Oral Commissure Research Articles

Assessment of Skin and Mucosa at the Equine Oral Commissures to Assess Pathology from Bit Wear: The Oral Commissure Assessment Protocol (OCA) for Analysis and Categorisation of Oral Commissures.

Simple SummaryThe goal was to implement a protocol to categorize and record pathological findings at the lip commissures. First, the precise anatomical location was defined; second, pigmentation was classified as natural or potentially pathological; and third, pathological lesions were characterized. Associations between the horse’s history and the observed findings were sought. A convenience sample of 206 horses presented for routine dental prophylaxis were sedated; the mouth was held open with a gag, and photographs were taken of the oral commissures and adjacent areas of the lips. The horses were divided in two groups: horses that had never been bitted and horses currently or previously bitted. The owners completed a questionnaire describing the horse’s name, identification number, breed, age, sex, colour, training level, and discipline. The photographs were analysed in a systematic manner, and a score chart was developed to standardize the reporting of lesions. Potentially pathological pigment changes occurred more frequently in horses with a higher level of training (p = 0.04) and light-coloured horses (p = 0.0004), but were not associated with current bit use or the discipline that the horse participated in (p = 0.20). Scars were more frequent in horses competing at a higher level. Only two horses had contusions/erosions, five had ulcers and none showed bleeding; these numbers were too low for statistical analysis.This study addresses the presence and location of natural pigmentation, potentially pathological changes in pigment, interruptions of the natural lining (scars), roughness, and erosions/contusion (bruising) in and around the corners of the lips of 206 horses presented to a veterinarian for routine preventative dental treatment. After sedation, photographs were taken and later evaluated for the presence of lesions. During the photographic analysis, the Oral Commissure Assessment (OCA) protocol was developed to map precisely the areas of skin and mucosa around the corners of the lips, and the presence of lesions was recorded for each area. Potentially pathological pigment changes occurred more frequently in horses with a higher level of training (p = 0.04) and in light-coloured horses (p = 0.0004), but there was no association with the current use of a bit or the discipline that the horse participated in (p = 0.20). Scars occurred more frequently in horses competing at a higher level. Only two horses had contusions or erosions, five had ulcers, and none showed bleeding; these numbers were too low for statistical analysis. Using the OCA protocol provides a detailed method for categorizing and recording lesions in and around the corners of the lips, including natural vs. potential and/or definite pathological character.

Quantified Facial Rejuvenation Utilizing High Intense Focus Ultrasound with Multiple Penetrative Depths

BackgroundMultiple penetration depths of high-intensity focused ultrasound (HIFU) treatment for facial rejuvenation have not been quantified.MethodsWe enrolled 12 participants (n=24) to undergo one session of HIFU rejuvenation between January 1, 2019, and January 10, 2020. We used a 2-, 4.5-, and 6-mm focal depth transducer on the upper and middle face. We evaluated efficacy on days 60 and 90 by using our specific assessment system.ResultsThe average eyebrow peak and pupil–eyebrow peak angles significantly increased by 2° (p < 0.0005) and decreased by 1° (p < 0.0001), respectively, at day 90. The shortened eyebrow–iris length indicated that the forehead tissues had lifted and moved medially to the central face. Supraorbital tissues were also vertically elevated, marked by the eyebrow–orbital (p = 0.0016) and vertical palpebral fissure lengths (p = 0.0052), which both exhibited a 0.8-cm elevation. For the midface, the increased canthus–oral–nasal angle (p = 0.5881) and decreased tragus–oral length (p = 0.5881) indicated that laxity had been corrected through lifted oral commissure, though the data were not statistically significant. No serious side effects were observed.ConclusionHIFU treatment with multiple depths quantitatively improved both upper-facial rejuvenation and midface rejuvenation after a single session.

Masseteric-to-facial nerve transfer combined with static suspension: Evaluation and validation of facial symmetry in patients with different levels of asymmetry

