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At least 577 records · Page 32Linked to original sources
PubMed2005

Report of altered sensation in patients with cleft lip.

OBJECTIVE: To determine whether patients with cleft lip have normal perioral sensation. DESIGN: Each subject was carefully questioned about the following: sensation in the face at rest, light touch of different areas, and sensation in natural situations (e.g., exposure to cold weather) that reveal sensory abnormalities. A cotton-tip applicator stick was stroked lightly across the facial skin. The subject's descriptions of the evoked sensations were used to identify and outline areas with abnormal sensation. SETTING: Data were obtained from subjects participating in a longitudinal, university-based study of the functional outcomes of lip revision surgery. PATIENTS: Seventeen patients with cleft lip and 12 control subjects (aged 7 to 22 years, mean 12.9 years) participated. RESULTS: In contrast to control subjects, 9 of 16 patients (56%) reported loss in sensation, described as decreased touch, scratch, tickle, or tingle intensity. Six other patients (38%) reported additional sensation, described as increased scratch, tickle, or tingle intensity. In eight patients, the altered sensation was restricted to the skin area flanking and including the visible scar, encompassing no more than 25% of the total area bound by the inferior nose, nasolabial grooves and inferior vermilion. In seven patients (unilateral cleft), the altered area extended to the contralateral, noncleft side of the upper lip or onto the philtrum. CONCLUSIONS: In contrast to the literature, sensation in the upper lip of many patients with cleft lip is not normal. Loss in sensation is exhibited most commonly and limited largely to the skin overlying tissues traumatized during reconstructive surgery.

Adolescent↗
PubMed2005

Dentocraniofacial morphology of 21 patients with unilateral cleft lip and palate: a cephalometric study.

OBJECTIVE: To assess the skeletal and dental craniofacial proportions of unilateral cleft lip and palate patients who were operated upon using the Malek technique, and compare them with a normal group to highlight the effect of surgical correction on craniofacial development during growth. DESIGN: Retrospective. METHODS: The cleft palate was closed using the Malek technique in a single operation at 3 months for 11 patients (complete closure of lip and palate) and in a two-stage operation for 10 patients (soft palate at 3 months, lip and hard palate at 6 months). Comparisons were made with a normal control group. Angular and linear measurements of anterior and posterior dimensions of the upper and lower compartments of the face were measured in the 7th and 12th years. RESULTS AND CONCLUSION: No significant differences were observed between the two groups of palate technique repair, although significant differences were observed between craniofacial dimensions of normal versus cleft lip and palate patients. At a skeletal level, the maxilla and mandible were retrusive relative to the cranial base in the cleft lip and palate group. In fact, there was a backward rotation of the palatal plane with repercussions on the maxillo-mandibular complex position. Furthermore, the maxilla was shorter than in normal patients, whereas the mandible was normally shaped. The upper incisors were retroclined and they locked the lower incisors in linguoversion. There was a posterior skeletal deficit of the respiratory compartment, compensated by more marked posterior maxillary alveolar growth. Facial growth in cleft lip and palate patients followed the same pattern, but was delayed compared with normal patients.

Age Factors↗
PubMed2005

A longitudinal study on influence of primary facial deformities on maxillofacial growth in patients with cleft lip and palate.

OBJECTIVE: The goal of this study was to use three-dimensional (3D) analysis to characterize the primary facial deformities in children with unilateral cleft lip and palate (UCLP) and then serially analyze the relationships between facial deformities and maxillofacial growth from infancy to adolescence. PARTICIPANTS: Twenty-one Japanese subjects with unilateral cleft lip and alveolus (UCLA) and 20 with UCLP who had been operated on and then followed up for more than 15 years were enrolled in this study. MAIN OUTCOME MEASURES: Facial cast models taken at cheiloplasty were scanned with a 3D laser scanner. Lateral cephalographs taken when subjects were 15 years of age or older were traced, and linear and angular measurements were calculated. The correlation between primary facial forms and maxillofacial morphology in adolescence was analyzed. RESULTS: Three-dimensional analysis showed larger ocular hypertelorism, wider cleft, greater deviation of the columella base, and more severe retruded position of the affected nasal alar base in subjects with UCLP than those with UCLA. Total surface area of the upper lips in subjects with UCLP was significantly smaller than those with UCLA. Correlation analyses revealed that the width of cleft lip, deviation of the columella base, difference of the nose base width, and surface area of the upper lip were statistically correlated with the maxillary length, the anterior position of the maxillary alveolar base, the posterior facial height, and the high angle of the mandible. CONCLUSION: The subjects who had less severe facial deformities and more tissue volume of the upper lips at cheiloplasty showed better maxillofacial growth.

