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At least 811 records · Page 45Linked to original sources
PubMed1995

The effect of a lip bumper on lower dental arch dimensions and tooth positions.

The effect of a lip bumper on the dimensions of the lower dental arch and on the inclination of the incisors and first molars was studied in 40 children, aged 9-12 years. The children wore their lip bumper full time for 7-10 months. The effects of the lip bumper therapy were recorded on dental casts and profile cephalograms made before and after the treatment. The positions and stages of development of the lower second molars were determined on pretreatment intra-oral radiographs. The lip bumper treatment resulted in an increase of the dental arch widths between the molars, premolars, and canines. The arch length increased through proclination of the incisors and uprighting of the first molars. The stages of development and the positions of the second molars had no influence on the effect of the treatment. Simultaneous treatment in the maxilla with a headgear, a transpalatal arch or a removable plate had no influence on the outcome of the lip bumper therapy.

Cephalometry↗
PubMed1995

An investigation of the association between overjet size, lip coverage, and traumatic injury to maxillary incisors.

This study investigated the association between overjet size and lip coverage when assessing the likelihood of traumatic injury to maxillary incisors. Eleven-hundred-and-thirty-seven 11- and 12-year-olds were examined in school for traumatic injury to their maxillary incisors. The size of overjet and the adequacy of lip coverage of the maxillary incisors was assessed for each child. One-hundred-and-sixty-seven (15 per cent) had experienced traumatic injury to their maxillary incisors. Both increased overjet and inadequate lip coverage of the maxillary incisors were found to be significant risk factors. However, inadequate lip coverage was the single most important independent predictor of traumatic injury (P < 0.001), with a relative odds ratio of 2.62. The results suggest that much of the predictive value of increased overjet may be explained by inadequate lip coverage.

Chi-Square Distribution↗
PubMed1979

Risk factors in lip cancer: a questionnaire survey.

An analysis was made of potential risk factors of cancer of the lip in Finland. The series comprised 290 lip cancer patients, and the controls were 254 patients with squamous cell carcinoma of the skin of the head and neck, all reported to the Finnish Cancer Registry in 1972-1973. The results obtained in a questionnaire survey (response rate, 75%; 54% of the total series) indicated that the male lip cancer patients had engaged in outdoor work and smoking with significantly greater frequency than had the male controls. Together, these two risk factors posed a markedly increased risk (RR = 15.4). However, when the factors were analyzed separately, each excluding the effect of the other, no significant risk could be noted. The male lip cancer patients had recurrent herpetic infections with significantly greater frequency than did the male controls. No significant differences were apparent with respect to urban or rural residence. It is concluded that tobacco smoking and outdoor work probably act together to induce lip cancer. The mode of interaction between these factors and the etiologic role of herpesvirus are discussed.

Aged↗
PubMed1982

Normal lip function in adults.

A superficial review of the literature revealed numerous types of surgical corrections for lip defects, but an in-depth search turned up little information on lip dimensions and functions. In the absence of a range of normal lip values, assessment of postoperative results is limited to the subjective impression of surgeon and patient. Using simple measuring techniques, some of the surgically important aspects of lip anatomy and function have been recorded, analyzed statistically, and presented as a range of normal values to facilitate objective comparison with abnormal and postoperative lip states.

Adult↗
PubMed1985

Primary repair of unilateral cleft lip.

The author's technique for the primary repair of unilateral cleft lip is described, including several improvements made over the last eight years. The technique aims at anatomical reconstruction of congenital anomalies of the orbicularis oris muscle as well as prevention of developmental disturbance and occurrence of deformity after surgical intervention. Cleft lip repair without muscle reconstruction may leave a concavity or a lump in the upper lip movement because of incomplete continuity of the orbicularis oris. No such result was found when muscle reconstruction was performed. In the primary repair of cleft lip, reconstruction of the orbicularis oris muscle is vital to preservation of good function and appearance of the lips.

Cleft Lip↗
PubMed1997

Rotation advancement in traumatic upper lip ectropion.