One-stage combined dynamic reanimation with static suspension has obvious advantages of improving facial symmetry. In clinical observation, patients with different levels of oral commissure drooping achieve different symmetry outcomes, despite undergoing the same surgical procedure. Patients with slight asymmetry obtain better outcomes than those with severe asymmetry. The mechanisms influencing postoperative outcomes have not been systematically explored. We retrospectively analyzed 44 patients performed with masseteric-to-facial nerve transfer combined with static suspension. Patients were divided into two groups according to the level of oral commissure drooping: slight-asymmetry group (n = 24) and severe-asymmetry group (n = 20). Static and dynamic symmetry were assessed with FACE-gram software pre and postoperatively. The symmetry of the oral commissures at rest and during smiling significantly improved postoperatively in all patients. The differences of the bilateral oral commissure positions were significantly smaller in slight-asymmetry group than that in severe-asymmetry group (p<0.001), indicating that slight-asymmetry group achieved better symmetry. Furthermore, these differences were caused by the oral commissures position on the unaffected side, both pre and postoperatively (p<0.001), but not the paralyzed side's (p>0.05). In conclusion, masseteric-to-facial nerve transfer combined with static suspension achieved dynamic and static symmetry in patients with different levels of asymmetry. Patients with slight asymmetry obtained better postoperative symmetry than those with severe asymmetry. Postoperative facial asymmetry might be influenced by the hypertonicity of facial muscles on the unaffected side.

Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia.

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

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis

Releasing the Smile: Depressor Anguli Oris Excision in the Context of Managing Nonflaccid Facial Palsy.

Nonflaccid facial palsy is a debilitating entity characterized by hypertonicity, synkinesis, and hypomobility. Patients with nonflaccid facial palsy often have smile asymmetry and restriction because of disruption of normal vector forces on the modiolus. Excision of the depressor anguli oris can lead to improved oral commissure excursion, smile angle, dental show, and symmetry. All depressor anguli oris resection cases between January 8, 2018, and December 26, 2019, were reviewed. Patients with postoperative photographs were included in this cohort study. Preoperative and postoperative photographs were analyzed using the Emotrics software program, and changes in oral commissure excursion, smile angle, and dental show were tracked. Clinician-graded facial palsy assessments and patient-reported outcome measures were compared preoperatively and postoperatively using the Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale, respectively. Forty-three patients were included in this study; 79 percent of patients underwent isolated depressor anguli oris resection. Depressor anguli oris resection led to a statistically significant increase in oral commissure median excursion, smile angle, and dental show [3.02 mm (p = 0.015), 1.70 degrees (p = 0.002), and 2.36 mm (p < 0.001), respectively]. Median Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale instrument scores also improved [6.0 (p = 0.001) and 7.5 (p = 0.013), respectively]. Depressor anguli oris resection also led to more symmetric smiles. No correlation was seen between duration of follow-up and change in metrics. Depressor anguli oris resection is a minimal-risk procedure that frequently results in improved smile dynamics, smile symmetry, and quality of life in patients with nonflaccid facial palsy. Therapeutic, IV.

Sternocleidomastoid Muscle Transfer for Treatment of Longstanding Facial Paralysis: Long-term Outcomes and Complications.

The use of sternocleidomastoid muscle (SCM) flap for facial reanimation was established in the 1980s by the senior author of this paper. We aimed to analyze long-term outcome and complications of this procedure. We conducted a retrospective chart review of all patients undergoing SCM reanimation for longstanding facial palsy between January 2009 and December 2015. Patients with follow-up longer than 12 months (range=12-96) were included in the study. Facial muscle function was evaluated before and at each follow-up after the surgery with the House-Brackmann (HB) scale-facial nerve grading system and Facegram analysis. Donor site morbidity and overall complication rates were documented and analyzed. Forty-two patients aged 18-66 years (mean age=37) with a mean duration of facial palsy of 5 years (range=2-48) met the inclusion criteria. The HB score 2 years after surgery improved significantly (p<0.05) in comparison to the pre-operative condition (3.6 vs. 4.7). Twelve months after surgery, oral commissure excursion improved by mean 8.95 mm. No flap necrosis occurred, nor compromise of neck and shoulder function despite an obvious contour defect in the SCM donor site. None of the patients presented head posture or movement issues. The SCM flap transfer is a reliable and effective procedure to achieve moderate improvement of the oral commissure excursion using a local method with moderate donor site morbidity. It can be regarded as a valuable option for dynamic facial reanimation in case of longstanding facial palsy.

