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PubMed1997

The Millard rotation-advancement lip repair using accurate measurements.

For many years a wide variety of surgical techniques for closure of unilateral cleft lip has been used. Still many surgeons prefer the Millard rotation-advancement lip repair because the surgical scar is masked in the filtrum crest and the nostril floor, and it improves the relationship of the alar base of the cleft side, producing harmonious symmetry of the nostril and the nostril sill. In addition, it uses and preserves the lip anatomy, returning lip tissue into its normal position, minimizing the amount of tissue that is discarded, and reconstructing the orbicular oris muscle. One of the major disadvantages of this procedure is the lack of accurate measurements. This article demonstrates that rotation-advancement lip repair can be performed with accurate measurements as in the Tennison-Randall lip repair and tends to invalidate the widely held belief that rotation-advancement lip repair is a "cut as you go" technique.

Cicatrix↗
PubMed2000

Philtral construction by composite skin-muscle rotation and orbicularis oris muscle advancement in secondary cleft lip deformity.

The authors describe a method of philtral construction in a secondary cleft lip deformity to achieve better philtral definition and natural lip animation. The operation begins with a skin incision based on the usual design of secondary revision. Subcutaneous undermining is then performed laterally, and medially up to the line of the new philtral ridge, where the lip is divided vertically to the mucosa. A wedge-shaped flap is developed in the medial lip by dissecting from the posterior mucosal wound edge toward the cutaneous midline up to the dermis. The composite skin-muscle flap is thus elevated and rotated 90 deg on the axis of the cutaneous midline to form the philtral ridge. The orbicularis oris muscle is reapproximated in the midline by advancing the lateral orbicularis segment. The wedge-shaped flap is placed over the advanced orbicularis, and the skin is closed. Ten consecutive patients, followed for more than 6 months, were evaluated. In all patients the lip showed a well-defined philtrum with sufficient thickness and smooth continuity. Natural lip animation was also reproduced. Purportedly, the composite skin-muscle rotation provides a well-defined philtrum, and the midline approximation of the orbicularis muscle provides natural lip animation.

Adolescent↗
PubMed1982

A comparative study of facial growth following cleft lip repair with or without soft-tissue undermining: an experimental study in rabbits.

The present study was performed in rabbits to test the hypothesis that incisions in the sulcus and soft-tissue undermining at the time of cleft lip repair contribute more to midfacial growth inhibition and aberrations than lip repair only. The design of this study, using three control groups, permitted assessment of the effects of soft-tissue undermining independently of the other surgical procedures. This study revealed that lip repair combined without soft-tissue undermining. Direct cephalometry on the skulls indicated that anteroposterior facial growth was most severely affected mean quantitative assessment revealed that anteroposterior facial growth inhibition was significantly greater when lip repair was combined with soft-tissue undermining than without. Maxillary width was found to be the greatest in groups 3 and 4 compared with the other two groups. Mean quantitative assessment revealed that lip repair with or without soft-tissue undermining was shown to overcorrect normal transversal growth. Significant growth aberrations also were found in maxillary height, posterior facial height, and nasal deflection. Constant high lip pressure can be explained as a result of an interaction of lip repair and scar contraction from soft tissue undermining. Results of this study cannot be readily transferred to the clinical setting, but they present the first documented evidence elucidating the influence of soft-tissue undermining on facial growth. Further experimental and clinical research is needed to determine the extent of growth inhibition that may be related to the use of this procedure.

Animals↗
PubMed1988

Analysis of the lengthening effect of the muscle repair in functional cleft lip repair.

In 14 patients undergoing functional cleft lip repair, changes in the lengths of the key lip segments were measured preoperatively, after the muscle layer was repaired, and after the skin was repaired using pieces of wire bent to follow the curves of the lip in three dimensions. The cleft side of the lip was shorter than the normal side in the vertical and horizontal dimensions. Freeing the muscle from its dermal insertions, splitting it, and advancing it into the medial side of the cleft lengthened the cleft side of the lip vertically and horizontally. The Z-plasty skin repair further lengthened the cleft side of the lip in the vertical dimension. The lengthening effect of the muscle repair appears to be the result of the loose skin redraping over the dissected muscle and further explains elimination of the orbicularis bulge and superior scar formation in the functional cleft lip repair.