Rotation advancement is a well-known technique in cleft lip repair. This procedure corrects lip length and abnormal muscle insertion, and allows for accurate approximation of lip structures. It is a widely accepted standard of practice for congenital harelip repair that teaches fundamental principles of reconstructive surgery. An innovation is presented in which this procedure is used to correct a traumatic lip ectropion. The anatomic design is identical to a congenital cleft lip repair. The benefits of this approach are discussed in an interesting patient report.

Adult↗
PubMed1998

The lip index: an anthropometric tool to evaluate objectively the result of the Abbe flap procedure.

To evaluate objectively the outcome of the Abbe flap procedure, an anthropometric ratio--the lip index--is introduced. The lip index is the ratio of the labiale superius-tragion to the labiale inferius-tragion. It represents the protrusion of the upper lip in relation to the lower lip. It has been assessed in preoperative and postoperative photographs of 19 patients who underwent an Abbe flap procedure. The values were compared with the values found in noncleft patients. In all 19 patients, postoperative values were found to have normalized. This study indicates that the lips are in better harmony postoperatively than they were preoperatively.

Adolescent↗
PubMed1999

Permanent lip augmentation with serial fat grafting.

A simple technique for lip augmentation with autologous fat is presented. Local anesthesia is injected into those areas used for fat harvesting and the perioral areas that are to receive the grafts. The fat is taken with a large needle and syringe, washed over meshed gauze, placed into the syringe, and injected into the lip tissue. Multiple passes with a small needle deposit the strained fat in horizontal tunnels within the lips. Subsequent injections are performed at a minimum of 3 months. Lip swelling is short lived and permanent lip augmentation occurs when patients undergo two to three grafting procedures.

Adipose Tissue↗
PubMed2000

Functional lip reconstruction with a radial forearm free flap combined with a masseter muscle transfer after wide total excision of the chin.

Total lower lip reconstruction was accomplished by combining a radial forearm free flap with a masseter muscle transfer. The patient, who had T4 carcinoma, had the entire lower lip resected including the depressor anguli oris muscle. A radial forearm flap was used to reconstruct the lower lip lining and the floor of the oral cavity. The right and left masseter musculofascial flaps were elevated and transferred in the medial-superior direction, and the peripheral margins of the flaps were sutured together. The lateral margins of the flaps were then sutured to the orbicularis oris muscle of the upper lip. Good sphincter function was obtained more than 1 year after the operation, electromyography revealed almost normal mobility of the transferred masseter muscles, and no sagging of the masseter muscle sling was observed. This procedure appears to be effective for the reconstruction of sphincter function of the lower lip after wide excision of the entire chin.

Aged↗
PubMed2002

Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review.

In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.

Adolescent↗
PubMed1993

Two patients with multiple facial clefts including cleft lip and palate.

Report of 2 patients with cleft lip and palate and multiple facial clefts are described using the anatomical classification of Tessier. The first patient was severely polymalformed, with heart, vertebral, and facial malformations. He was examined clinically and with an experimental three-dimensional computer reconstruction that identified an association of a classic cleft lip and palate with cleft nos. 4 and 11 on the right side and cleft nos. 3 and 11 on the left. The second patient, a partial form, with cleft lip and palate and cleft nos. 3 and 11 on the right side, also presented with bilateral cleft no. 7, preauricular tags, and an important microgenia. This second patient was operated for the cleft lip using the principles of Millard and Onizuka with a supplementary Z plasty. We comment on the difficulties of delimitation and treatment when the clefts are very close together and the difference in "quality" of the tissues compared with classic cleft lip and palate.

Abnormalities, Multiple↗
PubMed1985

Total reconstruction of the "end-stage" cleft lip and palate deformity.

The purpose of this paper is to present a 5-year experience using a comprehensive surgical approach to reconstruct what we have chosen to call the "end-stage cleft lip and palate deformity." The deformity consists of varying degrees of midface retrusion, malocclusion, nasal deformity, and lip deformity. Most of the patients afflicted had unacceptable upper lip anatomy characterized by tightness and lack of cupid's bow and bulk. All had severe palatal scarring with resulting arch collapse and severe malocclusion. Most had had multiple surgical attempts to improve nasal aesthetics using standard rhinoplasty techniques with little or no improvement. The procedure involves splitting the upper lip with incisions extending into the upper buccal sulcus and rim of the nose allowing wide skeletalization of the maxilla and osteocartilagenous nasal skeleton. LeFort I or II maxillary advancement, nasal reconstruction, and upper lip modification (with Abbé flap if indicated) are done. The jaws are placed in intermaxillary fixation for 6 to 8 weeks. This comprehensive approach has been used in 16 patients, aged 15 to 29 years, with follow-up of up to 5 years. Excellent functional and aesthetic improvement has occurred in all patients, and complications have been minimal.

