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PubMed2002

[Positioning of the premaxilla in cases of bilateral cleft lip, alveolus and palate using Latham's appliance].

UNLABELLED: SUBJECT MATTER: In cases of bilateral cleft lip, alveolus and palate, preoperative positioning of the premaxilla using Latham's appliance has been described. This method is controversial, since it may cause growth defects. PATIENTS AND METHODS: From 1992 to 2000, Latham's appliance was inserted preoperatively into 20 patients with bilateral lip, alveolus and palate clefts with extreme premaxillary protrusion. Pin fixation ensued at the age of 3 months. After adjustment of the premaxilla, the soft palate was closed and bilateral lip adhesion as well as bilateral gingivoperiosteoplasty were performed directly after the removal of the appliance. Final lip closure took place 4-6 weeks later. At the age of 2 years, the hard palate was closed. Evaluation was based on combined face-maxilla models, standard photographs and, when available, lateral skull x-rays showing the relative position of the segments, the influence of Latham's appliance on the nasal septum and the relation of the upper jaw to the skull base and mandibula. RESULTS: In all cases, a satisfactory alveolar alignment was achieved; thickening and curvature of the nasal septum occurred but receded. Neither growth disturbances nor dental germ damage were seen. In two cases, complications arose from suture dehiscence of the lip adhesion: in one patient, a screw defect caused a loosening of the appliance and there was also a transmigration of the postpremaxillary pin. CONCLUSIONS: On the basis of our experience, the use of Latham's appliance, combined with consistent orthodontic supervision and, if necessary, treatment, represents a practical option for the treatment of bilateral cleft lip, alveolus and palate, especially in cases with extreme protrusion of the premaxilla.

Alveoloplasty↗
PubMed1994

Involvement of substance P but not nitric oxide or calcitonin gene-related peptide in neurogenic plasma extravasation in rat incisor pulp and lip.

The possible involvement of the neuropeptides substance P and calcitonin gene-related peptide (CGRP) in the development of neurogenic plasma extravasation in the lower lip, gingiva and incisor pulp was examined in anaesthetized rats by means of the Evans blue method and by using newly developed blockers of substance P (CP-96,345) and CGRP (CGRP8-37). Electrical stimulation of the inferior alveolar nerve (15 V, 2 ms, 10 Hz) for 5 min significantly increased the Evans blue content of the ipsilateral lip, gingiva and pulp by 60 (p < 0.01), 62 (p < 0.01) and 92% (p < 0.05), respectively (n = 8). Pretreatment with CP-96,345 (total dose: 1.5 mg/kg, intravenously) counteracted the dye leakage in the lip and pulp but not in the gingiva (n = 6). The inactive enantiomer (CP-96,344, 1.5 mg/kg, n = 8) or the nitric oxide synthesis inhibitor (N omega-nitro-L-arginine methyl ester hydrochloride, 10 mg/kg, n = 7) did not reduce the stimulation-induced dye extravasation in any of the tissues. Pretreatment with CGRP8-37 (0.3 mg/kg, n = 7) did not significantly influence the development of neurogenic extravasation in the lip and incisor pulp, but it slightly attenuated extravasation in the gingiva. The results indicate that the afferent nerve-induced dye extravasation in the lip and pulp, but not in the gingiva, is to a large extent mediated by substance P acting via neurokinin-1 receptors. There was no evidence for an involvement of nitric oxide or CGRP in neurogenic extravasation in rat incisor and lip.

Animals↗
PubMed1979

Tonic stretch reflexes in lip, tongue and jaw muscles.