Cleft Lip↗
PubMed1998

A new principle for unilateral complete cleft lip repair, the lateral columellar flap method.

This article presents a different method for unilateral complete cleft lip repair. The tissue deficiency of the medial lip segment is filled with a flap from the lateral surface of the columella, which is in continuity with the lip segment. The lateral columellar flap and the medial lip segment are lowered in one piece vertically downward to such a position that the height of the arch of the Cupid's bow is equal on both sides. No lateral advancement is done. The suture line of the medial and lateral lip segments is an uninterrupted straight line, which imitates the natural line of the philtral column. The repaired lip has more fullness than the lips repaired with the conventional methods. The procedure is described in detail.

Cleft Lip↗
PubMed2003

Lip augmentation using eyelid tissue from upper blepharoplasty surgery.

PURPOSE: To study the efficacy of eyelid tissue removed during upper eyelid blepharoplasty as a filler graft to augment lips. METHODS: A prospective study involving 14 female patients who underwent lip enhancement with eyelid tissue. All patients underwent CO2 laser upper eyelid blepharoplasty and desired fuller lips. The eyelid tissue was deepithelialized with the CO2 laser before implantation in the lips. Patients were followed for 6 months, and an objective grading scale based on photographs was used to assess outcomes. RESULTS: In each case, the patient's lips were substantially fuller at 6 months after surgery. Patients were pleased with the natural feel and appearance of their lips. One patient had a bacterial infection, which was successfully treated with oral antibiotics. CONCLUSIONS: Eyelid tissue from upper blepharoplasty surgery provides a quick, economical and natural method to enhance lip volume.

Adult↗
PubMed2006

Prolabial lengthening by Turkish tulip method in bilateral cleft lip repair.

OBJECTIVE: In bilateral cleft lip, there is a characteristic deformity called cleft lip nose characterized by short columella and prolabium with a pressed nose. Although lots of surgical techniques were described for columella lengthening and correction of the nose deformity, no technical method was suggested for prolabium lengthening. STUDY DESIGN: In this paper we propose a simultaneous bilateral cleft lip repair and lengthening of the prolabium, and describe a new technique called "Turkish tulip" for this aim. PATIENTS AND METHOD: Eleven patients (6 males and 5 females) with bilateral cleft lip were treated using this method. Patients' ages ranged from 3 months to 17 years at the time of operation. Five patients had incomplete and six had complete bilateral cleft lips. The patients were evaluated in terms of functional and aesthetic results in postoperative period. RESULTS: : The average follow-up time was 8 months (ranged from 4 months to 15 months). There were no postoperative complications. The prolabium was lengthened adequately in all patients. No notch and whistle deformity was seen in our series. The patient or parent satisfaction was good or perfect in all cases. CONCLUSIONS: To avoid the disadvantage of the long time course required to correct the nose deformity and to lengthen the prolabium, we propose the "Turkish tulip" technique with the primary repair of bilateral cleft lips simultaneously. With this technique it is possible to lengthen the columello-prolabial complex with cleft lip repair in the same session without any intervention to any part of the nose including the columella. As a preliminary study, according to the early results, this new technique seems to have good cosmetic outcomes.

Adolescent↗
PubMed1991

Clinical and histological analysis of labial lip biopsy in Sjögren syndrome.

