Lip Symmetry Research Articles

Lip Symmetry After Cleft Lip Repair Fisher in Unilateral Cleft Lip: A Systematic Review

The purpose of this research is to learn the outcomes of lip symmetry after cleft lip repair by Fisher in unilateral cleft lip compared with other techniques. This systematic review searched English full-text available articles in 4 databases: Cochrane, PubMed, ScienceDirect, and Google Scholar, and hand searched through grey literature and reference lists. Subjects were those with unilateral cleft lip without syndromic disorders who had primary cleft lip repair. The authors compared the technique by Fisher with other cleft lip repair techniques. Outcomes were lip symmetry determined quantitatively by lip anthropometric measurement and qualitatively by the Steffensen grading criteria. Four studies were included with a total of 150 cleft lip repairs, comparing the technique by Fisher with techniques by Millard, Mohler, and modified Millard. The 4 studies underwent critical appraisal, data analysis, qualitative synthesis, and meta-analysis. Assessment with Cochrane Risk of Bias 2 for randomized controlled trials and “Risk of Bias in Nonrandomized Studies–of Interventions” for nonrandomized studies displayed an overall high risk of bias in the included studies. “Grading of recommendations, assessment, development, and evaluation” revealed a very low quality of evidence for this review. All 4 studies noted better subjective lip symmetry in the technique by Fisher, but lip and vermilion height were better after the technique by Millard. This review found superior lip symmetry quality but inferior lip symmetry anthropometry after the technique by Fisher compared with the technique by Millard and its modifications, with a low quality of evidence.

Comparative evaluation of postoperative functional and esthetic outcomes for lip reconstruction with Fujimori gate flap versus Abbe-Estlander flap in patients being operated for oral squamous cell carcinoma

Background: Lip carcinomas account for 23.6% to 30% of tumors affecting the oral cavity. Lip reconstruction aims to achieve a competent oral sphincter with a good cosmetic appearance while avoiding microstomia. There are various techniques for lip reconstruction like Fujimori gate flap, Abbe-Estlander Flap, Gillies fan flap, Nasolabial flap, Karapandzic flap, bilateral advancement flap, perialar crescentic advancement flap, Bernard-Burow flap, and free flap. Aims and Objectives: To compare the Fujimori gate flap and Abbe-Estlander flap in terms of functional and esthetic outcomes when used for reconstruction of the lip. Materials and Method: Ten patients diagnosed with oral squamous cell carcinoma requiring resection and reconstruction of lip were included in the study. Functionally, maximal interincisal opening, lip competence, speech intelligibility and esthetically, scar, symmetry of lip during mouth opening, and symmetry of lip at rest were evaluated at the end of 1 week and 1 month. Results: On evaluation of functional and esthetic parameters, the Fujimori gate flap provides superior results in terms of mouth opening, speech intelligibility, and symmetry of lip at rest. However, results were comparable in both groups in terms of lip competence, scar, and symmetry of lip during mouth opening. Conclusion: The results of this study suggest that the Fujimori gate flap provides superior results with respect to function and esthetics when used for the reconstruction of lower lip defects with minimal or less complications.

Cleft lip re-repair: How does it affect the nasolabial appearance?

Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures.20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (±8.13) to 18.77% (±6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (±8.03) vs. 18.27% (±5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners’ professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance.

Comprehensive analysis of alar base inclination and lip line cant following orthognathic correction of maxillomandibular asymmetry: A retrospective study

This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P = 0.016, P˂0.001, respectively) and II (P = 0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59 ± 1.57 and 0.73 ± 0.94, respectively, while those for Group II were 0.46 ± 3.70 and 0.39 ± 2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning.

PaWOX3 and PaWOX3B Regulate Flower Number and the Lip Symmetry of Phalaenopsis.

The standout characteristic of the orchid perianth is the transformation of the upper median petal into a distinctively formed lip, which gives orchid flowers their typically zygomorphic symmetry and makes them the most popular ornamental plants worldwide. To study orchid flower development, two WUSCHEL-related homeobox (WOX) genes, PaWOX3 and PaWOX3B, were identified in Phalaenopsis. PaWOX3 and PaWOX3B mRNAs accumulate abundantly during early reproductive development and perianths of young buds, significantly decreasing in mature flowers and absent in vegetative leaves and roots. PaWOX3 and PaWOX3B virus-induced gene silencing (VIGS) knockdown in Phalaenopsis significantly reduces floral bud numbers, suggesting that PaWOX3/PaWOX3B may be involved in flower initiation. Transgenic Arabidopsis ectopically expressing repressor forms of PaWOX3/PaWOX3B and their Oncidium ortholog, OnPRS, exhibit lateral organ development defects, implicating these genes likely have function in regulating growth and differentiation for lateral organs. Neither PaWOX3, PaWOX3B single nor PaWOX3/PaWOX3B double VIGS Phalaenopsis altered the flower morphology. Interestingly, double silencing of PaWOX3 or PaWOX3B with OAGL6-2, which controlled the identity/formation of lips, altered the symmetry of 'BigLip' produced in OAGL6-2 VIGS. This result indicated that the levels of PaWOX3/PaWOX3B are still sufficient to maintain the symmetry for the OAGL6-2 VIGS 'BigLip'. However, the symmetry of the OAGL6-2 VIGS 'BigLip' cannot be maintained once the expression of PaWOX3 or PaWOX3B is further reduced. Thus, in addition to controlling lip identity, this study further found that OAGL6-2 could cooperate with functionally redundant PaWOX3/PaWOX3B in maintaining the symmetric axis of lip.

Negative Impact of Synkinetic Mentalis Muscle on Smile Quality: Pathomechanism and Treatment with Mentalis-Targeted Selective Neurectomies.

The treatment of postparetic facial synkinesis is based on a combination of nonsurgical and surgical strategies. Improvements toward the restoration of a natural smile have been obtained with selective neurectomies and depressor anguli oris myectomy, but the lower lip frequently remains asymmetric and cranially displaced. The aim of this study was to evaluate the effect of the mentalis muscle on the position and symmetry of the lower lip in patients with synkinesis and to assess the added benefit of neurectomies of nerves innervating the mentalis muscle in improving the lower lip configuration and mandibular teeth show. A retrospective cohort study of all patients with postparetic synkinesis was performed at the authors' institution. A nonmentalis neurectomy group including 12 patients treated with selective neurectomies without targeting the branches to mentalis muscle was compared with a mentalis neurectomy group including 16 patients who underwent additional specific mentalis branches neurectomies. All patients underwent depressor anguli oris myectomy. Analyses of standardized images were performed with ImageJ software. Postoperative comparisons between the 2 groups showed superior and significant improvements in the mentalis neurectomy group across all measures, including lower and upper border deviation ( P = 0.035 and P = 0.004, respectively), inclination of the lower lip ( P = 0.019), and lower quadrant dental show ( P = 0.004). The addition of targeted selective neurectomies to the branches innervating the mentalis muscle significantly improved dental show and caudal position and symmetry of the lower lip during open-mouth smile. Therapeutic, III.

A new digital measurement system for assessing the lip in patients with cleft lip and palate (CLP)

ObjectiveIn order to better and more objectively assess and compare the aesthetics of the lip, we offer an inovative, digital measurement method. Patients and methodPatients were divided into 2 groups:a) patients with unilateral CLP andb) patients with bilateral CLP.Based on standardised photos from 3 different directions, lip symmetry and aesthetics were assessed. A new digital measurement system was used, which was integrated into a proven clinical programme. Different symmetry indices were compared with a non-cleft control group. In addition, the function was investigated and a standardised questionnaire was used. ResultsIn total, 92 patients with operated CLP could be recruitetd and showed significant residual asymmetry compared to the control group with 49 patients. The results were more symmetrical in group b) than in group a). In contrast, scar width and scar aesthetics as well as orofacial function were better in group a). The preoperative cleft width showed a positive correlation with the postoperative scar width and scar aesthetics. Socioeconomic factors were not related to surgical outcome. Satisfaction of affected children and parents correlated with objectively assessed scar aesthetics and function. There was no correlation between satisfaction and symmetry or cleft width or scar width. ConclusionThe presented measurement system can be used excellently and effectively in clinical routine, especially for the inexperienced examiner, for fast and yet detailed, objective recording of findings. The measurement results can be analyzed comparatively and interpreted predictively for diagnostics, planning and therapy.

Lessons Learned from a Single Institution's Eight Years of Experience with Early Cleft Lip Repair.

Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution's ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children's Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.

Evidence-Based Practices in Facial Reanimation Surgery.

After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients' social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.

Evaluation of Lip Symmetry after Unilateral Cheiloplasty by Rotation-Advancement Principle

Evaluation of Lip Symmetry after Unilateral Cheiloplasty by Rotation-Advancement Principle

Novel Reconstruction of Orbicularis Oris in Unilateral Complete Cleft Lip Repair.

Background: Orbicularis oris muscle repair is key to successful unilateral cleft lip repair. Objective: To measure the lip symmetry after repair of the lip muscles in the midline compared with traditional repair on the cleft side. Methods: A retrospective review and photographic analysis of patients with complete cleft lip treated with the modified approach were carried out. Anthropometric analysis was done at pre-, immediate, and 1-year postoperatively, and at 1-year follow-up. Four upper lip and six nostril landmarks were measured. Results: Fourteen patients met inclusion criteria. Immediate postoperatively, the horizontal lip length on the cleft side was shorter than that on the noncleft side, but the discrepancy decreased as facial development progressed over the course of a year. Lip measurements at the 1-year follow-up were approximately symmetrical in vertical lip height, philtral height, and lateral lip height. Small changes in the nasal correction occurred at 1 year. Conclusion: A modified technique in the unilateral complete cleft lip repair seeks to balance the perinasal and perioral muscles and improve symmetric outcomes.

A nonsurgical approach in management of burns induced microstomia: a review

Burns of head and neck region causes skin contracture which will result in microstomia and loss of skin flaccidity. The prevention and management of microstomia contracture is an important aspect of facial burn. The goal of microstomia repair include the reconstruction of orbicularis sphincter for adequate lip functioning, obtaining lip symmetry and well positioned scar and adequate mouth opening. The standard treatment for the prevention and management of contracture includes compression therapy, grafting, mouth splinting, scar massage, excercise, patient education. These types of maxillofacial prosthetic appliances may be indicated, in conjunction with or without surgery these appliances can be use to improve the reduced mouth opening caused by burns or other traumatic injuries With proper education and motivation of operator and the patient use of these appliances will not only improve the reduced mouth opening but also improve form, function, esthetics, and also enhance the patient’s quality of life.

Experience of Unilateral Cleft Lip Repair using the Anatomical Subunit Technique in an Omani Population over a Five-Year Period.

ObjectivesThis study aimed to report the authors’ experience with the anatomical subunit technique for unilateral cleft lip repair, which has gained popularity worldwide.MethodsFrom July 2015 to April 2020, 114 consecutive cases of cleft lip underwent primary cleft lip repair with closed rhinoplasty by a single surgeon. The demographic data, severity and type of the cleft lip, surgical outcomes, including vermillion notching, were assessed by an independent senior surgeon. The rate of revision surgery was collected from the Al-Shifa® - 3Plus healthcare information system (Ministry of Health, Oman). Parents’ satisfaction regarding scar quality and lip and nose appearance was collected and all data were statistically analysed.ResultsA total of 82 cases satisfied the inclusion criteria. The mean age at surgery for cleft lip was 32 weeks. Among these, 35 cases (43%) were complete cleft lips and 47 cases (57%) were incomplete. Additionally, 43 children (52%) were born of consanguineous marriage. Six patients (7%) needed revision surgery. The digital survey was completed by 40 subjects (response rate: 48.8%) which showed 85% satisfaction rate with the postoperative scar and 77.5% satisfaction with the aesthetic appearance of the nose.ConclusionThe anatomical subunit technique resulted in a predictable outcome indicating a high rate of patient satisfaction with scar quality and nasal and lip symmetry in children with varying severity of cleft lip. The high percentage of consanguinity (52%) in this study highlights the need for more targeted national campaigns involving premarital counselling in the Omani population.