Adolescent↗
PubMed1998

Adverse outcomes following endoscopic repair of a fetal cleft lip using an ovine model.

OBJECTIVE: The purpose of this study was to determine if endoscopic techniques could be used to repair an epithelialized lip cleft with accuracy and with an outcome comparable to fetuses treated through an open hysterotomy. INTERVENTIONS AND RESULTS: In contrast to previous open fetal cleft lip repairs in the same model, none of the five fetuses reported here had a good aesthetic result. Although there was no evidence of scar histologically, the edges of the lip were poorly approximated. The epithelial lining and underlying dermis of the wound margins were notably inverted. The orbicularis oris muscle, which had been reapproximated, appeared thin and hypoplastic. Most of the vermilion elements were poorly aligned, and in one animal, there was a complete dehiscence of the repair. CONCLUSIONS: In a more representative model of cleft lip that is not an acute lip wound, in utero endoscopic suture repair of the ovine lip gave a poor result using current technology. Only a meticulously performed, multilayered, open repair of a cleft appears to give a good cosmetic and functional outcome. Further studies to improve the endoscopic repair as our technology advances are therefore warranted.

Animals↗
PubMed2005

[Reconstruction after tumour's excision in lip's cancer: report of 100 cases].

OBJECTIVE: Cancer of the lips is a frequent pathology, it represents 1/5 of cancers of the upper aerodigestive tract. Its objectives are to present the experience of the plastic and reconstructive surgery unit of the universitary hospital of Casablanca. MATERIAL AND METHOD: The authors present a retrospective study about 100 cases of lips cancer treated between January 1999 and December 2002. RESULTS: The average age is 59 years. The sex-ratio is 7.3. Eighty-five percent of our patients were smokers and 22% were alcoholics, the association alcoholic and smoker was found in 20%. In our study 71% were classified T1-T2 and 29% as T3-T4. The tumoral location was the lower lip in 82% and the upper lip in 10%. The histological study showed a squamous cell carcinoma type in 85% and a basal-cell carcinoma type in 14% of cases. After the tumour's excision, the reparation was done by cross-lip flap in 25%, the naso-lateral flap in 16% and the Gillies flap in 8%. The functional result was good in 92% of cases and the aesthetic result was excellent in 60% of cases and good in 30% of cases. The survival rate at 2 year was 90%. CONCLUSION: Actually, lip's cancer treatment is essentially surgical. The reconstructive techniques are various, depending on the size and location of the loss of substance.

Adult↗
PubMed1993

[Median cleft of the upper lip. Apropos of 3 cases. The Association for the Study of Facial Clefts].

The authors report three cases of Median Cleft of the upper lip, a clinical entity really deserving the term of "hare lip", a very ancient denomination who dates back to the Tang Dynasty and unfairly used to describe the usual lateral clefts of the lip. The denominations of "true" and "false" median cleft lips recovering respectively such different embryopathic realities as clefts of the median element with varying degrees of vertical separation and as agenesis of the fronto-nasal process accompanied with cerebral anomalies are no more used now. Median clefts of the upper lip can be included in the "neurocristopathies" by less or more precocious dysneurulation of the fronto-nasal process creating anomalies from various single midline defects of the upper lip of our three cases, to associated midline defects like in the Median Cleft face syndrome (fronto-nasal dysplasia) described by De Myer and Sedano to holoprosencephaly (arhinencephaly), which are rarely associated.

Cleft Lip↗
PubMedDate not supplied

Reconstruction of total lower lip and chin defects using the composite radial forearm--palmaris longus tendon free flap.

BACKGROUND: Functional and aesthetic restoration of total lip and chin defects can be achieved using the composite radial forearm-palmaris longus tendon free flap. OBJECTIVE: To present the technique we use and our experience with this form of reconstruction in 10 consecutive patients with total lip and chin defects who were surgically treated between 1992 and 1998. METHODS: The palmaris longus tendon acting as a sling over which the flap is draped is responsible for long-term maintenance of vertical lip height and lip support. The factors responsible for this are the long-term maintenance of vertical lip height and lip support and the transfer of facial muscle activity to the neolip. RESULTS: All patients were satisfied with their final reconstructive result. Oral competence for deglutition and speech was achieved in all patients in our case series, with no incidence of drooling. CONCLUSION: We recommend the use of the composite radial forearm-palmaris longus tendon free flap for this type of reconstructive surgery. Arch Facial Plast Surg. 2000;2:53-56

Aged↗
PubMedDate not supplied

Cleft lip nasal reconstruction using porous high-density polyethylene.

