Perioral Soft Tissue Research Articles

A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan.

Background:Facial appearance is an important factor, affects social and psychological well-being. The ideal positioning of jaws and soft tissues is crucial during orthognathic surgery for a better outcome, but the response of facial soft tissues does not always reflect the exact movements of the underlying jaws in 1:1 ratio. So, soft tissue changes following orthognathic surgery require utmost attention during surgical correction to make successful treatment.Aims and Objectives:Evaluation of perioral soft tissue changes after orthognathic surgical procedures. The objectives of the study were to assess and compare pre and post-operative perioral soft tissue changes of lip width, nasolabial and mentolabial angle using Three Dimensional Computed Tomography scan (3DCT).Patient and Methods:The study involved ten patients for evaluation requiring orthognathic surgical procedures (maxillary or mandibular anteroposterior excess or deficiency, transverse deformities, vertical maxillary excess and facial asymmetry) presented to the department of oral and maxillofacial surgery during 2014-2016. Pre and post-operative 3DCT scan were taken after 12 months using iCT 256 slice whole body CT scanner and evaluated for changes using Dicom PMS D view.Results:Significant changes were observed in nasolabial angle after maxillary advancement (1.81°) and maxillary setback procedure (2.73°). The mentolabial angle was significantly increased with mandibular setback procedures (3.27°). Mandibular advancement procedures showed both increase (3.6°) and decrease (7.6°) in mentolabial angle.Conclusion:3DCT showed a significant difference in perioral soft tissue changes in nasolabial and mentolabial angle but no significant change was observed in lip width. 3DCT is a reliable tool for 3D assessment. The conventional thought of changes in Nasolabial angle after surgery is changing due to the underlying factors which should be considered for prediction.

Demographic Characteristic Of Patient With Traumatic Dental Injury Attending Kulliyyah Of Dentistry IIUM Kuantan Campus

Introduction: Traumatic dental injuries (TDI) refer to injury to the teeth and/or peridontium and perioral soft tissues. To date, very few dental trauma studies conducted in the university setting, thus the aim of this research is to provide an epidemiological data of TDI cases among patients attending Kulliyyah of Dentistry (KOD), IIUM Kuantan Campus. Materials and Methods: A total of 32 patient's record with TDI were retrieved from 2012 to June 2016. The inclusion criteria are patients attended KOD for management of dental trauma and diagnosis of TDI was properly documented. Patients attending KOD with complaint other than dental trauma and no proper diagnosis documented were excluded. The classification of dental trauma used is based on WHO Dental Trauma Classification (1978). For cases that were doubtful or with insufficient information, decision was made after further discussion with another examiner. Results: The mean age was 12.31 years old with the highest number of cases occurs in the 6-15 year-old group (37.5%) and male to female ratio of 3:2. Uncomplicated crown fracture was the most common injury in primary and permanent dentition (38% and 67%, respectively). Falls attribute 62.5% of the causes of TDI. November and December recorded the highest number of occurance of TDI cases (25% respectively). Conclusion(s): There is low occurance of TDI cases in KOD. The occurance of TDI cases is associated with school holiday

ORAL FACTITIAL INJURY ASSOCIATED WITH FAMILIAL DYSAUTONOMIA

Familial dysautonomia (FD), known as Riley-Day syndrome or hereditary sensory and autonomic neuropathy type III (HSAN3), is a rare autosomal recessive disorder occurring almost exclusively in individuals of Ashkenazi Jewish (AJ) descent (estimated carrier incidence 1:27). Mutations in the IKBKAP gene have recently been shown to be responsible for FD. Signs and symptoms of FD include: reduced sensitivity to pain and thermal extremes, absence of fungiform papillae, the inability to produce tears upon emotional crying, absence of axon flare after injection of intradermal histamine, and absent deep tendon reflexes. There is a high incidence of self-inflicted or accidental traumas to the oral cavity, including crown fractures, luxation or avulsion injuries, and ulceration of the oral and perioral soft tissues.

Use of the self-retaining Alexis ring retractor in transoral robotic surgery.

