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At least 955 records · Page 53Linked to original sources
PubMed2002

Correction of secondary cleft lip deformities.

LEARNING OBJECTIVES: After studying this article, the practitioner should be able to (1) describe the common secondary deformities of the cleft lip, (2) determine the appropriate timing for surgical intervention to correct the deformities, and (3) determine the best method of addressing each of the individual secondary deformities of the cleft lip. Secondary deformities are common in children born with a cleft lip and palate. Patients with cleft lip deformity will undergo multiple surgical procedures early in life, so it is imperative to prioritize treatment of their secondary deformities and minimize the number of interventions needed. Of the many approaches used to correct these problems, surprisingly few work well consistently. As with all plastic surgery, the timing and procedure should be predicated on the severity of the deformity.

Cleft Lip↗
PubMed2004

Muscle reconstruction in cleft lip repair.

This article presents a method of muscle reconstruction in the cleft lip patient that grossly reproduces the interlacing muscle anatomy in the central portion of the upper lip and thereby addresses both the static and the functional requirements of cleft lip repair. This lip repair procedure is combined with paranasal muscle reconstruction, preoperative nasoalveolar molding, and postoperative nasal stenting to constitute a comprehensive approach to cleft lip/nose repair.

Child↗
PubMed1995

Reconstruction of total loss of upper lip with hair-bearing flaps.

Carcinoma of the lip is a relatively common problem in Papua New Guinea, accounting for some 12% of all malignant tumours in the oral cavity. The cancer is associated with chewing betelnut with slaked lime and smoking. Advanced squamous cell carcinoma of the upper lip is necessarily managed by primary surgery when radiotherapy facilities are not available. Adequate surgical treatment of these carcinomas usually requires full thickness excision of a portion or whole of the lip. The purpose of this paper is to demonstrate the role of hair-bearing scalp flap for reconstruction of total loss of the upper lip in male patients.

Adult↗
PubMed2004

Sutures and Burrow's triangles placed in the red vermilion in the surgery of upper lip defects.

BACKGROUND: In upper lip defects both the design of the flap and the position of the Burrow's triangles may be reversed so as to conceal the scars among skin wrinkles, folds and the mucosal lip to maximize the aesthetic outcome. OBJECTIVE: To report two cases of upper lip defects in which both scars and Burrow's triangles were concealed in the natural folds and the vermilion. METHODS: Both surgeries were performed under local anaesthesia. RESULT: In both patients the scars were successfully concealed and the results aesthetically acceptable. CONCLUSION: The technique described can be used to conceal scars in cases of upper lip defects with aesthetically acceptable results.

Aged↗
PubMedDate not supplied

A review of common pediatric lip lesions: herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas.

Lip lesions are a common presentation to the pediatrician's office. These lesions are often benign in children, without significant functional morbidity. However, owing to the prominent placement of lips and their role in communication, lip lesions can be alarming to patients as well as to their parents. For these reasons the pediatrician has an important role in recognizing, diagnosing, and treating the various types of labial dermatoses that commonly present to a pediatric practice. Four of the most common lip lesions a pediatrician will see are herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas. This paper reviews the current literature on the diagnosis, treatment, and management of these 4 lesions.

2-Aminopurine↗
PubMed2005

Distinct functions for Bmp signaling in lip and palate fusion in mice.

Previous work suggested that cleft lip with or without cleft palate (CL/P) is genetically distinct from isolated cleft secondary palate (CP). Mutations in the Bmp target gene Msx1 in families with both forms of orofacial clefting has implicated Bmp signaling in both pathways. To dissect the function of Bmp signaling in orofacial clefting, we conditionally inactivated the type 1 Bmp receptor Bmpr1a in the facial primordia, using the Nestin cre transgenic line. Nestin cre; Bmpr1a mutants had completely penetrant, bilateral CL/P with arrested tooth formation. The cleft secondary palate of Nestin cre; Bmpr1a mutant embryos was associated with diminished cell proliferation in maxillary process mesenchyme and defective anterior posterior patterning. By contrast, we observed elevated apoptosis in the fusing region of the Nestin cre; Bmpr1a mutant medial nasal process. Moreover, conditional inactivation of the Bmp4 gene using the Nestin cre transgenic line resulted in isolated cleft lip. Our data uncover a Bmp4-Bmpr1a genetic pathway that functions in lip fusion, and reveal that Bmp signaling has distinct roles in lip and palate fusion.