Tongue Reconstruction by Nasolabial Flap

Background: The nasolabial flap is an easy, however untrained, modest tissue reconstruction process with an honest delivery of blood that may be utilized to restore minor tissue defects within the hollow mouth region. The study's intention turned into to peer how a success inferiorly primarily based completely nasolabial flaps had been for restore in sufferers with early mouth maximal cancer. &#x0D; Methods: A total of twenty-eight sufferers with T- or T2 malignant mass of the tongue which had reconstructions, the use of the inferiorly primarily based nasolabial flap was investigated retrospectively. All of the sufferers blanketed with inside the studies had their flap viability, wound issues, infections, function, scar, and recurrence mentioned post-operatively. After the manner, all sufferers had been monitored for at least six months.&#x0D; Results: The nasolabial flap is used to restore abnormalities withinside the buccal mucosa, oral commissure, decreased lip, lateral border of the tongue, demanding palate, and mouth floor. The flap becomes a success in all sufferers without a recurrence. The beauty and purposeful results have been each satisfactory. Minor complications include postoperative trismus, immoderate wound contracture, ectropion, infection, and wound dehiscence passed off in a few sufferers. One of the maximum not unusual place issues in most male sufferers becomes intraoral hair boom over the flap employed.&#x0D; Conclusions: The NLF is a feasible and adaptable choice for restoring small to intermediate deficits of the oral hole area due to ablation of early tumors of the oral hole area if proper interest is paid to flap design, operational approach, and postoperative treatment.

Facial reanimation using the hypoglossal nerve and ansa cervicalis: a short-term retrospective analysis of surgical outcomes.

BackgroundTransferring the hypoglossal nerve to the facial nerve using an end-to-end method is very effective for improving facial motor function. However, this technique may result in hemitongue atrophy. The ansa cervicalis, which arises from the cervical plexus, is also used for facial reanimation. We retrospectively reviewed cases where facial reanimation was performed using the ansa cervicalis to overcome the shortcomings of existing techniques of hypoglossal nerve transfer.MethodsThe records of 15 patients who underwent hypoglossal nerve transfer were retrospectively reviewed. Three methods were used: facial reanimation with hypoglossal nerve transfer (group 1), facial nerve reanimation using the ansa cervicalis (group 2), and sural nerve interposition grafting between the hypoglossal nerve and facial nerve (group 3). In group 1, the ansa cervicalis was coapted to neurotize the distal stump of the hypoglossal nerve in a subset of patients. Clinical outcomes were evaluated using the House-Brackmann (H-B) grading system and Emotrics software.ResultsAll patients in group 1 (n = 4) achieved H-B grade IV facial function and showed improvements in the oral commissure angle at rest (preoperative vs. postoperative difference, 6.48° ± 0.77°) and while smiling (13.88° ± 2.00°). In groups 2 and 3, the oral commissure angle slightly improved at rest (group 2: 0.95° ± 0.53°, group 3: 1.35° ± 1.02°) and while smiling (group 2: 2.06° ± 0.67°, group 3: 1.23° ± 0.56°). In group 1, reduced tongue morbidity was found in patients who underwent ansa cervicalis transfer.ConclusionFacial reanimation with hypoglossal nerve transfer, in combination with hypoglossal nerve neurotization using the ansa cervicalis for complete facial palsy patients, might enable favorable facial reanimation outcomes and reduce tongue morbidity. Facial reanimation using the ansa cervicalis or sural nerve for incomplete facial palsy patients did not lead to remarkable improvements, but it warrants further investigation.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection.

Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography

A consensus on facial artery anatomy has not been established due to the discrepancies in previous studies. The authors sought to assess the branches, course, and location of the facial artery in Asians by utilizing computed tomographic angiography. The computed tomographic angiography images of 300 facial arteries from 150 Asian patients were evaluated. The FA was classified as follows: type 1, facial artery terminates superior labial or inferior labial artery; type 2, facial artery terminates lateral nasal or inferior alar artery; type 3, facial artery terminates medial canthal artery; or type 4, facial artery is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course. Seventy (23.3%), 163 (54.3%), 49 (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3, and 4, respectively. A total 72.3% of facial arteries were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between the facial artery and the inner canthus or the midpoint of the inferior orbital rim decreased from type 1 to type 4 facial artery (P < 0.0001). The 4 types did not significantly differ in distance between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the facial artery at inferior of mandible. Detailed findings of the facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.

Perception about Importance of Buccal Corridor and its Width in Smile Esthetics

Aim: To assess the perception of dental students and house officers regarding role of buccal corridor in smile esthetics and to determine the most esthetically pleasing buccal corridor width. Methods: A photograph of the patient’s face, smiling with the teeth visible up to the first molar was modified digitally to create smiles with no buccal corridor, increasing buccal corridors widths of 5%, 10%, 15%, 20 % and 25% respectively compared with the width of inner oral commissure. A total of 376 dental students and HOs participated in the study and data was collected in questionnaires. Results: Buccal corridor is considered to affect the smile esthetics of an individual by 72.4% of house officers, 67.6% of second year students, 48.7% of 3rd year students and 52.4% of fourth year students(P value: 0.002). Visibility of around 5-10% of buccal corridor was considered most esthetically pleasing, however, the result was not significant. Conclusion: Buccal corridor is an important component in smile esthetics considered by students and house officers of dental colleges. Buccal corridor width of 5-10 % was considered most esthetically pleasing among participants. Keywords: Buccal corridor, Esthetics, perception

