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Five percent lidocaine cream applied simultaneously to the skin and mucosa of the lips creates excellent anesthesia for filler injections.

BACKGROUND: Injection of filler substances into the lips is painful, and many patients also find the injection of local or regional anesthesia into the lips painful. OBJECTIVE: To develop a highly effective and painless form of anesthesia to facilitate injection of filler substances into the lips. METHODS: Five percent lidocaine cream was applied simultaneously to the skin, vermilion, and mucosa of the lips (with the use of a barrier to keep the cream in contact with the mucosa and out of the rest of the mouth) for 20 to 30 minutes. RESULTS: Profound anesthesia of the lips was reliably produced, with no complications. CONCLUSIONS: This "anesthetic cream block" is easier to perform and better tolerated than injectable anesthetics. Use of this technique is likely to expand the range of physicians who perform filler injections on the lips and will probably also expand the range of patients who wish to have filler injections done on their lips and who (because they had little or no discomfort) are willing to return for additional filler injections in the future.

Anesthetics, Local↗

The ganglionic origins and central projections of primary sensory neurons innervating the upper and lower lips in the rat.

Retrograde and transganglionic transport of horseradish peroxidase (HRP) was used to investigate the neurons innervating the upper and the lower lips and their central projections in the rat. Both the upper and the lower lips were observed to be innervated by a very large number of trigeminal sensory neurons, with their cell bodies located in the maxillary and the mandibular parts of the trigeminal ganglion, respectively. The central projections of neurons innervating the upper lip formed a long continuous column starting rostrally at midlevels of the trigeminal main sensory nucleus (5P) and extending caudally through the C1 dorsal horn, with occasional fibers reaching the C3 segment. The heaviest projections appeared in the middle portions of 5P and nucleus interpolaris (5I), as well as in the rostral part of nucleus caudalis (5C). A small but consistent projection to the solitary tract nucleus, originating from cells in the inferior vagal ganglion, was observed in the upper-lip experiments. The central projections from neurons innervating the lower lip also appeared as a long column located dorsally or dorsomedially to the projections from the upper lip. The most prominent projections from the lower lip were located in the caudal part of 5P, the middle part of 5I, and the caudal two-thirds of 5C. Sparse projections could be traced as far caudally as C4. At 5C and cervical levels, some labeling appeared contralaterally in the same location as on the ipsilateral side.

Animals↗

Reconstruction of the lower face and lips.

The first step in rehabilitation of massive lower face injuries is usually control of drooling by the Wilkie operation. When destruction is extensive, the floor of the mouth, chin, upper neck, and mandible should be first restored as a foundation on which the lower lip is independently reconstructed. Local tissue should be used as much as possible. All remnants of normal lip tissue should be conserved and utilized in the reconstruction. When both lips are damaged, upper lip segments are often best used to fill out the lower lip, with total reconstruction of the upper. Although many of the principles of treatment of these injuries are well established, there are still major unsolved problems. These include adequate support of the lower lip, maintenance of the flat shape of the lips, and determination of the end-point of surgery.

Cheek↗

Lip prints (cheiloscopy).

External surface of the lip has many elevations and depressions forming a characteristic pattern called lip prints, examination of which is referred to as cheiloscopy. This is unique for individuals like the finger prints. The biological phenomenon of systems of furrows on the red part of the human lips was first noted and described by anthropologist R.S. Fischer, in 1902. However until 1930, anthropology merely mentioned the existence of furrows without suggesting a practical use for the phenomenon. Since 1950, the Japanese have carried out extensive research in this matter. In the period 1968 to 1971, Y.T Suchhihashi and T. Suzuki examined 1364 persons at the department of forensic odontology at Tokyo university and established that the arrangement of lines on the red part of the human lips is individual and unique for each human being. Lip print recording is helpful in forensic investigation that deals with identification of humans, based on lip traces. A lip print may be revealed as a surface with visible elements of lines representing the furrows. This characteristic pattern helps to identify the individuals since it is unique for individuals. When the lines are not clear (Only the shape of lines is printed), individual identification of human being based on this trace is extremely difficult, unless the trace contains more individual characteristics like scars, clefts etc, and often identification ends with group identification.