Labial lip biopsy findings from 52 patients with Sjögren syndrome (SjS) and cutaneous manifestations were clinically analyzed. Findings of the labial lip biopsy with more than one focus (a cluster of at least 50 lymphocytes) were positive in 52% (28/52). Sixteen patients who presented with oral dryness had negative labial lip biopsy findings with less than one focus score and five patients without oral dryness had positive results. Cells infiltrating into the salivary gland were categorized as plasma cell rich (Group 1), lymphocyte rich (Group 3), intermediate (Group 2), or no gland in biopsied specimens (Group 4). Sicca complaint and the grade of lip biopsy score were significantly higher in Group 3 than in Group 1; no differences were observed in laboratory findings between Groups 1 and 3. The patterns of age distribution and salivary flow rate were also not statistically significant in these two groups. The patients with plasma cell rich infiltrate presented oral dryness, although their clinical and grade of lip biopsy scores were relatively low; most of these patients have secondary SjS. Some of the patients in Group 4 showed an advanced stage of the disease through their lip biopsy score was grade 1 with atrophic or no gland. These data suggest that labial lip biopsy is a useful screening method for the diagnosis of Sjögren syndrome and that clinical manifestations may differ in parallel with the type of infiltrating cell.

Adolescent↗
PubMed1996

p53 protein expression in malignant, pre-malignant and non-malignant lesions of the lip.

AIM: To elucidate the role of the p53 tumour suppressor gene in the pathogenesis of lip cancer. METHODS: Expression of p53 was evaluated immunocytochemically in a retrospective study of formalin fixed, paraffin wax embedded tissue. Five cases each of four types of lip lesions were studied; these comprised squamous cell carcinoma (SCC), solar keratosis (SK), chronic hyperplastic candidosis (CHC), and lichen planus (LP). Five cases each of normal lip mucosa, SCC, and SK from sun exposed facial skin as well as LP, CHC, and SCC from buccal mucosa were also analysed. Immunolocalisation of p53 was scored semiquantitatively. The degree of apoptosis was also assessed in selected lesions by determining cell nuclear fragmentation. RESULTS: All SCCs from lip lesions were immunopositive for p53. All cases of SK and two of five CHC lip lesions were also p53 positive. Normal lip mucosa samples were p53 negative. Sun exposed skin lesions of SCC and SK were all positive for p53, but only three of five cases of SCC from the buccal mucosa had detectable levels of p53. p53 expression was not detected in CHC and LP lesions of the buccal mucosa. CONCLUSIONS: The aberrant expression of p53 is likely to occur early in the pathogenesis of lip cancer and may be related to exposure to the sun. The immunopositive p53 cells identified in the benign LP lesions do not necessarily correlate with commitment of cells within the lesion to programmed cell death. In light of the prior reports which indicate that p53 positive cells may progress to form malignant tumours, it is suggested that patients with p53 positive but otherwise benign lesions should be followed more closely.

Biomarkers↗
PubMed1986

A new technique for total reconstruction of the lower lip in a patient with malignant melanoma.

A very rare case of malignant melanoma of the lower lip was presented. While there are many concepts and techniques for reconstruction of the lower lip including advancement flaps, switching flaps, rotation flaps, and regional flaps from the cheek, upper lip, tongue, forehead, neck, and chest, no single flap is ideal in every instance. Lower lip reconstruction utilizing a modification of bilateral nasolabial flaps has been described. The distinct advantages of utilizing myocutaneous flaps in a Z augmentation manner, including the maintenance of good functional competence of the lower lip, maintenance of adequate oral commissure diameter, and a good cosmetic result, have been demonstrated. While no single technique for reconstruction of the lower lip is ideal for every case, we feel that the method presented here offers a very good option when faced with the challenge of complete reconstruction of the lower lip.

Female↗
PubMed1993

Soft-tissue profile changes during widening and protraction of the maxilla in patients with cleft lip and palate compared with normal growth and development.

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant increases of the sagittal maxillomandibular lip relation (angle SS-N-SM: mean increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonion line (ss.pg) revealed an improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasionsella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Cephalometry↗
PubMed1996

Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP.

Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO)-35 patients without surgical treatment; (2) operated lip group (OL)-23 subjects with lip closure only; (3) operated lip and palate group (OLP)-35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.

Adolescent↗
PubMed1979

Columella lengthening in bilateral cleft lip patients. Experience with the forked flap procedure.

