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PubMed1999

Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity.

Radical paring of the cleft edge during a primary cleft operation or repeated secondary surgeries can result in tightness of the upper lip. The degree of the resulting side-to-side tension can vary, from mild cases for which improvement is sought through realignment of the misplaced oral sphincter muscle in secondary revision, to severe cases for which the possibility of a lip switch flap must be considered. When the lip tightness accompanies more than three-quarters loss of the Cupid's bow, an Abbé flap is an alternative. However, the lip switch flap is far from ideal, in both artistic and functional perspectives, and should be avoided if at all possible in mild to moderate degrees of lip tightness. This study presents a method of correcting horizontal cleft upper lip tightness, especially of the vermilion. The method involves local transfer of an inferiorly based rectangular flap from the relatively redundant upper two-thirds to the lower one-third of the upper lip and vermilion. Primary indications for the technique include vermilion tightness with half to three-quarters loss of Cupid's bow. The method has the advantage of supplementing the horizontal lip dimension on the cleft side and restoring a natural Cupid's bow, thereby repositioning the shifted philtral column and adding fullness to the lower one-third of the upper lip. Incorporation of the upper lip scar in the rectangular flap removes ugly scars and spares the lower lip from surgical violation. The orbicularis sphincter function, as seen in facial animation, was well regained. Twenty unilateral and three bilateral cases with a maximal follow-up period of 4.5 years are presented.

Adolescent↗

PubMed1995

Evaluation of normal and abnormal lips in fetuses: comparison between three- and two-dimensional sonography.

OBJECTIVE: The purpose of this study was to determine if three-dimensional (3D) sonography could improve prenatal evaluation of fetal lips in comparison with conventional two-dimensional (2D) sonography. MATERIALS AND METHODS: Sixty-one high-risk pregnant women and 10 low-risk pregnant women were examined with conventional 2D sonography followed by 3D sonography with a volume transducer. The ability to visualize cleft lips and normal lips was compared between the two techniques. RESULTS: Of the 71 fetuses studied, faces were seen in 68 and not seen in three by either 2D or 3D sonography. Abnormal lips were seen in five fetuses on both 2D and 3D sonograms. Of the remaining fetuses, 3D sonography was able to confirm the presence of a normal lip in 92% (58/63) compared with 76% (48/63) with 2D sonography. In the subgroup of fetuses less than 24 weeks' estimated gestational age, 3D sonography confirmed a normal lip in 93% (38/41) of fetuses as compared with 68% (28/41) for 2D sonography. There was no difference between 3D and 2D in the subgroup of fetuses older than 24 weeks. One false-positive finding of cleft lip was observed at 36 weeks' gestational age with the rendered surface display on 3D sonography, whereas the 3D planar views of the same volume showed the lips to be normal. CONCLUSION: 3D sonography was able to confirm the presence of normal lips more frequently than did 2D sonography in fetuses less than 24 weeks' gestational age. Abnormal lips were seen on both 2D and 3D sonograms; however, 3D images of cleft lip were easier to understand for both the family and clinical colleagues.

Cleft Lip↗

PubMed1993

The anatomy of Cupid's bow in normal and cleft lip.

This is a gross and microscopic examination of the cutaneous-vermilion-mucosal region (Cupid's bow) in infants with normal lip as compared to cleft lip. Morphologic observations of lips in situ were made with magnification. Specimens for histology were from the normal upper lip of infants (n = 3) and adults (n = 4), and from redundant tissue made available during primary repair of cleft lip (n = 13) and cleft lip revision (n = 4). Tissues were analyzed with hematoxylin and eosin, Gomori trichrome, and Fontana-Masson stains. Immunoperoxidase stains were used to emphasize vascular endothelium and epithelial cytokeratins. Our observations support the hypothesis that the anterior projection of the pars marginalis of the musculus orbicularis oris gives rise to the normal cutaneous-vermilion junction ("white skin roll" of Gillies-Millard). The band of vellus hairs, found atop the vermilion-cutaneous junction, also highlights the rim of Cupid's bow. There was no abrupt alteration in vasculature, melanin, or cytokeratin content in the white roll. Proceeding caudally, the vermilion-mucosal region was characterized by progressively increasing epidermal thickness and size of rete ridges, decreasing melanin, more superficial capillaries, and an abrupt transition from keratinized to nonkeratinized squamous epithelium ("red line" of Noordhoff). In the cleft lip specimens, where white roll was absent, there was hypoplasia and disorientation of the underlying pars marginalis component of m. orbicularis oris. Vellus hair follicles were seen in the zone of presumptive white roll in clefts, just as in normal lip. Frequently, these pilar units contained disproportionately large sebaceous glands. In some cleft lip specimens, ectopic sebaceous glands were noted in the oral mucosa. We also observed a deficiency of vermilion width on the medial side of unilateral cleft lip, whereas the width of the vermilion at the crest of the bow was normal or slightly increased in the lateral cleft segment. A narrow vermilion band and exposed hypoplastic mucosa were characteristic of the prolabium in the bilateral complete cleft deformity. The findings of this study are pertinent to technical details for construction of the Cupid's bow and vermilion in unilateral and bilateral cleft lip.