Adolescent↗
PubMed1988

Lip-nasal aesthetics following Le Fort I osteotomy.

Forty-one patients undergoing Le Fort I osteotomy for superior and/or anterior repositioning of the maxilla were prospectively studied for changes in soft-tissue morphology of the nasomaxillary region. Nasal parameters studied were changes in interalar rim width and nasal tip projection. It was observed that alar rim width increases with anterior and/or superior repositioning of the maxilla, but increases in nasal tip projection occur only when there is an anterior vector of maxillary movement. These nasal changes could not be quantitatively correlated to magnitude of maxillary movement. Lip changes studied were the horizontal displacement at the vermilion border and subnasale versus that of the incisal edge and point A, respectively, when the maxilla is sagittally advanced and the vertical shortening of the lip versus that of the incisal edge when the maxilla is shortened. Using linear regression analysis, horizontal displacement of the upper lip at the vermilion border was 0.82 +/- 0.13 mm for every 1 mm of maxillary advancement at the incisal edge (p less than 0.001) and 0.51 +/- 0.13 at the subnasale for every 1 mm of maxillary advancement at point A (p less than 0.001). Eighty percent of patients undergoing maxillary intrusive procedures had lip shortening ranging from 20 to 50 percent of the vertical maxillary reduction. Surprisingly, no statistically significant correlation could be demonstrated for lip shortening versus extent of vertical maxillary reduction. Previous literature in disagreement with these findings is discussed. Guidelines for treatment planning utilizing these data are suggested.

Adolescent↗
PubMed1991

Reconstruction of the lower lip and chin with the composite radial forearm-palmaris longus free flap.

Four cases of total lip and chin reconstruction are presented. In three, the composite radial forearm-palmaris longus free flap was used for reconstruction. In the fourth case, the palmaris longus was separated from the flap but still used as a lower lip sling. In all cases, the entire lower lip and the soft tissue of the chin were reconstructed in one stage. All patients healed primarily, and the three who underwent radiotherapy tolerated it without complications. Lip seal and speech were good, and there was no problem with drooling. Postoperative results emphasize the importance of respecting the aesthetic unit of the lower lip and chin.

Adult↗
PubMed1993

Fetal cleft lip and palate: sonographic diagnosis and postnatal outcome.

This is a retrospective analysis of neonatal outcome in 32 fetuses diagnosed over a 3 1/2-year period as having cleft lip and palate by ultrasonographic examination. Unilateral versus bilateral complete cleft lip was accurately diagnosed in fetuses after 16 weeks' gestation. Incomplete cleft lip was more easily detected after 27 weeks' gestation. In only three newborns was the severity of the cleft overappraised. In no instance was a complete cleft lip mistakenly diagnosed as an incomplete form. The fetuses with labial clefting also were categorized sonographically as those without associated abnormalities (n = 15) and those with other detectable anomalies (n = 17), of which 5 had autosomal trisomy. One neonate assessed in utero to have an isolated unilateral incomplete cleft lip had vertebral/rib anomalies and died soon after birth of unsuspected pulmonic stenosis. This study confirms the accuracy of prenatal sonographic examination and underscores the high incidence of spontaneous fetal loss (terathanasia) that occurs whenever cleft lip/palate is associated with aneuploidy or other malformations.

Abnormalities, Multiple↗
PubMed1999

Natural history of fetuses with cleft lip.