Ring retractors, such as the Alexis® wound retractor, are simple devices used in a wide range of surgical settings to provide atraumatic exposure while protecting wound edges. Here, we describe the application of the Alexis® to provide access during transoral robotic surgery (TORS). Its ease of application and many benefits, including maximization of intraoral space and protection of perioral soft tissues, make this device an excellent adjunct for TORS procedures.

Perioral treatment options in cosmetic facial surgery

The perioral region is unique and important in the face, both from a functional and an aesthetic point of view. There is a strong relationship between the perioral soft tissues, such as the lips and the corners of the mouth, and the underlying dentition and the jaws. Perioral ageing phenomena, such as depressed corners of the mouth, volume loss and wrinkles, can be improved, however, to a limited extent with intraoral treatment. These ageing phenomena can usually be treated more effectively with several extraoral treatment modalities that also enhance perioral aesthetics. The perioral cosmetic treatment options can be divided into various lifting procedures and volumising techniques. Considering that the dentist has to deal regularly with patients with perioral aesthetic wishes and also functional problems, it is important that one has knowledge of the different perioral treatment options, for both cosmetic and functional options.

Perioral soft tissue change after isolated mandibular surgery for asymmetry patients

IntroductionThis study was intended to determine whether isolated mandibular surgery for the correction of asymmetry could also change perioral soft tissue asymmetry. Patients and methodsSkeletal class III patients who had undergone mandibular set-back surgery were included. The subjects were composed of two groups with (n = 20) or without (n = 30) menton (Me) deviation over 4 mm. The perioral lip landmarks were analyzed on three-dimensional image from cone-beam computed tomography taken before and 6 months after the operation. The bilateral and inter-group differences and pre- and post-operative changes were statistically analyzed. ResultsThe corner of mouth on the deviated side was 1.9 mm shorter vertically than that on the contralateral side in patients with asymmetry. After mandibular surgery, the deviated Me moved 5.5 mm to the contralateral side and the lip canting was corrected by 2.4° in the asymmetry group. The degree of Me deviation was significantly correlated with the degree of midline asymmetry in perioral soft tissue landmarks including subnasale, upper and lower lip midline. The predictor variable that affected the changes in lip cant was the surgical correction of Me deviation. DiscussionThe correction of chin deviation by isolated mandibular surgery could significantly improve the subnasal and lip asymmetry.

Simple Myofunctional Therapy Using Ready-made Mouthpiece Device before and after Orthodontic Treatment.

The present report describes myofunctional therapy using a ready-made training device, the T4A, in patients with permanent dentition and its effect on the prevention of relapse. The buccinator mechanism maintains the inner pressure of the tongue muscle equivalent to the outer pressure of the perioral soft tissues, such as the orbicular muscles, including the cephalopharyngeus and buccinator muscles. Training is performed so that patients learn to place their tongue and lips in the appropriate resting positions. The shape of the T4A and tongue guard supports the tongue from the bottom, allowing formation of the correct resting tongue position. However, the use of T4A for a long period of time may cause the teeth movement; therefore, caution is required. Use of the T4A is effective for the correction of oral habits, myofunctional therapy and for teaching the correct resting tongue position during the daytime and for the correction of oral habits, teaching correct resting tongue position during sleep.

Hyaluronic acid in cosmetic filler of perioral soft tissues. Case report

Hyaluronic acid in cosmetic filler of perioral soft tissues. Case report

Evaluation of Soft Tissue Changes Around the Lips After Mandibular Setback Surgery With Minimal Orthodontics Using Three-Dimensional Stereophotogrammetry