Adult↗

[A study of individual operation designs for bilateral cleft lip repair].

OBJECTIVE: To design an individual operation procedure that can be adaptable to various deformity of bilateral cleft lip and to assure the symmetry of lip and cupid's bow postoperatively in bilateral cleft lip. METHODS: The distance from both sides of columella to cupid's bow peaks in prolabium as well as both sides of alar base to cupid's bow peaks in lateral lip has been used as standard of classification of the deformity of bilateral cleft lip, then operative procedures respectively was designed in accordance with each special characteristic of bilateral deformity. RESULTS: Five kinds of operation procedures were designed, and each procedure was suitable only for one kind of preoperation deformity of bilateral cleft lip. CONCLUSION: The individual operation designs should be corresponding to the types of deformity before operation in bilateral cleft lip repair.

Cleft Lip↗

[Presurgical orthopedic treatment for cleft lip and palate].

INTRODUCTION: A multidisciplinary approach with several specialits allows a complete treatment for Cleft Lip and Palate. We show our experience in presurgical orthopedic treatment in these patients, their advantages, their problems and the results. MATERIAL AND METHODS: Since 1999 presurgical orthopedy has been applied to 12 patients (3 bilateral cleft lip and palate and 9 unilateral cleft lip and palate). This approach was applied when there was a long distance between the alveolar segments. A palate mould and the location of Latham's appliance have been made in the operating room under general anesthesia. The patients were controlled by the orthodoncist and Latham's appliance was removed when cleft lip was closed. RESULTS: Latham's appliance was kept for 4-7 weeks with once a week controls until the distance between the maxillary segments was less than 1 mm; in bilateral cases of cleft lip and palate the premaxilla was moved between lateral segments. Then, lip closure and nasoplasty was made and, sometimes, an obturador was placed. CONCLUSIONS: Latham's appliance permit to achieve a perfect alignment of alveolar segments decreasing the soft tissues tension and facilitating the lip surgery, thus, a better aesthetic and functional results can be achieved. A more anatomic position of palate can be made and easier future orthopedic treatments are possible.

Child, Preschool↗

[A clinical study of presurgical nasoalveolar molding in infants with complete cleft lip and palate].

OBJECTIVE: To observe the clinical effect of presurgical nasoalveolar molding in infants with complete cleft lip and palate. METHODS: Presurgical nasoalveolar molding was performed in 38 infants with cleft lip and palate (26 patients with unilateral cleft lip and palate, 12 patients with bilateral cleft lip and palate), aged between 5 and 30 days. The width of alveolar cleft was measured before and after the operation and the effect of treatment was assessed. RESULTS: After 108 - 152 days of therapy, the average width of alveolar cleft decreased by 5.3 mm in 26 patients with unilateral cleft lip and palate. Nasal profile was improved in 76 percent of cases. In 12 patients with bilateral cleft lip and palate, the average width of left cleft decreased by 4.7 mm and that of the right decreased by 4.2 mm. The distance between right and left cleft increased by 5.1 mm. Nasal profile was improved in 66 percent of cases. CONCLUSION: Presurgical nasoalveolar molding in complete cleft lip and palate can improve nasal profile and decrease the width of alveolar cleft.

Alveolar Process↗

[The beauty perspective of the horizontal lip position].

The purpose of the present study was to explore the role of horizontal lip position in the evaluation of beauty in a lateral facial profile. The sample size of 1,000 students were randomly selected from all the Junior High Schools in the city of Taipei. One hundred and ten 12-year-old students were judged to be good looking and were selected by 7 panelists of different educational backgrounds. The 110 good-looking students were composed of 83 males and 27 females. Absolute horizontal lip position (the shortest distance between tip of lip and the reference line used) and relative horizontal lip position (the difference between lower and upper lip position) were analyzed between males and females, then between the good-looking group and the non-good-looking groups. The following conclusions were drawn from the results: 1. The requirement on the soft-tissue lateral profile of females is more straight than that of males. 2. According to Ricketts' E line, Steiner's S1 line and Burstone's B line, the relative lip position between 0 to +2 is acceptable to most people. 3. Fullness of lips is more readily accepted by people for males than females. 4. Further investigation of the effectiveness of Holdaway's H line and Sushner's S2 line is desperately needed. Their reference consistency vibrated a lot in this study.

Analysis of Variance↗

Current management of cancer of the lip.

Carcinoma of the lip is the most common cancer of the oral cavity, occurring most frequently on the lower lip of elderly males. Less advanced neoplasms may be treated equally successfully by surgery or irradiation, and results are cosmetically acceptable by both methods. Reconstruction of the lip following surgical ablation of tumor usually consists of primary repair. Larger defects require flaps from the opposite lip, adjacent cheek, or more distant tissue. Although prophylactic neck dissection is usually not indicated, the presence of neck metastases from carcinoma of the lip is best managed by neck dissection followed by postoperative radiotherapy. The prognosis for curing lip cancer is dependent upon the size of the primary tumor and whether cervical metastasis has occurred. The overall five-year cure rate of lip cancer approximates 80%. The cure rate of patients with neck metastases is approximately 50%.

Carcinoma↗

Lip reconstruction with motor and sensory innervated composite flaps.

Among the most elegant of recent flap refinements are innervated composite skin-muscle-mucosal flaps that restore the oral sphincter and carry both motor and sensory nerves. These flaps are based on the orbicularis oris, depressor anguli oris, and levator anguli oris perioral muscles of facial expression. Each flap can be dissected in a manner that allows transfer of the muscle into the oral sphincteric ring while restoring lip form and preserves the motor and sensory innervation. Each flap can be designed to carry skin and mucosa as needed for cover, lining, and vermilion reconstruction. Choice is determined by the specific anatomic lip defects. The orbicularis oris flap is most useful for large central defects of either the upper or lower lip. The depressor anguli oris flap is most useful for lateral lower lip defects or total lower lip reconstruction with bilateral flaps. The levator anguli oris is most useful for upper lip lateral element defects or for total upper lip restoration with bilateral flaps and an Abbe flap philtral reconstruction. Innervated composite flaps demonstrate substantial advantages when compared with preceding methods because of the superior function conveyed by the sphincter reconstruction and preserved motor and sensory nerve innervation.

History, 15th Century↗

[Cleft lip and cleft palate in the Craniofacial Center, Chang Gung Memorial Hospital: incidence, sex, seasonality and topographic distribution].

Of 2963 patients registered at the Chang Gung Craniofacial Center, 1755 patients (906 males and 849 females) who did not have any previous surgery were carefully delineated according to cleft side, involvement of primary or secondary palate and severity of cleft. Cleft lip and palate (43.88%) was the most common cleft, cleft palate (30.88%) the second, while cleft lip (25.24%) the least. More males were found in cleft lip group or cleft lip and palate group, and more females in the cleft palate group. Regarding clefts involving both primary and secondary palates, the cleft of both palates was usually complete, but when the clefts involved either the primary or secondary palate, the cleft was usually incomplete. With regards to the laterality of unilateral cleft lip and/or palate, the left side was affected more than right side. With regard to seasonal variation, cleft palate patients showed the highest incidence from August to October and the lowest incidence from November to January. Cleft lip or cleft lip and palate patients showed the highest incidence from November to February but no obvious difference in the rest of the months. Topographic distribution disclosed that more patients were domiciled in the area north to Hsien-Chu, especially the urban Taipei area.

Adolescent↗

Major genes that cause cleft lip in mice: progress in the construction of a congenic strain and in linkage mapping.

