Lower Lip Research Articles

Long-term evaluation of Elmelegy’s technique of local muscle transposition for the functional restoration of large upper or lower lip defects

BackgroundAlthough more than 200 techniques have been reported for the reconstruction of the upper and lower lip defects since 1000 BC, none of them is ideal.Local flaps may result in extra skin incisions and in some cases, the surgeon may be confronted with the lack of sufficient tissues for the reconstruction of large defects.Several techniques have been described for near-total lip reconstruction. The two major available techniques are local flap reconstruction (Bernard–von Burrow–Webster technique) and free micro-vascular tissue transfer.In this study, we are going to evaluate the functional results of using local muscles transposition-assisted dermal fat flap and muco-buccal flap in the treatment of large upper or lower lip defects.Materials and methodsThis study was carried out on 128 patients, who presented to us with malignant tumors affecting the lips.ResultsLip defect sizes ranged from 4 to 6 cm in diameter. No flap failure was seen and desirable function and accepted esthetic results were obtained. The flap survival was 100%, and healing was eventful in all cases. No cases of microstomia were reported.ConclusionThe use of local muscle transposition-assisted dermal fat flap and muco-buccal flap technique, showed excellent results in regaining oral competence and lip mobility, and as much as possible, increased the aesthetic outcome.Level of evidenceIV therapeutic study.

Basal cell carcinoma: A report of a case in the upper lip

Basal cell carcinoma (BCC) is a malignant epithelial tumor that develops from the basal cell layer of the epidermis. It is predominantly found in older adults, with a high incidence in people aged 40 to 80. This form of cancer rarely metastasizes but is known to be locally invasive. In this report, we present a case of a 43-year-old male with a swelling on his upper lip. After thorough clinical, histopathological, and imaging assessments, a BCC was confirmed. He underwent full excision of the lesion with the surrounding tissue to ensure clear margins.

Gain of Protection Afforded by the Methoxypropylamino Cyclohexenylidene Ethoxyethylcyanoacetate (MCE) UVA1 Filter on Pigmentary and Aging Signs: An Outdoor 4-Week Randomized, Intra-Individual Comparative Study in 52 Brazilian Women.

Conventional sunscreens shield the skin from ultraviolet (UV) rays up to 370 nm leaving wavelengths between 370 and 400 nm unfiltered despite their potentially harmful biological and clinical effects. The beneficial effects of methoxypropylamino cyclohexenylidene ethoxyethylcyanoacetate (MCE) UVA1 filter were explored at 1% in a SPF50 sunscreen under outdoors summer conditions against pigmentation and aging signs compared against a reference SPF50 without the MCE filter. A prospective randomized comparative intra-individual study was conducted in 52 Brazilian women (phototype I-III). A hemiface application was performed for the SPF50 sunscreen with 1% MCE and SPF50 reference without MCE before 1-h outdoor sunlight exposure, twice daily for 4 weeks. Study endpoint included expert panel grading of pigmentation (3), vascular (1) signs as well as facial skin ageing and assessment of facial skin radiance and skin homogeneity by a naïve panel. Significant differences were reported for all facial signs comparing areas protected with SPF50/MCE and SPF50, respectively: upper lip wrinkles, crow's feet wrinkles, upper lip texture, upper lip pigmentation, vascular abnormalities (all p < 0.0001), texture of the mouth contour (p = 0.001), ptosis of lower face (p = 0.003), lateral facial pigmentation (p = 0.005), and whole face pigmentation (p = 0.01). The evaluations performed by naïve panel showed a significant superiority of the SPF50/MCE product for skin homogeneity (p = 0.043). Overall, this study demonstrates a significant gain of protection with the SPF50 containing 1% MCE in reducing hyperpigmentation, redness and aging signs compared to the same SPF50 sunscreen without MCE, thus supporting the need for an enlarged UVA1 photoprotection.

Insular Infraorbital Neurovascular Pedicle Labial Salivary Gland Transplantation for Severe Dry Eye: Anatomy Study and Case Report.