Most reports on the surgery-first approach in skeletal Class III malocclusion have focused on the skeletal changes. The present study evaluated the soft tissue changes around the lips over time after mandibular setback surgery (MS) with minimal orthodontics (MO) using 3-dimensional (3D) stereophotogrammetry. We performed a retrospective study of patients with mandibular prognathism who had undergone MS-MO. Lateral cephalograms and 3D photographs were taken before (T0) and 1 (T1) and 6months (T2) after surgery and were superimposed. A paired t test, independent t test, and simple linear regression analysis were used to evaluate the hard and soft tissue changes and their correlation. The sample included 15 patients (7 males and 8 females). The soft tissue landmarks on the X-axis (left-right) showed no significant positional changes. The landmarks of the lips and oral commissure on the Y-axis (vertical) moved downward until T2; however, most of these changes did not differ significantly over time (T1 compared with T0 and T2 compared with T0). The landmarks in the lower lip, oral commissure, and soft tissue chin on the Z-axis (anterior-posterior) showed posterior movement at T1 and T2. In contrast, the lower lip (labiale inferius, 1.67mm) and soft tissue chin (soft tissue B point, 1.28mm; soft tissue pogonion, 1.61mm) moved significantly forward from T1 to T2, but had no correlation with the anterior relapse of the mandible. Protrusion of the lower lip and soft tissue chin with forward and upward relapse of the mandible during postoperative orthodontics was observed. The results from the present study suggest that 3D stereophotogrammetry can be useful for evaluating the perioral soft tissue changes over time in orthognathic surgery patients.

Relationship between lip-closing force and three-dimensional lip morphology in adults with straight facial profile

The purpose of the present study was to investigate the relationship between multidirectional lip­closing force and the three-dimensional morphology of perioral soft tissue in adults. Twenty-three Japanese adults with straight facial profiles participated in this study. The signals of directional lip­closing force (DLCF) were investigated in 8 directions. Three-dimensional morphology of perioral soft tissue was recorded using a 30 surface-imaging device. Correlations between lip-closing force and the three-dimensional morphology of the perioral soft tissue were analyzed statistically. Upper lip-closing force significantly correlated with the anteroposterior, vertical, transverse morphology of the upper lip, while lower lip-closing force did not correlate with the anteroposterior, vertical, or transverse morphology of the lower lip. In adults with straight facial profiles, associations were found between upper lip-closing force and upper lip morphology. There were no associations between lower lip-closing force and lower lip morphology.

Subnasal and perioral soft tissue change in asymmetry after isolated mandibular set-back surgery

Subnasal and perioral soft tissue change in asymmetry after isolated mandibular set-back surgery

Measurement of three-dimensional perioral soft tissue changes in dentoalveolar protrusion patients after orthodontic treatment using a structured light scanner

To evaluate the three-dimensional (3D) perioral soft tissue changes after orthodontic treatment in patients with dentoalveolar protrusion using structured light-based scanners. Forty-four Korean adults (19 men and 25 women, 21.4 ± 3.4 years) with dentoalveolar protrusion treated by extraction of all four first premolars and then en masse retraction with maximum anchorage were evaluated. Lateral cephalograms and 3D facial scans were obtained before treatment (T1) and immediately after debonding (T2). Superimposition was performed, and 27 perioral landmarks were identified. The 3D changes in the landmarks and ratio of movement of the soft tissue relative to the horizontal incisal tip were evaluated. A paired t-test and one-way analysis of variance were performed. The upper incisors were retracted 5.76 mm and the lower incisors were retracted 4.62 mm (P < .001). The upper lip moved inferoposteriorly, and the lower lip moved superoposteriorly. In the lower lip, upward movement was greater than backward movement (P < .001). The most prominent changes appeared at the greatest bulge area. The relative ratios were 42%-53% in the upper lip area and 22%-82% in the lower lip area. The lip corners moved superoposteriorly (P < .001). Subnasale moved downward (P < .05) and posteriorly (P < .001), while the landmarks under the nostrils moved upward and posteriorly (P < .001). Facial scans from white structured light scanners efficiently evaluated 3D perioral soft tissue in dentoalveolar protrusion patients. Backward movement and significant vertical movement of the lip were observed. The nasal and lip angle areas showed considerable changes.