Necrotic ulcerative stomatitis in a patient with long-standing celiac disease: a case report

Celiac disease is the most common chronic gastroenterological disease. One of the extraintestinal manifestations of this multifaceted disease are changes in the oral mucosa. However, ulceration leading to the destruction of the soft and hard tissues of the orofacial region has not been reported so far. We report on the development of necrotizing ulcerative stomatitis in a 41-year-old woman with celiac disease. The initial ulcerative lesion was located in the lower lip mucosa. Necrosis of all layers of the left side of the lip and oral commissure progressed very quickly. The resulting defect required plastic reconstructive surgery. We successfully compensated for the defect by applying a combination of two flaps from the remaining tissue of the lower lip. Oral competence was established immediately after the operation, and a very good esthetic appearance two months later.

Dynamic facial reanimation in the elderly using masseteric-to-facial nerve transfer

Background: Masseteric-to-facial nerve (MTF) transfer offers the advantages of primary nerve coaptation, a high density of motor axons, and the potential connectedness between facial and trigeminal central cortical centres. Despite these benefits, its use in individuals aged greater than 60 years has not been widely described. Methods: A PubMed literature review from 1 January 1978 through to 31 December 2018 was performed to identify individuals older than 60 years who underwent a masseteric-to-facial nerve transfer. In addition, a retrospective chart review of all elderly patients who underwent a masseteric-to-facial nerve transfer at a single institution was conducted. Details on patient demographics, surgical techniques, outcomes and complications were recorded. Ethics approval for the study was obtained through the Monash Health Human Research Ethics Committee (RES-18-0000-768Q). Results: For the literature review, 12 out of 506 articles met the study criteria, with 28 patients identified and analysed. The average time to first facial movement was 5.5 months. Average improvement on oral commissure excursion was 11 mm. Of the eleven patients included in the clinical series, 27 per cent of patients experienced postoperative complications and there were no reported mortalities. Conclusion: Masseteric-to-facial nerve transfer is a safe and viable option for midface and perioral reanimation in the elderly with short term facial nerve palsies.

Lip Commissure Reconstruction with the Facial Artery Muscular-Mucosal (FAMM) Flap: A Case Report of a Child with Electrical Commissural Injury:

Electrical burn damages constitutes of 4% of all burn trauma. Approximately 20% of total electrical burn injuries occur in children. Most electrical injuries in children occur at home. When the child bites or chews an electrical cord, it results in oral and commissural injury. It is also noted that male children are predominantly affected with electric current injuries than female children. We introduce an immigrant 3-year-old boy admitted in the hospital one week after an electrical injury of the oral cavity due to biting a television cord. He had a necrotic lesion on his right oral commissure. There is controversy about the time and relevant management of mouth commissure injury. In this case, because of lack of parents’ consent, we did the reconstruction of his oral commissure very late without any molding intervention. There is more than 200 techniques in the management of lip and oral commissural injury; we used a Facial Artery Mucosal-Muscular (FAMM) flap for the repair with good result. Although with the improvement of burn care and its management outcomes, prevention is still the best way of minimizing the prevalence and severity of electric current burn injuries.

Three-Dimensional Motion Capture of a Smile in Repaired Unilateral Cleft Lip: What's Our Vector, Victor?

Following surgical repair, patients with unilateral cleft lip (UCL) exhibit dynamic asymmetry during facial expressions compared to healthy individuals. Previous studies using Euclidean distances to describe this asymmetry fail to take the direction of the movement into account. The aim of this study is to compare differences in participants with UCL and controls using analysis of motion vectors during facial expressions. In this cross-sectional study, twenty-six pediatric participants were recruited: 13 participants with repaired left UCL and 13 participants with no craniofacial diagnosis. Participants were recorded performing a maximal smile by a 4D stereophotogrammetric system. Phases of the smile were divided into closed lip and open lip smiles. Ten regions of interest were analyzed: subnasal area, upper lip, lower lip, oral commissure, and ala on both sides. The motion vectors were calculated and vector magnitude and direction for each region was compared. Between cleft and control groups, the differences in vector direction were greater than the magnitude differences. Significant differences in vector direction were identified at both oral commissures in the closed lip smile; and at the oral commissure, subnasal, upper lip, and lower lip regions during open lip smile. Vector analysis demonstrated significant movement asymmetry during facial animation in participants following UCL repair, not previously identified when analyzing magnitude of skin displacement.