The prospect of fetal surgery for cleft lip is predicated on our ability to accurately identify fetuses with clefts and exclude those that have associated anomalies. Prenatal ultrasound is currently the most appropriate means with which to do this. We reviewed the ultrasonographic data from two large perinatal referral institutions to determine the natural history of fetuses with cleft lip who may be candidates for fetal surgery. Forty fetuses had a cleft lip diagnosed prenatally by ultrasound. In this group, severe associated anomalies were common (30 of the 40) and multiple (23 of the 40) in a majority of fetuses. Life-threatening anomalies, such as central nervous system and cardiac anomalies, were the most common defects. As a result, many fetuses were aborted therapeutically or died in the perinatal period. Out of 12 surviving fetuses, only six had isolated clefts, and two surviving fetuses, diagnosed with isolated cleft lip, had no defect identified postnatally. This information has important implications for the perinatal management of fetuses with cleft lip and the potential role of fetal intervention.

Abnormalities, Multiple↗
PubMed2002

Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons.

Reconstruction of bilateral cleft lip nose deformity is difficult and the outcome is inconsistent. This study was conducted to evaluate the gross outcome and the difference in the assessment of nasal appearance as judged by two groups of raters, cleft surgeons and laypersons. Sixty-four patients with bilateral cleft lip were selected for review. The patients' ages ranged from 5 to 30 years. All patients had undergone primary cleft lip repair and secondary nasal reconstruction, and had been followed for at least 6 months. One image for each patient, which included a digitized frontal, lateral, and worm's-eye view, was projected for evaluation by the raters. The raters included five cleft surgeons and five laypersons. A rating scheme was used in which a score of 3 was given for a good, close to normal nasal appearance, 2 for an average result that needed minor revision, and 1 for a poor result that needed major reconstruction. The scores were averaged for each patient in each group and for each group as a whole. The final outcome was judged as good, fair, or poor on the basis of the mean score for each patient. Statistical analysis was performed. The mean score for all patients was 2.08 as assessed by the laypersons and 2.18 as assessed by the cleft surgeon group. There was no statistically significant difference between the two groups. Comparisons on rating scores among different raters revealed a fair agreement on the ratings within each of the two groups. The results were found to be good in 29.7 percent, fair in 64.1 percent, and poor in 6.3 percent of patients when evaluated by the surgeons. When rated by the laypersons, the nasal appearance was found to be good in 26.6 percent, fair in 60.9 percent, and poor in 12.5 percent of patients. This difference in distribution between the two groups was not statistically significant. When comparing the results given by the two groups of assessors, there was agreement on the nasal appearance in 65.6 percent of patients, and a difference in grading in the rest. For the patients who received different grading, the surgeons rated them one grade higher in 63.6 percent and one grade lower in 36.4 percent. There was no difference in grading between any of the evaluators that reflected a two-grade discrepancy in evaluation of results. This study shows that the surgical outcome of bilateral cleft lip nose deformity repair, at the authors' institution, is less than optimal. When assessing bilateral cleft lip nose appearance, the judgment of results by cleft surgeons was similar to that of the laypersons. However, different rating of results existed within each of the two groups, supporting the importance of clearly assessing patient/parent expectations and defining realistic surgical goals.

Adolescent↗
PubMed2006

Management of bilateral cleft lip and nasal deformity.

PURPOSE OF REVIEW: Management of bilateral cleft lip and nasal deformity can be a challenging task. This paper provides an overview of bilateral cleft lip and nasal deformity with an updated review of current management issues in the literature. RECENT FINDINGS: The Centers for Disease Control and Prevention recently reported that orofacial clefts are now the most common birth defect. While this statistic may be disheartening, the increased prevalence brings the problem to light at the forefront of the medical community, thus gaining more support and resources. Many techniques have been described for repair of bilateral cleft lip and nasal deformity. A recent advancement in presurgical orthopedics is the use of nasoalveolar molding to narrow wide clefts. SUMMARY: Surgical management of bilateral cleft lip and nasal deformity poses a challenge to the skill and judgment of the cleft surgeon. Although techniques continue to evolve over the decades, the basic principles of cleft surgery remain the same. The main principles are to achieve an appropriate philtral size and shape, to position the cartilages in a more optimal position, and to attain muscular continuity and symmetry for optimal appearance and function. Thus, while keeping the basic principles in mind, management of bilateral cleft lip and nasal deformity becomes a valuable and rewarding experience for the surgeon, patient and caregiver.

Cleft Lip↗