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Salivary gland tumors of the lip.

The UCLA experience with minor salivary gland tumors of the lip is presented and contrasted with that of the literature. The incidence of benign to malignant tumors of the lip does not follow the inverse relationship stated in the axiom that the smaller the salivary gland the greater the probability that a developing tumor will be malignant. Benign tumors represent over 80% of all salivary gland tumors of the lip. There is no preponderant malignant tumor for the lip. Adenoid cystic carcinoma, mucoepidermoid carcinoma, and adenocarcinoma occur with almost equal frequency. Because of the indolent nature of these tumors, excellent survival rates can be achieved with wide local excision with few recurrences, if the tumors are adequately treated when first seen.

Adenocarcinoma↗

Cervical lymph node metastases and squamous cell carcinoma of the lip.

BACKGROUND: Squamous cell carcinoma of the lip generally has a favorable outcome. The chance of long-term survival is significantly reduced if lymph node metastases develop. Any features that could identify patients having increased risks of occult lymph node metastases would allow more aggressive treatment and, possibly, a better outcome. METHODS: A chart review of lip cancer from this institution identified 1001 patients with squamous cell carcinoma of the lip. This database was used to identify the characteristics that are associated with occult lymph node metastases. RESULTS: Delayed cervical lymph node metastases developed in 40 patients. No significant differences were noted in the frequency of delayed lymph node metastases according to gender, lip subsite, or age less than 40 years. Significant differences were noted in association with the tumor size, tumor differentiation, and local recurrence. CONCLUSIONS: Elective cervical lymphadenectomy is justifiable for higher grade tumors and for locally recurrent tumors. An increase in delayed metastases was observed in patients with tumors greater than 3 cm, but the proportion is not great enough to justify elective neck dissections.

Adult↗

Corticosteroid-induced cleft lip in mice: a teratologic, topographic, and histologic investigation.

Unlike cleft palate, relatively few teratogens have been found to induce cleft lip in mice. The present study was designed to assess the teratologic, topographic (SEM), and histologic effects on lip morphogenesis following the administration of triamcinolone hexacetonide on the eighth day of gestation. The frequency of cleft lip in treated A/J mice was found to be more than three times greater than the spontaneous frequency in untreated controls. Comparable studies with other murine strains suggest no association between the cleft lip response and either a maternal effect or the H-2 complex. Affected A/J embryos showed a severe reduction in the size of the lateral nasal processes; affected embryos also demonstrated localized cell type-specific alterations, particularly in the epithelia and at the interface between epithelium and mesenchyme.

Abnormalities, Drug-Induced↗

Parasympathetic nerve fibers invade the upper dermis following sensory denervation of the rat lower lip skin.

The sympathetic division of the autonomic nervous system is known to play a role in the genesis of neuropathic pain. In the skin of the rat lower lip (hairy skin), sympathetic and parasympathetic fibers normally innervate the same blood vessels in the lower dermis but do not occur in the upper dermis. However, we have shown that sympathetic fiber migration into the upper dermis occurs following mental nerve lesions (Ruocco et al. [2000] J. Comp. Neurol. 422:287-296). As sensory denervation has a dramatic effect on sympathetic fiber innervation patterns in the rat lower lip skin, we decided to investigate the possible changes in the other autonomic fiber type in the skin-the parasympathetic fiber. Sensory denervation of the rat lower lip was achieved by bilateral transection of the mental nerve, and animals were allowed to recover for 1-8 weeks. Lower lip tissue was processed for double-labeling light microscopic immunocytochemistry (ICC), using antibodies against substance P (SP), which labels a subpopulation of peptidergic sensory fibers, and against the vesicular acetycholine transporter (VAChT), as a marker for parasympathetic fibers. In sham-operated rats, SP-immunoreactive (IR) sensory fibers were found in the epidermis and upper and lower dermal regions, whereas VAChT-IR fibers were confined to the lower dermis. Mental nerve lesions induced the gradual disappearance of SP-IR fibers from all skin layers accompanied by the progressive migration of VAChT-IR fibers into the upper dermis. Cholinergic fiber migration was evident by the second week post surgery, and the ectopic innervation of the upper dermis by these fibers persisted even at the last time point studied (8 weeks) when SP-IR fibers have completely regrown. VAChT-IR fibers were observed in the upper dermis, well above the opening of the sebaceous glands into the hair follicles. These results show that considerable changes occur in the innervation patterns of parasympathetic fibers following mental nerve lesions.

