Normal Lip Research Articles

Primary W-Plasty Closure for Surgical Repair of the Injured Lip.

To describe the results obtained using the primary W-plasty closure technique for the surgical repair of lip defects of traumatic etiology. This study followed both the Declaration of Helsinki on medical protocol and ethics and the Ethical Guidelines of Hospital San Francisco de Asis institutional review board. A retrospective case series study was designed and implemented. The medical status, demographic, etiology, complications, and outcomes associated to the primary W-plasty technique in patients with lip injuries seen at Hospital San Francisco de Asis Oral and Maxillofacial Surgery Department in Quibdó, Colombia between 2010 and 2013 were assessed. Data were collected and analyzed using a statistic package. Eighteen patients were treated, 8 women and 10 men, with ages ranging from 2 to 38 years. Patients presented lip avulsion injuries associated to different etiologies. They underwent surgery under general anesthesia after prophylactic antibiotic therapy and tetanus booster vaccination. Defect repair was performed using the primary W-plasty closure technique, obtaining satisfactory esthetic and functional results. Primary W-plasty closure is a surgical option that allows the safe and practical restoration of the injured lip, even in lesions exceeding 50% of the normal lip.

Speech and Speech-Related Quality of Life After Late Palate Repair: A Patient's Perspective.

Many patients with cleft palate deformities worldwide receive treatment at a later age than is recommended for normal speech to develop. The outcomes after late palate repairs in terms of speech and quality of life (QOL) still remain largely unstudied. In the current study, questionnaires were used to assess the patients' perception of speech and QOL before and after primary palate repair. All of the patients were operated at a cleft center in northeast India and had a cleft palate with a normal lip or with a cleft lip that had been previously repaired. A total of 134 patients (7-35 years) were interviewed preoperatively and 46 patients (7-32 years) were assessed in the postoperative survey. The survey showed that scores based on the speech handicap index, concerning speech and speech-related QOL, did not improve postoperatively. In fact, the questionnaires indicated that the speech became more unpredictable (P < 0.01) and that nasal regurgitation became worse (P < 0.01) for some patients after surgery. A total of 78% of the patients were still satisfied with the surgery and all of the patients reported that their self-confidence had improved after the operation. Thus, the majority of interviewed patients who underwent late primary palate repair were satisfied with the surgery. At the same time, speech and speech-related QOL did not improve according to the speech handicap index-based survey. Speech predictability may even become worse and nasal regurgitation may increase after late palate repair, according to these results.

Residents' journal review

Residents' journal review

A Case of Subcutaneous Destructive Facial Swelling in a Dog Caused by Mucor Species

A Case of Subcutaneous Destructive Facial Swelling in a Dog Caused by Mucor Species A three-year-old Black Jack dog was presented in August, 2014 to Mansoura veterinary teaching hospital, Egypt for investigation of a firm non-painful subcutaneous swelling beneath the right eye. Oral examination revealed normal lips, gums, teeth, tongue and palate. Incision of the swelling discharged whitish yellow fluid, pyogranulomatous masses and bloody exudates. Subsequent biopsy and culture examination revealed a pure growth of a Mucor species. On necropsy, right maxillary bone, underneath the swelling, showed erosion and destruction of bony wall extending into orbit, anterior ethmoidal sinus and soft tissue of right cheek. Histopathological evaluation showed pyogranulomatous inflammation associated with intra lesional hollow thin walled branched aseptated hyphae characteristic of Mucor species. The fungus was visualized by periodic acid Schiff (PAS) and Grocott’s methenamine silver (GMS) stain.