Despite considerable speculation it remains unclear as to whether stretch reflexes perform a functional role in speech articulator muscles. Recent research, however, has shown that long loop stretch reflex mechanisms are brought into play during voluntary contraction of limb muscles and a functional role in oscillatory damping has been suggested. It was decided, therefore, to use a method and a technique of analysis similar to that used in limb muscles to search for tonic stretch reflex (TSR) responses in lip, tongue and jaw muscles during sustained voluntary contraction. The term 'action TSR' is used to differentiate stretch reflex responses measured from voluntary activity from those measured at rest. Simultaneous electromyogram (EMG) recordings were taken from the lip, tongue and jaw musculature in normal, stutterer and cerebral spastic subjects. Subjects were instructed to hold the appropriate articulator in a fixed position while the experiment applied an irregular, continuously changing, stretching force. The stretch and EMG signals were analyzed using a cross correlation and spectral analysis technique. This provided a sensitive means of detecting any EMG fluctuations which covaried with applied stretch and might therefore be classified as reflex. No suggestion of such action TSR responses could be found in lip or tongue muscles of any of the subjects tested, including the cerebral spastic subjects with dysarthric speech. It is therefore concluded that action TSR mechanisms are not operative in control of lip and tongue muscles in man. Furthermore, dysarthric speech in cerebral spasticity cannot be attributed to exaggerated tone of lip and tongue muscles resulting from hypersensitivity of TSR mechanisms. In contrast, clear action TSR responses were demonstrable in jaw closing muscles while in jaw opening muscles, small amplitude responses were detected but were not substantial in comparison with background activity. Since the action TSR is present in jaw and limb muscles, but absent in lip and tongue muscles, the suggestion of a functional role of this reflex in damping mechanical oscillations associated with inertial loads is further supported.

Adult↗
PubMed1991

Comprehensive treatment of bilateral cleft lip by multidisciplinary team approach.

Repair of bilateral cleft lip presents numerous problems, and in our opinion, it is better to begin treatment at the earliest age possible. At Fujita Health University Hospital, we utilise a multidisciplinary team approach to cleft lip. Nonsurgical correction of the nasal deformity using a nose retainer and preoperative orthodontics using a Kuwahara-modified Hotz's palatal plate begins soon after birth. Surgical repair of the lip is done within the first 2 months of life, by the time the nose, alveolus and projecting prolabium are adequately reformed. A one-stage surgical procedure, including restoration of muscle union, labial sulcus construction and nasal correction is performed. After lip repair, lip and tongue pressure are well balanced by the plate, and a good alignment of the alveolus can be achieved. A total of 27 cases of bilateral cleft lip were treated from August 1986 to October 1990. In all cases, the postoperative course was uneventful, and no complications due to early surgery were encountered.

Cleft Lip↗
PubMed1994

Role of dorsal and median raphe nuclei in lower lip retraction in rats.

Induction of lower lip retraction after local infusion of the selective 5-HT1A receptor agonist (+/-)-8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) in the dorsal and median raphe nuclei was measured. Infusion of 8-OH-DPAT (2.5, 5 and 10 micrograms/rat) into the median raphe nucleus caused an immediate and dose-dependent lower lip retraction. After infusion into the dorsal raphe nucleus a higher dose was needed. The lowest dose of 8-OH-DPAT that induced lower lip retraction was 10 micrograms/rat. Infusion of 8-OH-DPAT (10 micrograms/rat) into the pontine reticular nucleus induced the same degree of lower lip retraction as seen after infusion of the compound into the dorsal raphe nucleus. 8-OH-DPAT-induced lower lip retraction was attenuated by s.c. injection of the preferential 5-HT2C receptor agonist m-chlorophenyl-piperazine. The results suggest that lower lip retraction is mediated by 5-HT1A receptors in the median rather than in the dorsal raphe nucleus.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1982

Physical properties of human lips: experimental and theoretical analysis.

The lip stiffness characteristics in the vertical plane of a white population sample, aged 18-26, were studied. The physical properties of the lip system were analyzed and a mathematical model was derived to approximate this system. The instrumentation consisted of a force-transducer bar, a head holder and a three-directional micrometer adjustment. Four specific contact areas were used. Individual lower lip is stiffer than upper lip and the corresponding male lip is stiffer than the female lip. The force-displacement relationship approximates a linear function at small displacements (less than 1 mm) and is a second order function at larger displacements. A mechanical T-spring model approximates the system to an accuracy of about 96%.