Facial reanimation with interposition nerve graft or masseter nerve transfer: a comparative retrospective study.

Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve. However, no comparative study of these two procedures has yet been reported. In this two-site, two-arm, retrospective case review study, 32 patients were included. Of these, 17 patients (eight men and nine women, mean age 42.1 years) underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute, School of Medicine, Shanghai Jiao Tong University, China, and 15 patients (six men and nine women, mean age 40.6 years) underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital, China. More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair (15/15 vs. 12/17). The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft. These findings suggest that masseter nerve transfer results in strong oral commissure excursion, avoiding obvious synkinesis, while an interposition nerve graft provides better resting symmetry. This study was approved by the Institutional Ethics Committee, Shanghai Ninth People's Hospital, China (approval No. SH9H-2019-T332-1) on December 12, 2019.

Ideal Reference Lines for Assessment of Facial Asymmetry in Rhinoplasty Patients.

Assessing facial asymmetry is important to prevent unsatisfactory results in rhinoplasty. There has yet to be a consensus on reference lines for determining asymmetry. This study aimed to determine ideal reference lines to assess facial asymmetry and identify predictors of subjective perceptions of facial asymmetry. Preoperative photographs of 47 patients who underwent rhinoplasty were adjusted according to two reference lines (vertical line from the mid-glabella to Cupid's bow and horizontal interpupillary line). In total, 94 photographs were generated, randomly ordered, and evaluated by two independent observers for anthropometric measurements including six distances (distances from the midline to the medial and lateral canthi, ala, oral commissure, width of midface at maximum distance, and mandible width) and three angles (lateral canthal, lateral alar, and lip margin angles). Photographs were rated by 18 independent observers for subjective perceptions of facial asymmetry. Observers perceived faces as asymmetric if accompanied by nasal deviation, irrespective of the reference line (p < 0.001). Based on the horizontal reference line, subjective perceptions of asymmetry were correlated with the midline to lateral alar margin distance (r = 0.489, p = 0.003) and sum of the distance ratios (r = 0.354, p = 0.037). None of the objective parameters correlated with subjective perceptions when adopting the vertical reference line. A deviated nose and lateral alar angle were significant predictors of subjective perceptions of facial asymmetry. To assess facial asymmetry, the horizontal reference line should be determined first followed by the perpendicular vertical line. The nose is the most important feature determining overall facial asymmetry. LEVEL OF EVIDENCE V: "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

HUMAN BITES TO THE FACE TREATMENT WITH PEDICLE FLAP TECHNIQUE: CASE REPORT

Human bite wounds are less common than those caused by animal bites, and in general are contaminated by a wider range of microorganisms, thus increasing incidence of infectious complications. Patient management in the emergency room consists in aesthetic and functional rehabilitation and infection prevention. The aim of this article is to report a case of human bite to the face with upper lip and oral commissure tissue loss of a patient, who was a victim of assault, seen at a public emergency hospital in Rio de Janeiro, providing information on the clinical characteristics of the injury and the most appropriate treatment for the case studied. Keywords: bite, face, lip, flap

Oral Commissure Lift: A Retrospective Analysis of Complication Rates and Overall Outcomes.

Downward-turning oral commissures and sagging mouth corners can present an unfavorable impression. We introduced a new oral commissure lift procedure and investigated its effectiveness and complication rates. Patients who underwent oral commissure lift in the plastic surgery clinic between January 2010 and December 2017 were enrolled retrospectively. Pre-and postoperative photographs were evaluated to measure oral commissure angles and analyze surgical complications, including visible scarring, unnatural appearance, and asymmetry. Many patients underwent a oral commissure lift with a simultaneous facelift. To exclude potential bias, we compared angular changes between patients receiving both oral commissure lift and facelift, with those receiving only oral commissure lift. Moreover, oral commissure angles of patients only receiving facelift were also measured. Statistical significance was set at p < 0.05. Oral commissure lift was performed in 51 patients. The mean ages and follow-up periods were 46.7 ± 11.9 years, and 25.2 ± 22.9 months, respectively. The preoperative mean angles of the right and left oral commissures measured - 3.1 ± 4.0° and - 3.4 ± 3.7°, respectively, and postoperative mean angles measured 3.6 ± 3.2° and 3.3 ± 3.5°, respectively. Postoperative changes in oral commissure angles were statistically significant (p < 0.05). The low complication rate included undercorrection in one patient, asymmetry in one patient, and visible scarring in three patients. We found no statistically significant differences in the studies excluding bias. The new oral commissure lift procedure for correcting sagging oral commissures was simple, safe, and effective with a low complication rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .