Lower Lip Research Articles

Quantitative evaluation of vertical control in orthodontic camouflage treatment for skeletal class II with hyperdivergent facial type

BackgroundIn this study, we sought to quantify the influence of vertical control assisted by a temporary anchorage device (TAD) on orthodontic treatment efficacy for skeletal class II patients with a hyperdivergent facial type and probe into the critical factors of profile improvement.MethodsA total of 36 adult patients with skeletal class II and a hyperdivergent facial type were included in this retrospective case–control study. To exclude the effect of sagittal anchorage reinforcement, the patients were divided into two groups: a maxillary maximum anchorage (MMA) group (N = 17), in which TADs were only used to help with anterior tooth retraction, and the MMA with vertical control (MMA + VC) group (N = 19), for which TADs were also used to intrude the maxillary molars and incisors. The treatment outcome was evaluated using dental, skeletal, and soft-tissue-related parameters via a cephalometric analysis and cast superimposition.ResultsA significant decrease in ANB (P < 0.05 for both groups), the retraction and uprighting of the maxillary and mandibular incisors, and the retraction of protruded upper and lower lips were observed in both groups. Moreover, a significant intrusion of the maxillary molars was observed via the cephalometric analysis (− 1.56 ± 1.52 mm, P < 0.05) and cast superimposition (− 2.25 ± 1.03 mm, P < 0.05) of the MMA + VC group but not the MMA group, which resulted in a remarkable decrease in the mandibular plane angle (− 1.82 ± 1.38°, P < 0.05). The Z angle (15.25 ± 5.30°, P < 0.05) and Chin thickness (− 0.97 ± 0.45°, P < 0.05) also improved dramatically in the MMA + VC group, indicating a better profile and a relaxed mentalis. Multivariate regression showed that the improvement in the soft tissue was closely related to the counterclockwise rotation of the mandible plane (P < 0.05).ConclusionsTAD-assisted vertical control can achieve intrusion of approximately 2 mm for the upper first molars and induce mandibular counterclockwise rotation of approximately 1.8°. Moreover, it is especially important for patients without sufficient retraction of the upper incisors or a satisfactory chin shape.

Anomalies of Midbrain/Hindbrain Development: Malformations of Cerebellum: Diagnosis, Classification, and Rehabilitative Hypothesis

AbstractExtensive research has been conducted on the cerebellum, making it one of the most thoroughly investigated regions of the brain. It plays a fundamental role not only in motor control but also in motor learning and cognition. The development of the cerebellum is a lengthy process, beginning during the embryonic period up to the first years of life. This slow and protracted process makes it a vulnerable organ liable to different insults, responsible for many developmental disorders such as Dandy–Walker syndrome, medulloblastoma, dystroglicanopathy, pontocerebellar hypoplasia, thubulinopathies, and Jubert syndrome. Due to several factors, the true prevalence of cerebellar malformations is not known in most cases. The cerebellum undergoes development through following four fundamental stages:(1) Identification of the cerebellar region at the boundary between the midbrain and hindbrain.(2) Establishment of two cell proliferation compartments: firstly, Purkinje cells and deep cerebellar nuclei emerge from the ventricular zone of the metencephalic alar plate; secondly, granule cell precursors are generated from a separate proliferation compartment known as the upper rhombic lip.(3) Migration of granule cells toward the interior: granule precursor cells constitute the external granular layer (EGL), and during the initial postnatal year, granule cells migrate inward to their final position in the internal granular layer.(4) Formation of cerebellar circuitry and subsequent differentiation.Based on different types of involvement of the structures detected in the brain magnetic resonance, the classification of brainstem and cerebellar anomalies is divided into three categories: (1) mainly the cerebellum, (2) mainly the brain stem, and (3) both involved. This review will outline the developmental processes of the cerebellum and delve into common developmental disorders associated with it, including the Dandy–Walker syndrome, cerebellar hypoplasia, rhomboencephalosynapsis, lissencephaly, and gray matter heterotopias.

Does artificial intelligence predict orthognathic surgical outcomes better than conventional linear regression methods?

