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At least 631 records · Page 35Linked to original sources
PubMed2003

Effects of upper lip closing force on craniofacial structures.

Force generated by the perioral musculature is known to be a potent factor that can affect tooth position and malocclusion. To evaluate the influence of the force of the orbicularis oris muscle on incisor position, we determined the maximum and average strengths of the upper lip of male Class I malocclusion patients with a Y-meter, which was devised to measure the vertical closing force of the lip with a load cell. The skeletal structures and incisor angulation were recorded by lateral cephalograms. Correlation and stepwise regression analyses were performed to determine whether a relationship existed between lip force levels and craniofacial morphology. The average value of the upper lip closing force (AVE) was 7.16 N. Our results showed that the upper incisor angulation was related to the perioral muscle force. The maxillary incisor to Frankfort horizontal angle showed r values of -0.681 (at AVE) and -0.652 (at maximum lip closing force) as determined by correlation analysis. Stepwise regression analysis also showed that the maxillary incisor to Frankfort horizontal angle was more related to the upper lip closing force. Disuse atrophy of the orbicularis oris seems to be an important factor in the development of malocclusion.

Adult↗
PubMed2000

Upper lip length after V-Y versus continuous closure for Le Fort I level maxillary osteotomy.

PURPOSE: The purpose of this report is to document changes in lip length and thickness after Le Fort I maxillary osteotomy by using continuous versus V-Y closure. MATERIALS AND METHODS: This is a retrospective analysis of 18 patients who underwent Le Fort I maxillary osteotomy. Ten patients had a single midline V-Y closure and 8 patients had simple continuous closure. Lateral cephalometric analysis was performed, and preoperative and 12-month postoperative changes in lip dimensions were calculated. Lip length and thickness were analyzed at 5 points: A-point (A), subnasale (Sn), cervical margin of incisor (C), stomion superius (Ss) and labrale superius (Ls). The lengths from A to Sn, C to Ls, and Sn to Ss were calculated. RESULTS: After 12 months, there was no significant difference in lip length (P =.39) or thickness of the upper lip in its upper (P =.75) or lower (P =.19) parts, between the 2 groups. CONCLUSION: Lip length and width show no significant differences before surgery versus after surgery with either closure technique after Le Fort I osteotomy.

Cephalometry↗
PubMed2006

Aesthetic phenomena as supernormal stimuli: the case of eye, lip, and lower-face size and roundness in artistic portraits.

In the first study, eye and lip size and roundness, and lower-face roundness were compared between a control sample of 289 photographic portraits and an experimental sample of 776 artistic portraits covering the whole period of the history of art. Results showed that eye roundness, lip roundness, eye height, eye width, and lip height were significantly enhanced in artistic portraits compared to photographic ones. Lip width and lower-face roundness, on the contrary, were less prominent in artistic than in photographic portraits. In a second study, forty-two art academy students were requested to draw two self-portraits, one with a mirror and one without (from memory). Eye, lip, and lower-face roundness in artistic self-portraits was compared to the same features derived from photographic portraits of the participants. The results obtained confirmed those found in the first study. Eye and lip size and roundness were greater in artistic self-portraits, while lower-face roundness was significantly reduced. The same degree of modification was found also when a mirror was available to the subjects. In a third study the effect of lower-face roundness on the perception of attractiveness was assessed: fifty-three participants had to adjust the face width of 24 photographic portraits in order to achieve the highest level of attractiveness. Participants contracted the face width by a mean value of 5.26%, showing a preference for a reduced lower-face roundness. All results are discussed in terms of the importance of the 'supernormalisation' process as a means of assigning aesthetic value to perceptual stimuli.

Adolescent↗
PubMed2003

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

PURPOSE: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. PATIENTS AND METHODS: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. RESULTS: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. COMMENT: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Adult↗
PubMed1998

Millard repair of unilateral isolated cleft lip: a 25-year follow-up.

Twenty-five patients with isolated unilateral cleft lip took part in a follow-up study at a mean age of 28.6 years. All had had a primary, Millard lip repair, at a mean age of 4.6 months. In 20 patients, at least one secondary correction had been undertaken during adolescence. The overall long-term outcome was thought to be good, leaving a fairly inconspicuous fine lip scar and acceptable nose configuration. In half the patients, however, the lip was slightly elongated and the nostrils were still asymmetrical. These findings concurred with the patients' subjective assessments, which showed that appearance of the lip and nose were rated good by 20 (80%) and 16 (64%), respectively. The findings of this study provide a baseline for future evaluation of the results achieved with lip closure by Johanson's technique.

Adolescent↗
PubMed2000

The feasibility of a kinematic measure of lip closure during meaningful speech.

