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At least 613 records · Page 34Linked to original sources
PubMed1998

Differences in fine control of forces generated by the tongue, lips and fingers in humans.

This study compared the fine control of forces generated by the tongue, lips and fingers in middle-aged adults. The aims were to determine whether (1) the articulatory organs (tongue, lips) and fingers differed in the manner of motor control, (2) force control of the various articulatory organs was similar, and (3) control of forces generated by males was different from that of forces generated by females. The relation among several variables of the ramp-and-hold force contraction and target force level was quantified for the articulatory organs and the fingers in 14 normal individuals (7 males and 7 females). Using visual feedback, participants produced ramp-and-hold compression forces as rapidly and accurately as possible to targets ranging from 0.25 to 2 N. The results showed differences in the profiles of forces generated by the articulatory organs and fingers. In particular, the forefingers were characterized by a greater accuracy of force control and precision of movement, a greater stability of the hold phase, but by slower velocities than the articulatory organs. Motor control of the lower lip differed from that of the upper lip and tongue. Mostly, the lower lip was characterized by a greater precision of contraction, faster development of the force, and greater stability of the hold phase than the upper lip and tongue. Gender was a distinguishing factor in the force task; males were able to produce forces with higher velocities and greater precision than females.

Analog-Digital Conversion↗
PubMed2003

Long-term outcome of simultaneous repair of bilateral cleft lip and nose (a 15 year experience).

We have performed primary repair of bilateral cleft lip and nose on 169 patients in the past 15 years. During the first eight years, we used a small triangular flap skin design for the lip and for the nose correction, we used a corrective nasal cartilage lifting suture through rim incisions in order to bring the nasal dome cartilage toward the center and create the columella. The small triangular flap at the columella base was rotated 90 degrees posteriorly to emphasize the contour of the nasolabial angle. In the subsequent 7-year period, the lip design was changed to the straight line method, and an inverted trapezoid suture was placed between the alar and nasal dorsum at four points. By this procedure displaced cartilages are moved into correct position and the alar groove became more distinct.Long-term observations showed a favorable configuration of the nose, and eliminated the bilateral cleft nose stigma with only minimum degree of growth disturbance. The remaining problem is the somewhat superior faced nasal tip. To leave the bilateral cleft lip nasal deformity uncorrected for a long period places great psychosocial burden on the patient and the family. We believe that it is desirable to conduct early lip and nose repair synchronously in a minimally invasive manner, as a collaborative effort between plastic surgeons with specialized training in cleft lip repair and an interdisciplinary team.

Aged↗
PubMed1996

Autonomic and sensory innervation of cat molar gland and blood vessels in the lower lip, gingiva and cheek.

Innervation of the molar gland and blood vessels in the lower lip, gingiva and cheek mucous membrane was investigated in the cat with the aid of whole mount acetylthiocholinesterase (WATChE) histochemistry and retrograde neuronal tracing methods with horseradish peroxidase (HRP) and HRP-conjugated wheat germ agglutinin (WGA-HRP). The molar gland was found to be supplied from the buccal nerve and branches of the mylohyoid nerve on the basis of microdissection of WATChE-stained mandibular preparations under a dissecting microscope. The rostral half of the lower lip-gingiva was innervated by mental branches from the inferior alveolar nerve. The caudal half of the lower lip-gingiva and cheek mucous membrane were observed to be supplied from the buccal nerve. Following injections of HRP/WGA-HRP into the molar gland, lower lip-gingiva and cheek, many retrogradely labeled ganglion neurons were observed in the ipsilateral main and accessory otic ganglia, superior cervical ganglion and mandibular division of the trigeminal ganglion. In the pterygopalatine ganglion, a small number of positive neurons were found, but in a few cases in which the injected tracer was restricted to the lower lip-gingiva and anterior half of the molar gland, labeled neurons were not detected in the main ganglion nor in its accessory microganglia. These findings indicate that the cat molar gland receives a postganglionic parasympathetic supply from the otic ganglia, postganglionic sympathetic input from the superior cervical ganglion and sensory innervation from the trigeminal ganglion by way of the buccal nerve and mylohyoid nerve. Vessels in the rostral half of the lower lip-gingiva receive the same inputs from the inferior alveolar nerve, and vessels in the caudal half receive inputs from the buccal nerve. The vessels in the cheek mucous membrane receive dual parasympathetic supplies from the otic ganglia and the pterygopalatine ganglion by way of the buccal nerve.

Acetylcholinesterase↗
PubMed1989

Predictability of upper lip soft tissue changes with maxillary advancement.

To improve predictability of the esthetic (soft tissue) results after maxillary advancement surgery, a better understanding of the relationships between the dental osseous movement and overlying soft tissue response is essential. Twenty-one adult patients who underwent isolated maxillary advancement via LeFort I osteotomies without adjunctive nasal soft tissue procedures and/or V-Y closure of the vestibular incision were studied. Homogeneity of the patient population was ensured by selecting cases with less than 2 mm vertical change. The mean maxillary advancement and mean change in Sn was calculated for these 21 patients. Additionally, the 21 patients were subdivided into two groups based on lip thickness: group 1 (lips between 10 and 17 mm thick) and group 2 (greater than 17 mm thick). In each patient group a linear regression (LR) was determined on the magnitude of maxillary advancement (MMA) to the change in soft tissue subnasale (Sn) and on the ratio of Sn change to bone move. The results using mean data showed that the relationships produce significantly high standard deviations; thus, a general correlation between change in soft tissue position to bony advancement cannot be made. Individuals with thin lips (12 to 17 mm) had a good correlation between the magnitude of bony move and amount of soft tissue change. However, increased lip thickness (greater than 17 mm) produced a less predictable correlation between soft and hard tissue changes. All lips thinned around 2 mm when compared with preoperative values. Lip thickness stabilized at approximately 6 months postoperatively.

Adult↗
PubMed1998

Comparative study of diagnostic measures in borderline surgical cases of unilateral cleft lip and palate and noncleft Class III malocclusions.

Patients with complete unilateral cleft lip and palate present difficult growth problems. Their anteroposterior discrepancies in jaw and dentition are frequently so severe that some epidemiologic studies report the necessity of orthognathic surgery in 25% of their sample. The aims of this study were three-fold: (1) to delineate diagnostic measures in borderline surgical cases of unilateral cleft lip and palate, (2) to verify the significance of negative overjet as a measure of anteroposterior discrepancy, and (3) to compare these diagnostic measures with those of borderline surgical cases of noncleft Class III malocclusions. The sample consisted of 29 patients with unilateral cleft lip and palate and 25 noncleft Class III Korean patients (mean age, 18.69 years); all had crossbites of all four incisors. Each of their pretreatment study casts and cephalograms were analyzed. The group with unilateral cleft lip and palate was divided into two subgroups on the basis of the method of their anterior crossbite resolution; 18 subjects were treated with orthodontics alone (Cleft-NS) and 11 subjects with orthognathic surgery (Cleft-Surg). The noncleft Class III group was divided into two subgroups; 6 of the subjects were orthodontically treated (Cl III-NS), and 19 were surgically treated (Cl III-Surg). The group with unilateral cleft lip and palate showed smaller SNA and SNB angles than the noncleft Class III group, but the ANB angles and the amount of anterior crossbites showed no statistical differences. When the Cleft-NS and the Cleft-Surg groups were compared, the ANB angle and the Wits measurements were significantly different. When the Cl III-NS and Cl III-Surg groups were compared, the SNB, ANB, L1GoGn, Wits, and the crossbite showed significant differences. For borderline surgical Class III unilateral cleft lip and palate cases, ANB angle, Wits appraisal, and ABGoGn angle were critical diagnostic parameters. On the other hand, the magnitude of anterior crossbite, the negative overjet, was shown not to be a significant measure of anteroposterior discrepancy.

