteotomy results in interruption of the inferior alveolar nerve. However, questioning of the older patients has failed to detect any change in sensation of the lower lip. The status of the inferior alveolar nerve in the hypoplastic mandible has also never been studied. Insertion of the screws required an area of bone stock that is edentulous, and this finding can make application of the device difficult in some patients. The length of treatment has been criticized--approximately 3 months. However, this is offset by the ease of treatment, the degree of safety, and the reduction in hospital time without the need for blood transfusion or bone graft. The results to date indicate that the technique can be applied to the correction of the milder mandibular deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Inferior Alveolar Nerve Reconstruction with a Polyglycolic Acid Bioabsorbable Nerve Conduit

A custom-designed polyglycolic acid (PGA) bioabsorbable nerve conduit was used to reconstruct a 25-mm defect in the right inferior alveolar nerve. The initial nerve injury, following a dental extraction, resulted in loss of lower lip sensation and severe facial pain. Sixteen months after tooth extraction, with no improvement in symptomatology, the alveolar canal was enlarged in diameter by means of mandibular osteotomy to accommodate a 2-mm-diameter polyglycolic acid tube. The proximal end of the inferior alveolar nerve was sutured into the polyglycolic acid tube. The mental nerve was sutured into the distal end of the tube. Pain of neural origin was relieved in the early postoperative period. Two years following nerve reconstruction, pain relief remains excellent and perception of pressure and vibration is similar to the thresholds for these perceptions on the contralateral lip.

Recovery of neurosensory function following orthognathic surgery

The purpose of this study was to prospectively define the recovery of touch discrimination following four commonly performed surgical procedures in 22 consecutive patients with no previous maxillofacial surgery. The surgical groups studied were Le Fort I osteotomy (LEFORT; n = 13), sagittal split ramus osteotomy (SSRO; n = 6), intraoral vertical ramus osteotomy (IVRO; n = 9), and isolated genioplasty (GENIO; n = 5). Neurosensory function was assessed by three different testing modalities which included static light touch (SLT), moving touch discrimination (MTD), and two-point discrimination (TPD). Cutaneous sensation of the lower lip and chin were examined for the mandibular procedures, whereas the infraorbital and upper lip regions were evaluated following maxillary surgery. Immediately following surgery, each group varied in both the incidence and magnitude of neurosensory deficits (NSD). The SSRO group had the highest percentage of sites with immediate postsurgical NSD to both SLT (72%) and MTD (67%), followed by the LEFORT (SLT = 50%, MDT = 58%), GENIO (SLT = 27%, MTD = 6%), and IVRO groups (SLT = 11%, MTD = 18%), respectively. Each group also varied in the severity of the initial postoperative deficit as measured by SLT, with the SSRO group showing the greatest deficit followed by the LEFORT, GENIO, and IVRO groups. During the 6-month recovery period each group approached preoperative levels of sensation at a different rate. The LEFORT group recovered most rapidly, with few anatomic sites showing NSD (SLT = 20%, MTD = 5%) at the 1-month postoperative examination, and the majority of the group (96%) returned to preoperative sensation by 3 months following surgery. The SSRO group recovered more slowly, with approximately half of the group demonstrating a deficit (SLT = 50%, MTD = 59%) at 1 month, which diminished to about one fourth of the sites (SLT = 25%, MTD = 5%) by 3 months. Most of the SSRO group (90%) exhibited no residual deficit 6 months following surgery. The IVRO group had few sites with immediate NSD (SLT = 11%, MTD = 15%). In none of the surgical groups was a statistically significant correlation found between the severity of the initial NSD and length of time to complete recovery.

Cross mental nerve graft for restoration of lip sensation after inferior alveolar nerve damage

Cross mental nerve graft for restoration of lip sensation after inferior alveolar nerve damage

Complications of genioplasty done alone or in combination with sagittal split-ramus osteotomy

Thirty-one patients who had genioplasty done alone or in combination with bilateral sagittal split-ramus osteotomy of the mandible (BSSRO) were examined within 12 to 68 months after surgery. Neurosensory tests revealed that 10% of the mental nerves in patients who had had isolated genioplasties showed altered sensation of the lower lip, compared to 28.5% of the nerves in patients who had genioplasties and bilateral sagittal split-ramus osteotomies. However, when questioned, 71% of the patients in the latter group indicated awareness of abnormal feeling in the lower lip. Fourteen teeth in isolated genioplasty cases gave an abnormal response to electric pulp testing. The incision lines healed satisfactorily in most patients. Of the intraosseous wires used for fixation, 5.38% were removed 3 to 10 months after surgery. A notch at the osteotomy site on the lower border of the mandible was noted radiographically in 72.5% of the sites. Chin ptosis was noted in one patient. The cosmetic results satisfied 93.6% of the patients.

Nerve sharing by an interpositional sural nerve graft between the great auricular and inferior alveolar nerve to restore lower lip sensation

A case of bilateral nerve sharing via an autogenous sural nerve graft interposed between the ipsilateral great auricular nerve and the inferior alveolar nerve was used to restore sensation to the lower lip. To our knowledge this is the first report of successful nerve sharing between a sensory branch of the cervical plexus and the inferior alveolar nerve.

Cross mental nerve graft for restoration of lip sensation after inferior alveolar nerve damage: Report of case

Cross mental nerve graft for restoration of lip sensation after inferior alveolar nerve damage: Report of case

Mandibular metastasis from a primary adenocarcinoma of the fallopian tube

A case of a metastatic lesion to the mandible from a Fallopian tube carcinoma is reported. The presenting symptoms were altered lip sensation and an intraoral mass. A previous history of pelvic infection was reported, but later a diagnosis of adenocarcinoma of the left Fallopian tube was made. Metastatic spread also involved other bones and the liver. No previous case of a metastatic lesion to the oral cavity from the Fallopian tubes has been reported.

Lip function: a study of normal lip parameters

This paper presents a study of normal lip parameters in 500 individuals representing both sexes and all age groups. The parameters studied were intercommissural distance at rest and during activity, soft-tissue gape, oral access, elasticity of perioral tissues, and upper and lower sulcus depths as an indication of lip curtain height. The strength of the orbicularis oris was measured using the pommeter (Peri-Oral-Muscle-Meter). Lip sensation was studied by testing two-point discrimination in all four lip quadrants. Statistical analysis revealed results to be significant to a p value of 0.01.

Ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and bone grafting

The results of five cases of ameloblastoma of the mandible treated by resection, preservation of the inferior alveolar nerve, and immediate bone grafting are reported. The incisions in all cases healed by first intention. Lip sensation on the operated side returned to normal in four to six weeks in four cases and slight numbness persisted to the eighth week in one case. All patients were followed postoperatively for 13–15 years. In one case the tumor recurred in the mucous membrane seven years after surgery at the original intraoral site and invaded the underlying bone graft. The indications and contraindications for surgery and details of the procedures, including measures to prevent recurrence, are presented.