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PubMedDate not supplied

New concepts in lower lip reconstruction.

This article presents three methods that enable immediate and satisfactory repair of defects of the lower lip. In partial defects of the lower lip, an advancement flap technique developed from the Bernard method is used. Two methods are described for total resections. The first method is a combination of the advancement flap technique with a reverse Abbé-Estlander flap brought down from the upper lip and is done in two stages. The second method achieves reconstruction in one stage and consists of bringing two arterialized island flaps from the nasolabial region to reconstruct the lower lip. The new methods are superior to traditional methods of lower lip reconstruction in terms of esthetics and function.

Humans↗
PubMed2006

Prenatal detection of associated anomalies in fetuses diagnosed with cleft lip with or without cleft palate in utero.

OBJECTIVE: The aim of this study was to determine the prenatal detection rate of associated anomalies in fetuses with a suspected cleft lip with or without cleft palate. METHODS: Fetuses with a suspected cleft lip with or without cleft palate, determined by prenatal ultrasound, were prospectively enrolled. Additional anomalies suspected by ultrasound or genetic testing were recorded. Postnatal outcome was obtained. RESULTS: Forty-five fetuses with a cleft lip with or without cleft palate, diagnosed prenatally with either two-dimensional and/or three-dimensional ultrasound, were studied. Postnatal follow-up revealed that 16 (35.6%) of these 45 fetuses had an additional structural or syndromic abnormality. Of the 37 fetuses with prenatally determined 'isolated' cleft lip with or without cleft palate, eight (21.6%) had an additional malformation identified after delivery. CONCLUSION: In pregnancies complicated by a cleft lip with or without cleft palate, patients should be informed of the risks of associated anomalies, some of which may be undetected prenatally.

Abnormalities, Multiple↗
PubMed1982

Structure and composition of the oral mucous membrane on the lips and cheeks of the monkey, Macaca fascicularis.

In seven monkeys (6 Macaca fascicularis, 1 M. mulatta; 2.4 +/- 0.6 kg in weight) the labial and buccal mucosae were studied morphologically and quantitatively. Following fixation by perfusion, the upper and lower lips and entire cheeks were dissected free and processed for light-, scanning and transmission electron microscopy. Established programs (HISTOMEP, MUMANA II) and appropriate morphometric techniques were used to estimate, at the light-microscopic level, the epithelial thickness, the width of the combined lamina propria/submucosa, and the volumetric composition of the gland-containing portions of lip and cheek mucosae. The cheek epithelium was more than twofold thicker than the lip epithelium, on the average 0.46 +/- 0.04 and 0.21 +/- 0.02 mm, respectively, with no differences related to sex or topographical sites. The combined lamina propria/submucosa was 1.32 +/- 0.19 and 1.50 +/- 0.26 mm in width in cheeks and lips, respectively. The main mucosal constituents at both sites were glandular and connective tissue, and lymph follicles associated with secretory ducts. In lips, the volume of plasma cells around gland acini correlated positively with the amount of lymphoid tissue present around topographically related ducts. It is suggested that the duct/lymph follicle assembly may serve as a local antigen-recognition system.

Animals↗
PubMed1991

Lip muscle reflex and intentional response levels in a simple speech task.

Sensorimotor integration in human lip muscle was studied by recording muscle activity while subjects produced simple speech utterances in response to mechanical stimulation. On each trial subjects were instructed either to produce the syllable "pa" or not respond when they detected movement of a small paddle held between the lips. Mechanical stimuli were adequate to elicit reflexes over poststimulus intervals of 15-30 ms (R1) and 30-50 ms (R2). EMG recordings were obtained from upper and lower lip muscles, and EMG levels were calculated for individual trials over several poststimulus time intervals. The independent effects of stimulus magnitude, prestimulus EMG, and reaction time on poststimulus response levels were assessed using multiple regression analysis. R1 and R2 levels were positively correlated with stimulus magnitude, but stimulus magnitude had little modulating effect on intentional lip muscle responses. Both reflex and intentional response levels showed positive associations with prestimulus EMG level. Instructional set had significant modulating effects on reflex responses in 9 of 10 subjects, but the nature of these effects varied among subjects. These various findings are discussed in relation to similar studies on limb motor systems and lip motor control for speech.

Adult↗
PubMed1990

Cleft lip-nose repair technique: sequential repair.

The results of repairing cleft lip by aesthetic plastic surgery are now excellent. However, the cleft lip-nose deformity is still very difficult to repair with the present techniques. A technique that can repair the cleft lip-nose deformity with good results is presented. The technique is divided into three parts: Part I consists of nasal repair of the primary cleft lip. Part II is nasal reconstruction as a secondary operation with or without lip repair. For example, nasal reconstruction may be secondary to repair of deformities of the sill, rim, limen nasi, septum, or nasal bones. Part III is an aesthetic nasal operation such as rhinoplasty, mentoplasty, or zygomaplasty.