BACKGROUND: The multitude of factors involved with a unilateral cleft lip nasal defect has spurred various surgical techniques in the past. Recently, synthetic materials have been introduced for use in nasal reconstruction. OBJECTIVE: To report on and illustrate the use of porous high-density polyethylene implants in cleft lip nasal reconstruction. DESIGN: A retrospective review of cleft lip nasal reconstruction using porous high-density polyethylene in patients with a unilateral cleft lip defect from January 1, 1993, through June 30, 2000. SETTING: Facial plastic surgery private practice. PATIENTS: Eighteen patients with a unilateral cleft lip without a history of formal rhinoplasty. INTERVENTIONS: All 18 patients required multiple implants, including a columellar strut, premaxillary and prealveolar plumper grafts, a dorsal tip implant, and a unilateral nasal valve batten, using the open rhinoplasty approach. RESULTS: Favorable aesthetic results, as judged by one of us (T.R.), were achieved in all patients. All implants were well tolerated. Postoperative follow-up ranged from 6 months to 7 years. A complication occurred in 1 patient (6%), which resolved with removal of a single implant and intravenous antibiotic therapy. No other complications, including skin erosion or implant extrusion, have been noted. CONCLUSIONS: Porous high-density polyethylene implants for cleft lip nasal reconstruction are well tolerated and achieve good aesthetic results. Porous high-density polyethylene implants lend stability through fibrovascular ingrowth, with integration of the implants to the surrounding tissue.

Cleft Lip↗
PubMedDate not supplied

The split orbicularis myomucosal flap for lower lip reconstruction.

OBJECTIVES: To describe the split orbicularis myomucosal flap and to review our center's experience with this technique for large defects of the lower lip. METHODS: All patients presenting to the senior author (Y.D.) for lower lip reconstruction using this flap were reviewed in a retrospective fashion. RESULTS: A total of 14 patients with a minimum follow-up of 6 months (mean, 3.4 years; range, 6 months to 5 years) underwent lower lip reconstruction using the split orbicularis myomucosal flap from May 1999 to May 2004. Twelve of the defects arose as a result of cancer resection (squamous cell carcinoma [n = 8], basal cell carcinoma [n = 3], and melanoma [n = 1]), and 2 arose secondary to trauma. The defect crossed the vermilion in two thirds of the cases, extending for a variable distance onto the cutaneous portion of the lower lip. The defect size varied from 50% to 80% of the transverse dimension of the lower lip (mean, 68%) and involved the commissure in 4 patients. There were no flap failures, facial nerve palsies or paralyses, oral incompetence, or need for scar revision in any of our study population. CONCLUSION: The split orbicularis myomucosal flap is a reliable method of reconstructing significant defects of up to 80% of the lower lip with minimal risks of microstomia or functional impairment.

Adult↗
PubMed1988

Effects of cleft lip and palate on the nasal airway in children.

Clefts of the lip and palate often produce significant nasal deformities and reduced nasal airway size. The purpose of this study was to assess how type of cleft affects nasal cross-sectional area and mode of breathing. The pressure-flow technique was used to estimate nasal airway size and modified inductive plethysmography was used to determine percent of nasal breathing in 60 children with cleft lip and palate aged 6 to 15 years. Ninety-five normal children served as controls. The data demonstrate that nasal size decreased among cleft types as follows: children with bilateral cleft lip and palate had largest airway, followed by unilateral cleft lip, cleft of the hard and soft palate, cleft of the soft palate, and unilateral cleft lip and palate. The data also indicated that most subjects with cleft were mouth breathers. Results of otolaryngologic examinations suggest that septal deformities affecting nasal valve function are responsible for much of the impairment, especially in the group with unilateral cleft lip and palate. The differences among groups appear to relate to developmental differences associated with the original defect and the surgical procedures used in primary repair.

Adolescent↗
PubMed1996

Wide polytef (Gore-Tex) implants in lip augmentation and nasolabial groove correction.