PURPOSE: Assessment of dysarthria has traditionally been based on perceptual methods. The purpose of this study was to examine the feasibility of using 2D kinematic analysis to measure lip closure during normal speech. METHOD: Retroflective markers (4 mm diameter) were placed on the midline of each lip of three healthy male, caucasian volunteers aged 69 years who repeated the sentence 'My mother made me an apple and blackberry pie' six times. Videorecordings were analysed using the Ariel Performance Analysis System to calculate the distance between the lips before, during and after the sentence. RESULTS: The graphs produced from the data objectively measured the distance between the lips and identified the eight bilabial sounds. However, in spite of stringent study criteria to minimize differences linked to age, gender and race, differences were found between participants. CONCLUSION: Kinematic 2D analysis may have potential for the objective measurement of lip closure in dysarthria in the context of meaningful speech. These results justify further pilot work to explore: the possible variability within defined populations; and the usefulness of 2D kinematic analysis in the measurement of disordered lip closure in dysarthria.

Aged↗
PubMed2003

A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study.

We explored the possibility that a simple and single test could replace the modified Mallampati score for either a difficult or an unaccomplished tracheal intubation in an impending hypoxic patient. Three hundred adult patients were enrolled in this study. They were subjected to the following assessments: 1) oropharyngeal class according to the modified Mallampati criteria; 2) the new, upper lip bite criteria-class I = lower incisors can bite the upper lip above the vermilion line, class II = lower incisors can bite the upper lip below the vermilion line, and class III = lower incisors cannot bite the upper lip; and 3) laryngeal view grading according to Cormack's criteria. The incidence of difficult intubation was 5.7%. The upper lip bite test showed significantly higher specificity and accuracy than the modified Mallampati test (P < 0.001). Comparisons of sensitivity, positive and negative predictive values, between the two tests, however, did not reveal any significant differences (P > 0.05). In conclusion, the upper lip bite test is an acceptable option for predicting difficult intubation as a simple, single test.

Adolescent↗
PubMed1980

The Abbe flap for unilateral cleft lip.

The modified Abbe flap procedure is indicated in secondary unilateral cleft lip in which the Cupid's bow and philtral complex of the cleft side have been destroyed as the result of previous faulty surgery. The Abbe flap is inserted in the center of the tight upper lip with or without prior scar revision, which may be done several months beforehand. The recipient pocket for the flap is made by dividing the upper lip into two parts at the line of the philtral ridge in the noncleft side and bringing the whole prolabial tissue with the residual lateral lip to the cleft side of the upper lip. The natural midline groove included in the lower lip flap is enhanced by a traction suture and simulates a philtral dimple with the split philtral ridges on both sides. Various other techniques are used to improve the final result.

Cicatrix↗
PubMed1985

Upper and lower lip reconstruction using the step technique.

The step technique for lip reconstruction is a simple, flexible, one-stage operation that allows reconstruction of full-thickness defects spanning up to two-thirds of the lower lip and, in our experience, one-half of the upper lip without violating the opposite lip or using distant advancement flaps. Twelve patients, ranging in age from 24 to 86 years, underwent full-thickness lip excisions for squamous cell and deeply invading basal cell carcinomas. Reconstruction was achieved by advancing the remaining lateral lip elements to close the defects in a stepwise fashion without violating the remaining orbicularis oris muscle. All patients had a symmetrical, mobile, oral sphincter with intact commissures, adequate buccal sulcus, no symptomatic microstomia, and normal sensation at the completion of the procedure. There have been no recurrences in a nine-month to four-year follow-up, and satisfactory aesthetic results were achieved.

Adult↗
PubMed1987

Primary surgery of the prolabium in bilateral cleft lip and palate--a comparative study of two methods.

In children with bilateral cleft lip and palate the short prolabium may cause problems during primary lip closure. The prolabium can be used as a lip structure to its full length or it can be partly or totally slid up into the columella. By comparing two groups of children differently treated, we have found that the prolabium as a lip structure should be used to its full length as a central element in primary lip repair, otherwise an excessively long upper lip with unusual scarring of the central portion is the result.

Adolescent↗
PubMed2000

Bilateral congenital pits of the upper lip.

Congenital sinuses, fistulas, dimples, or pits of the lips are uncommon congenital malformations. In the upper lip they are extremely rare, and only one third of them are placed laterally. The authors present a patient with bilaterally placed upper lip pits associated with speech disorders, a short and everted upper lip with an orbicularis muscle defect in the midline, slight hypertelorism, and low-set ears. Orbicularis muscle repair and tubercle augmentation were performed. No further treatment was administered to the upper lip pits because of lack of symptoms. This is the third bilateral case of the sinus or pit of the upper lip reported in the literature.