Adolescent↗
PubMed2000

p53, cyclin-D1, PCNA, AgNOR expression in squamous cell cancer of the lip: a multicenter study.

BACKGROUND: The development of squamous cell carcinoma of the lower lip is an interesting model of photocarcinogenesis because of the structural and topographic characteristics of the lips. The purpose of this study was to evaluate the expression of immunohistochemical markers on the lips of patients with lower lip squamous cell carcinoma (LLSCC), compared with a control population. METHODS: Of the 98 subjects involved in the study, 58 were suffering from squamous cell carcinoma of the lower lip. The remaining 40 acted as a control. The case studies were taken from six university and hospital dermatology and plastic surgery departments. Questionnaires were administered to assess the risk factors for LLSCC. The cases involving squamous cell carcinoma underwent surgical excision and punch biopsy specimens were obtained from 20 control patients. Tissues were prepared in 5-microm-thick sections to carry out the following immunohistochemical study: PCNA, p53, AgNOR, cyclin-D1, bcl-2. RESULTS: The lower lip was the predominant location of squamous cell carcinoma, with the following factors playing important roles: chronic sun exposure, history of smoking, alcohol use and familial risk of cutaneous tumors. The male/female ratio in our survey was 5:1. The p53 protein was positive in approximately 50% of SCC cases and in 20% of controls. This protein is mostly associated with chronically photoexposed skin areas. AgNOR positivity increased with the loss of cellular differentiation; a progressive increase in size and a poorly defined shape were evident in poorly differentiated carcinomas. CONCLUSIONS: The results of this multicenter study showed that there is a noticeable difference in the expression of PCNA, p53, cyclin-D1, and AgNOR in tissues from patients with LLSCC and controls.

Aged↗
PubMed2003

The effects of commonly prescribed premolar extraction sequences on the curvature of the upper and lower lips.

The potential for premolar extractions to produce adverse facial effects after orthodontic treatment is still controversial. Detailed documentation of the predictability, or otherwise, of various soft tissue treatment effects would obviously be of assistance to clinical orthodontists in day-to-day treatment planning, by potentially refining the criteria for appropriate selection of various premolar extraction sequences. With this in mind, a retrospective lateral cephalometric study of 80 premolar extraction cases was undertaken to assess whether different patterns of premolar extraction do in fact produce predictably different lateral profile effects. A comparison was made of the changes in lip curvature after the extractions of all first premolars (4/4), all second premolars (5/5), or upper first and lower second premolars (4/5). Changes in the depths of curvature of both the upper and lower lips were not solely dependent on the selection of a particular premolar extraction sequence. Instead, there were wide ranges of individual variation in the changes in the depths of the lip curves. Therefore, in addition to the inherent soft tissue morphology of the lips in individual patients, it is the combined effect of the lip response to various dental and skeletal changes and the competent clinical management of extraction spaces that apparently affects the shapes of the lips within the lateral profile during treatment. In other words, it would seem possible for the clinician to carefully manage either first or second premolar extraction spaces while still protecting the facial profile.

Adolescent↗
PubMed2006

Lip shape and position in Class II division 2 malocclusion.

OBJECTIVE: To determine whether differences exist in the shape and position of the lips between Class II division 2 and Class I malocclusions. MATERIALS AND METHODS: Lateral cephalometric radiographs of subjects with Class II division 2 (n = 30) and Class I (n = 30) incisor relationships were scanned at 300 dpi to produce digital images. These were subsequently digitized in random order. Twenty-one landmarks characterizing the upper and lower lips and the maxillary and mandibular central incisors were digitized. Procrustes algorithms optimally superimposed the landmark configurations to standardize size, location, and orientation. Discriminant analysis of the principal components of shape determined the differences between the Class II division 2 and Class I groups. RESULTS: The shape and position of the upper and lower lips differed significantly between the Class II division 2 group and the Class I group (P < .001). Principal component (PC) 1 (46% of the variance) involved an increase in the thickness of the upper and lower lips in the Class II division 2 group. PC2 (11% of the variance) was characterized by a relatively higher lip line in the Class II division 2 group. CONCLUSIONS: The shape and position of the lips differ between Class II division 2 and Class I malocclusions.