Cleft Lip↗

PubMed2005

Treatment options to optimize display of anterior dental esthetics in the patient with the aged lip.

PURPOSE: With aging a number of predictable changes occur in the upper and lower lips that act to mask otherwise esthetic dental procedures including dental implants, gingival esthetic surgery, and optimal dental restorations. The purpose of this article is to show how lip modification can be used to enhance the esthetic appearance of the patient, with specific attention to esthetic dental smile line characteristics. METHOD: Proper evaluation and diagnosis of senile lip changes, such as lip atrophy, loss of lip architecture, and lip lengthening lead to a reliable treatment plan that provides a more esthetic frame to view the oral aperture. Treatment options will be discussed that act to reverse these problems. Directed lip augmentation procedures are used to correct loss of lip volume and architecture. The subnasal lip lift technique is presented as a method to correct lip lengthening. Risks and limitations of these procedures are addressed. CONCLUSION: Safe and reliable methods are presented that can improve and rejuvenate the lip complex, thus allowing for optimal display of dental esthetics.

Aged↗

PubMed2000

Muscle activity with the mandibular lip bumper.

This prospective study was designed to measure muscle activity with lip bumper treatment. Surface electromyography was used to measure upper and lower lip activity with and without the appliance in place. Measurements were taken on a sample of 25 adolescent patients (age range, 10 to 17 years) before and after 12 months of lip bumper treatment. Recordings included a closed lip rest position, swallowing of water, and speech of the words "church," "phone," and "pop." Insertion of the lip bumper at the pretreatment recording resulted in significantly increased activity of the upper and lower lips at rest (P <.001) and while swallowing (P <.05), whereas the response for speech was variable. Pretreatment and posttreatment muscle activity measurements of the lower lip were compared to determine whether 12 months of treatment with the appliance resulted in muscle adaptation. The initial increase of muscle activity with insertion of the appliance for the closed lip rest position and for swallowing was not followed by a decrease during the treatment period. There were significant differences in muscle activity when comparing the "new" equilibrium introduced by the lip bumper to the "old" pretreatment equilibrium without the appliance. Although it was shown that the insertion of the appliance had a significant influence on muscle activity of the lips, the results of this study did not indicate adaptation of the lower lip to the appliance over the treatment period.

Adaptation, Physiological↗

PubMed2004

The esthetic properties of lips: a comparison of models and nonmodels.

It is perceived that fuller lips are more attractive, and hence lip augmentation has become common in esthetic plastic surgery. Numerous materials have been used, including collagen, autologous adipocytes, and more recently Restylane; however, little data exist on what comprises esthetically beautiful lips. Photographs of 28 models from fashion magazines were scanned to obtain digital images. These were selected strictly, using only exactly anterior-facing pictures. Using image analysis software, a range of defined lengths, angles, the lip area, and perimeter were measured. Lengths were expressed as a ratio of the intercanthal distance. A group of 14 nonmodel hospital employees were used as controls, with images obtained using a digital camera, and the same measurements were calculated. Results were compared for the two groups, and statistical analysis was performed using the Student's t-test. Overall lip width was not significantly different between the two groups (models, 15.7 units; nonmodels, 15.9 units). Both upper- and lower-lip height was significantly greater in models than in nonmodels (models, 2.1 and 3.6 units; nonmodels, 1.6 and 2.7 units, respectively), as was the upper-lip height laterally at the point of the angle of cupid's bow. Correspondingly, the angles of both upper and lower lips were also greater in models (models, 30.0 degrees and 47.3 degrees; nonmodels, 23.2 degrees and 37.6 degrees, respectively). We have assumed the model group to have esthetically beautiful lips. Our quantitative measurements have confirmed that this population has fuller lips compared with nonmodel controls, as determined by the lip height and angles.

