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At least 937 records · Page 52Linked to original sources
PubMed2006

TZ-transposition flap: an alternate method of lower lip reconstruction for partial thickness defects.

PURPOSE: This study examined the reliability and cosmetic outcome of a Z-transposition flap with mucosal advancement for repairing partial thickness defects of the lower lip measuring less than 50% the lower lip length. MATERIALS AND METHODS: Eleven patients treated in 2003 and 2004 were prospectively evaluated. All patients had undergone Moh's tumor excision and were referred for reconstruction. All defects measured less than 50% the lower lip length. Wound healing problems, cosmetic outcome, and flap reliability were evaluated at greater than 3 months postoperatively. RESULTS: All patients healed uneventfully with good cosmetic results and flap reliability. CONCLUSIONS: The Z-transposition flap is an acceptable alternative for reconstructing partial thickness defects of the lower lip.

Aged↗
PubMed1981

The anatomy of the philtrum: observations made on dissections in the normal lip.

Cadaver dissections and histological studies were performed on the philtral region of eight adults and four foetal lips to elucidate the detailed anatomy of the orbicularis oris muscle in the intact normal lip. The findings are correlated with clinical observations on lip function and modifications of technique are suggested that might improve the results in cleft lip repair.

Adult↗
PubMed1985

Correlations of sinus, conical elevation, median depression of the lower lip and types of oral clefts.

The incidence of autosomal dominantly inherited Van der Woude's syndrome among Finnish patients with cleft lip and palate CL(P) and with isolated cleft palate (CP) is approximately 2.5%. The incidence of conical elevation of the lower lip (CE) is 39% in CP and 0.8% in CL(P) patients. A pathogenetic similarity of sinuses and CE's was noted. The following classification was used to study associations between sinuses and CE's: (1) sinus; bilateral, unilateral, atypical; (2) CE: bilateral, unilateral; (3) median depression of the lower lip (MD); (4) combined sinus and CE; (5) combined CE and MD. According to the classification developed, a group of 77 sinus patients and 156 CE and/or MD patients was classified in subgroups of CL(P), CP, Pierre Robin anomalad (PR) and non-cleft subjects. The findings were: the sinus was bilateral on 52%, unilateral in 34% and atypical in 14%; the CE without associated sinus was bilateral in all cases; the sinus was associated with CE in 77% of all sinus subjects. The highly increased incidence of the CE in the CP (92%) and in the CL(P) (61%) sinus groups compared to the incidences of CE in these groups in general (39% and 0.8%) shows a close relationship between these 2 disorders of the lower lip, but the similarity of the genetic etiology still remains unclear.

Child↗
PubMed1975

A contribution to the primary reconstruction of the upper lip and labial commissure following tumour excision.

Two procedures for the primary reconstruction of the upper lip and corner of the mouth following tumour excision have been described in the paper presented. One method represents a modification of Burow's technique (1855) for the reconstruction of the lower lip, which is very suitable in the reconstruction of the lateral border of the upper lip. The second procedure is best suited for the remoulding of the area of the angle of the mouth. The tumour is excised in a crescent-shaped manner, and the missing upper and lower lip reconstructed by means of a horizontal incision in the cheek, and de-epithelisation of two triangular areas which are covered with undermined buccal mucosa. The incision lines described have been illustrated in two cases.

Aged↗
PubMed1992

Latham's appliance for presurgical repositioning of the protruded premaxilla in bilateral cleft lip and palate.

Dislocation of the maxillary segments in cleft lip and palate still is a challenge to the surgeon and the orthodontist. The premaxillary protrusion in bilateral cleft lip and palate, complicates the treatment severely. Latham's appliance, inserted on average at 2-months-of-age, relocates the segments over 3-4 weeks. Removal of the appliance is immediately followed by functional surgery. The first operation comprises: (1) intra-alveolar veloplasty; (2) closure of the alveolar cleft with the help of a gingivo-periosteal-plasty; (3) lip adhesion and (4) insertion of ear tubes. This operating schedule establishes the functional matrix as early as possible. Midfacial growth as well as language and speech development are provided with the necessary preconditions as far as we understand this complex situation. Five cases, being representative of 41 cases, are outlined in detail. The longest follow up period is 3 years; no growth disturbance of the maxilla has been detected to date. Definitive lip and columella surgery is facilitated.

Child, Preschool↗
PubMed2002

Three-dimensional facial morphology, following primary cleft lip repair using the triangular flap with or without rotation advancement.