Adult↗
PubMed1984

Reassessing the epidemiology of lip cancer.

The risk factors associated with carcinoma of the lip are reviewed with an aim toward reassessing the epidemiology of the disease. Descriptive studies show lip cancer to occur most commonly in aging white men. The geographic distribution of the disease varies widely, both nationally and internationally; recent studies show that at the national level there is not a uniformly high risk of lip cancer across the sunny states, as has been believed. Secular disease trends show a decline in both morbidity and mortality while survival rates have remained stable. The risk factors consistently associated with lip cancer are rural residence and outdoor occupation, but the latter does not apply to all outdoor workers. In addition, both actinic radiation and tobacco smoking have long been considered to be causally related to lip cancer. An extensive review of the literature, however, reveals that the studies evaluating the association between these exposure variables and the disease do not yield consistent results; in addition, many recent, well-designed studies fail to support independent causal hypotheses. We conclude that (1) any risk factors considered to be causally related to lip cancer must be congruent with the descriptive factors (geographic distribution, secular disease trends, etc.) and (2) although sunlight and smoking are highly likely risk factors, their interrelationship as well as their interaction with other factors, such as genetic predisposition, needs reassessment.

Adult↗
PubMed1993

Squamous cell carcinoma of the lip: analysis of the Princess Margaret Hospital experience.

We reviewed 117 patients with squamous cell carcinoma of the lip who were treated at the Princess Margaret Hospital between 1976 and 1985. Ninety-eight cancers arose from the lower lip, 18 from the upper lip and 1 from the commissure. Two patients had lymph node metastases at presentation. Sixty-one patients were treated with radiation therapy following a biopsy, 28 underwent surgery followed by post-operative radiation, and 28 had surgery alone. With a median follow-up time of 5.4 years, the 5-year actuarial overall and cause-specific survival rates were 81% and 99%, respectively. Local failure developed in 4 patients after radiation treatment, 3 of whom were salvaged by surgery. Six patients developed regional metastases after initial treatment, 4 of whom were salvaged with surgery and/or radiotherapy. Two patients died from lip cancer. After a univariate analysis, the only factor which predicted for nodal failure was T stage of the primary lesion, with a 4% risk of nodal failure for T1 lesions vs. 20% for T2/3 lesions (p = 0.03). No other patient, tumour or treatment variables influenced loco-regional control or survival in a statistically significant manner. Cosmetic and functional outcome were evaluated in 8 patients whose radiation treatments were administered 13 years ago. No patients had compromised lip function, and the majority had minimal cosmetic sequelae from their radiation therapy. Based on the excellent results of this review, we would continue to recommend radiation therapy as an effective treatment modality for patients with lip cancer because of the ease by which the entire tumour can be encompassed whilst maintaining excellent cosmetic and functional outcome.

Adult↗
PubMedDate not supplied

Human hand and lip sensorimotor cortex as studied on electrocorticography.

We investigated functional topography of human hand and lip sensorimotor cortex using somatosensory evoked potentials (SEPs) from chronically indwelling subdural grid electrodes (ECoG) in 3 epilepsy patients during stimulation of median nerve, ulnar nerve, and lower lip. We used dipole modeling to determine the cortical location of each peripheral sensory field. The cortical locations were in the postcentral gyrus and showed a clear somatotopic organization from medial superior to lateral inferior in the order: ulnar nerve, median nerve, and lip. The source localizations agreed with the results of cortical stimulations and anatomical features on intraoperative photographs. The cortical regions of median and ulnar nerve each could be modeled by sequential tangential and radial dipoles. The cortical region of lip was different and could be explained mostly by tangential dipoles. These findings suggest a difference in the cortical organization of human lip and hand sensory cortex and are consistent with a larger representation of lip in the posterior bank of central fissure in area 3b than on the gyral surface in area 1, similar to findings in macaque. Further studies in a larger population of patients with ECoG or normal subjects with scalp-EEG and MEG are warranted to test this hypothesis.