Cosmetic Techniques↗

PubMed1997

Coordination of lip muscle activity by 2-year-old children during speech and nonspeech tasks.

This investigation was designed to quantify the coordinative organization of lip muscle activity of 2-year-old children during speech and nonspeech behaviors. Electromyographic (EMG) recordings of right upper and lower lip activity of seven 2-year-old children were obtained during productions of chewing, syllable repetition, lip protrusion, and speech (repeated two-word utterances) tasks. Task comparisons revealed that the coordinative organization of upper and lower lip activity is task specific; different coordinative strategies are employed for different tasks. Lip protrusion and syllable repetition tasks yielded strong coupling of upper and lower lip activity. Lip rounding (sentences containing the lip-rounding vowel /u/) and "nonlabial" speech tasks (sentences free of bilabials and lip-rounding vowels) resulted in low coupling of upper and lower lip activity. Moderate levels of coupling of upper and lower lip activity were evident for chewing and bilabial speech tasks (sentences loaded with bilabial plosion). This finding, that the coordinative elements of the perioral system of 2-year-olds are task specific, extends the results of previous studies of adults and children, where task-specific coordinative strategies were employed by the mandibular and perioral systems (Moore, 1993; Moore & Ruark, 1996; Moore, Smith, & Ringel, 1988; Wohlert & Goffman, 1994). The task-dependent coordination of the perioral system of 2-year-olds supports the notion that developing speech and earlier developing oromotor behaviors (i.e., sucking, chewing) are mediated by different control mechanisms.

Child, Preschool↗

PubMed2000

Fetal cleft lip and palate detection by three-dimensional ultrasonography.

OBJECTIVES: To demonstrate a standardized approach for the evaluation of cleft lip and palate by three-dimensional (3D) ultrasonography. DESIGN: This was a retrospective study of seven fetuses with confirmed facial cleft anomalies. Post-natal findings were compared to a blinded review of 3D volume data from abnormal fetuses with seven other normal fetuses that were matched for gestational age. Upper lip integrity was examined by 3D multiplanar imaging. Sequential axial views were used to evaluate the maxillary tooth-bearing alveolar ridge contour and anterior tooth socket alignment. Alveolar ridge disruption suggested cleft palate. Premaxillary protrusion, either by multiplanar imaging or surface rendering, indicated bilateral cleft lip and palate. RESULTS: Post-natal findings confirmed bilateral cleft lip and palate (four cases), unilateral cleft lip and palate (one case), and unilateral cleft lip (two cases). Multiplanar review identified all three fetuses with unilateral cleft lip, three of four fetuses with bilateral cleft lip, one fetus with unilateral cleft palate, and three of four fetuses with bilateral cleft palate. Surface rendering correctly identified all cleft lips, with the exception of one fetus, who was thought to have a unilateral cleft lip and palate, despite the actual presence of a bilateral lesion. One cleft palate defect was directly visualized by 3D surface rendering. No false-positives occurred. CONCLUSION: Interactive review of standardized 3D multiplanar images allows one to evaluate labial defects, abnormalities of the maxillary tooth-bearing alveolar ridge, and presence of premaxillary protrusion for detecting cleft lip and palate anomalies. Surface rendering may increase diagnostic confidence for normal or abnormal studies. This technology provides an array of visualization tools that may improve the prenatal characterization of facial clefts, particularly of the palate.

Cleft Lip↗

PubMed2000

A comparison of growth impairment and orthodontic results in adult patients with clefts of palate and unilateral clefts of lip, palate and alveolus.