INTRODUCTION: There are numerous methods of repairing a cleft lip. In our institution, two methods have been used for primary lip repair, the triangular flap method, and the rotation-advancement plus small triangular flap method. The purpose of this study was to compare postsurgical anthropometric results following these two surgical methods. PATIENTS: Twenty children with a unilateral complete cleft lip, alveolus and palate (UCLAP) were selected for this study. Ten underwent primary lip repair by the triangular flap method (Triangular Group), and the other 10 underwent repair by the rotation-advancement plus small triangular flap method (Rotation Group). METHOD: They were documented with a three-dimensional optical scanner, and analysed with computer-aided anthropometric method reported previously (Comput. Methods Programs 58: 159-173, 1999a; J. Cranio-Maxillofac Surg 27: 345-353, 1999b). RESULTS: The shapes of the nose and nostril were a little better in the Rotation Group. However, in the Rotation Group, differences between good and poor cases were more extreme than in the Triangular Group. The shape of Cupid's bow was good shortly after surgery in the Triangular Group. A good shape of Cupid's bow was also obtained in the Rotation Group, but the improvement was more delayed. On the non-cleft side, the length of Cupid's bow was more extended in the Triangular Group. Certain deformities were common to both groups, such as deviation of the columella and a flattened ala on the cleft side. CONCLUSION: Rotation-advancement plus the small triangular flap method was thought to produce somewhat better results, however, further improvements in the technique are needed.

Alveolar Process↗
PubMed2002

The potential peril from caliber-persistent arteries of the lips.

The arteries supplying the lips are very tortuous so they can accommodate the movements of the mouth. Labial arteries taper only slightly and are usually caliber-persistent vessels. On rare occasions, older adults have a tumor-like lesion form on the vermilion of the upper or lower lip or have an ulcer of the lower lip. Cancer is the concern of the person and his or her physician and dentist. In surgical excision of this tumor-like lesion or removal of a specimen for biopsy, the treatment team needs to prepare for the possibility of brisk arterial bleeding and have proper materials to ligate the labial artery in the event it is inadvertently transected. It is also important to remember that both ends of a transected artery should be ligated. Could the tumor-like lesion or lip ulcer be a mucosal sign of a caliber-persistent artery of another area of the gastrointestinal tract? This question has not received adequate investigation. The relationship is unlikely but deserves consideration.

Adult↗
PubMed2002

A maxillary lip prosthesis retained by an obturator with attachments: A clinical report.

This article describes the prosthetic rehabilitation of small maxillary lip and maxilla defects with a lip prosthesis attached to an obturator. The definitive obturator prosthesis was designed with 3 plastic ball attachments on the labial surface that provided adequate retention for the lip prosthesis. The thin margin of the lip prosthesis ensured that it adapted well to functional movements.

Carcinoma, Adenoid Cystic↗
PubMed1985

Anatomy of the orbicularis oris muscle in incomplete unilateral cleft lip based on histological examination.

Histological sections of tissue removed from three incomplete cleft lips at the time of repair, a nature's scar line, and a noncleft lip were examined serially in the horizontal and saggital planes. The findings confirm previous data from electrical stimulation studies of clefts and a three-dimensional histological model of the orbicularis oris in a complete cleft lip. There is a disorganized mass of muscle fibers with numerous dermal insertions and no evidence of well-defined muscle bundles running parallel to the cleft margins. The fibers are somewhat hypoplastic and less abundant than those present in noncleft lips.

Child↗
PubMed2000

Arrangement of the orbicularis oris muscle in different types of cleft lips.

A thorough knowledge of the anatomy of the labial region, especially the arrangement of the muscle fibers, is essential for the success of primary repair of the cleft lip. Pared lateral and medial edges from 20 unilateral incomplete cleft lips and 25 unilateral complete cleft lips were obtained during primary surgery. Three specimens of normal lips were taken from unclaimed infant cadavers as the controls. They were prepared for routine histological studies and were examined to study the direction of muscle fibers. Intrinsic and extrinsic bundles were identified in both lateral and medial sides of specimens of both cleft types. The intrinsic bundle was not displaced but was interrupted by the cleft. The extrinsic bundle in the lateral side of both cleft types ran upward along the lateral cleft margin, whereas in the medial side it ran horizontally to terminate close to the medial cleft margin. The extrinsic bundle is the retractor, which is associated with facial expression, whereas the intrinsic bundle is the constrictor of the mouth. Because there are two functional components in the orbicularis oris muscle, identifying and repairing them separately will enable each of them to accomplish their distinctive functions.

Cadaver↗
PubMed2003

Total lower lip reconstruction using sensate composite radial forearm flap.

In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery.

Adult↗
PubMed1979

Correction of major defects of the vermilion with a cross-lip vermilion flap.

A method is described to correct major vermilion defects by using a transverse, cross-lip, vermilion flap. Sizable defects can be easily filled in to obtain an upper lip with better contour and simultaneously reduce the unpleasant fullness of the lower lip to produce better balance between the two lips.

Cleft Lip↗
PubMed1984

A tissue-expanding vermilion myocutaneous flap for lip repair.

An approach to lip reconstruction is described utilizing a myocutaneous vermilion flap based on the inferior labial artery. The inherent elasticity of the lip is used to great advantage by stretching the freed vermilion flap to bridge a loss of about one-half the lower lip. This vermilion flap may be worthy of consideration when reconstructing lip defects resulting from trauma (e.g., electric burns), tumor resections, and other congenital anomalies.

Adolescent↗
PubMed1990

Functional support for flap reconstruction of the lower lip and mandible.