Animals↗
PubMed2006

Sutureless skin closure for cleft lip repair.

OBJECTIVE: To study the quality of scars following the use of butyl cyanoacrylate to close the skin during cleft lip repair. DESIGN: Nonrandomized prospective study. SETTING: Tertiary care hospital. PATIENTS: Patients (n = 104) with cleft lip and palate in combination of various degrees of cleft with the age group ranging from 3 months to 5 years. INTERVENTIONS: Use of butyl cyanoacrylate to close the skin during cleft lip repair after inserting dermal stitches with delayed absorbable sutures. RESULTS: None of the 104 patients required revision of the vertical scar, which was excellent in nature. No patients had complications such as wound infection, dehiscence, nasal obstruction, or eyelid adhesion. CONCLUSIONS: Quality of the scar following the closure of skin of cleft lip repair using butyl cyanoacrylate was considered excellent.

Absorbable Implants↗
PubMed1991

Operations for microforms of cleft lip.

Microform cleft lip is a mild expression of cleft lip and may be difficult to repair. Its severity may be defined by the degree of downward depression of the nostril rim, skin striae of the upper lip, notching of Cupid's bow, and deformity of the vermilion border. Variation in surgical repair is reported for each type of microform cleft lip.

Cleft Lip↗
PubMed1992

Superior orbicularis oris muscle activity in children with and without cleft lip and palate.

An analysis of integrated electromyographic (IEMG) activity of the superior orbicularis oris muscle was undertaken in 15 children with cleft lip and palate who have undergone surgery compared to 10 children without clefts (control group). Bipolar surface electrodes were used for IEMG recordings of resting level activity and during the swallowing of saliva. Similar resting level activity was observed in both groups. During the swallowing of saliva, activity in children with cleft lip and palate was higher than in children without clefts (noncleft children). Moreover, in the cleft lip and palate group, children with abnormal lip seal showed the highest values for IEMG activity during the swallowing of saliva. This fact suggests that with each swallow of saliva, a greater counteracting effect of the superior orbicularis oris muscle could be produced on the growing maxilla. This may result in a significant long-term effect on the growth of the stomatognathic system, since the process of swallowing is a 24-hour function repeated between 600 and 2400 times each day.

Child↗
PubMed1994

Electromyographic analysis of lip muscle function in operated cleft subjects.

EMG activity of the upper lip was measured with bipolar surface electrodes during speech and nonspeech tasks in order to assess labial function in subjects with repaired clefts. Eighteen patients between 15 and 23 years of age with repaired unilateral cleft lip (isolated or combined with repaired cleft palate) were compared to 24 matched noncleft subjects. Data analysis demonstrated that the amplitude of action potentials of the upper lip was significantly greater in the cleft group. We hypothesize that the enhanced activity of the repaired upper lip during function may contribute to the facial growth abnormalities usually seen in the cleft population.

Action Potentials↗
PubMed1995

Longitudinal study of craniofacial growth in subjects with cleft lip and palate: from cheiloplasty to 8 years of age.

Craniofacial morphology was compared in 10 patients with unilateral cleft lip and alveolus (UCLA), 33 with complete unilateral cleft lip and palate (UCLP), and 14 patients with isolated cleft palate (CP). Serial lateral and posteroanterior cephalograms, obtained just before lip repair at 4 months or palatoplasty at 2 years, and at 4 and 8 years of age, were analyzed through comparisons with the means and growth increments of craniofacial dimensions. Facial forms at 8 years of age were compared with those of 33 noncleft subjects. Wider upper facial width before lip repair in the UCLP patients diminished slightly following surgery, but the condition persisted up to 8 years of age. Less forward growth of the maxilla was found in the subjects who received palatoplasty and a larger vertical growth increment in anterior maxilla occurred in the UCLP patients. Posterior maxillary height showed no significant differences in its growth increment among patients with clefts, but shorter posterior maxillary height in the UCLP patients continued. Linear dimensions of the mandible did not differ among cleft subjects, but a larger intercondylar width, a larger gonial angle, and a slightly retruded mandible in the CP patients and UCLP patients suggested compensation of the mandible to a wider and retroinclined nasomaxillary complex.