OBJECTIVE: To evaluate and compare the long-term aesthetic and functional results of surgical and orthodontic treatment in patients with cleft palate and unilateral cleft lip, palate, and alveolus. DESIGN: 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with isolated cleft palate, mean age of 18.9 years, were evaluated by cephalometric and model analysis a mean of 1.5 years after orthodontic treatment. In each group the surgical treatment has been similar. RESULTS: Model analysis: The sum of every mesiodistal tooth diameter in the maxilla and in the mandible was recorded according to the Bolton analysis. Twenty patients with unilateral cleft lip, palate and alveolus had relatively large upper dental arches and nine had relatively large lower dental arches. Twenty-two patients with cleft palates had large upper dental arches and seven had large mandibular arches. Eleven patients with unilateral cleft lip, palate, and alveolus and 18 patients with cleft palate had a negative space supply (the sum of the mesiodistal tooth diameters compared with the sagittal length of the alveolar ridge) in the region of the lateral teeth. All patients had persistent transverse space deficits that were increased on the side of the cleft in patients with cleft lip, palate, and alveolus. These unilateral transversal space deficits were recorded in 22 patients with unilateral cleft lip, palate, and alveolus and in 8 patients with isolated cleft palate. Sagittal measurements were reduced in 26 patients with unilateral cleft lip, palate, and alveolus and in 23 patients with cleft palate alone. The alveolar midline of the maxilla and the mandible were displaced in 25 patients with unilateral cleft lip, palate, and alveolus and in 19 patients with isolated cleft palate. Lateral cephalometric analysis: The lateral cephalograms taken at the same time as the models showed a mean SNA of 76.8 degrees and a NL-NSL angle of 8.7 degrees, indications of a tendency towards maxillary retrognathia in patients with unilateral cleft lip, palate, and alveolus. Patients with cleft palate had a mean SNA of 79.6 degrees and NL-NSL angle of 8.1 degrees. The anterior facial vertical index was within normal limits in patients with cleft lip, palate, and alveolus (44% vs 56%). An anterior facial height index of 42% compared with 58% in patients with isolated cleft palate indicated a slight reduction in midface height with an increase in the lower face as a consequence. CONCLUSION: Orthodontic and surgical treatment can result in satisfactory results on model analysis. However, there is specific growth impairment of the maxilla 1.5 years after termination of orthodontic treatment and this influences the final cephalometric analysis, particularly in patients with cleft lip, palate, and alveolus.

Adolescent↗

PubMed1999

Functional and aesthetic objectives in the reconstruction of lip defects.

The reconstruction of lip defects presents a challenge to the surgeon. Apart from attaining a good aesthetic result, preserving the function of the oral sphincter is an essential objective. A variety of techniques and modifications of procedures for reconstructing lip defects have been reported in the literature. It is up to the surgeon to select the reconstruction procedure ensuring optimum functional and cosmetic results, depending on the location, size, and depth of the defect. The division of the lips into aesthetic subunits can prove very beneficial in designing lip reconstruction procedures. The upper lip is divided into three aesthetic subunits: two lateral subunits and a median subunit, the philtrum. The lower lip constitutes a single subunit. In this study established reconstruction techniques are discussed, and a concept serving to facilitate the appropriate choice of technique is introduced. This concept differentiates between vermilion defects on the one hand and partial-thickness and full-thickness lip defects on the other hand. For the lower lip the full-thickness defects are classified as defects involving one third and one third to two thirds of the lower lip width and between two thirds and complete loss of lip tissue. For the upper lip a distinction is made between isolated defects of the central and lateral subunits and combined defects of the central and lateral subunits. Important principles of surgery and the advantages and disadvantages of different reconstruction techniques are discussed.

Esthetics↗

PubMed1990

Effect of muscle exercise with an oral screen on lip function.

The study aimed at evaluating how training of the lips with an oral screen affects the strength of the lips and the pressure of the lips on the teeth. In addition, the effect of the treatment with an oral screen on the dentition was studied. The treatment and lip training programme was instituted for 9 months in 16 children, 7-11 years old, with protruding maxillary incisors. The effect on the dentition was studied on dental casts made before and at the end of the treatment, and 5 months thereafter, as well as on lateral cephalograms. The lip strength was recorded with a dynamometer. The pressure from the lips on the upper and lower central incisors at rest, and during chewing and swallowing was measured with an extra-oral pressure transducer incorporated in a water-filled system with an intra-oral measuring point. Measurements of lip strength and pressure were made regularly before and during the treatment, and continued for up to 10 months thereafter. The treatment resulted in a decrease of the overjet and upper dental arch length, but with some relapse after the treatment. The strength of the lips increased during the treatment, but decreased afterwards. The pressure from the lips on the teeth at rest and during swallowing was unaffected by the lip training. The pressure from the lower lip during chewing increased temporarily during the treatment period.

Cephalometry↗

PubMed1998

Microsurgical replantation of the lip: a multi-institutional experience.

Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective review of 13 lip replantations performed in 12 institutions utilizing a form database and clinical and photographic analysis. Lip replantation was successful in all 13 patients; partial flap loss occurred in one patient owing to iatrogenic injury. Follow-up averaged 3.1 years. Average patient age at the time of injury was 21.1 years. There were six male and seven female patients. Injuries in two patients were the result of a human bite, the remaining injuries resulted from dog bites. One patient had significant associated injuries. Average length of hospital stay was 11.9 days. Ten patients suffered amputations of the upper lip, and three suffered amputations of the lower lip. Average defect size was 10.6 cm2. Operative time averaged 5.7 hours (range 2.5 to 12 hours). Warm ischemia time averaged 2.9 hours, and cold ischemia time averaged 2.7 hours. Donor and recipient veins were often scarce; all patients had at least one arterial anastomosis, whereas no vein was available in 7 of 13 patients; vein grafts were required in one patient. Leech therapy was employed in 11 of 13 patients. Anticoagulant therapy was administered in the majority of patients. Systemic heparin was utilized in 10 of 13 patients, low molecular weight dextran was used in 7 of 13 patients, and aspirin was given to 7 of 13 patients. One bleeding complication was incurred. An average of 6.2 units of packed red blood cells was administered to 12 of 13 patients (adjusted to 250 cc/unit). Antispasmodic therapy was employed in six of eight patients intraoperatively and in two of eight patients postoperatively. Intraoperative complications included difficulty identifying veins in 7 of 13 patients, arterial spasm in 1 of 13 patients, and vessel diameter < 0.5 mm in 4 patients. Postoperatively, one patient suffered vein thrombosis requiring anastomotic revision. Broad spectrum antibiotics were administered to all patients, and there were no infections. Nearly one-third (4 of 13) patients suffered prolonged edema lasting > 4 months. Color match of the replanted lip segment was rated excellent in all cases. Hypertrophic scarring occurred in 6 of 13 patients. A total of 12 revision procedures was performed in six patients. Interestingly, leech therapy resulted in permanent visible scarring as a result of the leech bite in 6 of 11 patients treated. Ten patients demonstrated active orbicularis muscle contraction in the replanted lip segment. Stomal continence was present in all lips. Sensibility return in the replanted lip segment was quite good with 12 of 13 patients demonstrating at least protective moving two-point sensibility (> or = 10 mm). Partial replant necrosis in one patient resulted in significant scar and contraction that compromised the aesthetic appearance. Overall, however, all patients were uniformly pleased with their final results. This clinical study is one of the largest of its kind on lip replantation. Although this represents a multi-institutional experience, the data are remarkably consistent. Re-establishment of venous outflow seems to be the most problematic technical challenge. By incorporating the adjuncts of anticoagulation, leech therapy, and antispasmodics, a successful outcome can be expected despite the paucity of vessels and small vessel size. The risks of blood transfusion, lengthy operative time, and hospital stay must be weighed against the functional benefits.

Adolescent↗

PubMed2006

Alar base flap and suspending suture: a strategy to restore symmetry to the nasal alar contour in primary cleft-lip rhinoplasty.

OBJECTIVE: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. We describe the mechanism and contribution of different surgical techniques to restore alar symmetry in primary cleft-lip rhinoplasty. STUDY DESIGN: We evaluate surgical results using a retrospective, randomized, blinded surgical grading system. We describe a surgical technique designed to restore nasal symmetry in patients undergoing primary cleft-lip rhinoplasty. Patients were selected retrospectively. METHODS: A series of patients were identified with nasal asymmetry associated with cleft-lip deformity. All patients underwent cleft-lip repair with concurrent primary cleft-lip rhinoplasty. Patients who underwent alar base flap suspending suture (ABF-SS) were grouped and selected consecutively after a modification in the senior author's surgical technique. A control group was matched for age, sex, and cleft characteristics. Primary rhinoplasty was carried out concurrently for both study groups while undergoing unilateral cleft-lip repair. The control group did not undergo the described ABF-SS technique. All patients were operated on by the same surgeon over a period of 5 years. Surgical outcomes were evaluated by a panel including lay people as well as trained health care workers experienced in the critical evaluation of esthetic results after cleft-lip rhinoplasty. RESULTS: Forty-six records were reviewed of patients undergoing complete unilateral cleft-lip repair. After applying strict inclusion/exclusion criteria, nine patients underwent the described ABF-SS technique. All patients in the preoperative group had a clinically and statistically comparable degree of deformity (P > .05). There was a clinical and statistically significant improvement in nostril size, shape, symmetry, alar base symmetry, and nasal tip/dome symmetry for patients undergoing repair with the described technique compared with the control group. No clinical or statistically significant difference was observed in the scarring scores between groups. CONCLUSIONS: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. Execution of the described surgical techniques restores nasal alar symmetry in patients undergoing concurrent primary cleft-lip rhinoplasty.