Brain Mapping↗
PubMed1995

Columella lengthening using a cartilage graft in the bilateral cleft lip-associated nose: choice of cartilage according to age.

PURPOSE: This article describes the technique of columellar lengthening using a cartilaginous strut in patients with a severely deformed bilateral cleft lip-associated nose. MATERIALS AND METHODS: When the upper lip is not deficient, and especially when resection of lip scar tissue is indicated, the Millard forked flap technique is recommended. Advancement of the prolabium into the columella for lengthening, combined with an Abbé flap for upper lip reconstruction, is indicated when a deficient upper lip is unable to provide adequate donor tissue. A cartilaginous strut is inserted behind the forked flap or the advanced prolabium. According to the age of the patient, septal cartilage, costal cartilage, or ear cartilage is selected. Ten patients with a severely deformed bilateral cleft lip-associated nose underwent these procedures. RESULTS: In each case, the columella was lengthened satisfactorily. In four patients, the scar became hypertrophic at the base of the columella and scar revision was performed secondarily. CONCLUSIONS: A cartilaginous strut is the key to avoiding the tendency toward retraction or thickening of the lengthened columella. It gives a slight lift to the tip, provides more definition, and improves the columellar contour.

Adolescent↗
PubMed1987

Changes in lip pressure following extension and flexion of the head and at changed mode of breathing.

The changes in upper and lower resting lip pressures following extension and flexion of the head and at changed mode of breathing were studied in a sample of 15 adults with Class I molar relationship. The lip pressure was measured with bonded strain gauge transducers on the upper and lower central incisors. The transducers could be calibrated directly in the subject's mouth. The upper and lower lip pressures during natural head posture had a mean value of 3.91 g/cm2 and 8.58 g/cm,2 respectively. The mean values of the differences between pressures obtained during natural head posture and during 5 degrees, 10 degrees, and 20 degrees of extension showed a continuously, highly significant increase in pressure. During 5 degrees, 10 degrees, and 20 degrees of flexion, the upper lip pressure continuously decreased with highly significant values. Changes in the lower lip pressure during flexion were difficult to measure because of intense muscle activity. A significant decrease was shown for the difference in upper and lower lip pressures between nose breathing and mouth breathing, whereas there was a significant increase in pressure when the subject extended the head 5 degrees during mouth breathing.

Adult↗
PubMed1992

Some vertical lineaments of lip position.

This study was performed to elucidate quantitatively upper lip-tooth-jaw relativity in the vertical dimension. Values for five linear dentolabial measurements were generated from male (n = 42) and female (n = 46) reference samples. In addition, three vertical skeletofacial dimensions and two vertical dental dimensions were recorded. A significant sexual dimorphism was found in the vertical lip-tooth-jaw relationship: the upper lip of the female subjects was positioned on average 1.5 mm more superiorly at maximum smile than the upper lip of the male subjects (p less than 0.01). High smile lines appeared to be a female lineament, and low smile lines appeared to be a male lineament. There was a significant sex difference in upper lip length: the male subjects exhibited a longer upper lip than the female subjects (p less than 0.001). The mean difference was 2.2 mm. A similarly significant male-female difference was seen in the skeletal maxillary height measurement: the male sample showed a 2.2 mm mean vertical maxillary increase over the female sample (p less than 0.001). Furthermore, a significant difference was found between the clinical crown height of the maxillary central incisors in the male and female subjects of comparable ages: the male group had longer central incisor crowns (p less than 0.01).

Adolescent↗
PubMed2005

Unilateral complete cleft lip repair: orthotopic positioning of skin flaps.