Alveolar Process↗
PubMed1995

Follow-up of electromyographic and cephalometric findings in patients with unilateral cleft lip and palate after fifteen months of continuous wearing of a special removable appliance.

A 15-month follow-up study was conducted on 13 children with unilateral cleft lip and palate. The patients presented with short upper lip, abnormal lip seal, and maxillary retrusion. All had undergone surgery in childhood. Cephalometric and electromyographic measurements were made prior to the start of treatment, 4 months into treatment, and after 15 months of continuous wear of a special removable appliance. The cephalometric measurements on paired comparison showed major improvement in both the sagittal maxillary and dentoalveolar positions. The electromyographic activity of the superior orbicularis oris muscle demonstrated no significant changes over the treatment period. Improvement in the sagittal maxillary and dentoalveolar positions seems to suggest that the elimination of the restrictive effect of the superior orbicularis oris muscle is a good therapeutic approach to promote normal growth potential in children with cleft lip and palate.

Activator Appliances↗
PubMed1997

The lambda flap for secondary cleft lip repair.

OBJECTIVE: A modified Abbe flap of the lambda figure type, designed by the author and used before or after secondary cleft lip repair in 146 consecutive cases since 1990 is described. DESIGN: This series consisted of 71 cases with unilateral deformity and 75 cases with bilateral deformity at adolescent or adult ages. The technical details of this method and representative cases with the results are shown. The philtrum is created by incising the two branches of the lambda flap obliquely at 45 degrees to the skin surface in the lower lip, then matching them in the central recipient bed of the deficient upper lip. RESULTS AND CONCLUSIONS: The resultant upper lip is not only full and slack, but also attractive with an acute cubic contour of the philtrum. Furthermore, the residual scar at the donor site is concealed in the mentolabial fold.

Adolescent↗
PubMed1998

Unilateral cleft lip with or without cleft palate and handedness: is there an association?

OBJECTIVE: The purpose of this study was to investigate the possibility of a relationship between the side of occurrence of unilateral clefting of the lip and/or palate and handedness, also taking into account the type of the initial cleft condition, a factor that has not been adequately assessed in previous studies. DESIGN: This was a retrospective study. SETTING: Division of Orthodontics, The Hospital for Sick Children, Toronto, Canada, and Cleft Lip and Palate Program, Children's Hospital, Winnipeg, Canada. PARTICIPANTS: Subjects were 289 patients (176 males and 113 females) 9 years of age or older presenting with a history of unilateral clefts of the lip with or without the palate. Of these patients, 217 were recruited from the patient pool of the Orthodontic Clinic at the Hospital for Sick Children in Toronto. The remaining 72 were selected from the registry of the Cleft Lip and Palate Program of the Children's Hospital in Winnipeg. Any syndromic cases were excluded from the sample. MAIN OUTCOME MEASURES: Assessment of handedness was performed by asking the patients to fill out a multi-item questionnaire in which patients were asked to identify which hand they would use for different tasks. The side and type of the initial cleft condition were identified by reviewing each patient's hospital chart and by cross-referencing with clinical examination. Statistical evaluation of the results was performed by using the chi-square test. RESULTS: There was a significantly larger number of left-sided clefts (198) in the sample than right-sided clefts (91), (p < .001). The proportion of left-sided clefts among left-handers (84.6%) was higher than that among right-handers (66.8%). However, the relationship between side of cleft and handedness was not statistically significant (p = .185). Clefts of the primary palate only seemed to occur on the left side 3.5 times more often than on the right, whereas the corresponding ratio of left:right manifestation for clefts of the primary and secondary palate was 1.8:1. The difference was statistically significant (p < .05). CONCLUSION: The findings of this study confirm the affinity of unilateral clefts for the left side but suggest that there are differences between clefts of the primary palate only and clefts of the primary and secondary palate. Also, non-right-handed patients show a greater predilection for having a cleft on the left side than do right-handed patients.

Chi-Square Distribution↗
PubMed1998

Soft tissue profile changes in patients with cleft lip and palate following maxillary osteotomies.