ABSTRACT Objectives To evaluate the performance of an artificial intelligence (AI) model in predicting orthognathic surgical outcomes compared to conventional prediction methods. Materials and Methods Preoperative and posttreatment lateral cephalograms from 705 patients who underwent combined surgical-orthodontic treatment were collected. Predictors included 254 input variables, including preoperative skeletal and soft-tissue characteristics, as well as the extent of orthognathic surgical repositioning. Outcomes were 64 Cartesian coordinate variables of 32 soft-tissue landmarks after surgery. Conventional prediction models were built applying two linear regression methods: multivariate multiple linear regression (MLR) and multivariate partial least squares algorithm (PLS). The AI-based prediction model was based on the TabNet deep neural network. The prediction accuracy was compared, and the influencing factors were analyzed. Results In general, MLR demonstrated the poorest predictive performance. Among 32 soft-tissue landmarks, PLS showed more accurate prediction results in 16 soft-tissue landmarks above the upper lip, whereas AI outperformed in six landmarks located in the lower border of the mandible and neck area. The remaining 10 landmarks presented no significant difference between AI and PLS prediction models. Conclusions AI predictions did not always outperform conventional methods. A combination of both methods may be more effective in predicting orthognathic surgical outcomes.

Oxynoemacheilus kottelati, a new species from the Havran and Karınca streams in Northern Aegean Basin, Türkiye (Teleostei, Nemacheilidae)

The taxonomic status of the Oxynoemacheilus from the Karınca and Havran streams in the north Aegean Basin was evaluated, and it was concluded that these populations contain a new species. The new species, Oxynoemacheilus kottelatisp. nov., is distinguished by a body with a marbled pattern, a deeper caudal peduncle, a shorter caudal peduncle, a wider interorbital distance, and a shorter middle caudal-fin lope. Oxynoemacheilus kottelatisp. nov. is differentiated from the closest species, O. marmaraensis, in possessing 51 nucleotide substitution sites, a genetic distance of 8.40%, the presence of an axillary lobe at the base of the pelvic fin (vs. absent), and a narrower median incision in the upper lip (vs. absent). Three species delimitation tests (ASAP, ABGD, and PTP) and phylogenetic analyses reinforce the validity of O. kottelatisp. nov. as a distinct species.

Myomucosal composite graft: A simple technique for full-thickness vermilion defects of the lower lip.

Reconstruction of vermillion defects of the lower lip requires careful consideration of functional and aesthetic aspects. Traditionally, various local flap methods involving tissue advancement from the corner of the mouth, lateral chin, and medial cheek have been commonly employed to fill lower lip defects. However, these approaches have inherent limitations, which include technical complexity, disruption of the orbicularis oris muscle, lip tightening, microstomia, and visible scarring. To overcome these limitations, we employed a free myomucosal composite graft from the lower lip to reconstruct small to medium vermilion defects. Our technique is based on a simple and reproducible surgical approach that facilitates natural volume rearrangement of tissues. Moreover, this method enables precise inset and tension-free repair, prevents lip tightening, and offers excellent aesthetic outcomes with no vertical scarring and appropriate color matching with surrounding tissues.

Bilateral Subcutaneous Pedicled Nasolabial Island Flap for Total Reconstruction of the Lower Lip.

Squamous cell carcinomas are the most common cancer of the lower lip. In most cases, the tumor is small and occupies less than a third of the lower lip, so the defect created can be closed with a primary suture without altering the esthetics and function of the lower lip. However, there is a percentage of large tumors that affect more than two thirds of the lower lip, in which the primary suture is insufficient to correct the defect created by resection of the tumor. Therefore, these cases require more complex reconstructions using facial locoregional flaps. Hence, in this article, the authors present a total reconstruction of the lower lip with a bilateral subcutaneous pedicled nasolabial island flap after complete resection of a squamous cell carcinoma with involvement of the entire lower lip.

Combined Genioplasty and External Oblique Line Grafting: An Innovative Method to Improve Lower Facial Contour.

Microgenia and the accompanying plump cheeks or hamster-like facial contour are all unattractive appearances among the Asian. Genioplasty with autogenous bone grafting is one of the effective ways to improve microgenia, in which a suitable donor area with less additional damage, lower infection rate, and more excellent effect is crucial. Patients who had undergone genioplasty and autogenous external oblique line grafting (G-EOL) were followed up. The operation-related complications, preoperative, and long-term follow-up 3-dimensional spiral computed tomography (3D-CT) were collected and analyzed. Eight female patients who had received G-EOL and received 1 to 3 years of follow-up were included in this study. There were no short-term or long-term complications. CT data of bone of 8 patients and CT data of soft tissue of 6 patients at the preoperative and long term were compared. Through comparing CT data, the width at the level of the intersection of EOL and mandibular body, and the protrusion of the bony chin had improved significantly; the P values were all <0.001. Through measuring the soft tissue and analyzing the data, the ratio of lower and middle facial width, and the distance from the lower lip to Ricketts' line were all improved, with the P values 0.042 and 0.001, respectively. For patients with microgenia and hamster-like facial contour, the combination of genioplasty and autogenous external oblique line grafting is innovative and effective in improving both the front and side contour of the lower face simultaneously, with excellent stability, bone healing, and low complication rates.