OBJECTIVE: To describe a new technique of polytef (Gore-Tex) implantation into the upper and lower lips and nasolabial grooves by using large implants as a method that achieves effective cosmetic improvement. SETTING: A private cosmetic surgery center. PARTICIPANTS: Thirty-three (female) patients who desired fuller lips and 62 patients (52 female and 10 male) who requested less prominent cheek lip grooves. MAIN OUTCOME MEASURE: Significant patient satisfaction after 12 to 54 months. RESULTS: Conspicuous aesthetic effect that related to both lip and nasolabial groove correction was documented. All patients but 4 (2 in each group) were pleased with the final outcome of the treatment. CONCLUSIONS: In the opinion of the authors, the threading technique of polytef implantation creates inconspicuous improvement-both in lip augmentation and nasolabial groove correction. Large polytef implants that were inserted through a tunneling technique produced consistently good results. Implants (lip augmentation: width, < or = 10 mm, and thickness, 4 mm; nasolabial groove correction: width, 8 mm, and thickness, < or = 8 mm) were found to be safe, simple, and effective.

Adult↗
PubMed1988

Cleft lip and handedness: a study of laterality.

Research on the malformation cleft lip with or without cleft of the palate is complex and may involve studies of etiology, pathogenesis, natural history, and other disease associations. One of the more intriguing areas of study is developmental lateralization. The 3 extant reports of the relationship between laterality of cleft lip and handedness are in conflict. The purpose of the present study is an attempt to resolve the confusion and to explore possible hypotheses that could explain the data. A random sample of 149 probands with unilateral cleft lip +/- palate was ascertained from 2 Los Angeles area hospitals. Laterality of clefting and handedness was determined for each, the former by inspection and the latter by the method of Oldfield [1971]. Information was also obtained on the nuclear family about the number of sibs, presence of clefting, and handedness of the probands' parents. The probability of non-right-handedness (NRH) was much greater for probands with left-sided cleft lip than those with right-sided cleft lips; this was independent of the proband's sex. The cleft lip laterality in probands was independent of parental handedness, suggesting that the significantly increased frequency of left-sided clefting and NRH is embryologic in origin and may have a common etiology and/or pathogenesis. Several explanations are proposed and discussed.

Biometry↗
PubMed1994

Median nodule of the upper lip: an autosomal dominant trait.

We describe a total of 18 individuals, in 3 families, with a median nodule of the upper lip. In family 1, the proposita, an 8-month-old infant girl, was otherwise phenotypically normal except for a median nodule of the upper lip. The proposita's elder brother and mother, both phenotypically normal, also had the similar nodule of the upper lip. On the mother's side, the proposita's greatgrandmother, greatgrandaunt, grandfather, greataunt, two aunts, and one female cousin all had a median nodule of the upper lip. In family 2, the proposita, proposita's mother and maternal grandfather had a median nodule of the upper lip. In family 3, the proposita, proposita's father, paternal grandfather, paternal uncle, and cousin had a median nodule of the upper lip. Analysis of 3 families indicates that the condition is an autosomal dominant trait.

Adult↗
PubMed1995

Congenital healed cleft lip.

Congenital "healed" cleft lip (CHCL) is an unusual anomaly including a paramedian "scar" of the upper lip, which appears as if a typical cleft lip has been corrected in utero. The CHCL is frequently associated with an ipsilateral notch in the vermilion, and "collapsed" nostril. Twenty-five CHCL cases are presented, eighteen of which were an isolated malformation found among the 3,950,715 births examined in two similar birth defect registries: ECEMC in Spain and ECLAMC in Latin America. Like open cleft lip, of which it seems to be a variant, CHCL is most frequently seen among males (14/18 isolated cases), it preferentially affects the left side (10/18 cases), and it segregated together with cleft lip in one family. The five CHCL cases with other congenital anomalies included: two cases with hydrocephalus, two VACTERL associations, and one atypical oblique facial cleft infant with single umbilical artery. CHCL may result from a defective fusion of the frontonasal and maxillary processes (before week 7 of embryonic life), or from a spontaneously repaired open cleft lip, later on. In either way, these cases heal with a visible scar, and the pre-occurrence of CHCL in two families suggests a familial predisposition to this phenomenon.

Adult↗
PubMed1984

Increased susceptibility to 6-aminonicotinamide-induced cleft lip of heterozygote Dancer mice.