Child↗
PubMed1981

Ultrasound diagnosis of cleft lip and cleft palate before birth.

Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately 200 scans, have been found in patients with no previous family history of cleft lip-palate. The first case was a bilateral cleft lip-palate visualized at 28 weeks gestation. The second was a unilateral cleft lip-palate detected at 33 weeks gestation. Diagnosis of cleft lip-palate is dependent on appreciation of facial topography in multiple planes, adequate experience in the technique, and observation of the degree of excursion of the undulating tongue. Detection of the facial clefting in utero by ultrasound has resulted in our formulation of a routine for informing the parents of the deformity and referring them for consultation with a plastic surgeon. This is recommended before birth, so that the parents are well acquainted with what the deformity will look like and the sequential steps necessary for its correction. We encourage plastic surgeons, obstetricians, pediatricians, and ultrasonographers to be aware of the ability to diagnose cleft lip-palate before birth.

Cleft Lip↗
PubMed1991

Growth status of children treated for unilateral cleft lip and palate.

Cephalometric distances, angles, and proportions were evaluated for 32 children 5 to 8 years of age treated for unilateral cleft lip and palate. The children were age and sex matched with untreated controls with normal skeletal relationships. The unilateral cleft lip and palate sample was treated by the same surgeon and orthodontist using the same techniques and appliances. Measures of overall facial proportions, facial convexity, and prognathism were not significantly different between the two groups. The primary group differences pertain to the posterior aspect of the maxilla, which is vertically short in the unilateral cleft lip and palate sample. Horizontally, the maxilla of the unilateral cleft lip and palate children was significantly longer, producing a steeper palatal plane. In addition, the zygoma and orbits of unilateral cleft lip and palate children were somewhat retruded; the posterior cranial base and total mandibular length also were longer in the unilateral cleft lip and palate children.

Analysis of Variance↗
PubMed2000

Surgical treatment of the senile upper lip.

Aesthetic changes in the aging upper lip constitute a troublesome problem for modern women. During the process of aging, the following alterations appear in the upper lip: (1) vertical wrinkles, (2) reduction in height of the vermilion border along with lengthening of the skin area of the lip, and (3) "disappearance" of the Cupid's bow. In 1993, Guerrissi and Sanchez described a surgical technique that allowed them to correct the effects of these senile changes in 19 patients. With the use of this surgical technique, a strip of skin on the vermilion border was deepithelialized. The remaining dermal flap was buried in the pocket, which was performed by undermining the superior third of the skin of the upper lip. The short-term results were satisfactory, although a slight reduction in height of the vermilion border and a decrease in the thickness of the lip were observed in five patients (26 percent) 4 years postoperatively. Beginning in 1994, the authors began using a new approach combining dermal flap reshaping with simultaneous lip augmentation using dermal-fat grafts, Gore-Tex (W. L. Gore and Associates, Flagstaff, Ariz.) or AlloDerm (LifeCell Corp., Branchburg, NJ.). No serious or definitive complications were observed. Scars on the vermilion border were not conspicuous. A peel was necessary at the same time for complete elimination of rhytids. With this method, both the patients and the surgeons were satisfied with the results.

Female↗
PubMed2003

Outpatient cleft lip repair.

The emphasis on cost reduction and increased efficiency in health care delivery has prompted an increase in outpatient (ambulatory) surgical procedures. A retrospective review of the perioperative management of patients undergoing cleft lip repair at two urban tertiary pediatric hospitals was performed to assess the safety of outpatient cleft lip repair. The hospital database at Childrens Hospital Los Angeles was searched to find all patients who had been operated on for cleft lip repair during calendar years 1999 and 2000. Two groups were identified from Childrens Hospital Los Angeles: the outpatient cleft lip repair group (patients discharged the same day as the operation; n = 91) and the inpatient cleft lip repair group (n = 14). A data set was acquired from the Royal Children's Hospital in Melbourne, Australia, using the same criteria, for fiscal years 1998 to 2000 (n = 50). All patients from Royal Children's Hospital had operations as inpatients. Parameters considered for each group were age, sex, race, ethnicity, length of hospital stay, preexisting medical conditions or diagnoses, complications, and readmissions or presentation to the emergency department within 4 weeks of operation. The Childrens Hospital Los Angeles outpatient group had three readmissions that were considered to be complications of the operation. The Childrens Hospital Los Angeles inpatient group had one readmission attributable to a complication. The Royal Children's Hospital group also had one readmission for a complication. There was no significant difference in the complication rate of the Childrens Hospital Los Angeles outpatient group and the Royal Children's Hospital group (p > 0.05). There was also no significant difference in the complication rate of both of the Childrens Hospital Los Angeles groups compared with the Royal Children's Hospital group (p > 0.05). This study indicates that cleft lip repair performed in an outpatient setting may be a safe alternative to the inpatient operation. Certain preexisting medical conditions, however, may dictate the need for inpatient hospitalization after repair.