A case of functional support for distant flap reconstruction of the entire lower lip and mandibular symphysis following resection of an aggressive recurrent basal cell carcinoma of the lip is presented. Resection of the entire lower lip and mandibular symphysis includes loss of the orbicularis oris and attached muscles of the modiolus as well as the buccinator and masseter muscles. Without the support of these muscles, control of saliva as well as solid and liquid food is lost and articulation is hampered. In this case, fasciae latae strips attached to distally transected temporalis muscle tendons were tunneled bilaterally into the lower lip and chin area, which had been previously reconstructed with deltopectoral and pectoralis major musculocutaneous flaps.

Aged↗
PubMed1994

The effects of lip repair with and without soft-tissue undermining and delayed palate repair on maxillary growth: an experimental study in beagles.

Undermining of the soft tissue on the surface of the maxilla at the time of cleft lip repair remains a controversial issue in cleft management. Using 64 eight-week-old beagles, we tested the hypothesis that lip repair with soft-tissue undermining contributes more to maxillofacial growth aberrations than lip repair without these additional procedures. Animals were assigned to four groups: unoperated controls, unrepaired controls, and two experimental groups (with and without undermining). Defects simulating cleft of the lip, alveolus, and palate were surgically created in the unrepaired and experimental animals. At 36 weeks of age, 11 measurements were made directly on the cleaned maxillae. Analysis revealed that all groups with surgically created defects were significantly different from normal; however, animals with undermining exhibited the greatest group deviation from normal. These findings reaffirm our earlier conclusions that undermining of the soft tissue on the surface of the maxilla is detrimental to maxillofacial growth.

Analysis of Variance↗
PubMed1997

Unilateral cleft lip repair in the presence of a vermilion hemangioma.

This case describes a repair of a unilateral cleft lip complicated by a lip hemangioma. The relevant issues regarding timing of the repair include safety of the procedure by minimizing blood loss during excision of the hemangioma and minimizing anesthesia risk. In obtaining a lasting cosmetic result, excision of the hemangioma would need to be done when the potential for residual tumor growth would be least likely (during tumor involution). Finally, the difficult issue of psychosocial concerns would balance the need for traditional early cleft repair with a definitive repair prior to increased social interaction in school. All these concerns were met with a delayed single-stage repair after partial involution of the hemangioma. We feel that a single-stage excision and lip repair is an acceptable option. It is reasonable to delay the cleft lip repair until significant involution of the hemangioma has occurred. An acceptable aesthetic result is obtainable.

Child, Preschool↗
PubMed2000

Formation of philtral column using vertical interdigitation of orbicularis oris muscle flaps in secondary cleft lip.

The philtrum in the lip has an important aesthetic significance and is a mark of individual distinction. For patients who have undergone cleft lip surgery, the construction of the philtrum is crucial for restoring a normal appearance to the upper lip. A total of 13 patients with unilateral cleft lip nose deformities were treated for the creation of a philtral column between January of 1998 and February of 1999. Eight of the patients were male and five were female with an age range of 10 to 40 years old. The scar on the philtral column is excised and a full-thickness incision is made down to the orbicularis oris muscle and mucosa. The medial and lateral muscle flaps are then exposed and split into two leaves. The two leaves of each muscle flap are sutured together to create a vertical interdigitation. Any excess skin is not excised but rather closed with 7-0 nylon. The follow-up period ranged from 6 to 15 months, with an average of 10 months. Ten of 13 patients were satisfied with their good surgical results. Two had fair results. One patient experienced a widening of the scar and no improvement in the philtral column. A possible cause for this lack of improvement was a partial disruption of the interdigitated muscle flaps due to the early active movement of the muscle before wound healing. In conclusion, the advantages of this procedure include the creation of an anatomically natural philtrum through preserving the continuity and function of the muscle, sufficient augmentation of the philtral column by the vertical interdigitation of the muscle, relief of skin tension, and no donor-site morbidity.

Adolescent↗
PubMed2001

Primary repair of bilateral cleft lip and nasal deformity.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. List five principles that guide synchronous repair of bilateral complete cleft lip and nasal deformity. 2. Explain how different growth rates for the principal nasolabial features are applied during primary repair. 3. Describe two approaches for positioning the alar cartilages to form the columella. 4. Discuss the influences on referral patterns for a newborn with bilateral cleft lip. --Traditional repair of bilateral cleft lip focused on labial closure but accentuated the nasal deformities, which were addressed later. By the end of the past century, single-staged labial closure had replaced the old multistaged procedures and the technical emphasis had begun to shift from secondary to primary nasal correction. Now, presurgical maxillary orthopedics sets the bony foundation for synchronous nasolabial repair and for closure of the alveolar clefts. The study of normal nasolabial growth and the typical stigmata of the conventional methods provides the necessary foreknowledge to guide surgical sculpture in three dimensions and to anticipate the fourth dimension. The convergence of several forces are changing referral lines for children born with bilateral cleft lip. These include affirmation of centers of excellence, surgeons' self-regulation, prenatal diagnosis, economics of health-care delivery, and increasing parental sophistication. These pressures are not necessarily in conflict. Care by a subspecialized plastic surgeon and experienced team is in the best interests of the child and the third-party payer.

Child, Preschool↗