A New Option to Preserve Esthetics in Perioral Defect Reconstruction With Normal Anatomical Structures: Bipedicled Preexpanded Forehead Flap With Random Skin Flap Extension.

Plastic surgeons charged with reconstructing extensive perioral defects face dual challenges of functional restoration and esthetic considerations. While forehead flaps are commonly used to reconstruct perioral defects, in cases involving partial upper lip defects where normal anatomical structures are preserved, traditional forehead flaps may compromise esthetics. This study aimed to address this issue by employing bipedicled preexpanded forehead flaps based on the frontal branches of the superficial temporal artery (hereafter, "STA-bfb-based preexpanded forehead flap") with random flap extensions to repair perioral defects. Between April 2004 and July 2020, 7 patients (5 males and 2 females; 6 had post-burn facial scars involving the entire lower lip and part of the upper lip, and 1 presented with noma sequelae) underwent perioral defect reconstruction using this approach. Tissue expanders were placed in the forehead donor area, and an STA-bfb-based preexpanded forehead flap with random flap extensions was used to repair the perioral defect. The flap pedicle was divided into 3 weeks. All flaps remained viable with no perfusion-related complications. At follow-up 12 to 96 months later, the color and texture of the flaps demonstrated excellent compatibility with the surrounding skin, suggesting that the use of an STA-bfb-based preexpanded forehead flap with random skin flap extensions is a reliable method for repairing perioral defects. The authors' results have implications for plastic surgeons seeking a solution for challenging perioral defect reconstructions, balancing the need for esthetic outcomes with functional restoration.

Repair of an Upper Lip Defect.

Repair of an Upper Lip Defect.

Combination of phototherapy for treatment of labial necrotizing lesion

Lip necrotizing lesions are painful, complex to heal, and negatively impact the patient’s orofacial condition. The present study reports a clinical case of a necrotizing lesion on the lower lip in a 38-year-old male patient, previously healthy, f ive days after receiving the first dose of the SARS-COV-2 vaccine, with an initial diagnosis of labial herpes zoster, with secondary infection and unsatisfactory response to clinical treatment. After debridement of the necrotic tissue, followed by a combination of antimicrobial photodynamic therapy (aPDT), photobiomodulation therapy (PBMT) and hydrofiber dressing with silver, the patient evolved with complete healing of the lip lesion and satisfactory restoration of orofacial functions after 7 days. According to the present case report, this combination of phototherapy modalities suggests to be a promising tool for the treatment of necrotizing labial lesions.

Multiple, Grouped Translucent Papulovesicles on the Lower Lip: Challenge.

Multiple, Grouped Translucent Papulovesicles on the Lower Lip: Challenge.

Multiple, Grouped Translucent Papulovesicles on the Lower Lip: Answer

Multiple, Grouped Translucent Papulovesicles on the Lower Lip: Answer

Congenital Upper Lip Sinus.

Congenital upper lip sinus (CULS) is an extremely rare anomaly. The aim of the study is to present a new case and compile the present knowledge of CULS to help foster a deeper understanding of this disease. A 9-year-old girl with a midline CULS, a prolonged maxillary labial frenulum, and a palatal epulis is presented. Thirty-nine papers met the eligibility criteria and 45 cases were included in the systematic review. CULS shows typical clinical and pathologic characteristics. It tends to occur at the midline region horizontally (n=35; 78%) and the upper part of the white lip (n=23; 51%) vertically. No ethnic predilection is found, but it tends to show a female predilection (n=28; 62%). Twenty-six cases (58%) are symptomatic. Thirteen cases (29%) are accompanied by other maxillofacial defects. In all cases, the sinus was lined with stratified squamous epithelium. The etiology remains unknown but 3 theories have been put forward: the fusion theory, the merging theory, and the invagination theory. The authors believe that CULS shows homogeneity with cleft lip to some extent and maybe a microform of it. Primary treatment is surgical excision and the prognosis is favorable, with no complications or recurrence.

Assessment of the association of myofibroblasts and structural components of the extracellular matrix with histopathological parameters of actinic cheilitis and lower lip squamous cell carcinoma.