A fascia bow traction method for the treatment of unilateral marginal mandibular nerve paralysis after mandibulectomy for head and neck cancer

BackgroundUnilateral paralysis of the marginal mandibular nerve (UPMMN) after head and neck cancer surgery is a relatively common condition that causes deformity and an asymmetric appearance of the lower lip and impairs the quality of life of patients. We developed a novel fascia grafting method to improve the appearance of the lower lip in patients with UPMMN. MethodsTwo fascia strips and a small fascia loop connecting the two strips are used: one is fixed horizontally to pull the lower lip toward the paralyzed side, and the other is fixed in a bow shape at rest to avoid approaching the lateral mandibular margin. When patients smile or open their mouths, the bow-shaped graft straightens, pulling the paralyzed lower lip laterally downward through the small connecting loop. We used this method to treat four patients with UPMMN who had undergone head and neck cancer ablation. The symmetry and movement of the lower lip were assessed using preoperative and postoperative photographs of three poses (at rest, smiling, and opening the mouth). ResultsThe fascia grafting procedure restored the symmetry of the lower lip at rest and greatly improved symmetrical lower lip movement when smiling and opening the mouth. According to photographic evaluation scores, all patients had poor lower lip symmetry in the three poses before the procedure, whereas after the procedure, three had excellent lower lip symmetry, and one had good lower lip symmetry. There was a significant difference between the scores before and after the surgery. ConclusionsFascia grafting is easy and minimally invasive, allows patients to generate an almost symmetrical smile, and consequently improves their QOL. This method may be particularly useful when the lateral mandibular bone is resected during cancer surgery, and the defect is reconstructed with metal plates/soft tissue, as the method does not require approaching the lateral mandibular region.

Curved-line cleft lip repair in unilateral complete cleft lip patients: Comparative analysis of lip dimensions after cheiloplasty

This study aimed to restore upper lip symmetry and minimize tissue sacrifice using a curved line design and wire technique and analyze the postoperative outcomes. In this retrospective study, medical records of patients with complete unilateral cleft lip who underwent unilateral cheiloplasty between August 2017 and February 2019 were reviewed. The postoperative clinical photos were analyzed to determine vertical, diagonal philtral heights and the horizontal lengths of the upper lip. The average of the cleft side to non-cleft side length ratios were compared between the curved line group and conventional group. At 3, 6, and 12 months, the average vertical length ratios were significantly greater in the curved line group than in the conventional group (0.927–0.823, p = 0.007; 0.940 to 0.885, p = 0.037; and 0.947 to 0.883, p = 0.040, respectively), but the average horizontal length ratios were not significantly different between the two groups. Within the limitations of the study it seems that curved line cheiloplasty aids in preventing short lip deformity development at regular term without significantly sacrificing the horizontal length and, therefore, should be adopted whenever appropriate.

Lip symmetry following rotation advancement cleft lip repair in 5-year-old children treated by Ralph Millard and Ron Pigott

ObjectiveTo compare the symmetry of the lip following Rotation-Advancement cleft lip repair by Millard and Pigott and to investigate the effect on the symmetry of cleft side and gender by using different surgical protocols. Symmetry following cleft surgery was compared to that of non-cleft children. DesignRetrospective study of photographs of children aged 5 years. SettingThree decades of post-operative photographs of children treated by Millard and Pigott. PatientsEighty-nine children treated by Millard, 87 by Pigott and 91 non-cleft children. InterventionsPhotographs were assessed using the Symnose Computer program, a rapid semi-objective quantitative assessment of lip symmetry. Main Outcome Measure(s)Asymmetry score for each surgeon, and non-cleft children. ResultsThere was no significant difference in the median lip % mismatch score of Millard, 36.65% and Pigott, 38.52%. Right-sided clefts showed better symmetry than left-sided clefts for Millard (p<.001). This was reversed for Pigott (P=.0121). There was a difference (P<.001) between the symmetry of the two cleft cohorts and the non-cleft children (asymmetry 19.9%), and between Millard's outcomes following different lip surgical protocols (P < .0001), but no difference between Pigott's outcomes using different palate surgical protocols (P = 0.59). ConclusionsCleft lip repair by Millard and Pigott resulted in similar lip asymmetry (37% and 39% symmetry mismatch, respectively). Lip surgical protocol and cleft side may affect lip asymmetry. Palate surgery did not affect lip asymmetry. Following cleft surgery, children were more asymmetric than non-cleft children.

Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia.

Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of facial paralysis in patients with craniofacial microsomia and outcomes after free functioning muscle transfer for dynamic smile reconstruction. A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software. This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent) affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent smile reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in lip symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes. The authors' institution's incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction. Therapeutic, IV.

Improved lip esthetics in patients with skeletal Class III malocclusion and facial asymmetry after isolated mandibular orthognathic surgery

Asymmetry of the lips severely affects facial esthetics and is often one of the chief complaints of orthognathic patients, especially those with Class III malocclusion. The objectives of this study were to investigate the changes in lip symmetry in patients with mandibular prognathism and deviation and the relationships between jaw hard tissue and lip soft-tissue changes. Three-dimensional facial scan and cone-beam computed tomography scan data of 30 orthodontic-orthognathic patients treated with bilateral sagittal split ramus osteotomy were combined to conduct the research. Paired-sample t test and Pearson correlation coefficient were applied to compare the differences in the same variable before and after the orthognathic surgery and the potential correlations between the changes in hard and soft variables. To explore the important hard tissue variables influencing the lip soft-tissue changes, linear regression analysis was performed. Although there was significant upper lip asymmetry presurgery, the upper lip asymmetry was corrected postsurgery. Surgical correction of the mandibular deviation was also accompanied by lengthening of the bilateral philtrum crests. Improvement in lip asymmetry and lengthening of the philtrum crests were primarily related to the transverse correction of the mandible rather than sagittal changes. The corresponding prediction formulas were established. The isolated mandibular bilateral sagittal split ramus osteotomy surgery can substantially improve the upper and lower lip asymmetry in patients with mandibular prognathism and deviation, but one should be wary of the unesthetic effects associated with lengthening of the philtrum crests.

Labial-Nasal Evaluation for Nasal Floor Reconstruction With the New Triangular Flap in Unilateral Cleft Lip Repair.

In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. ( P &lt; .05). In addition, statistical significance was detected in the 1-year postoperative columellar angle, alar width ratio, nostril width ratio, nostril height ratio, and nostril shape (cleft) ( P &lt; .05), showing more successful repair of the nose compared with the traditional repair. The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry.

Incorporating local muscle and tendon for facial reanimation

Local muscle and tendon can be readily incorporated for facial reanimation procedures specifically related to the midface and periorbital area. Our objective is to describe temporalis muscle and tendon procedures that increase smile excursion including indications, modifications of these procedures, perioperative care, and reported outcomes. Temporalis tendon and muscle procedures capitalize on the redundancy of the muscles of mastication to repurpose for facial reanimation. Temporalis tendon transfer is indicated for patients who benefit from immediate results with a low risk, low morbidity procedure that can improve lip symmetry at rest and with smiling. The technique has evolved to be more minimally invasive with 1 or 2 incisions in an outpatient surgery that provides the same or more benefit from the originally described technique. Provider and patient reported questionnaires as well as computer-based algorithms have been reported to assess subjective and objective outcomes for this procedure. Local muscle and tendon can be readily incorporated for facial reanimation procedures specifically related to the midface and periorbital area. Our objective is to describe temporalis muscle and tendon procedures that increase smile excursion including indications, modifications of these procedures, perioperative care, and reported outcomes. Temporalis tendon and muscle procedures capitalize on the redundancy of the muscles of mastication to repurpose for facial reanimation. Temporalis tendon transfer is indicated for patients who benefit from immediate results with a low risk, low morbidity procedure that can improve lip symmetry at rest and with smiling. The technique has evolved to be more minimally invasive with 1 or 2 incisions in an outpatient surgery that provides the same or more benefit from the originally described technique. Provider and patient reported questionnaires as well as computer-based algorithms have been reported to assess subjective and objective outcomes for this procedure.