All patients with bilateral complete clefts of the lip and some patients with incomplete clefts have a short or almost non-existing columella. This is a characteristic deformity which can only be corrected by surgical lengthening of the columella. Among the numerous methods which have been used for this purpose, the forked falp method as described by Millard (1958) has certain advantages: 1. Sufficient donor tissue is available in the lateral parts of the prolabium to produce full lengthening of the columella and adequate projection of the tip of the nose. 2. Most patients with bilateral clefts need secondary correction of the lip scars and a narrowing of the nostrils after the primary operation. Both of these objectives are achieved as a part of the forked flap procedure. 3. Access is gained both to the lip muscles and to the alar cartilages at the tip of the nose. 4. Narrowing of the lip in the upper part results in a natural eversion of the lower part, and a short lip can be lengthened by letting the remaining central part of the prolabium go down during suturing. 5. The scars left in the upper lip are in an unobtrusive position corresponding to the philtral ridges. During the period 1965-77, 87 patients with bilateral cleft lip have had a columella lengthening performed according to the forked flap method. Our experience with this method has been very favourable. No serious complications have ensued, and the cosmetic results have been most satisfactory in the majority of cases.

Adolescent↗
PubMed1986

Observations about the normal and abnormal embryogenesis of the canine lip and palate.

Twenty-three puppies with cranofacial and limb abnormalities from a family of Australian shepherd dogs were studied anatomically. Limb abnormalities included lumbar scoliosis, short malformed tibias and fibulas, and polydactyly. Craniofacial abnormalities consisted of retronathia, cleft palate, and cleft lip. The clefts can be separated into three categories: group I, cleft of the secondary palate associated with a midline cleft lip; group II, unilateral cleft of the lip and primary and secondary palate; and group III, complete bilateral cleft of the lip and primary and secondary palate. Comparing human clefts with the canine clefts suggests that the development of the secondary palate is similar whereas the development of the upper lip is different. In the dog, the maxillary processes fuse in the midline to produce the majority of the upper lip, whereas in the human the upper lip is composed of fused maxillary and medial nasal processes.

Animals↗
PubMedDate not supplied

Development of the upper lip.

OBJECTIVES: To affirm and reanalyze George L. Streeter's "merging theory" of upper-lip development in primates by observing progressive embryologic stages in facial development using scanning electron microscopy (SEM) and to further understand upper-lip development. DESIGN: The study was conducted at the California Regional Primate Research Center, Davis. Twenty primate embryos (Macaca fascicularis) and 2 fetuses were examined with SEM. The development of the frontonasal prominence, maxillary prominence, medial nasal prominence, and lateral nasal prominence were sequentially observed. The contribution of these prominences to the formation of the upper lip and nose were carefully analyzed. RESULTS: The maxillary prominence and medial nasal prominence form the upper lip, whereas the lateral nasal, medial nasal, and maxillary prominences form the nose. There is fusion of the maxillary prominence with the medial nasal prominence. This fusion has not been previously described. This has resulted in a modification of the current theory of upper-lip development into one we refer to as the "dynamic fusion theory." CONCLUSIONS: The dynamic fusion theory explains the merging process of the mesenchymal and ecotodermal layers of the facial prominences that contribute to the upper-lip formation. The dynamic fusion theory of facial prominence movement details the interaction between epithelial layers: both epithelial layers must fuse properly to avoid cleft-lip deformities.

Animals↗
PubMed2000

p53 mutational spectra are different between squamous-cell carcinomas of the lip and the oral cavity.