Occlusal Features , Perception of Occlusion and Orthodontic Treatment Need and Demand among 13 Years Aged Baghdadi Students : Part II : Cross Sectional Epidemiological Study

Background: The present study aimed to assess the distribution, prevalence, severity of malocclusion in Baghdad governorate in relation to gender and residency Materials and Methods: A multi-stage stratified sampling technique was used in this investigation to make the sample a representative of target population. The sample consisted of 2700 (1349 males and 1351 females) intermediate school students aged 13 years representing 3% of the total target population. A questionnaire was used to determine the perception of occlusion and orthodontic treatment demand of the students and the assessment procedures for occlusal features by direct intraoral measurement using veriner and an instrument to measure the rotated and displaced teeth. Results and conclusions: The presence of malaligned teeth was reported by 39% of the sample. The most prevalent reported types of malaligned teeth were spaced teeth (26.6%); Of the students who stated that they have malaligned teeth, 70.3% thought that it affected their appearance, 17.8% affected chewing, and 7.8% affected speech; The most common reasons for not seeking orthodontic treatment were the thought that treatment is not important or not possible (25.8%) and fear of pain (48.8%).One or more missing teeth due to extraction or trauma were found in 4.9% of the sample,the most common extracted tooth was the mandibular first molar. Crowding was more concentrated in the lower anterior segment while the spacing cases were higher and more concentrated in the upper anterior segment. A maxillary central diastema was found in 18.1 % of the sample with a mean of 0.306 mm. Anterior irregularities were found in (18.36 %maxillary and 26.84% mandibular),mean overjet 3.310 mm, mean overbite was 2.99 mm, Class I Angle class was found in 78.29%, class II in 19.5% and class III in 2.3%. Posterior crossbite found in 5.6%, anterior openbite (1.7%) and midline shift (54.34 %).Normal lip form was found in 86.6%, soft tissue impingement in 3.3%.The treatment need according to DAI show that 72.3% of the sample were found to have no or slight treatment need, 15.9% with treatment elective, 7.3% with treatment highly desirable, and 4.5% with treatment mandatory.Also increase the need and decrease demand for orthodontic treatment among adolescents in the Baghdad commune. This data will be useful for public oral health service and emphasize the need for orthodontic treatment among Baghdadi adolescents.

Lip reconstruction.

The lips consist of 2 fleshy folds that surround the mouth in humans. They play a dynamic role in facial esthetics, human communications, and oral functions. Defects may result from trauma, malignancy, and congenital disorders. These defects may cause significant alterations of normal lip appearance and function that profoundly impact patients' quality of life. Surgical management of patients in need of lip reconstruction requires a clear understanding of the lip anatomy, aesthetics, and function as well as extensive knowledge and background information of various techniques proposed to this date. This article is a comprehensive review of lip defects reconstruction.

Oral strength in subjects with a unilateral cleft lip and palate

PurposeFacial appearance and speech outcome may affect psychosocial functioning in girls and boys. Several studies reported dissatisfaction with facial appearance and more specifically the lip and mouth profile in children with cleft lip and palate (CLP). The purpose of this controlled study was to measure the tongue and lip strength and endurance in boys and girls with CLP. MethodsTwenty-five subjects (mean age: 10.6 years) with a unilateral CLP and a gender- and age- matched control group were selected. All subjects with an unilateral CLP consulted the same craniofacial team and had undergone an identical surgical procedure. Surgical procedure of the lip was performed using a modified Millard technique without primary nose correction at an average age of 5.5 months. The Iowa Oral Performance instrument was used to measure lip and tongue strength and tongue endurance. ResultsThe results of the Iowa Oral Performance measurement showed no significant differences between the subjects with an unilateral cleft lip and palate and the age and gender matched control group without a cleft lip and palate. ConclusionThere is no significant differences regarding oral strength more specifically the lip and tongue strength and endurance between subjects with and without an unilateral cleft lip and palate. ENT specialists and speech pathologists must be aware of this aspect of the normal lip and tongue functions.

Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips

IntroductionAccurate lip contour identification is demanding since variations in color, form and surface texture, even in normal lips, introduce artifacts in non-adapted segmentation algorithms. Herein, a method for vermilion border detection and quantification in healthy and diseased lower lips is presented. AimTo quantify the morphological irregularities of lower lip border, to validate its discriminative power in solar cheilosis diagnosis and to provide supportive tools toward, cost effective, non invasive, disease monitoring. MaterialsSegmentation algorithm for lower lip border was based on spatial fuzzy c-means clustering algorithm with adaptive selection of fuzzy exponent m. Lip features measuring morphological lip border deviations were estimated. The method of lip border extraction and quantitative description was evaluated in a gold standard set of 25 young volunteers without onset of lip diseases. Quantitative descriptors were evaluated in terms of correct classification rates in differentiating 30 healthy control cases from 41 patients with solar cheilosis and were further applied to quantify the therapeutic outcome after immunocryosurgery in eight patients with solar cheilosis. ResultsAdaptive estimation of fuzzy exponent m substantially boosted the segmentation quality in gold standard cases yielding quite smooth lip contours and uniformly low values of lip irregularity features. Discriminant analysis highlighted the distance between the extracted and modeled vermilion border as a feature with excellent diagnostic accuracy (sensitivity and specificity 98% and 93% respectively). Results on patients with solar cheilosis followed up after treatment with immunocryosurgery showed that proposed quantitative lip marker was able to trace the improvement of disease after treatment. ConclusionCorrect lip border recognition is the prerequisite for extracting essential morphological descriptors from lips with epithelial diseases like solar cheilosis. In this paper we presented an efficient method for the automatic identification and quantitative description of lower lip vermilion border morphology in health and disease using digital photography and image analysis techniques.

The Philtrum in Cleft Lip

The philtrum is imperfectly formed in both unilateral and bilateral cleft lip. Surgical construction of this exquisite feature in the upper lip is challenging and often takes a back seat to construction of Cupid's bow and the nose. However, the philtrum is one of the defining features of a normal lip. The purpose of this review is to compile information on philtral anatomy and techniques for construction to guide the reader on his or her own quest to optimize cleft lip repair. In this article, we review the normal anatomy of the philtral dimple and ridges, with particular attention to pars peripheralis configuration. We also review methods for philtral construction during primary labial repair and secondary labial revision. For unilateral cleft lip, eversion of orbicularis oris muscle is necessary to build a philtral ridge. For bilateral cleft lip, emphasis is on proper design of the philtral flap and efforts to simulate a dimple and ridges. For secondary philtral correction, techniques include complete labial revision with various types of muscular re-repair and autologous philtral ridge augmentation. Objective methods are needed to document the efficacy of the many techniques for philtral construction and reconstruction.

Detecting Genetic Association of Common Human Facial Morphological Variation Using High Density 3D Image Registration

Human facial morphology is a combination of many complex traits. Little is known about the genetic basis of common facial morphological variation. Existing association studies have largely used simple landmark-distances as surrogates for the complex morphological phenotypes of the face. However, this can result in decreased statistical power and unclear inference of shape changes. In this study, we applied a new image registration approach that automatically identified the salient landmarks and aligned the sample faces using high density pixel points. Based on this high density registration, three different phenotype data schemes were used to test the association between the common facial morphological variation and 10 candidate SNPs, and their performances were compared. The first scheme used traditional landmark-distances; the second relied on the geometric analysis of 15 landmarks and the third used geometric analysis of a dense registration of ∼30,000 3D points. We found that the two geometric approaches were highly consistent in their detection of morphological changes. The geometric method using dense registration further demonstrated superiority in the fine inference of shape changes and 3D face modeling. Several candidate SNPs showed potential associations with different facial features. In particular, one SNP, a known risk factor of non-syndromic cleft lips/palates, rs642961 in the IRF6 gene, was validated to strongly predict normal lip shape variation in female Han Chinese. This study further demonstrated that dense face registration may substantially improve the detection and characterization of genetic association in common facial variation.

Visualization of the Fetal Lip and Palate: Is Brain-Targeted MRI Reliable?

Objective : To evaluate the ability of brain-targeted magnetic resonance imaging (MRI) to assess the anatomy of the fetal upper lip and palate. Design : Two independent readers made a blind retrospective review of 60 brain-targeted MRIs of fetuses from 20 to 38 gestational weeks (GW). Fifty-five MRIs were normal and five had orofacial anomalies, including one isolated cleft lip and four cleft lip and palate. Both normal and cleft MRIs had postnatal confirmation. The upper lip, primary palate, secondary palate, and nasal septum were scored into four levels, from evidently normal to evidently abnormal. In case of a suspected pathology, the readers attempted a diagnosis. Setting : Collaboration between a university hospital and a large private practice MRI center. Results : Interobserver agreement (weighted kappa) was 0.79 for the upper lip, 0.70 for the primary palate, 0.86 for the secondary palate, and 0.90 for the nasal septum. The scoring levels of the readers did not change significantly across gestational age. Normality was correctly scored in 96% to 100% of the normal lips and primary palates and in 93% to 97% of the normal secondary palates depending on the reader. A deviated septum was only scored in two fetuses with unilateral cleft palates. The readers identified all pathological cases. Conclusion : Brain-targeted fetal MRI in experienced hands seems to be highly accurate for the evaluation of the lip and palate in fetuses above 20 GW, regardless of gestational age. The assessment of the secondary palate may be slightly more limited than the lip or primary palate.