Ambulatory Surgical Procedures↗
PubMed2004

From birth to maturity: a group of patients who have completed their protocol management. Part I. Unilateral cleft lip and palate.

The optimal management of the cleft lip and palate patient from birth to completion of treatment presents a formidable challenge to the plastic surgeon and the associated health care system. The multidisciplinary team approach for the management of these patients is widely accepted. However, a paucity of literature exists discussing specific protocol management, interventions, and the long-term outcomes of patients who have completed a strict treatment protocol with a consistent multidisciplinary team. The aim of this study was to present the details of the specific management protocol at the Australian Craniofacial Unit for cleft lip and palate patients and to present a group of patients who have completed this specific protocol and discuss the details of their long-term care. During a 28-year period from 1974 to 2002, the records of 337 patients treated for unilateral cleft lip and palate were evaluated. Of these 337 patients, 22 have completed the same specific protocol management. The same surgeon (David, the senior author) has been responsible for performing all operative interventions and for overseeing the care of each of the 22 patients, ensuring that the treatment protocol has been executed appropriately and without deviation. The interventions and outcomes were analyzed on the basis of speech, hearing, nasal airway, occlusion, psychosocial adjustment, and appearance. Because of the large volume of data and potential differences in outcomes, the authors' intention is to present this as part I of a four-part series beginning with unilateral cleft lip and palate. The results of isolated cleft palate, isolated cleft lip, and bilateral cleft lip and palate will be presented as parts II, III, and IV, respectively. Speech results were assessed as normal speech, mild abnormality, or severe abnormality by objective measures, and intervention for velopharyngeal insufficiency was noted. Seventeen patients were rated as having normal speech. Four patients were rated as having mild speech abnormality, one patient was rated as having severe speech abnormality, and seven patients required surgery for velopharyngeal insufficiency. Hearing results were measured objectively, and good hearing results were obtained in 18 cases. Five patients required tympanoplasty. All patients required alveolar bone grafting. The high Le Fort I osteotomy was performed in six cases. Bimaxillary surgery was performed in one case. Of all the patients assessed from birth to maturity, 13 required between three and five surgical interventions, and nine required six operations or more. Further details and photographs of preoperative and postoperative examples are provided.

Adolescent↗
PubMed2005

Double unilimb Z-plastic repair of microform cleft lip.

BACKGROUND: Microform unilateral cleft lip is characterized by 1) notched mucosal margin; 2) thin medial vermilion; 3) elevated medial peak of Cupid's bow; 4) furrowed philtral column; 5) hypoplastic orbicularis oris; and 6) minor nasal deformity. METHODS: The author's registry of unilateral incomplete cleft lip was culled for patients with microform cleft lip. Operative correction included: double-limb Z-plasty at the vermilion-cutaneous and vermilion-mucosal junctions; eversion of orbicularis oris; augmentation of philtral ridge with a dermal graft; medial positioning of the alar base; and elevation of the lower lateral cartilage. RESULTS: Microform phenotype was found in 33 of 360 infants (9.2 percent) with unilateral incomplete cleft lip. Male-to-female and left-to-right ratio were both 2:1. Median age at presentation was 11 months (range, 2 weeks to 9 years). Twenty-three patients had a double unilimb Z-plastic repair (including dermal graft and nasal correction). No revisions have been necessary at median follow-up of 5 years, however, 13 percent of children lacked prominence of the upper philtral column and one-third of children exhibited minor nostril asymmetry. CONCLUSIONS: Double unilimb Z-plasty corrects the vertical asymmetry in a microform cleft lip while limiting the scar to the lower one-half of the lip. The philtral ridge is formed by repair of the muscular diastasis and onlay of a dermal graft. Components of this technique are applicable to secondary cleft deformities, such as elevated peak of the Cupid's bow and inadequate philtral ridge.

Adolescent↗
PubMed2005

Congenital lip pits and van der Woude syndrome.

Van der Woude syndrome is an autosomal dominant disease characterized by lower lip pits with or without cleft lip and/or cleft palate. The lip pits commonly have salivary glands that drain into them, which leads to salivary flow from the lip pits. Lip pits may be associated with submucosal palatal cleft, velopharyngeal insufficiency, or genitourinary or cardiovascular anomalies. The pits are treated by surgical resection. The authors report a case of van der Woude syndrome with isolated lip pits and speech difficulties that had been unrecognized until the patient was 6 years old. The surgical technique is described to ensure that the often-bifurcating tracts are removed entirely.

Child↗