Cleft Lip↗

PubMed2003

The cleft lateral lip element: do traditional markings result in secondary deformities?

In cleft surgery, two methods have traditionally been used to mark the height of cupid's bow on the lateral lip element. One technique measures the distance from the oral commissure to the height of cupid's bow on the noncleft side, and transposes this distance onto the cleft-side lateral lip element. The second technique marks the height of cupid's bow on the cleft-side lateral lip element where the white roll disappears. The authors believe these techniques may result in deformities of residual cleft tissue in the repair. Marking the height of cupid's bow on the cleft-side lateral lip element, just before the attenuation of lip fullness, can prevent this deformity. A retrospective study yielded a series of 17 patients with secondary deformities of residual cleft tissue in their repair. The method used to mark the lateral lip element was determined by chart review. Patients then underwent secondary surgery with excision of residual cleft tissue, and repair using the initial technique. A random group of primary cleft patients, repaired using the authors' technique for marking the lateral lip element, was likewise evaluated for the presence of residual cleft tissue in the repair. Of the 17 cases of secondary deformities, 14 were unilateral and 3 were bilateral. Among the unilateral cases, seven were repaired with a triangular flap and seven by rotation advancement. The bilateral cases were repaired using the modified Millard technique. The lateral lip element was marked using cessation of the white roll in 8 patients, and the commissure to the height the of cupid's bow in 2 patients, whereas in 7 patients the method was unreported. Using the authors' technique, both "controls" repaired primarily and cases repaired secondarily resulted in no redundant cleft tissue. Average follow-up was 11 months (range, 1-41 months). The authors think that traditional markings for establishing the height of cupid's bow on the cleft lateral lip element may result in residual cleft tissue in the repair. This deformity can be prevented by marking the height of cupid's bow on the cleft lateral lip element just before the attenuation of lip fullness.

Child, Preschool↗

PubMedDate not supplied

[Anthropometrical measurements of the height of the upper lip and length of the philtrum].

BACKGROUND: indirect anthropometrical measurements of the height of the upper lip and length of the philtrum. AIM: to describe the measurements of the height of the upper lip and length of the philtrum, extracted from video x-rays, in children with mixed dentition, relating these measurements to facial typology--medium and long-, to occlusion--Angle's class I and II--and to the rest position of the lips--with and without lip seal. METHOD: verification of 123 x-rays, in lateral norm, of children with ages between 7:7 and 11:10 years, 56 male and 67 female, extracted from archives of orthodontical documentation prior to treatment. RESULTS: the T-Student test, with a significance level of 5%, was used for the statistical analyses and the obtained results were: for the height of the upper lip no statistical difference was found considering the variables of face typology, occlusion and gender; there was no statistical difference for the measurements of the philtrum considering the variables of face typology and occlusion, but a statistically significant difference was found for the variable gender: a statistically significant difference was found for the height of the upper lip and length of the philtrum considering the variable rest position of the lips--with and without lip seal--being this a determinant factor for the measurements. This finding suggests that a direction of structural modifications may exist. CONCLUSION: the mean value for the height of the upper lip was established at 21mm; the mean value for the length of the philtrum was established at 12mm. It is important to consider the rest posture of the lips, during assessment and therapy, when taking the measurements of the height of the upper lip and length of the philtrum.

Cephalometry↗

PubMed1992

Configuration of facial profile in adults with cleft lip with or without cleft palate.