To evaluate the presence of myofibroblasts (MFs) in the development of lip carcinogenesis, through the correlation of clinical, histomorphometric and immunohistochemical parameters, in actinic cheilitis (ACs) and lower lip squamous cell carcinomas (LLSCCs). Samples of ACs, LLSCCs, and control group (CG) were prepared by tissue microarray (TMA) for immunohistochemical TGF-β, α-SMA, and Ki-67 and histochemical hematoxylin and eosin, picrosirius red, and verhoeff van gieson reactions. Clinical and microscopic data were associated using the Mann-Whitney, Kruskal-Wallis/Dunn, and Spearman correlation tests (SPSS, p < 0.05). ACs showed higher number of α-SMA+ MFs when compared to CG (p = 0.034), and these cells were associated with the vertical expansion of solar elastosis (SE) itself (p = 0.027). Areas of SE had lower deposits of collagen (p < 0.001), immunostaining for TGF-β (p < 0.001), and higher density of elastic fibers (p < 0.05) when compared to areas without SE. A positive correlation was observed between high-risk epithelial dysplasia (ED) and the proximity of SE to the dysplastic epithelium (p = 0.027). LLSCCs showed a higher number of α-SMA+ MFs about CG (p = 0.034), as well as a reduction in the deposition of total collagen (p = 0.009) in relation to ACs and CG. There was also a negative correlation between the amount of α-SMA+ cells and the accumulation of total collagen (p = 0.041). Collagen and elastic density loss was higher in larger tumors (p = 0.045) with nodal invasion (p = 0.047). Our findings show the possible role of MFs, collagen fibers, and elastosis areas in the lip carcinogenesis process.

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap.

Free flaps and their modifications are used to reconstruct multiple large defects in the lip and face. In this study, we present our results on the reconstruction of these defects using bipaddle and sensate free radial forearm-palmaris longus flaps and subsequent revision surgeries. Patient medical records of 11 patients with a mean age of 63.9 ± 12.8 years were retrospectively reviewed. Functional oral competence, lip cosmetics, lip sensation, and donor forearm scars were evaluated using the drooling rating scale, visual analog scale, Semmes Weinstein Monofilament test, and patient and observer scar assessment scale, respectively. The mean dimensions of distal and proximal skin paddles of bipaddle free radial forearm-palmaris longus flaps were 12.7 ± 9.9 and 20.5 ± 3.8 cm2. Mean lengths of the bridge and proximal pedicles were 4.7 ± 1.6 and 5.5 ± 0.7 cm. All the flaps survived. No drooling was observed in the 2 patients without lower lip defects. The mean drooling scores of the 9 patients with lower lip defects were statistically different (Analysis of Variance, pANOVA < 0.00001) at 3, 6, 9, and 12 months postoperatively. The differences between 3 and 12 months were the most significant (pANOVA < 0.00001, pTUKEY < 0.000001). The lip sensation and drooling scores showed a strong positive correlation (r = 0.8504). All patients were able to speak fluently, drink fluid without leakage, and blow a balloon easily. All patients and observers were satisfied with the lip cosmetics, with no significant difference between satisfaction scores (P = 0.087615).There was a statistically significant difference (P < 0.00001) between mean sensation scores of surrounding healthy lip (2.94 ± 0.27) and free flaps (4.15 ± 0.4). All the donor scars healed uneventfully.

Comments on the cranial and pectoral girdle osteology of Lepidotes gigas (Actinopterygii, Lepisosteiformes) from the Lower Jurassic (lower Toarcian) of Germany

ABSTRACT A transfer-prepared specimen of Lepidotes (Actinopterygii, Lepisosteiformes) from the Posidonia Shale Formation of south Germany is tentatively identified specifically as L. gigas. The genus and its species are insufficiently defined and in need of revision. The new specimen reveals details of the cranial and pectoral girdle skeletal architecture and previously unknown osteological features of Lepidotes, such as a large foramen on the maxilla and the formation of two tooth-bearing clavicle elements (serrated appendages). Maxillary foramina are also known in the related contemporaneous lepisosteiform Mengius and possibly served for passage of nerve branches supplying either a maxillary pit-line or cutaneous sense organs (taste buds) in a thickened upper lip or barbels. The clavicle elements agree morphologically with those of the Recent Amia. Their function remains obscure.