Severe dry eyes often require surgical intervention. Submandibular salivary and minor salivary gland transplantation are options for refractory dry eyes but have limitations. We innovatively designed an insular infraorbital neurovascular pedicle labial salivary gland transplantation (IINPLSGT) and validated its feasibility and safety through anatomical studies. An anatomical study was conducted on 13 red-colored latex arterial-perfused cadavers (24 sides). Two specimens (4 sides) simulated IINPLSGT. We recorded the branching patterns and courses of the infraorbital artery, infraorbital nerve, and angular artery, as well as the distribution of nerves, vessels, and salivary glands in the upper lip. Infraorbital artery and angular artery were anatomically classified. The feasibility of the IINPLSGT was validated. Otolaryngologists and ophthalmologists performed IINPLSGT, transferring the labial mucosal flap to the lower eyelid conjunctival fornix to treat severe dry eye in 1 patient. Infraorbital artery exhibited 5 potential branches, classified into 5 types based on developmental patterns. Angular artery was classified into 3 types based on the courses. Patient symptoms significantly improved postoperatively, with Schirmer I increasing from 0 mm to 6 mm, noninvasive breakup time from 0 seconds to 6 seconds, and SPEED (Standard Patient Evaluation of Eye Dryness questionnaire) score decreasing from 10.5 to 3 in the OD 1 year after surgery. No severe complications were observed. IINPLSGT is a safe and feasible method for treating severe dry eyes. The procedure is simple, with a high postoperative gland survival rate, stable secretion, and minimal complications.

Formorsaneleotris hualienensis, a new genus and species of inland water sleeper (Teleostei: Eleotridae) from eastern Taiwan

A very unusual sleeper gobioid fish was obtained from netting in the inland waters of the Hualien River basin in eastern Taiwan. This new genus and species of sleeper has only been collected from Taiwan. Formosaneleotris hualianensis n. gen. &amp; n. sp. can be well distinguished from other sleepers by a unique combination of the following characters: (1) fins: no first dorsal fin; second dorsal fin I/8; anal fin I/8; pectoral fin 13–14; (2) squamation: entirely body naked; (3) vertebral count: 10 + 14 = 24; (4) branchiostegal rays 6; (5) head lacking any canal and pore with longitudinal-like infraorbital sensory papillae; and (6) specific coloration: body and head bloody red entirely; one thin deep red infraorbital stripe to upper lip.

Descriptions of two new dark-body snake eels of the genus Ophichthus (Anguilliformes, Ophichthidae) from Taiwan.

Two new species of dark-body snake eels are described based on specimens collected from Taiwan. Ophichthuskbalanensis sp. nov. has a long tail; dorsal-fin origin above posterior third of pectoral fin; tip of lower jaw anterior to anterior-nostril tube; two simple, pointed protrusions along upper lip; preoperculomandibular pores 6 or 7 + 3; teeth on jaws and vomer mostly uniserial, except for biserial on posterior portion of maxilla and anterior portion of symphysis of dentary; vertebral formula 12-55-153 and median fins with narrow dark margins, except the pale fin origins. Ophichthusmultidentis sp. nov. has a dorsal-fin origin well behind gill opening; mainly 4 rows of teeth on jaws; no protrusions along upper lip; a smaller head; mean vertebral formula 24-64-163 and pale median fins. Based on some recent papers and our result, a revised key to species is herein provided.

Modified Hatchet Flap for Reconstruction of Large Full Thickness Defects of the Lower Lip.

Reconstruction of large lower lip defects due to malignancies with good aesthetic result remains challenging. In this study we presented reconstruction of full thickness lower lip defect with modified hatchet flap. The charts of patients with 50% to 95% of the total lower lip defect due to lower lip tumor resection who had reconstruction with modified hatchet flap were reviewed. Seven of the patients had unilateral, two had bilateral modified hatchet flap. After follow-up period, it was concluded that this method provided a wide and functional mouth opening. Six of the patients stated that they were aesthetically satisfied with their appearance, while 3 patients found the result acceptable. None of the patients required additional surgical procedure. Modified hatchet flap is an easy-to-design, easy-to-remember flap with good aesthetic and functional results which makes it a reliable flap in the reconstruction of the large lower lip defects.

Non-invasive procedure implementation for enhanced smile facial muscle movement after orthognathic surgery: a case report.

This study examined the case of 27-year-old female who underwent orthognathic surgery to correct class 3 malocclusion, resulting in an unnatural smile. The research aimed to assess the efficacy of non-invasive treatment in enhancing facial muscle movement during smiling to achieve a natural smile. The patient received eight sessions of treatment using non-invasive devices, and facial assessment were conducted using three-dimensional scanner (Morpheus 3D Scanner) to evaluate facial features in both relaxed and maximum smile states pre- and post-treatment. The results demonstrated improvements in the symmetry of the lower lip height during smiling, along with increases in mouth width and volume in the upper central area. Subjectively, the patient also reported enhanced comfort while smiling. These findings suggest that non-invasive procedures can effectively improve unnatural smiles following orthognathic surgery, contributing to a more aesthetically pleasing smile presentation.

“The streaming eyes of all the many men”: Revisiting male weeping in British commemoration of the First World War

Abstract This article argues that commemoration practices performed in the aftermath of the First World War, on occasion of the British Armistice Day, and during the two minutes’ silence in particular, served as incubators for a change in feeling rules for the British population. It will show how British society engaged with, challenged, and finally shifted what the “emotional regime” of the period – commonly referred to as the “stiff upper lip” – commanded them to feel. A very short lapse of time – two minutes – turned into a moment where a fundamental change in an important subset of feeling rules specifying this emotional regime became manifest: those applied to male weeping. The two minutes encapsulated a challenge to the harsh contempt for expressive mourning through the shedding of tears, a verdict that was inherited from the nineteenth century but increasingly seemed inappropriate, not the least in the wake of the emotional turmoil that Britons had faced during the “Great” War.

Stepwise multi-stage resection technique for surgical extraction of a partially erupted mandibular third molar with inferior alveolar nerve entrapment: a case report

The removal of lower third molars is one of the most common surgical procedures in routine dental practice. However, perforation of the mandibular third molars by the inferior alveolar nerve (IAN) is a rare occurrence. These cases are considered to carry a heightened risk of IAN injury due to the nerve being entrapped within the tooth. This case report details the experience of a 43-year-old female who visited the clinic for surgical removal of her lower third molar. She reported a six-month history of pain in area of tooth number 38, along with persistent hypersensitivity radiating through the lower lip and chin on the left side of her face, accompanied by abnormal sensations and numbness occurring alongside the pain. The case includes entrapment of IAN within the root of the partially erupted tooth, causing neurosensory disturbances. The associated lower third molar was extracted using a stepwise multi-stage resection technique in order to preserve the entrapped nerve. The patient's pain improved after surgery. This report contributes to current clinical knowledge and practices for extracting teeth with IAN entrapment. It addresses a gap in the limited and outdated literature on such cases.

Basaloid Squamous Cell Carcinoma of the Oral Cavity: A Report of Two Cases with Review of Literature

Basaloid Squamous Cell Carcinoma (BSCC) is a rare, aggressive variant of squamous cell carcinoma. It exhibits diverse histological features. The present case reports provide valuable insights by focusing on BSCCs of the tongue and gingiva, including a detailed review of 19 cases in the literature specific to gingival involvement, which is a less common location for BSCC. Case 1 involves a 76- year-old female with a history of BSCC who presented with a painful 4x4 cm recurrent lesion on her upper lip. Case 2 is a 62-yearold male smoker with a history of thyroid carcinoma who exhibited a rapidly growing, painful 2x2 cm lobulated mass on his tongue. In both cases, a thorough clinical evaluation and incisional biopsy were performed to establish a diagnosis. Histopathological examination confirmed BSCC and both lesions were surgically excised with wide margins, taking their age into consideration. Both patients have since remained recurrence-free under regular follow-up, emphasising the efficacy of timely intervention. The present study findings suggest that while radiation exposure may contribute to the development of BSCC of the tongue, it is not the only causative factor. Other factors, such as smoking or genetic predispositions, may also play a role. The aggressive nature of BSCC, particularly in the gingiva, highlights the need for a comprehensive diagnostic approach, including biopsy and histopathological evaluation. Furthermore, the present cases align with evidence suggesting that combining surgery with postoperative chemotherapy or radiation therapy may not significantly improve survival outcomes. Long-term follow-up remains important to monitor for any potential complications.

Analysis of clinical and radiographic outcomes at least 5 years after coronectomy for deeply impacted mandibular third molars

ObjectiveCoronectomy is an alternative to traditional mandibular third molar extraction when the inferior alveolar nerve (IAN) is closely associated with the roots of these molars. Given the paucity of research on the long-term outcomes after coronectomy, we conducted this study to evaluate clinical and radiographic outcomes at least 5 years post-coronectomy. MethodsThis retrospective study enrolled all patients with impacted mandibular third molars treated with coronectomy at our institution who were willing to return for follow-up evaluation 5 years or more after their original procedure. Patient data were obtained retrospectively from hospital records and during oral examinations at the follow-up study appointment. We assessed the following postoperative clinical outcomes: injury to the IAN, root migration distance, root exposure in the oral cavity, non-healing sockets, pain or sensitivity in the coronectomy area, and the presence of periapical pathology. ResultsOf the 196 patients invited to participate, 66 patients (male, 32%; female, 68%) who underwent a total of 75 coronectomies were included in this study. No persistent hypoesthesia of the lower lip were reported during follow-up. Two patients required reoperation because of root eruption into the oral cavity. Approximately two-thirds of residual roots migrated from their position on preoperative radiographs; the mean migration distance was 3.2 ± 1.3 mm. Two patients (2.6%) had pain in the soft tissues around the coronectomy site. ConclusionOur findings confirm that coronectomy is an effective treatment option for preventing IAN injury when the nerve is in close proximity to the roots of these molars.

USE OF ESTLANDER FLAP IN SMALL TO LARGE LIP AND COMMISSURE DEFECTS - A CASE SERIES

Background: The Estlander flap is an axial-pattern, lip-switch technique used to reconstruct lip defects that include the oral commissure. The Estlander flap is a hardy local flap which can be used to reconstruct defects of small to large defects of both the upper and lower lip. The lips are the principal aesthetic and functional unit of the lower 1/3rd of the face. Alterations to normal lip appearance and motion can have a profound impact on patients daily activities and psychosocial wellbeing. Aim of this case series is to evaluate the versatility of Estlander flap in lip reconstruction with regard to function and aesthetic outcome Material and Methods: From May 2022 to May 2024, single centric case series study was done in a tertiary care center in Southern India. This case series comprised of 6 cases of small to moderate defects of the lip and commissure in our institution. Prospective case series from May 2022 - May 2024.The cases were post traumatic, including RTA, dog and human bite and also included post tumor excision Results: This case series had a 100% flap success and all 6 patients were satisfied with the functional and aesthetic outcome of the surgery. One patient underwent commisuroplasty. Conclusions: By the use of this case series, we can conclude that the Estlander flap is a reliable flap for the reconstruction of small to large sized lip and commissure defects Conflict of interest: None.

Combining local flap with depressor anguli oris transfer for lower lip reconstruction and orbicularis oris sphincter function restoration.

Despite the versatility of flap designs for lower lip reconstruction, the notion of orbicularis oris (OO) ring integrity was barely stressed. Traditional flap transfer leads to fibrous orientation inconsistency with the remaining OO. Therefore, the aim of this study is to share the experience of combining local flaps with depressor anguli oris (DAO) transfer for lower lip reconstruction and OO sphincter function restoration. 48 patients were included in this study. Four types of local flaps were transferred for lower lip reconstruction. Each technique was modified by adding an additional DAO transfer for OO reconstruction. Functional outcomes were evaluated by grading scales based on clinical examination and observation. Aesthetic outcomes were evaluated by Patient and Observer Scar Assessment Scale. The surgical outcomes were favorable in both functional and aesthetic aspects. No statistically significant differences were observed among different types of flaps. Patients at T1 stage showed statistically significant mouth opening compared with patients at T2 stage (P = 0.004). Patients whose commissure was preserved showed statistically significantly better competence compared with patients whose commissure was sacrificed (P = 0.006). Combining local flap with DAO transfer is a reliable and effective approach for lower lip reconstruction and OO sphincter function restoration. Moreover, the modiolus seems to play a vital role in enhancing competence. Thus, it should be preserved during oncologic ablation if possible. It is vital to match the orientation of the transferred muscle fiber with the orientation of the remaining OO. Therefore, DAO becomes an excellent candidate.

Lateral forehead flap in oral reconstruction: A case report

Introduction: Lateral Forehead flap is very versatile as it represents a good choice for reparation of different types of nose and oral cavity defects and provides an optimal, aesthetic, and functional outcome. In era of free transfer tissue, the use of loco-regional flaps, alone or in combination may prove to be the only practical solution in the absence of resources or other options. Case presentation: A-65 years old male with multiple comorbidities underwent a wide resection with adequate margin of the lower lip and small segment of the upper lip due to a locally advanced squamous carcinoma. After long consideration, the last resort was the pedicled lateral forehead flap. Information was sourced from patient’s case notes and operating theatre report. Results: The donor defect was covered with a split-thickness skin graft harvested from the right thigh area. The flap survived and both functional and aesthetic outcome were satisfactory. The site of the donor defect result was also acceptable. No complications were noted in our case study beside a small tip necrosis and breakdown of the suture line. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in cases with previous history of radiotherapy or surgery. Decision making of a particular reconstructive option should be done taking in consideration the available resources, surgical team expertise along with the patient's general condition. The pedicled forehead flap still useful when other options are inappropriate or have not been successful.

Management of the Maxillary Labial Frenum

This study examined the maxillary labial frenum (MLF) and its clinical implications, focusing on its anatomy, developmental changes, and management strategies. The MLF functions as a connective tissue linking the upper lip to the alveolar ridge, facilitating essential processes such as speech production, food consumption, and the maintenance of proper dental alignment. Abnormal development or attachment can result in midline diastema, speech difficulties, and breastfeeding challenges. During growth, the MLF typically migrates from the alveolar crest in infancy to the mucogingival junction by adulthood; however, in some cases, this migration fails, leading to persistent diastema or other oral health concerns. The timing of frenectomy remains unclear. Certain experts advocate for early intervention to facilitate orthodontic treatment, while others recommend postponing surgical procedures until orthodontic efforts are completed, as the majority of diastemas close naturally with the eruption of permanent canines. In instances where diastema persists, frenectomy may be necessary to prevent relapse. Restrictive frenum attachments have been linked to breastfeeding difficulties; however, feeding outcomes can also be influenced by factors such as maternal technique and infant feeding patterns. This review highlights the need for individualized assessment and treatment planning, balancing surgical intervention with natural development, to ensure the best outcomes for each patient.

Modified lip repositioning for management excessive gingival display: A case report

Introduction: Excessive Gingival Display (EGD), commonly known as “gummy smile” is a condition in which the maxillary gingiva looks excessive (&gt;2 mm) than normal when someone is smiling. This condition is considered aesthetically disturbing, affecting the patient's self-confidence and psychological state. The objective of this case report is to describe the stages of gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case Report: A 21-year-old male came with the main complaint of wanting to improve his smile which showed less attractive gums. The results of the examination obtained the presence of EGD and hypermobile upper lip so a combined surgical action was planned with gingivectomy and modified lip repositioning for EGD reconstruction and attachment of the labial mucosa of the maxillary anterior region. Case management: The first surgical procedure performed was gingivectomy. One month later, modified lip repositioning was performed. The patient was satisfied with the treatment results and at follow-up after 7 months there was no EGD when the patient smiled. Conclusion: Combined gingivectomy and modified lip repositioning surgery can be an alternative treatment to correct Excessive Gingival Display and provide satisfactory aesthetic results for patients

A case of double aneuploidy of Down and Klinefelter syndrome in an Indian infant: a detailed case report

BackgroundA variation in the number of chromosomes can lead to chromosomal disorders. These chromosomal aberrations might be related to autosomes or sex chromosomes. The most common chromosomal aberrations that are sex-linked and autosomal are Klinefelter syndrome and Down syndrome, respectively. However, the worldwide occurrence of double chromosomal aneuploidy in a single individual is relatively exceptional event and random meiotic nondisjunction events result in double aneuploidy, which causes trisomy of two distinct chromosomes. The clinical manifestations vary depending on whether aneuploidy is dominant or an amalgam of both. Moreover, double aneuploidy including autosome and sex chromosome is not often documented. In this paper, we document a case of Down–Klinefelter double aneuploidy syndrome in an Indian infant hospitalized to the neonatal care unit.Case presentationA full-term 9-month-old male infant born to a 36-year-old female with classical clinical signs of Down syndrome like epicanthus, a depressed nasal bridge, a flat face, small ears, an open mouth, thick lower lip vermilion, a protruding tongue, and a short neck was referred for cytogenetic examination, revealing a rare karyotype of 48, XXY, + 21.ConclusionDown–Klinefelter syndrome is a rare chromosomal anomaly with unique characteristics, often displaying only Down syndrome-like traits at birth. Early diagnosis can be challenging due to the lack of noticeable symptoms until puberty. Early cytogenetic investigation can detect double aneuploidy, improving the affected person's quality of life and educating family members about potential medical and psychosocial difficulties.

Molecular Insights Into Actinic Cheilitis and Lower Lip Squamous Cell Carcinoma: AURKA and AURKB Amplifications and Their Association With Tumor Microenvironment.

Lip exposure to carcinogens lead to several disorders, such as actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC). Although several studies have described important pathways in lip carcinogenesis, the comprehension of association of target genes in this process and their association with tumor microenvironment still need to be better understood. Tissue samples of 30 AC and 17 LLSCC cases were included for histopathological analysis, immunohistochemical expression of CD4, CD8, and PD-L1, and fluorescence insitu hybridization for AURKA, AURKB, TP53, PTEN, CCND1, and MYC. Non-parametrical tests were done and p < 0.05 was considered significant. LLSCC patients presented higher amplifications of AURKA and AURKB, deletion of TP53, and PTEN and rearrangements of MYC than AC. AURKA, AURKB, TP53, PTEN, and CCND1 changes were correlated with PD-L1 expression. AURKA and AURKB amplifications and other gene changes are pointed by their association of lip disorders.

Patient Satisfaction during Upper Lip Augmentation Procedures: V-Y in V-Y Technique Compared to Micro-fat Injection: A Randomized Clinical Trial.

To compare two different techniques for lip augmentation: A surgical technique (V-Y in V-Y) and a filler technique (autogenous micro-fat injections), with a focus on comparing the patients' satisfaction using the Visual analog scale (VAS). This randomized controlled trial was conducted on 40 female patients, aged 18-45, who were outpatients at the Oral and Maxillofacial Surgery Department. The patients were randomly assigned with a 1:1 allocation ratio into two groups. The first group (n = 20) underwent the surgical procedure using the V-Y in the V-Y Technique. The second group (n = 20) received autogenous micro-fat injections using an abdomen fat extraction technique that was subsequently centrifuged. The VAS assessed the patient's satisfaction after 1 and 6 months. There was a statistically significant difference in the evaluation of patient satisfaction with treatment 1-month post-procedure when comparing the surgical procedure group and the fat injection (p < 0.001), favoring the fat injection group. Moreover, there was a statistically significant difference in the evaluation of patient satisfaction with treatment 6 months post-procedure when comparing both groups (p < 0.001), favoring the surgical group. The micro-fat injection technique had higher VAS scores reported by patients in the first month of treatment. In contrast, the surgical technique using the V-Y method was more favorably received by patients in the sixth month of treatment. The V-Y in V-Y technique may yield more favorable long-term outcomes for upper lip augmentation, while micro-fat injection is initially well-received by patients, but satisfaction tends to diminish over time. How to cite this article: Khalil SDS, Harfoush M, Alkour B, et al. Patient Satisfaction during Upper Lip Augmentation Procedures: V-Y in V-Y Technique Compared to Micro-fat Injection: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(8):715-721.