X-ray cephalometric studies were carried out in 114 adult males with cleft lip and with or without cleft palate. According to the type and extent of the cleft they were subdivided into 4 groups and were compared with a control group of 50 normal males matched in age. Investigated were the parameters of the skeletal and soft facial profile. The results showed that cleft lip alone is associated with deviations of local character concerning only soft tissues within the oronasal region. The ascertained deviations included a flattening of the nose, reduction of the height, concavity and prominence of the upper lip, increased height of the upper lip vermilion and a more horizontal slope of the columella leading to a reduction of the nasolabial angle. Cleft lip and palate was associated with deviations of global character related predominantly to the extent of retrusion of the upper and lower jaw. The skeletal profile was altered and its deviations were reflected by changes of the soft profile. Of the deviations of soft tissues per se were most important the flattening of the nose and reduction of the height and thickness of the upper lip, which underlined the presence of retrocheilia. Maxillary retrusion was more marked in complete than in incomplete unilateral clefts, while mandibular retrusion and maxillary dentoalveolar retroinclination were more marked in bilateral than in unilateral clefts. Occlusion was always impaired. In unilateral involvement, especially in complete clefts the more horizontal slope of the columella resulted in a marked reduction of the nasolabial angle. Incomplete clefts, similarly as cleft lip alone were not associated with a reduction of thickness of the upper lip and showed an increase of the vermilion height. Because of the persisting protrusion of the premaxilla bilateral clefts were accompanied by only a slight flattening of the skeletal profile and by an excessive nasal depth after the prolongation of the columella. The nasolabial angle was unchanged. The concavity of the upper lip was reduced in complete unilateral and bilateral clefts. Certain characteristics of the oronasal region disclosed a similarity between incomplete cleft lip and palate (in unilateral involvement) and cleft lip alone, however global deviations (due to skeletal changes) were identical with those recorded in complete clefts.

Adult↗

PubMed1990

[Role of substance P on neurogenic inflammation in the rat dental pulp and inferior lip].

A physiological role of substance P (SP) in inflammatory reaction was examined in the rat incisor pulp and inferior lip. SP content in pulps and lips significantly increased after antidromic stimulation of the inferior alveolar nerve. Following the same stimulation, vascular permeability also increased significantly in pulps and lips, and this permeability response was significantly inhibited by an SP-antagonist. Morphine reduced the permeability response to antidromic stimulation in pulps but had no effect in lips. N-methyl levallorphan (a peripherally selective narcotic antagonist) prevented the morphine-induced reduction, and was more potent than naloxone. Morphine caused a marked increase of SP content in pulps following antidromic stimulation of the inferior alveolar nerve but failed in lips. These suggest a possibility that a peripheral SP release-suppressive mechanism by opiates may exist in pulps but not in lips. The permeability response to antidromic stimulation was also reduced by aspirin and a bradykinin antagonist in both of the tissues, indicating that prostaglandin and bradykinin may be related to this response. Since mepyramine and methysergide inhibited the permeability response in lips but were inactive in pulps, there is a difference in participation of histamine and serotonin between the two tissues. SP injection into the dental pulp and lip induced dye leakage. This response was inhibited by compound 48/80 pretreatment in lips whereas it was resistant in pulps. Histamine content in lips decreased significantly after antidromic stimulation and compound 48/80 pretreatment, but it was not changed in pulps. The present results suggest that in lips after being released from the peripheral sensory nerve endings SP may act on vascular system through histamine release from mast cells, while in pulps SP may directly cause vascular response because mast cells may be few or not exist.

Animals↗

PubMed1990

[An evaluation of the functional lip posture].

The purpose of this study was to evaluate the relationship of the functional lip posture to the anterior teeth and gingiva and at the same time establish an objective esthetic standard in the clinic. The functional lip posture referred here were the smiling lip line and the maximum opening lip line. From an esthetic and clinical point of view, the functional lip posture was described, classified and scored using the relationship of the border of the upper and lower lip to the labial surface of the anterior teeth and gingiva. A device for taking standardized oral photographs with a high degree of reproducibility was used. Tjan, et.al. studied the esthetic factors in a smile. Using their classification the result of this study were as follows: high smile, 32%; average smile, 42%; and low smile, 26%. The difference in the amount of maxillary and mandibular gingival exposure were also determined in this study. The measurement of the maxillary area was used in classifying the smile since the mandibular area showed interproximal gingiva only. In analyzing the maximum opening lip line, it was not possible to apply Tjan's classification since it referred only to the smile line. A scoring system (smile score) was devised, instead, to evaluate the functional lip posture. By this scoring system, the smiling lip line was classified using the maxillary teeth and gingiva only. The classification were as follows: high smile, score was over 4; average smile, from 3-4; and low smile, under 3. Note that the maxilla was used as reference in analyzing the smiling lip line and the mandible for the maximum opening lip line.

Cuspid↗