Mucocele in the Posterior Mucogingival Region of Mandibula: a Rare Case Report

Mucocele means a cavity filled with mucus. These lesions, which are the second most common soft tissue growth in the mouth, mostly originate from minor salivary glands. A 30-year-old female patient was admitted to our clinic. On examination, an asymptomatic lesion was detected in the right premolar region of the mandible, which was fluctuant on palpation and similar in color to the surrounding tissues. After surgical removal of the lesion, a diagnosis of mucocele was made after histopathologic examination. Mucoceles are frequently seen in the lower lip, they can rarely be observed in many areas of the intraoral region where the minor salivary glands are located. No case of mucocele in the mandibular premolar region, especially in the mucogingival area, was found in the literature.

APPORT DE LA CHIRURGIE PLASTIQUE DANS LES TUMEURS MALIGNES EVOLUEES DES LEVRES

Lip cancers are among the pathologies that are quite common in the practice of plastic surgeons in our country. These tumors in their advanced form provide aesthetic, functional and life-threatening sequelae, which defines their seriousness and the difficulties of management for both oncological excision and reconstruction. The average consultation time was 18 months. The predominant site was located at the level of the lower lip in 53.4%, the macroscopic appearance of the tumors was ulcero-budding in the majority of cases. The repair process was adapted to the location and extent of the defect. Reconstruction involved direct suture in 4.6% of patients, skin grafts in 4.6% of cases, bone graft in 2.3% of cases, locoregional flaps in 72.1%, and bone grafts in 72.1%. remotely in 16.2% of patients.

Squamous Cell Carcinoma of the Lip: Clinical Presentation and Management Outcome

Background: Squamous cell carcinoma (SCC) is the second most common amongst skin cancers, following the basal cell carcinoma. SCC of the lip carries relatively better prognosis if detected early and treated adequately. Public awareness about the significance of early presentation would help to improve the outcome of management. Objective: The current study was conducted to determine the clinical presentation of lip SCC and management outcome with surgery as the primary treatment modality. Methods: This descriptive study was carried out at the National Institute of Rehabilitation Medicine, Islamabad over a period of seven years. All patients who presented with lip SCCs during the study period were prospectively included in the study. Non-consenting patients were excluded. The lesions were excised with 1-2-cm palpable macroscopic safety margins. Results: Out of 37 patients, there were 28 (75.67%) males and 9 (24.32%) females. The ages ranged between 47-79 years with a mean of 59.91±9.17 years. Lower lip was the most commonly affected site (n=30; 81.08%). The duration of the lesions at first presentation varied from 6-13 months with a mean of 7.32±1.79 months. Majority (n=31; 83.78%), of the patients had early stage (stage I and II disease) whereas 6(16.21%) patients had stage III disease. The margin clearance rate after initial excision of the lesions was 91.89%. Karapandzic flap was employed as reconstructive tool among 15(40.54%) patients. The 5-year overall survival rate was 62.16%. Conclusion: Lip SCCs were found more frequently among males aged over 50 years. Lower lip was the commonest seat of lip SCCs. Surgical excision with recommended safety margins was associated with tumor free margins in 91.89% cases. Karapandzic flap was the most useful reconstructive tool. The 5-year overall survival rate was 62.16%.

Mentalis nerve branches supplying the lower lip revisited: a study of human fetuses and donated elderly cadavers.

Little information is known about the mentalis nerve course from the lower lip approximation margin (free margin) to the upper lip. Likewise, no difference in nerve distribution has been observed between the cutaneous and mucosal parts of the lip. Therefore, this study reexamined mentalis nerve morphology. For macroscopic observations, three fresh cadavers were dissected (one male and two females; aged 78-93). We also evaluated histological sections obtained from five donated elderly cadavers (two males and three females, aged 82-96 years) and 15 human fetuses (11-40 weeks or crown-rump length 80-372mm). Immunohistochemical analysis for S100 protein and tyrosine hydroxylase was performed. In both fetuses and adult cadavers, one to three nerve branches ran upward in the submucosal tissue from the mental foramen. Near the free margin of the lip, some branches passed through the orbicularis oris muscle layer toward the lip skin, whereas others followed a reversed J-shaped course along the free margin. Nerve twigs ran in parallel beneath the mucosa, whereas wavy nerve twigs attached to the basal lamina of the lip epidermis. The difference in nerve endings abruptly occurred at the skin-mucosal junction. Tyrosine hydroxylase-positive sympathetic nerve twigs surrounded arteries and formed a branch composed of S100-negative unmyelinated fibers. The lower lip skin was innervated by a perforating branch passing through the orbicularis oris muscle, that was different from the lip mucosa. A sudden change in the nerve ending configuration at the mucocutaneous junction seemed to develop postnatally.