Cleft Lip↗
PubMedDate not supplied

Galea and subgalea graft for lip augmentation revision.

In this paper we will review the results obtained during the last 2 years with the aponeurotic galea and subgalea for vermillion lip augmentation. The survey was carried out on 42 patients who displayed either an absence of or reduction in the vermillion of one or both lips or a senile lip. In all cases the surgical procedure introduced aponeurotic galea and subgalea in the space found between the orbicular lip muscle and the vestibular mucus, just behind the vermillion. All the operations were performed under local anaesthetic. The size of the aponeurotic galea fragment removed varied in length between 10 and 12 cms. and in width between 1 and 2 cms., using the following parameters for its dimensions: the previous volume of the lips, and the distance between the two buccal commissures when in the "smile position."

Adult↗
PubMed1997

[Outcome of Van der Meulen columellar extension in bilateral lip-jaw-palate clefts].

A total of 42 patients were operated on for secondary columellar elongation at the Department for Cranio-maxillofacial Surgery in Essen, Germany, from 1990 to 1996. The procedures were carried out because of nasal deformity in bilateral cleft lips (n = 35) or unilateral cleft lips (n = 7). The well-established drawbacks of Millard's forked flap technique, especially the resulting unfavourable scars at the lip columellar angle and the unpredictable, more conspicuous scar formations within the upper lip gave rise to an intensive search for an alternative surgical technique in our clinic. Since 1995 we have undertaken 14 secondary columellar elongations by means of Van der Meulen's three dimensional Z-plasty at the alar rim. Avoiding reopening of the lip we were able to lengthen the columella and project the nasal tip forward between 3 mm and 8 mm in all patients without introducing additional visible scars. The procedure led to an improved contour of the nasal tip, the alar rims and the nostrils. Nevertheless, we observed secondary broadening and shortening of the elongated columella in two children. This complication could subsequently be avoided by postoperative application of a nostril splint. The results confirm the effectiveness of the described technique for moderate columellar lengthening. The postoperative application of nostril splints is mandatory.

Adolescent↗
PubMed2003

[Social orientation of parents of children with cleft lip and palate].

BACKGROUND: Cleft lip and palate are the most common malformation in the orofacial region. The type and dimension of the cleft determine the functional limitations of respiration, swallowing, speech, articulation and hearing. In addition, cosmetic and communicative restrictions influence the cognitive, social and educational progress and the wellbeing of the children affected. Their parents face a difficult and lasting task: They have to cope with their child's handicap and the current standardised treatment procedures which start in early infancy. To guarantee optimum therapeutic success parents must be included as co-therapists. Therefore more information about parents' concerns and coping strategies are required. METHOD: To assess the strain put on parents of children with cleft lip and palate as well as the parents' coping strategies, a standardised questionnaire for the German-speaking parents was used during consultation in the out-patient clinic. RESULTS. In comparison with parents of children with other handicaps, the parents of children with cleft lip and palate feel less stressed out and adopt strategies of coping such as intensification of partnership, use of social support, as well as self-respect and fulfillment. Working mothers are less preoccupied and less at risk of being focussed on the handicapped child only. In comparison, the parents of children with Orofacial clefts focus less on the handicapped child in general than those parents whose children suffer from additional behavioural disorders. DISCUSSION: Though several functional, behavioural and psychological disorders may occur in children with cleft lip and palate their parents feel comparatively little stress. They do use a variety of coping strategies and tend to adopt a rather positive approach. Certainly, additional disorders of the child lead to more parental stress and likewise requiring more attention to the child which may even accentuate existing behavioural disorders. CONCLUSION: Parents of children with cleft lip and palate experience less stress in comparison with parents of children with other handicaps. Therapeutic efforts and regular check of the child's progress might support parents' coping strategies. Therapists should also ask for additional disorders such as behavioural disorders and initiate adequate support.

Adaptation, Psychological↗
PubMed2003

Species differences in the reflex effects of lingual afferent nerve stimulation on lip blood flow and arterial pressure.