Cephalometry↗
PubMed1990

Ramp-and-hold force control in the upper and lower lips: developing new neuromotor assessment applications in traumatically brain injured adults.

The relation among several parameters of the ramp-and-hold force contraction and target force level was quantified for the upper and lower lip in 40 normal adults and in 4 young adults who had sustained traumatic brain injury (TBI). Using visual feedback, subjects produced ramp-and-hold compression lip forces as rapidly and accurately as possible to end-point target levels ranging from 0.25 to 2.00 newtons. In normal adults, significant positive linear relations were found between the parameters of the ramp-and-hold lip force task and target force level, including the peak rate of force change, peak force, and the mean and standard deviation of force during the hold phase. Though males and females have been shown to differ greatly on absolute maximum force-generating capabilities, they are virtually identical on the measures used to quantify the lip force ramp-and-hold task over the range of compression forces studied. Preliminary investigation of lip force control in 4 TBI subjects suggests that these quantitative measures are useful in determining the distribution and nature of motor impairment between the upper and lower lips during a dynamic force control task.

Adolescent↗
PubMed2001

Fetal cleft lip and palate: sonographic diagnosis, chromosomal abnormalities, associated anomalies and postnatal outcome in 70 fetuses.

OBJECTIVE: The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities. STUDY DESIGN: Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%). RESULTS: The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%). CONCLUSIONS: Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome.

Abnormalities, Multiple↗
PubMed2002

Basal cell carcinoma of the lip treated with radiotherapy.

Basal cell carcinoma (BCC) of the lip is uncommon relative to other cutaneous sites for BCC, such as the central face or scalp. A female predisposition and predilection for the upper lip have been previously documented. A retrospective analysis of patients treated for BCC of the lip was undertaken within the department of Radiation Oncology, Westmead Hospital, Sydney. Twenty patients were identified; 12 women and 8 men. The majority (15/20) had T1 lesions of the upper lip (17/20). Eleven patients were referred for radiotherapy alone and nine for adjuvant radiotherapy following either incomplete excision or local recurrence. With a mean follow up of 36 months no patient has recurred following either definitive or adjuvant radiotherapy. Despite the majority of BCCs of the lip being amenable to surgery fractionated external beam radiotherapy remains an option especially when functional and/or cosmetic concerns are an issue. We present the findings from this small case series and use our findings to illustrate the role of radiotherapy in treating BCC of the lip.

Adult↗
PubMed2000

Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88.

BACKGROUND: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective. METHODS: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions. RESULTS: Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period. CONCLUSIONS: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.

Adolescent↗
PubMed2001

Failure to thrive in babies with cleft lip and palate.

We established the frequency of failure to thrive (FTT) in children undergoing primary cleft procedures by using growth charts and standard-deviation scores. Initially, 147 babies with cleft lip and/or palate undergoing 186 primary lip-and-palate repairs were studied between 1993 and 1996. Rates of FTT were categorised according to cleft type. There was an increasing rate of FTT from 32% for unilateral cleft lip and palate to 38% for bilateral cleft lip and palate to 49% for cleft palate. There was a high incidence of FTT in palatal clefts, especially if these were associated with a syndrome or anomaly (P= 0.001). The incidence of FTT with the Pierre Robin sequence was 100%. In view of the high rates of FTT, two changes were instituted: a feeding-support nurse was appointed to supervise and monitor patients at risk and all patients with the Pierre Robin sequence had supervised airway management. Thereafter, the incidence of FTT was prospectively studied in 68 babies undergoing 84 primary procedures between 1997 and 1999. There was a decrease in the incidence of FTT in comparison with the earlier cohort (9% for unilateral cleft lip and palate, 20% for bilateral cleft lip and palate, 26% for cleft palate). There was a significant decrease in the incidence of FTT in the group with the Pierre Robin sequence, from 100% to 40%. As a result of the provision of a feeding-support nurse and airway management of patients with the Pierre Robin sequence, the incidence of FTT was reduced and the audit loop closed.

Cleft Lip↗
PubMed2001

A comparison of aesthetic, functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures.

Good access to the site of oral cancer is essential to allow for adequate three-dimensional resection of the tumour. Splitting the lower lip in conjunction with a mandibulotomy offers excellent access to all areas of the mouth and pharynx, but this inevitably produces a facial scar and there is morbidity associated with the healing of the mandibulotomy. An alternative approach is the mandibular lingual releasing technique, which provides good access to the oral cavity and avoids the morbidity associated with lip-split mandibulotomy. The aim of this study was to compare aesthetic, functional and patient subjective outcomes between the two access procedures. One hundred and fifty patients had oral access procedures between 1992-95 (ninety lip-split mandibulotomy and sixty mandibular lingual release). Thirty patients fulfilled selection criteria (primary surgery as treatment, tumour size < 5.1 cm, anterior oral cavity tumours, and reconstructed with a radial forearm free flap) and 10 patients from each group were able to attend a review appointment for objective clinical assessment of their speech, tongue mobility, lip competence and temperomandibular signs. Using items from the University of Washington quality of life questionnaire patient subjective outcomes were assessed. Using standardised photographs the clinician and lay persons assessed the overall post-operative facial appearance. The patients also assessed their own facial appearance using a similar scoring method. Resection margins were similar in both groups and it would seem that both methods provide adequate access to the anterior oral cavity. Clinical examination showed no differences in function between the two access procedures. Although there was a small number, the lip-split mandibulotomy group reported significantly better speech, swallowing and chewing. Previous concerns about a possible detrimental effect on appearance following lip-split, were not borne out in this study.

Child↗
PubMed2001

Treatment of squamous cell carcinoma of the lip using Foscan-mediated photodynamic therapy.

Carcinoma of the lip is a common cancer of the head and neck area; its incidence is approximately one-quarter that for oral cavity cancers. It occurs most frequently on the lower lip of elderly males. This non-randomized Phase II study aimed to estimate the complete response (CR) rate to Foscan-mediated photodynamic therapy (Foscan-PDT) in patients with primary cancer of the lip, duration of CR, and the tolerability and safety of Foscan-PDT. Twenty-five patients with squamous cell carcinoma (SCC) of the lip (Tis, T1, T2/N0/M0) and Karnofsky status > or = 70 received 0.15 mg/kg Foscan intravenously, followed 4 days later by a single non-thermal illumination of the tumour (light dose 20 J/cm2, irradiance 100 mW/cm2, lambda=652 nm). Response was determined after 12 weeks and mean follow up is 424 days so far. After 12 weeks, 96% of cases (24/25) showed CR, and all CRs were confirmed by biopsy. The most common adverse event was swelling and local pain at the treatment site. Tumour recurrence was observed in two patients 4 and 18 months after PDT. One patient developed a single lymph node metastasis 7 months after therapy. Photosensitivity reactions occurred in five patients. The functional results were excellent in all patients without any signs of limited mouth opening or impaired lip closure. The cosmetic outcome was better than after surgical therapy. Foscan-PDT is an effective treatment modality for small primary tumours of the lips. Foscan-PDT yields complete response rates comparable to those published for surgery or radiotherapy without causing major toxicity. It allows preservation of form and function and does not compromise future treatment options for recurrent, residual or second primary disease.

Adult↗
PubMed2000

Psychological study of cleft palate children with or without cleft lip by kinetic family drawing.

To clarify how cleft palate children with or without cleft lip perceive their family, we applied the Kinetic Family Drawing (KFD) technique to 60 cleft palate children (with or without cleft lip). The children were aged 7-9 years (in the 1-3 grade of elementary school) and attended the Department of Oral Surgery, Nagoya University Hospital, between 1990 and 1997. Controls consisted of 100 normal elementary school children of the same age. Major findings were: (1) Compared with normal children, cleft lip and palate boys and cleft palate only girls drew their self-images significantly more often in region D (lower right) and in region A (upper left), respectively. (2) Cleft palate children with or without cleft lip felt anxiety and fear toward their family, rarely viewing their homes as a restful place; this suggested insecurity. Uniquely dynamic relations were also suggested in their homes. (3) Cleft palate children with or without cleft lip often perceived their father or mother as persons easily acceptable in society. Rather remote psychological distance between parents and cleft palate children with or without cleft lip was suggested.

Activities of Daily Living↗
PubMed2004

Interferon regulatory factor 6 (IRF6) gene variants and the risk of isolated cleft lip or palate.

BACKGROUND: Cleft lip or palate (or the two in combination) is a common birth defect that results from a mixture of genetic and environmental factors. We searched for a specific genetic factor contributing to this complex trait by examining large numbers of affected patients and families and evaluating a specific candidate gene. METHODS: We identified the gene that encodes interferon regulatory factor 6 (IRF6) as a candidate gene on the basis of its involvement in an autosomal dominant form of cleft lip and palate, Van der Woude's syndrome. A single-nucleotide polymorphism in this gene results in either a valine or an isoleucine at amino acid position 274 (V274I). We carried out transmission-disequilibrium testing for V274I in 8003 individual subjects in 1968 families derived from 10 populations with ancestry in Asia, Europe, and South America, haplotype and linkage analyses, and case-control analyses, and determined the risk of cleft lip or palate that is associated with genetic variation in IRF6. RESULTS: Strong evidence of overtransmission of the valine (V) allele was found in the entire population data set (P<10(-9)); moreover, the results for some individual populations from South America and Asia were highly significant. Variation at IRF6 was responsible for 12 percent of the genetic contribution to cleft lip or palate and tripled the risk of recurrence in families that had already had one affected child. CONCLUSIONS: DNA-sequence variants associated with IRF6 are major contributors to cleft lip, with or without cleft palate. The contribution of variants in single genes to cleft lip or palate is an important consideration in genetic counseling.

Cleft Lip↗
PubMed2002

Soft tissue profile in Anatolian Turkish adults: Part I. Evaluation of horizontal lip position using different soft tissue analyses.

This study investigated cephalometrically the horizontal lip position of Anatolian Turkish adults using the soft tissue analyses of Steiner, Ricketts, Burstone, Sushner, Holdaway, and Merrifield. Ninety-six adults (55 females, mean age, 21.63 years; 41 males, mean age, 22.45 years) with Angle Class I occlusal relationships were selected from the dentistry students at the University of Istanbul and called the dentally normal group. Their lateral cephalometric radiographs were analyzed, and 44 subjects (21 females, mean age, 21.35 years; 23 males, mean age, 21.41 years) with normal anteroposterior (ANB angle, 2 degrees +/- 2 degrees ) and vertical (SN-MP angle, 32 degrees +/- 5 degrees ) skeletal relationships were selected from the dentally normal group and called the dentally and skeletally normal group. Ten linear and 6 angular measurements were analyzed on each radiograph, and the significance of the differences between the groups was studied by means of the Mann-Whitney U test. The results of this study indicate that in Anatolian Turkish adults (1) the upper and lower lips were retrusive according to the norms of Steiner and Ricketts; (2) both the upper and lower lip values were within the normal range according to Burstone's B line; (3) the upper lip was protrusive and the lower lip was retrusive compared with the norms developed by Sushner for a black population; (4) the value for the lower lip was similar to the standard proposed by Holdaway, while the values for the nasal prominence and the H angle were greater than Holdaway's norms; and (5) the Z angle was smaller than the norm established by Merrifield.

Adult↗