The major gene that causes cleft lip in the A/WySn mouse strain is being transferred to the unrelated normal AEJ/GnRk strain background by the backcross-testcross method. The result, a congenic strain pair differing only at the major cleft lip locus and closely linked loci, will allow the unequivocal identification of the genetic lesion that causes cleft lip. Four backcross generations have been completed, and the background geneotype is calculated to be 97% of AEJ/GnRk origin. The recovery of the cleft lip trait in testcrosses of each generation is compatible with the expected values for the transfer of a single major gene with 8% penetrance. Multilocus inheritance beyond two loci is ruled out. In separate experiments using mostly Robertsonian chromosomes as markers of the normal allele at the cleft lip locus, portions of the genome have been screened for the map location of the cleft lip gene. The gene is probably not within 10-20 cM of the centromere of 12 different identified autosomal chromosomes nor linked to Ph on chromosome 5. Previous studies have suggested that the cleft lip gene is not linked to c (chromosome 7), b (chromosome 4), d (chromosome 9), T, H-2 (chromosome 17), or N (chromosome 15).

Alleles↗

Does reduced hospital stay affect morbidity and mortality rates following cleft lip and palate repair in infancy?

Insurance carriers affected decisions regarding admissions and length of stay in our hospital in 1987. Charts were reviewed retrospectively to determine whether this affected morbidity and mortality rates following cleft lip and palate operations in infants. Two periods were studied: May of 1983 through April of 1987 (group I) and April of 1987 through May of 1991 (group II). A total of 248 infants with cleft lip and/or palate underwent 398 operations: lip adhesion (74), definitive lip repair (130), and palatoplasty (194). Half were performed in each period. Admission status, length of stay, length of operation, and short-term morbidity were documented. Morbidity included spontaneous and traumatic lip dehiscence, palatal dehiscence, and palatal fistula. Intergroup analysis was performed by the chi-squared method; p < or = 0.05 was statistically significant. In group I, 93 percent of patients were admitted before surgery. In group II, 5 percent were admitted before surgery and 79 percent the day of surgery. Hospital stay decreased nearly 2 days for each operation. There was no statistically significant difference between groups in distribution of operations, length of operations, or morbidity: lip surgery complications (p = 0.263), palatoplasty complications (p = 0.624). Reductions of hospital admissions and length of stay do not affect outcome of cleft lip and palate surgery in infants. The reduction in hospital days is equivalent to a savings of $138,000 (1991 dollars).

Ambulatory Surgical Procedures↗

The prevalence of chapped lips during an army hot weather exercise.

OBJECTIVES: To identify risk factors associated with chapped lips in soldiers during prolonged exposure to a hot, dry environment. METHODS: We examined 1,053 of 2,500 soldiers (42%) participating in a desert training exercise at Fort Irwin, California, in September 1983. We measured the prevalence of chapped lips during the third week of a 4-week training period. Our independent variables (complexion, sex, lip protectant use, age, and the prevalence of recurrent herpes labialis) were obtained by observation and interview. RESULTS: We found severe chapping in 150 (10%) and moderate chapping in 247 (23.5%) of the soldiers. Stepwise ordinal logistic regression was used to identify risk factors associated with chapped lips and to determine the prevalence odds ratios (OR). Risk factors with statistically significant associations with chapped lips were the presence of recurrent herpes labialis (OR = 2.88), very fair complexion (OR = 3.23), and fair complexion (OR = 1.58). CONCLUSIONS: Moderate to severe chapping occurred in approximately one-third of the soldiers. Lip protectants appeared to be relatively ineffective in the prevention and treatment of chapped lips but were associated with a lower prevalence of recurrent herpes labialis.

Adolescent↗

Analysis of nasal and labial deformities in cleft lip, alveolus and palate patients by a new rating scale: preliminary report.