We evoked changes in lower lip blood flow and systemic arterial blood pressure by electrically stimulating the central cut end of the lingual nerve in artificially ventilated, urethane-anesthetized, cervically vago-sympathectomized cats, rats, rabbits, and guinea pig. The systemic arterial blood pressure changes were species-dependent: increases in rat, consistent decreases in rabbit and guinea pig, and variable among individuals in cat. In cat and rabbit, lip blood flow increases, which occurred only ipsilaterally to the stimulated nerve and showed no statistically significant correlation with the systemic arterial blood pressure changes. In rat, the ipsilateral lip blood flow increase was markedly greater than the contralateral one, and although there was a significant correlation between each of them and the systemic arterial blood pressure changes, the ipsilateral increase presumably included an active vasodilatation. In guinea pig, lip blood flow decreased on both sides in proportion to the systemic arterial blood pressure reductions. Thus, species variability exists in the sympathetic-mediated systemic arterial blood pressure changes and parasympathetic-mediated lip blood flow responses themselves, and in the relationship between them.

Animals↗
PubMedDate not supplied

The V.L.S. classification for secondary deformities in the unilateral cleft lip.

A classification designed to be used as a simple and reproducible method to evaluate the residual lip deformities following unilateral cleft lip repair is presented. It was developed by analysing the appearance of the upper lips of 81 patients referred to the author with repaired unilateral clefts. The assessment of each lip was divided into 3 separate components: the vermilion (V), the lip itself (L), and the scar (S), and the resulting classification was termed the V.L.S. classification.

Adolescent↗
PubMedDate not supplied

The V.L.S. classification for secondary deformities in the unilateral cleft lip: clinical application.

Results obtained in 70 cleft lip and palate patients who were assessed using the V.L.S. classification are presented. Of these 70 patients, 24 (34%) had had a Millard repair, 13 (19%) a straight line repair, and 33 (47%) had had a repair incorporating a Z-plasty. Both the Millard repair and the Z-plasty repair were associated with a lip of equal height in 54% of patients, whilst in the straight line repair group, 69% of patients had lips of equal height. A long lip was more often associated with the Z-plasty type repair group (27%) of patients, and short lips were more associated with Millard type repair (33%), and straight line repair (31%). Irrespective of the technique used, a notch at the site of the scar was the most common defect found at the vermilion. Wideness and irregularity were the most common unaesthetic features of the scar.

Adolescent↗
PubMed1983

Classifying cancer of the lip: an epidemiological perspective.

A review of papers related to oral cancer reveals some non-uniformity in the classification of cancer of the lip. This paper examines the incidence of lip cancer in England and Wales using age-standardized and age- and sex-specific rates, and relates the results to those for other sites of oral cancer. There is a falling trend in age-adjusted incidence rates for lip cancer but not for intra-oral cancers, and the age-specific incidence shows a plateau effect for lip cancer after about 75 yr of age, whereas the incidence rate continues to rise throughout life for intra-oral cancers. These differences underline the importance of classifying cancer of the lip separately from other oral cancers.

Age Factors↗
PubMed1995

Nasal symmetry after primary cleft lip repair: comparison between Delaire cheilorhinoplasty and modified rotation-advancement.

PURPOSE: Periosteal musculoaponeurotic (PMAS) reconstruction is a key objective in primary repair of the cleft lip. The reconstructed muscles provide a sound framework and stimulus for development of the nasolabial region. In this study two primary cleft lip repair techniques were retrospectively studied to determine if one [Delaire (Del)] which involves PMAS repair around the cleft results in more nasolabial symmetry than a technique that does not fully addressed the musculature [modified Rotation-Advancement, (mR-A)]. PATIENTS AND METHODS: Four-and 5-year-old children with complete unilateral cleft lip and palate were recalled for study (n = 33 children; Del group, 16; mR-A group, 17). Clinical and photographic records were obtained and anthropometric analyses determined for comparison between groups. RESULTS: In the mR-A group, noses had more asymmetrical tips, were shorter, projected less, and tended to be flatter or wider. Nasal indices tended to support these findings. Nasal height was similar for the mR-A and Del groups. When comparing cleft versus noncleft sides, alar width and length and nostril length were significantly different for both cleft groups. CONCLUSIONS: It appears from this study that reconstruction of the PMAS of the nasolabial region during primary cleft lip repair may positively influence growth and development of the nose in unilateral cleft lip and palate patients.

Child, Preschool↗
PubMed1988

Linear changes of the maxillary and mandibular lips.

This investigation was designed to assess the growth effect on the linear dimensions of human lips from childhood to adulthood. By means of serial computerized cephalometry, the changes in lip length and thickness were studied in 32 untreated male and female subjects from 8 to 18 years of age. It was observed that the maxillary and mandibular lips, under the influence of growth, increase in both dimensions with the advancement of age. During the period studied, the length and thickness of the lips of the male subjects exhibited greater increases both proportionally and numerically than the corresponding dimensions of female lips.

Adolescent↗
PubMed1989

Vertical dimensional changes of the lips in the North American black patient after four first-premolar extractions.