OBJECTIVE: To investigate the soft tissue profile changes associated with Le Fort maxillary osteotomy in subjects with cleft lip and palate and the predictability of those changes. DESIGN: A retrospective cephalometric study. The sample comprises 28 patients with cleft lip and palate. All consecutively treated cases with satisfactory records at Frenchay Hospital, Bristol, and St. Lawrence Hospital, Chepstow, were included. RESULTS: Males and females showed no significant differences in their soft tissue response. The proportion of soft to hard tissue change increased progressively for points that are more inferiorly placed on the upper soft tissue profile. The horizontal change in upper incisor position was the most common significant predictor of soft tissue change but accounted for less than 50% of the variability of change for all soft tissue points. The cleft lip patients in this study did not have upper lips that were compressed as a result of the orthognathic surgery by a significantly different amount when compared with those of noncleft patients in previous studies. CONCLUSIONS: The soft tissue response to Le Fort osteotomy is similar in amount in cleft and noncleft subjects. Movement of the upper incisor tip is the best predictor of soft tissue changes, but the confidence limits of predictability are relatively wide.

Adult↗
PubMed2001

Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics.

OBJECTIVE: The purpose of this study was to examine possible associations between severity of clefting in infants and maxillary growth in children with complete unilateral cleft lip and palate. DESIGN: This was a retrospective study of measurements made on infant maxillary study casts and maxillary cephalometric variables obtained at 5 to 6 years of follow-up. SETTING: The study was performed at the Institute of Reconstructive Plastic Surgery of New York University Medical Center, New York, New York. PATIENTS: Twenty-four consecutive nonsyndromic unilateral complete cleft lip and palate patients treated during the years 1987 to 1994. INTERVENTIONS: All the patients received uniform treatment (i.e., presurgical orthopedics followed by gingivoperiosteoplasty to close the alveolar cleft combined with repair of the lip and nose in a single stage at the age of 3 to 4 months). Closure of the palate was performed at the age of 12 to 14 months. RESULTS: Infant maxillary study cast measurements correlated in a statistically significant manner with maxillary cephalometric measurements at age 5 to 6 years. CONCLUSIONS: The results demonstrate the large variation in the severity of unilateral cleft lip and palate deformity at birth. Patients with large clefts and small arch circumference, arch length, or both demonstrated less favorable maxillary growth than those with small clefts and large arch circumference or arch length at birth.

Age Factors↗
PubMed2005

Ultrasonography: a noninvasive tool to diagnose a caliber-persistent labial artery, an enlarged artery of the lip.

OBJECTIVE: Currently, practitioners use clinical and histopathologic examination to diagnose a caliber-persistent labial artery (CPLA). We illustrate the use of ultrasonography as a noninvasive diagnostic tool to visualize this enlarged artery of the lip. METHODS: We examined the lips of 3 patients with a suspected CPLA. We localized and determined the extension of the intralabial artery with ultrasonography, including pulsed and color Doppler analysis. We compared the sonograms to the clinical and histopathologic findings. RESULTS: Sonograms showed clear enlargement of the labial artery in the 3 cases. The course of the constant-diameter artery was either vertical or oblique from the depth of the lip to the surface of the mucosa. This vascular abnormality was confirmed by histopathologic examination. CONCLUSIONS: Ultrasonography and color Doppler imaging may be useful noninvasive tools for the diagnosis and preoperative evaluation, as well as the follow-up, of labial lesions related to a CPLA, thus eliminating the need for diagnostic surgery in typical pulsatile nodules. Ultrasonography may help distinguish a CPLA from other vascular lesions of the lip such as an aneurysm. Atypical cases or chronic ulcerations mimicking a cancer should undergo biopsy so that a malignant process is not missed.

Adult↗
PubMed1999

[A case of carcinoma of lower lip showing excellent response to chemotherapy with UFT].

We report a case of squamous cell carcinoma of the lower lip showing an excellent response to chemotherapy with UFT. A 68-year-old woman with a painless swelling of her lower lip was refereed to our service. This tumor was 19 x 18 mm with cauliflower surface, and induration was noted around the mass. The pathological diagnosis was squamous cell carcinoma of well-differentiated type. After chemotherapy with UFT (400 mg/day), the tumor became flat. It was then removed with a 7 mm-safety margin and the lower lip was reconstructed with an Abbe-Estlandar flap from the upper lip. Post-operative histological findings indicated a complete response. Wound healing was uneventful, and there has been no evidence of recurrence for these 6 months after the operation. This case is still under observation.

Aged↗