The effect of incremental lower lip advancement on oral pressure and EMG activity of the lower lip

During orthodontic arch expansion, the teeth are displaced against the perioral soft tissues. This can affect the equilibrium of forces that are thought to act on teeth, with consequent implications for long-term stability. The aim of this study was to investigate the effect of incremental lower lip advancement on intraoral pressure and electromyographic (EMG) activity of the lower lip. Intraoral pressure and EMG activity was measured in 10 participants (2 males, 8 females; 22 years ± 7 months) as the lower lip was incrementally advanced using three custom-made vacuum-formed stents of differing labial thicknesses (0.5, 2.5, and 4.5 mm). A task paradigm including at rest recordings and maximal voluntary contraction was completed for each tray. Resting lip pressure generated increased as the lower lip was advanced (P < 0.001). The EMG activity of the lower lip increased significantly (P < 0.001) only once the lip was advanced from 2.5 to 4.5 mm. For the pressure recordings, the response to incremental lip advancement showed considerable individual variation. These findings suggest that the initial pressure increase on the lower incisors was mostly likely due to the inherent viscoelastic properties of the lower lip, while the pressure increase between the 2.5 and 4.5 mm advancement was due to increased muscle activity. Each individual also responded to lower lip advancement in a different yet subject-specific manner.

Intra-oral Mouth-Guard In Sport Related Oro-Facial Injuries: Prevention is Better Than Cure!

India is rapidly assuming a more health-conscious posture. Olympic competition and professional sports have turned from mere dreams into goals. Many major professional sports leagues are expanding. Sports dentistry is a composite of skills for treatment, prevention, education and research in which dentistry and sports come together. Custom athletic mouth guards present additional health-care opportunities. They are designed to reduce the impact force of a direct blow to the jaw and create a gap between the condyle and skull thereby reducing the transference of the impact to the brain. The prevalence and severity of injuries to the teeth, jaws and intra-oral and peri-oral soft tissues, concussions and neck injuries are reduced when mouth guards are used. The dentist can play a proactive role in helping to deliver important expanded health care services.

Perioral rejuvenation: restoration of attractiveness in aging females by minimally invasive procedures

Lips and the perioral area are of outstanding importance in youthful appearance, attractiveness, and beauty. In contrast to younger and middle aged females, there is only scant published data on minimally invasive procedures to restore and revitalize lips and perioral soft tissue in elderly females. In this review we report the signs of aging in this particular region and the underlying anatomy. We review studies on lip restoration in younger females and present our techniques for elderly women. With an individually tailored approach, elderly females benefit from minimally invasive techniques.

Capture, analysis and measurement of images of speech and smile dynamics

INTRODUCTION: Dynamic analysis of smile and speech makes it easier to identify the features that define facial esthetics while allowing researchers to study different variables and observe the effects of aging. OBJECTIVE: The aim of this study is to present a method for capturing, analyzing and measuring video images to support the study of speech and smile dynamics. METHODS: Natural head positioning was standardized with the aid of a head holder (cephalostat). Image acquisition is performed with a video camera attached to a tripod, positioned at a fixed distance of 0.90 m. The subjects are trained to say out loud: "Tia Ema torcia pelo antigo time da Tchecoslováquia" and then to smile. The resulting images are fragmented and yielded four pictures that best represent a resting position, the least exposure of maxillary incisors, the greatest exposure of upper and lower incisors, and a posed smile. A freeware computer program called VIDEOMED was used to carry out measurements. CONCLUSION: The method presented in this study is an effective resource to record images captured during rest, speech and smile, thereby enabling a better understanding of changes in perioral soft tissues.

Three‐dimensional analysis of lip and perioral soft tissue changes after debonding of labial brackets