The purpose of this investigation was to evaluate the vertical dimensional changes of the lips in the North American black patient after four first-premolar extractions. A sample of 15 patients treated at the Orthodontic Clinic of Howard University College of Dentistry was selected. Pretreatment and posttreatment lateral cephalograms were traced on acetate tracing paper: landmarks of the skeletal and soft tissues were identified, and angular and linear measurements were made. Changes in the vertical dimensions of the lips used the Frankfort horizontal as a reference plane and changes in the horizontal dimensions of the lips used the pterygoid plane as a reference plane. Statistical significance was tested by means of two-tailed t tests and Pearson's r correlations. Findings indicated that retraction of the maxillary incisors correlated with an increase in upper lip depth, an increase in interlabial vertical dimension, and an increase in the inferomentolabial angle. The increase in interlabial vertical dimension correlated with an increase in the horizontal dimension of the upper lip relative to upper incisor retraction. This increase in interlabial vertical dimension relative to upper incisor retraction differed significantly from the results of the study by Jacobs1 on a sample of white patients treated with four first-premolar extractions. It is necessary to investigate this difference in future studies using larger sample sizes.

Adolescent↗
PubMed1995

Squamous cell carcinoma of the lips in a northern Greek population. Evaluation of prognostic factors on 5-year survival rate--I.

The purpose of this study was to determine the clinical features of squamous cell carcinoma (SCC) of the lips, along with its prognostic factors, in order to extend and update the information related to lip cancer in northern Greece and to provide a basis for international comparison. Records of 1510 patients with SCC of the oral cavity presented at the Theagenion Anticancer Institute of Thessaloniki, Greece from 1979 and 1989 were reviewed. The most common site for oral squamous cell carcinoma (OSCC) was found to be the lips (59.4%) as compared to 40.5% of intra-oral SCC. Males were affected more frequently, presenting a ratio of 9.2:1. The peak age of incidence was found to be the 6th decade for men and the 8th for women. Rural residents and outdoor workers were affected more than urban residents (79.9% versus 28.1%). Most of the patients were diagnosed in early categories and early clinical stages of the disease. Almost all (98.5%) were classified into T1 and T2 categories, and 92.9% into stages I and II. A total of 7.59% of patients presented with clinically-positive lymph-node involvement. Most of them were classified as an advanced stage of the disease. Primary surgical excision was performed on 60.14%, radiotherapy on 35.14%, a combination of these on 2.47%, and chemotherapy alone or in combination with the above regimens in 2.22% of the cases. The outcome was adequate for surgery, radiotherapy, and the combination of the two, since 91.3, 74, and 90%, respectively, survived for more than 5 years. An overall 5-year survival rate of 83.3% was found. Our findings showed that the survival rate was significantly influenced by the main prognostic factors, such as the size of the tumour, the lymph-node involvement, the clinical stage of the disease and the histologic differentiation. SCC of the lips continues to be the most common site of oral cancer development amongst the Greek population. The aetiologic significance of actinic radiation for SCC of the lips is confirmed by our findings. The main prognostic factors proved to significantly influence the survival of our patients. Our results support the fundamental principal of head and neck cancer, i.e. that early detection of the primary tumour is the best prognostic factor for increasing survival rates. Therefore, public awareness concerning the disease, and better education for health care workers which will provide a thorough knowledge for the prognosis of oral cancer and the factors influencing it, is necessary.

Adult↗
PubMed2005

Lip and perioral reconstruction.

For defects up to approximately 80% of either upper or lower lip, reconstructions that use remaining lip and cheek can function and look reasonably well. Free tissue transfers, such as the free radial forearm flap, are useful for larger defects as they import additional tissue in one step and reduce microstomia, which is more likely to result from local tissue repairs. At best, free flaps provide a static dam or curtain that functions as a lip; at worst, they deliver a large amount of composite tissue to allow for primary healing. Satisfactory outcomes after free flap reconstructions for lip are best achieved when the transferred tissue is integrated with the native tissues by suspending free flaps appropriately, resurfacing with the flaps with vermilion substitutes, and judicious interposition of remaining lip segments.

Face↗
PubMed2005

Preliminary study of post mortem identification using lip prints.

Identification using lip prints was first performed in the 1950s and was the subject of much research in the 1960s and 70s, leading to the acceptance of this technique as evidence in the criminal justice system. Previous research has focused on identifying lip print types or on methods of obtaining hidden lip prints left at the crime scene. The present study aimed to clarify characteristics of lip prints from cadavers with various causes of death (including drowning and hanging) and to determine the effects of fixation on post mortem changes in lip impressions.

Adult↗