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.

Tessier 30 symphyseal mandibular cleft: Early simultaneous soft and hard tissue correction – A case report

A symphyseal mandibular facial cleft (Tessier 30) is a rare congenital abnormality. Nonunion of bone in the symphysis of the mandible, median cleft of the lower lip and tongue adherence in the midline to the floor of the mouth are the principle features of the anomaly. A satisfactory result can be achieved with early surgical correction of both hard and soft tissue defects in the age of 6 months. More than 3 years follow-up shows total bony fusion of the symphysis and normal lower lip function. There were only left deciduous central incisor and the ipsilateral tooth bud of the permanent central incisor missing.

Determining normal and abnormal lip shapes at border positions for use as a longitudinal surgical outcome measure

Objective measures of facial movement are important for interventions where surgical repositioning of facial structures can influence soft tissue mobility and include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. As such, the aim of this study is to present a method for determining the outcome of surgical procedures on lip shape during speech. A control group (CG) of 115 average subjects and 30 patients with a Class 3 malocclusion requiring bimaxillary surgery performed four reproducible verbal utterances during image capture using a non-invasive, three-dimensional (3D) motion scanner (3dMDFace™ Dynamic System). Landmark coordinates around the lips of the 3D facial shells were extracted and subjected to discriminant analysis and principal component analysis to statistically differentiate lip shapes between the CG and the patient group (PG) pre- and post-surgery. Pre-surgically, the PG showed statistically significant differences in lip shape during speech in the lateral and vertical dimensions, preferring a wider, shorter lip shape when compared with the CG for all the utterances. The shape differences normalised towards the CG post-surgery. The method presented utilises pre-existing statistical shape analyses and can be reproduced in the clinical setting to provide a diagnostic and functional outcome tool. In this example, correction of the Class 3 skeletal disproportions appeared to normalise lip shape during speech.

The ecological and genetic basis of convergent thick‐lipped phenotypes in cichlid fishes

The evolution of convergent phenotypes is one of the most interesting outcomes of replicate adaptive radiations. Remarkable cases of convergence involve the thick-lipped phenotype found across cichlid species flocks in the East African Great Lakes. Unlike most other convergent forms in cichlids, which are restricted to East Africa, the thick-lipped phenotype also occurs elsewhere, for example in the Central American Midas Cichlid assemblage. Here, we use an ecological genomic approach to study the function, the evolution and the genetic basis of this phenotype in two independent cichlid adaptive radiations on two continents. We applied phylogenetic, demographic, geometric morphometric and stomach content analyses to an African (Lobochilotes labiatus) and a Central American (Amphilophus labiatus) thick-lipped species. We found that similar morphological adaptations occur in both thick-lipped species and that the 'fleshy' lips are associated with hard-shelled prey in the form of molluscs and invertebrates. We then used comparative Illumina RNA sequencing of thick vs. normal lip tissue in East African cichlids and identified a set of 141 candidate genes that appear to be involved in the morphogenesis of this trait. A more detailed analysis of six of these genes led to three strong candidates: Actb, Cldn7 and Copb. The function of these genes can be linked to the loose connective tissue constituting the fleshy lips. Similar trends in gene expression between African and Central American thick-lipped species appear to indicate that an overlapping set of genes was independently recruited to build this particular phenotype in both lineages.

Presurgical Nasoalveolar Molding (PNAM) for a Unilateral Cleft Lip and Palate: A Clinical Report

Cleft lip and palate deformity is a congenital defect of the middle third of the face. Incidence varies from 1:500 to 1:2500 live births. Etiology depends upon hereditary and environmental factors. Restoration of these defects is important not only for functional and esthetic reasons, but also because there may be a positive psychological impact for the patient and parents. The goal of primary closure of the lip for unilateral cleft lip is to ensure a normal and symmetrical lip and nose. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar molding (PNAM) represents a paradigm shift from the traditional methods of presurgical infant orthopedics. PNAM consists of active molding of the alveolar segments as well as the surrounding soft tissues. This clinical report describes a new approach of PNAM therapy for an infant with complete unilateral cleft lip and palate showing significant reduction in cleft defect size and improved contour and topography of deformed surrounding soft tissues.

The Use Of Control Suture In Cleft Lip Surgery

&#x0D; &#x0D; &#x0D; &#x0D; To achieve an optimal result in cleft surgery, executing the proper designs and precise techniques are mandatory.&#x0D; Several techniques are proposed for the repair of unilateral and bilateral cleft lip. In 1955, Millard !rst described the techniques of advancing a lateral upper lip "ap combined with downward rotation of the medial segment.1 From experience, the above- mentioned technique may be modi!ed to facilitate better lip rotation and symmetry. Technically, it also provides a more ef!cient work"ow and more accurate results. All efforts in lip repairs have one ultimate goal, which is to achieve corrected lips with minimal scar and as much resemblance to that of the normal lips: by anatomy, symmetry, and muscle function.&#x0D; &#x0D; &#x0D; &#x0D;

Surgical Technique for Remodelling Lip Deformities Due to Overinjection of Silicone Oil

The injection of large volumes of silicone oil for lip augmentation can lead to the formation of abnormally prominent or projected lips. Conservative treatment measures are largely ineffective. This observational study describes the application of a surgical technique developed at our center for the correction of silicone oil-induced lip deformities. Fifty-nine patients presented at a tertiary medical center over a 6-year period with complaints of lip deformities caused by injections of silicone oil for lip augmentation 2 to 4years previously. All had proven refractory to conservative treatment. The patients underwent individually tailored surgery consisting of a series of wedge-like incisions and Z-plasties to reproduce a normal lip line. Patients returned to their normal daily routine after 3 to 7days. Only two patients (3.4%) required revision surgery after 6months to correct lip asymmetry. Ninety percent of the patients expressed satisfaction with the aesthetic and functional outcome after 3months. Our innovative, individually tailored surgical technique for the correction of lip deformities due to silicone oil injection for lip augmentation is simple and safe to perform and yields a satisfactory outcome in most cases.

Next‐generation Sequencing Facilitates the Diagnosis in a Child With Twinkle Mutations Causing Cholestatic Liver Failure

Next‐generation Sequencing Facilitates the Diagnosis in a Child With Twinkle Mutations Causing Cholestatic Liver Failure

Effect of phentolamine mesylate on duration of soft tissue local anesthesia in children.

Objective:Addition of vasoconstrictors to local anesthesia results in prolonged pain control. However, associated soft-tissue anesthesia (STA) of the lips and tongue typically lasts 3-5 hours which is longer than required time for pain control after routine dental procedures can lead to inadvertent biting of the soft tissue, particularly in children. The present study aimed to evaluate phentolamine mesylate (PM) effect on duration of STA and incidence of soft-tissue trauma after mandibular block injection.Methods:This randomized, double-blinded, controlled clinical trial included 54 patients with the age of 4-11 years. In group 1 at the first visit, the children received ordinary local anesthetic (LA) consisting of lidocaine 2% and epinephrine 1:80,000 and the PM injection was performed 30 minutes later. At the second visit, the contralateral side received LA injection then the dental procedure was done and a sham injection was performed. In group 2 at the first visit, patients received control injection and at the second visit received PM injection. Then the reversal time for normal sensation of soft tissue, the vital signs, and the incidence of soft-tissue trauma in a period of 3-5 hours after injection were evaluated.Findings:There was a statistically significant difference (P < 0.001) in recovery time of normal lip sensation between case and control groups and also between two groups (P < 0.003). Incidence of soft-tissue trauma between case and control groups showed a statistically significant difference (P < 0.039).Conclusion:PM can be considered as a safe and effective drug for reduction of reversal time of STA after dental procedures.