To evaluate the possible soft tissue changes after debonding of labial brackets using three-dimensional (3D) images acquired by a laser scanner. On the same day, 3D facial scans were taken immediately before debonding (T1) and immediately after debonding (T2) from 53 patients, and follow-up scans were taken 3 months after debonding (T3) from 31 patients. To compare the scans, superimpositions were performed and shell-to-shell deviations were used for quantitative analysis. Shell-to-shell deviation map showing warm colors in lip and perioral tissue represented the retrusion of soft tissue after bracket removal. Soft tissue retrusion was significant for all landmarks immediately after debonding (T1-T2) and 3 months after debonding (T1-T3). Gender, bracket type, and the lip thickness variables did not show a clinically significant influence on the amount of soft tissue retrusion at the T1-T3 period. Lip corners and vermilion borders were significantly retruded at the T1-T3 period more than other perioral areas. A negative linear relationship was found in the amount of soft tissue retrusion immediately after debonding (T1-T2) and from debonding to 3 months after debonding (T2-T3). Three-dimensional imaging showed significant changes in lip and perioral soft tissue after debonding of labial brackets. Clinically significant changes, approximately 2 mm of retrusion, occurred in the mouth corners bilaterally. Vermilion border landmarks also demonstrated significant changes in more than 1 mm. However, it was not possible to predict the soft tissue changes. A wide range of individual variability in the response to treatment and soft tissue adaptation was noted.

Three-dimensional analysis of dentolabial relationships: effect of age and sex in healthy dentition

Morphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided into a youthful group (21–34 years, mean 26 years, SD 4) and an older group (45–65 years, mean 53 years, SD 5). Stone labial and dental models were made, digitized and 3D virtual reproductions of dentolabial morphology were obtained. From the digital reconstructions, the relative positions of the labial commissure and of the maxillary dental clinical crowns in the vertical direction were obtained. Sex and age effects were compared using two-way analysis of variance. Lip position relative to the teeth was significantly different in youthful and older subjects (P<0.01). No statistically significant effects of sex in dentolabial relationship were demonstrated, but a sex×age effect was found in the anterior labial segments (P<0.05). The perioral soft tissues drop down in older subjects and the soft tissue descends on the entire labial arch. These differences may help the clinician when estimating, planning and evaluating surgical, orthodontic and prosthetic treatments.

Versatile Use of Submental Tissue for Reconstruction of Perioral Soft Tissue Defects

To obtain optimum aesthetic result, perioral soft tissue defects require reconstruction using similar tissue. The submental area has very similar characteristics to perioral soft tissue and consists of thin, pliable tissue with a perfect color match. Therefore, we have used submental tissues for reconstruction of perioral soft tissue defects and application of the techniques, and results are discussed in this article. Between February 2001 and April 2008, 14 perioral soft tissue reconstruction procedures using the submental tissues were performed. The defect was on the upper lip including nasal columella in 5 cases, mentum in 3 cases, and oral commissure including buccal cheek in 6 cases. The techniques that were used included composite graft in 3 cases, local advancement flap in 3 cases, pedicled flap in 5 cases, and free flap in 3 cases. Patients were followed up for 9 months to 5 years. During this period, no major complications were noted, and satisfactory aesthetic results were obtained. All transferred submental tissues survived. In all patients, donor defects were closed primarily except in cases of local advancement flap. The donor-site scar was inconspicuous and well hidden below the mandibular margin and did not restrict neck motion in all patients. In particular, hair restoration on the flap was excellent in male patients. We believe that the submental area can provide useful soft tissue for perioral soft tissue defects because it provides a good color and texture match with perioral skin and can be harvested with minimal donor-site morbidity.

Orofacial granulomatosis presenting as bilateral eyelid swelling

Orofacial granulomatosis (OFG) is an uncommon but increasingly recognized disease of unknown etiology. The typical presentation is chronic swelling of the perioral soft tissue, but eyelid edema can be the sole manifestation. Terminology of this disease can be confusing as it may also be referred to as granulomatous cheilitis and a monosymptomatic presentation of Melkersson–Rosenthal syndrome (MRS). Crohn’s disease and sarcoidosis should also be considered in the differential as the histopathology can be similar. Corticosteroids are the mainstay of treatment but can lack efficacy. Atypical presentations and the possibility of systemic disease involvement can further challenge the management. We describe an unusual case in which OFG manifests solely as chronic eyelid swelling. This 69-year old Asian female patient had a delayed diagnosis that responded well to intralesional corticosteroid injection with surgical skin reduction. In addition to describing this unusual presentation of OFG, we review the relevant literature and evaluate the current terminology used to describe this entity.