INTRODUCTION: In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analysed and the relevant role of the perinasal-perioral muscular balance, and the inborn dislocation of the alar cartilages is presented. PATIENTS AND METHODS: 50 CLAP patients were analysed in whom 29 primary cheiloplasties, 12 lip revisions and 9 rhinoplasties were performed. The lip repair was done by a modification of Millard's technique, the nose by either a closed or open-sky rhinoplasty. The severity of the cleft appearance was evaluated pre- and postoperatively, according to a pre-agreed visual rating scale. There were 4 degrees of severity of the deformity preoperatively (mild, moderate, severe and very severe), and postoperatively 5 categories of outcome (excellent, very good, good, satisfactory and poor) depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. RESULTS: 17 excellent, 4 very good, 2 good, 5 satisfactory and 1 poor result were obtained in the group of primary cheiloplasty. Eight excellent, 4 very good results were obtained by the lip revisions. Seven excellent and 2 satisfactory results were obtained following rhinoplasty. CONCLUSIONS: During the primary lip repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. When correct insertion of m. transversus nasi to the nasal spine is achieved and a good repair of m. orbicularis oris, symmetry of the alae and normal growth of lip and columella was obtained even in most severe bilateral cases. In cases of diastasis of the orbicularis and transversus nasi muscles, in combination with other soft tissue deformities or scars, a secondary musculo-periosteal revision is recommended. The defect of the soft tissue triangle of the nose is best corrected via an open rhinoplasty.

Adolescent↗

Ornithine-vasopressin gangrene and reconstruction of the upper lip. Case report.

A bilateral cleft lip and palate case received ornithine-vasopressin intra-operatively in preparation for a vasoconstricted field of the various lip segments prior to the repair of the cleft lip. A cyanotic tinge appeared immediately. This eventually led to total necrosis of the upper lip. Various relevant blood tests were done and a mild thrombocytosis was found. Surgical reconstruction of the upper lip was performed by means of a forked cross-lip flap--the main blood supply coming from the columella--as well as by means of an inferiorly pedicled cheek flap from the para-nasal area.

Cleft Lip↗

Neural correlates of reward and attention in macaque area LIP.

Saccade reaction times decrease and the frequency of target choices increases with the size of rewards delivered for orienting to a particular visual target. Similarly, increasing rewards for orienting to a visual target enhances neuronal responses in the macaque lateral intraparietal area (LIP), as well as other brain areas. These observations raise several questions. First, are reward-related modulations in neuronal activity in LIP, as well as other areas, spatially specific or more global in nature? Second, to what extent does reward modulation of neuronal activity in area LIP reflect changes in visual rather than motor processing? And third, to what degree are reward-related modulations in LIP activity independent of performance-related modulations thought to reflect changes in attention? Here we show that increasing the size of fluid rewards in blocks reduced saccade reaction times and improved performance in monkeys performing a peripherally-cued saccade task. LIP neurons responded to visual cues spatially segregated from the saccade target, and for many neurons visual responses were systematically modulated by expected reward size. Neuronal responses also were positively correlated with reaction times independent of reward size, consistent with re-orienting of attention to the saccade target. These observations suggest that motivation and attention independently contribute to the strength of sustained visual responses in LIP. Our data thus implicate LIP in the integration of the sensory, motor, and motivational variables that guide orienting.

Action Potentials↗

LIP-1 phosphatase controls the extent of germline proliferation in Caenorhabditis elegans.

Caenorhabditis elegans germline cells are maintained in an undifferentiated and mitotically dividing state by Notch signaling and the FBF (for fem-3 binding factor) RNA-binding protein. Here, we report that the LIP-1 phosphatase, a proposed homolog of mitogen-activated protein (MAP) kinase phosphatases, is required for the normal extent of germline proliferation, and that lip-1 controls germline proliferation by regulating MAP kinase activity. In wild-type germ lines, LIP-1 protein is present in the proximal third of the mitotic region, consistent with its effect on germline proliferation. We provide evidence that lip-1 expression in the germline mitotic region is controlled by a combination of GLP-1/Notch signaling and FBF repression. Unexpectedly, FBF controls the accumulation of lip-1 mRNA, and therefore is likely to control its stability or 3'-end formation. In a sensitized mutant background, LIP-1 can function as a pivotal regulator of the decision between proliferation and differentiation. The control of germline proliferation by LIP-1 has intriguing parallels with the control of stem cells and progenitor cells in vertebrates.

3' Untranslated Regions↗