Lower Orbicularis Research Articles

Correction of whistle deformity in bilateral cleft lip with lower lip bipedicle orbicularis oris musculomucosal island flap

To explore a new method to correct the whistle deformity in bilateral cleft lip. A lower lip bipedicle orbicularis oris musculomucosal island flap was designed to repair the upper vermilion defect.The pedicle of this flap was deepidermidalized and then embedded into the upper lip. The dry lip in the central was reserved to reconstruct the vermilion tubercle. From Aug.2013 to Aug.2015,10 cases were treated successfully with primary healing. With the follow-up period of 5-17 months, the appearance of upper lip was greatly improved with a balanced proportion and full lip tubercle. This lower lip bipedicle orbicularis oris musculomucosal island flap is an ideal method for the correction of whistle deformity in bilateral cleft lip.

Anatomical studying of the tear trough area

To explore the mechanism of the aging deformity of tear trough through the anatomic study of the tear trough region. 13 adult cadaveric heads (26 sides), including 9 male heads (18 sides) and 4 female heads (8 sides), aged 22-78 years old, were used. Anatomic study was performed around the orbital, especially tear trough region, with microsurgery instrument under microscope( x 10 times). The lower orbicularis retaining ligament was dissected and exposed. The anatomic location was recorded and photographed. (1) The anatomic layers of the tear trough region contains skin, subcutaneous tissue, orbicularis oculi muscle, periosteal membrane. There is no subcutaneous fat above the tear trough, while it exists below the tear trough, called malar fat pad. (2) There is a natural boundary between the septal and the orbital portions of the orbicularis oculi muscle of lower eyelid at surface of the orbital bone. The natural boundary, projected on the body surface corresponds to tear trough. The width of boundary is (2.06 +/- 0.15) mm on the vertical line through inner canthus and (3.25 +/- 0.12) mm on the vertical line through the lateral margin of the ala. The septal portion and the orbital portion of the orbicularis oculi muscle began to merge in (16.56 +/- 0.51) mm to inner canthus. (3) There is ligament attachment in the medial, upper and lower orbital and no ligament attachment in the lateral orbital. Orbicularis retaining ligament of lower eyelid is divided into two layers. (4) The medial of the upper layer of the orbicularis retaining ligament in lower eyelid originates from orbital margin and from preorbital walls laterally in (16.10 +/- 0.43) mm to the medial of lateral orbital margin, through orbicularis oculi muscle and ends at the skin. The lower layer of the orbicularis retaining ligament of lower eyelid originates from preorbital walls through orbicularis oculi muscle and its superficial fat, then ends at the skin. The length of tear trough is (16.56 +/- 0.51) mm, the width of tear trough is (2.06 +/- 0.15) mm and (3.25 +/- 0.12) mm on the vertical line through inner canthus and the lateral margin of the ala nasi respectively. The main reason of the aging deformity of tear trough attributes to the increased distance between the upper and lower layers of the orbicularis retaining ligament in lower eyelid, which is caused by loose of the orbicularis retaining ligament and its underlying fat atrophy or decline.

Orbicular oris muscle flap wrapped by acellular dermis for the treatment of upper lip atrophy in children

To investigate the treatment of upper lip atrophy resulted by previous therapy. From Mar. 2008 to Mar. 2012, 4 cases with upper lip atrophy resulted by radiotherapy and sclerosing agent injection were treated with lower orbicularis oris muscle flap wrapped by acellular dermis. The thickness and height of upper lip were increased to improve the lip atrophy. Primary wound healing was achieved in all the 4 cases. All the patients were followed up for 3 years with obvious improvement and inconspicuous scar. The volume of lower lip in children is not sufficient as donor site. The lower orbicularis oris muscle flap wrapped by acellular dermis can effectively improve the lip thickness and vermilion portion of upper lip.

Application of levator aponeurosis in double eyelids operation

Objective To improve an obvious postoperative man-made crease when eyes closed and to achieve the optimal cosmetic and functional results.Methods Exposing and scissoring the levator aponeurosis were performed to make it move freely.Fairly infra-incision and lower margin orbicularis oculi muscle were cut.The double eyelids were formed by fixing the palpebral dermis of the lower skin flap onto the levator aponeurosis.Results The follow-up of 580 patients (1160 eyes) showed that double eyelid crease were natural and fluent,eyelashes raised slightly,there was no an obvious postoperative man-made crease when eyes closed,and there was no sausage-appearing. Conclusions The method is quick,with minor injury and fast restoration. There is no sausage appearance and an obvious man-made crease when eyes are closed,and so double eyelids are natural and nice,the postoperative results are all aesthetically and functionally pleased. Key words: Levator aponeurosis; Double eyelids surgery

The technique of periorbital defects reconstruction with island orbicularis oculi myocutaneous flap in orbital zone

To investigate the technique of periorbital defects reconstruction with island orbicularis oculi myocutaneous flap in orbital zone. The upper or lower eyelid island orbicularis oculi myocutaneous flap,medially based,were used for the defects of the periorbital area, according to the position,shape and size of the defects. The donor site was closed directly. From July 2003 to October 2009, 24 patients were treated in this method, the flaps survived totally. The flap proved to be flexible, safe, relatively simple, and provided good functional and aesthetic results with follow up 6 to 24 months. Complications were minimal. The upper eyelid or lower eyelid island orbicularis oculi myocutaneous flap, medially based, is a satisfied method in repairing periorbital defects in one stage with good blood supply, excellent color texture matching and inconspicuous donor scar and deformity.

Medial epicanthoplasty by using palpebral margin incision

Objective To introduce a new method for correction of epicanthal folds, which could avoid obvious scar in medial canthus. Methods First, through upper and lower palpebral margin incisions, the connective and orbicularis oculi muscle dense fibers underlying epicanthal folds as well as the superficial head of medial canthal ligament were thoroughly released and excised. After repositioning the medial canthus, the redundant skin tissue was removed and then the incisions closed. Results 122 epicanthoplasties had been performed. Postsurgical scars were invisible in all cases. All patients were satisfied with operation results. No recurrence of epicanthal fold was observed. Conclusions The introduced method has advantages in avoiding scar formation and is an especially suitable approach for epicanthoplasty in Asian patients. Key words: Medial epicanthal fold; Medial epicanthoplasty; Double eyelid formation

Botulinum toxin A for the treatment of ulcer caused by oro-mandibular dyskinesia in a patient with a vegetative state

Background: The number of botulinum toxin applications is expanding, as evidenced by the studies that demonstrate its new therapeutic indications. Botulinum toxin type A (BoNT-A) alone or adjunct to other agents has emerged as a new important therapeutic strategy for clinicians treating a wide range of neurological and not-neurological disturbances, and it may result useful for particular clinical pictures. Case description: A 73 year-old male subject had a severe sub-arachnoid hemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Its clinical features showed quadriplegia, vegetative state and oro-mandibular dyskinesia. The dyskinetic repetitive disorder produced a chronic ulcer on the lower lip. The ulcer had slightly irregular borders and resulted stage II–III according to the European Pressure Ulcer Advisory Panel wound classification system. Because of dyskinetic movement disorder, all efforts to heal the ulcer by topical medication were vanished. The upper and lower orbicularis oris and masseter muscles with a total of 320 units per single session botulinum toxin type A (BoNT-A) (Dysport® Ipsen) were injected. The treatment reduced the sucking and forced jawing and promoted the care of ulcer, which after 3 months from the initial infiltration healed completely. Outcome and discussion: The vegetative state can represent a dramatic neurological sequel of extensive brain tissue damage. The rehabilitation process of these patients involves all clinicians, nurses and caregivers in several complex and challenging tasks. BoNT-A infiltration reduced oro-mandibular dyskynesia and weakened orbicularis oris muscle and repetitive sucking hallowing topical medication and the ulcer healing. It has been suggested that the use of BoNT-A as adjunct to other interventions may represent an important therapeutic aid for the clinicians treating rare pathological conditions that otherwise result untreatable.

Intramuscular Hemangioma of the Lower Lip

We report a case of intramuscular hemangioma in the lower orbicularis oris muscle. A 5-year-old boy presented a fairly firm mass in the lower lip. The mass was noticed a few weeks after birth and had been progressing slowly for years. On histology, proliferating vascular channels infiltrated diffusely the skeletal muscle, adipose, and connective tissue. The vascular channel was lined inside by endothelium and varying amounts of component smooth muscle.

Swallowing activity of lip muscles in patients with a complete upper and a partial lower denture.

In 30 partially edentulous subjects provided with an immediate complete upper and a partial lower free-end denture the lip activity in swallowing was studied before and after denture treatment and during a 2-year period of denture wearing. Electromyographic recordings of the right side upper and lower orbicularis oris, mentalis and anterior temporal muscles were obtained during swallowing saliva and during swallowing of water with and without the dentures in the mouth. In the different types of swallows recorded, the lower lip and mentalis muscles showed much stronger activity than the upper lip and anterior temporal muscles and also initiated the swallowing activity. No significant changes in mean voltages of the swallowing activity were observed during the 2-year observation period. On the other hand, the durations of the swallows showed marked increases after 1 year of denture use, when no further rebasings of the complete upper denture had been made.

Transfer of lower orbicularis muscle flap for lower lip incontinence

Correction of lower lip incontinence by suspending the lower lip to the zygomatic muscle by means of a muscle flap of the lower lateral orbicularis oris is described. In the absence of a suitable muscle, the suspension is achieved by a strip of lyophilized dura. Reports on two patients are presented.