We studied the p53 mutational spectra of 34 lip and 60 intra-oral squamous-cell carcinomas and examined possible etiological and prognostic correlations for these tumor sites. For the p53 analysis of exons 5-8, we used PCR/TGGE screening followed by DNA sequencing. Mutations were found in 18/34 (53%) lip and 22/60 (38%) intra-oral carcinomas. The p53 mutational spectrum of the intra-oral carcinomas comprised transitions and transversions in nearly equal frequency (11 to 10). In comparison, transitions were 3.5 times more frequent than transversions (14 to 4) in carcinomas of the lip. The predominant types of base change found in intra-oral tumors were G:C-to-T:A transversions and G:C-to-A:T transitions (32% each), while in lip tumors G:C-to-A:T transitions (70%) were the most frequent. The rate of lip tumors with mutations was higher in non-smokers (8/13) than in smokers (9/20). In contrast, p53 mutations in intra-oral tumors clustered in smokers (18/47 vs. 2/10). G:C-to-T:A transversions, regarded as tobacco smoke-associated in lung cancer, were found in 2 moderate and 4 heavy smokers with intra-oral cancer. This base substitution was found in none of our lip cancers. In lip tumors, a high rate of mutations occurred at dipyridine sites (13/18); among these were 8 C-to-T transitions and 1 CC-to-TT tandem base transition. These changes are characteristic of DNA damage caused by UV light. The presence of mutational events at the DNA-binding surface of the p53 protein may correlate with poor clinical outcome. However, we could not find any statistically significant correlations between p53 status and survival. Only the recurrence-free interval was significantly shortened in cases with mutations affecting residues of the DNA-binding surface of the p53 protein.

Alcohol Drinking↗
PubMed1984

Left cleft lip predominance and genetic similarities of L line and CL/Fr strain mice.

Newborn litters of the L line and CL/Fr and A/JFr strains were examined, and sex, frequency and type of cleft lip (left, right or bilateral) were recorded. Embryos and fetuses from crosses between these strains and line were collected on days 13 to 16 of gestation, and frequency and type of cleft lip recorded. Overall cleft frequencies in L X CL/Fr, CL/Fr X L, and CL/Fr X A/JFr crosses (female stated first) were similar, while in A/JFr X L (10.3%) they were significantly lower than in L X A/JFr (23.3%). The data suggested that the same maternal effect genes were present in CL/Fr and the related L line and absent from A/JFr. In the L, CL/Fr, and A/JFr newborns, there was a tendency for males to have higher frequencies of cleft lip and bilateral cleft lip and the latter was significant for L. Left cleft lip frequency was significantly higher than right for L and CL/Fr newborns and in embryos of the CL/Fr X L and L X CL/Fr cross. No significant differences in laterality were found in the A/JFr strain, A/JFr X L, L X A/JFr, and CL/Fr X A/JFr crosses. It was concluded that (1) the embryonic and maternal effect genes for cleft lip are similar or identical in CL/Fr and L; and (2) using data from the literature, there are additional genetic factor(s) increasing left cleft lip occurrence acting in the embryo, which are present in CL/Fr, L, A/HeJ, A/He, and A/St and absent from A/JKt, A/J, A/JFr, and A/WySn.

Animals↗
PubMed1994

The role of lip configuration in monkey vocalizations: experiments using xylocaine as a nerve block.

Human and nonhuman primates commonly alter the configuration of their lips during vocal production and thereby modify vocal tract length and shape. In nonhuman primates, however, the effects of lip configuration on call structure are unknown. This study was designed to investigate the importance of lip configuration in rhesus monkey (Macaca mulatta) vocal production by temporarily blocking lip movement with injections of xylocaine. For "coo" vocalizations, an affiliative contact call that is normally produced with protruded lips, the xylocaine treatment had no statistically significant effect on call duration or characteristics of the fundamental frequency (i.e., features associated with respiration and laryngeal function). However, the two formant frequencies (i.e., features resulting from the filtering properties of the supralaryngeal cavity) of the call were significantly effected. Specifically, formant frequencies increased, as would be expected from an individual incapable of compensating for a shortened vocal tract. In contrast to coos, xylocaine had no statistically significant effect on the acoustic structure of "noisy screams," a call given in response to being attacked by a dominant and produced with retracted lips (i.e., a shortened vocal tract). Results suggest that for some vocalizations, lip configuration may be essential for achieving the intended acoustic target, whereas for other vocalizations, it is less important.

Animals↗