The ideally repaired cleft lip should provide a symmetrical Cupid's bow, philtrum, and minimal scar. In the appearance of the upper lip, the philtrum plays a key role. The most popular method for unilateral cleft lip repair is the rotation-advancement technique introduced by Millard. This technique requires the rotation of the noncleft side flap in unilateral cleft lip. As the vertical discrepancy between the peaks of Cupid's bow is increased, the scarring becomes more evident. Also, where it crosses the philtral column in the oblique extension of the upper lip, it becomes apparent for the eye to notice. Thus, many surgeons have tried to modify this technique to improve the symmetry of the philtral columns. The philtral dimple is composed of centrally located thin dense subcutaneous tissue bordered by thick loose subcutaneous tissue producing the philtral columns laterally. The aim of this surgical modification is to form a more natural looking philtrum using its original anatomical structure. The tissue defect after rotation of the noncleft side flap is filled with the C flap, not the advancement skin flap from the cleft side. The C flap helps to form the upper philtral column into a more straight appearance. The skin flaps of the cleft side and noncleft side are placed either side of the philtral column, and the skin flap from the columella is not used for the repair of the philtrum. Twenty-five patients with unilateral complete cleft lip were repaired using this technique from 1996 to 1999. Adequate alignment of the Cupid's bow and symmetric philtral appearance were obtainable.

Cleft Lip↗
PubMed2005

The change in the appearance of the vermilion border region caused by the difference of the design in symmetric bilateral incomplete cleft lip repair.

In the widely performed methods for repair of bilateral cleft lips, such as Mulliken and Trott methods, the formation of the median tubercle is done with the mucocutaneous flaps from the lateral lips. By this manoeuver, a visible horizontal scar just above the white skin roll of the philtral region tends to result, especially among Asian patients. To avoid the formation of this visible scar, we changed our design in such a way that mucosal flaps, instead of mucocutaneous flaps, are elevated from the lateral lips, and the prolabial white skin roll is preserved to become the final philtral white skin roll. By this change in design, the horizontal scar is shifted to the inferior edge of the vermilion border. In the past 8 years, we have performed this refined method along with the conventional one. In the present study, the five cases of symmetric bilateral incomplete cleft lip from each of the two groups are evaluated: one group with the mucocutaneous flaps and the other with the mucosal flaps. From the review of the cases, it was noted that when the philtral region is formed with the mucocutaneous flaps, the horizontal scar tends to be visible. On the other hand, when it is formed with the mucosal flaps, the scar is less conspicuous, although the white skin roll sometimes becomes less-defined. The refined method involving mucosal flaps from the lateral lips produces a better-accepted appearance concerning the prolabial horizontal scar in the symmetric bilateral incomplete cleft lip repair.

Child, Preschool↗
PubMed2006

A long term subjective and objective assessment of the scar in unilateral cleft lip repairs using the Millard technique without revisional surgery.

The aim of unilateral cleft lip repair is to achieve a functional and aesthetically acceptable upper lip scar. Many techniques have been described but do not fulfil the basic aesthetic criteria. This series assessed the long term results from a subjective and objective point of view in a group of 20 patients who only had the initial repair, as described by Millard, without further revisional surgery. Surgery was undertaken at approximately 3 months of age and no secondary procedures were performed thereafter. The analysis related essentially to the residual scar. Patients were assessed subjectively and objectively by means of questionnaires. A control group (n = 20) of normal patients, of similar age, male to female ratio and of similar racial distribution was selected for comparison of the Cupid's bow. No patients were unhappy with the middle part of the scar, however, the upper and lower thirds created more concern. The complaints in the upper part of the scar were related to an unattractive scar crossing the base of the columella. The complaints relating to the lower part of the scar were related to peaking of the vermilion skin junction and notching of the lip margin. The most striking features that were noted from the objective evaluation were: 1. Virtually all patients had scar transgression of normal anatomical boundaries in the upper part of the lip. 2. There was a very high incidence of peaking (65%) and notching (45%) in this study group. 3. Cupid's bow to horizontal lip length ratio was greater in most patients as compared to normal. The study shows that the upper part of the scar close to the nose is problematic both from a subjective and objective point of view. In addition, the ratio of Cupid's bow to the overall lip length seems to be large.

Adolescent↗
PubMed2004

Orofacial granulomatosis presenting as persistent lip swelling: review of 6 new cases.