Dancer heterozygotes (Dc/+) very rarely have cleft lip and show a dancing behaviour due to inner ear defects while homozygotes (Dc/Dc) have cleft lip. Males of the two genotypes Dc/+ and +/+ were mated to C3H strain and R stock females and Dc/+ males to Dc/+ females. On day 10/8 of gestation females were treated with 6-aminonicotinamide (6AN) at either 19 mg/kg or 28.5 mg/kg followed 3 h later by a protective dose of nicotinamide. Controls were untreated. Both 6AN treatments caused a significant increase in cleft lip to between 25% and 29% for crosses of Dc/+ males to C3H and R females whereas crosses with +/+ males gave 0% cleft lip. In the controls the cleft lip frequency was: for Dc/+ X Dc/+ 14%, Dc/+ X C3H 1.4%, and for the other three crosses 0%. The four crosses given the high dose of 6AN and the +/+ X C3H and Dc/+ X R cross at the low dose showed significantly increased resorption rates to between 23% and 47% over the control rates of from 5% to 11%. The presence of the Dc gene increased the susceptibility to cleft lip caused by 6AN.

6-Aminonicotinamide↗
PubMed1994

Neuromagnetic studies of the lip area of primary somatosensory cortex in humans: evidence for an oscillotopic organization.

Magnetic trigeminal somatosensory responses from human subjects were recorded using a 14-channel magnetoencephalographic system. Sensory stimuli comprising a 15-ms vibration at frequencies of 50 Hz, 150 Hz and 250 Hz were given at randomized interstimulus intervals. Using a single dipole model, the neuronal sources of the evoked responses were determined, and mapped onto magnetic resonance images of each subject. Source localization analysis was based on the main peak of the averaged signal (M55). All of the sources were located deep in the anterior bank of the postcentral gyrus, corresponding to area 3b of somatosensory cortex SI. In all cases, the source for the upper lip was significantly higher in the vertical axis (0.6-1.1 cm) than for the lower lip, while the lower lip stimulation produced a larger response than the upper lip. Furthermore, statistically significant differences were found between the locations of the dipoles evoked by different frequency stimulation. The location of the response shifted with change in stimulation frequency, showing a trend among all subjects with medial shift between 150 and 250 Hz for both upper and lower lip. The accuracy of source localization calculated from magnetic fields ranged between +/- 0.9 and +/- 3.0 mm (SEM). These results demonstrate (1) that a large area of the somatosensory cortex is utilized for lip representation and (2) that the spatial displacement of the trigeminal somatosensory response may be related to the discrimination of frequency.

Adult↗
PubMed1998

Anatomy of the arterial vascularization of the lips.

The findings from 12 dissections of previously injected facial masks, 8 dissections of the face following intraarterial injection of a red solution of Latex Neoprene, and a corrosion cast specimen allowed us to study the arterial supply of the lips. The arterial supply of the upper lip arises mainly from the superior labial arteries, but also from the subseptal arteries and from the subalar arteries. There is a figure of 8 shaped anastomotic system between these arteries lying on the upper lip. The arterial supply of the lower lip arises from the inferior labial arteries and from branches of the mental artery. A constant inferior labial arterial network was shown at the level of the lower lip arising in a fifth of cases from a T-shaped inferior labial artery. All these recent anatomic findings help us to improve our understanding of plastic surgery of the lips.

Arteries↗
PubMed2004

Meyer's surgical procedure for the treatment of lip carcinoma.

Lip carcinomas are generally treated by surgery. A reconstruction is often required if the resected segment exceeds one-third of the lip. Meyer's plasty is an alternate way of reconstructing the lower or upper lip. The aim of this study is to describe the technique, its indications and results. A retrospective review of all patients who underwent a Meyer's plasty in our institution is presented. Twenty-four consecutive patients were treated in Lausanne for T1 and T2 lip carcinomas between 1983 and 2001. Primary surgery associated with Meyer's plasty was performed in all cases. Data were collected from the medical records, and eight patients were recalled for clinical evaluation. The oncological, functional and aesthetic results were analyzed. The 5-year local control was 100%. Three patients developed metachronous lymph node metastasis. No patient died from the disease. A hindering microstomy was found in three cases, and two patients suffered from temporary oral leakage. No speech difficulty was encountered. The aesthetics was described as satisfying or good in 87% of the patients. Meyer's plasty following lip surgery of the upper or lower lip allows an aesthetic and functional one-stage reconstruction without compromising the oncological outcome.

Adult↗