PURPOSE: Orofacial granulomatosis (OFG) is an uncommon disease, which presents usually as a persistent swelling of the soft tissues in the orofacial region and is characterized histologically by a granulomatous inflammation. The term orofacial granulomatosis is used in the literature to describe a nonspecific granulomatous inflammation. A subset, cheilitis granulomatosa (CG), which presents clinically as persistent lip swelling, is a granulomatous inflammation of unknown origin of the lips. CG may also be part of the triad of the Melkersson-Rosenthal syndrome (MRS) and some consider it as an oligosymptomatic form of MRS. PATIENTS AND METHODS: In a retrospective study, we reviewed the clinical records of all patients between the years 1990 and 2002 with the histologic diagnosis of granulomatous inflammation of the lip from the Department of Pathology at the Montreal General Hospital. The age at biopsy, sex, site of lesion, other signs of MRS, signs and symptoms of systemic granulomatous disease, and the treatment were compiled. RESULTS: Six subjects were included in the study, 5 females and 1 male. Four had swelling of the lower lip and 2 of the upper lip. In one patient a history of facial nerve palsy was reported and in another one a mild fissured tongue was present. No signs or symptoms of systemic granulomatous disease were noted. The treatment consisted of intralesional steroids with good results in 5 out of 6 patients. CONCLUSION: A thorough work-up to eliminate other etiologies of granulomatous disease is essential when a patient presents with granulomatous inflammation of the lip. CG seems to respond well to steroid treatment and the need for surgery is minimal and should be reserved for recalcitrant cases.

Adolescent↗
PubMed2005

An instrument for the non-invasive assessment of lip function during speech.

This paper describes the development of an instrument using infrared light as a non-invasive means of detecting lip opening, the extent of the opening and also the forward protrusion and backward movement of the lips during speech. The design criteria were to build a simple stand alone means of assessing lip function, which could also link to the group's commercially available Super Nasal-Oral Ratiometry System (SNORS+). SNORS+ allows objective assessment of the function and co-ordination of key articulators, with lip function previously monitored using a video camera. Synchronised tests were carried out using the new Lip Function Monitor and the video camera simultaneously, in order to verify that the signals produced related directly to the activity of the mouth. A small trial was then conducted to show that the system provides reproducible results throughout a range of 'normal' subjects. These subjects were of different gender and race to create a sample group within which there was a variety of lip sizes and face shapes. Technical aspects of the instrument and trial results are presented here. These suggest that the simple visual output and feedback of the instrument will prove useful in the assessment and management of speech disorders.

Equipment Design↗
PubMed2005

Squamous cell carcinoma of the oral cavity, maxillary antrum and lip in a Zimbabwean population: a descriptive epidemiological study.

Squamous cell carcinoma accounts for approximately 90% of oral malignancies. The objective of this study was to document the gender, age, sub-site distribution and histologic differentiation of squamous cell carcinoma of the oral cavity, maxillary antrum and lip in a Zimbabwean population. Hospital records of patients with a histologic diagnosis of squamous cell carcinoma of the oral cavity, maxillary antrum and lip seen at Harare Central Hospital and Parirenyatwa Hospital in Zimbabwe during the period January 1982-December 1991 were reviewed. 20.8% (n = 358/1723) were squamous cell carcinoma of the oral cavity, maxillary antrum and lip. Age ranged from 3 to 70years with a 2:1 male:female ratio. Peak incidence in both sexes were in the 41-50 and 51-60years age groups. Sub-site distribution was mandibular gingiva 18.4%, tongue 17.9%, floor of the mouth 16.2%, maxillary gingiva 9.2%, buccal mucosa 9.2%, maxillary antrum 12.6%, hard palate 7.8%, soft palate 4.8%, lower lip 2.8% and upper lip 1.1%. 64.8% were well differentiated, 24.8% moderately differentiated and 10.4% poorly differentiated. The mandibular gingiva, floor of the mouth and tongue were most commonly affected. Lip squamous cell carcinoma was uncommon. Well-differentiated squamous cell carcinoma was most common in the 41-60 years age group.

Adolescent↗