Animals↗

Taste bud form and distribution on lips and in the oropharyngeal cavity of cardinal fish species (Apogonidae, Teleostei), with remarks on their dentition.

The oral dentition and type and number of taste buds (TB) on the lips and in the oropharyngeal cavity were compared by means of SEM in 11 species of cardinal fishes (Apogonidae) belonging to five genera. The occurrence of a dense cover of skin papillae on the lips of some species (e.g., Apogon frenatus), as well as differences in structure of vomer, tongue, and palatinum, expose additional morphological characters important for clarification of the taxonomy of this group of fishes. Differences are also revealed in the type of dentition, such as on the vomer and epi-hypopharyngeal bones. Strong and dense dentition of the anterior part of the oral cavity and a high number of TB on this site in species feeding on larger prey (e.g., Cheilodipterus spp) is compared to the relatively feeble jaw armor and richness of TB on the more pharyngeal site in species feeding on smaller prey (e.g., Apogon angustatus, A. frenatus). In addition to the three types of TB (Types I-III) previously described from various teleost fish, a fourth type (Type IV), comprising very small buds, was found in some cardinal fish (Apogon angustatus, A. frenatus). The various TB are distributed from the lips to the pharyngeal bones, on the breathing valves, tongue, palatinum, and pharyngeal bones; their number and type on the various sites differ in the different species. In all species studied the Types I and II TB, elevated above the surrounding epithelium, dominated the lips and anterior part of mouth, while Types III and IV, which end apically at the level with the epithelium, dominated the more posterior pharyngeal region. The highest number of TB, around 24,600, were found in Fowleria variegata, a typical nocturnal species, and the lowest in the diurnal and crepuscular Apogon cyanosoma (1,660) and Cheilodipterus quinquestriatus (2,400). Differences are also revealed in the type of dentition, such as on the vomer and epi-hypopharyngeal bones. The number of TB increased with growth of the fishes. The differences in the total number of TB and their distribution in the oropharyngeal cavity in the various species indicates possible different mechanisms of foraging and food-recognition.

Animals↗

Ultrastructure of initial nasal process cell fusion in spontaneous and 6-aminonicotinamide-induced mouse embryo cleft lip.

A search was made for cell ultrastructure differences in the initial fusion process of the medial and lateral nasal processes in mouse embryos of the following types: A/J with 12% cleft lip (CL), CL/Fr with 23% CL--both cleft-lip-predisposed strains, CL/Fr 6-aminonicotinamide (6AN)-treated (94% CL) and controls from the C57BL/6 strain (0% CL) and dancer stock (0% CL). No detectable differences were found between the A/J and CL/Fr strains and the controls in the epithelial cells showing initial contact and fusion. Epithelial surfaces not in contact in controls and where clefts were developing were smooth. Cells approaching or in contact had cell projections, intercellular junctions, desmosomes, and microfilaments demonstrating firm contact between the apposed epithelia. It has been postulated that spontaneous cleft lip was due to a predisposing face shape bringing about a failure of contact in some embryos and in others where contact was achieved fusion was normal. These data support this view. The situation, however, in 6AN-treated embryos is different. A few 6AN-treated embryos showed abnormal contact that appeared malpositioned and tenuous. The teratogen also caused increased cell death and a denser epithelium and mesenchyme. Thus 6AN-induced cleft lip could be due to the epithelial cell changes and/or to the reduction in size of the nasal processes.

6-Aminonicotinamide↗

Epithelial-mesenchymal transformation is the mechanism for fusion of the craniofacial primordia involved in morphogenesis of the chicken lip.

We have previously demonstrated that epithelial-mesenchymal transformation (EMT) brings about TGF beta 3-induced confluence of craniofacial primordia that derive from the maxillary processes and give rise to the avian palate. The upper lip of the chick embryo forms by confluence of primordia also derived from the maxillary processes, but in this case, they fuse with the intermaxillary segment of the nasofrontal process. Here, we ask whether the bilateral epithelial seams formed when these primordia contact each other in vivo are removed by apoptosis (as formerly was believed to occur in developing palate) or by EMT. We found that, as is the case in the palate, the periderm of the two-layered embryonic epithelium begins to slough shortly before these primordia fuse, bringing the basal epithelial cells into close contact. We show by TUNEL staining and confirm by TEM that apoptosis occurs only in periderm. TEM reveals that basal epithelial cells contacting each other to form the midline seam produce numerous desmosomes with each other. Then, basement membrane begins to disappear, numerous filopodia extend from the basal surfaces of epithelial cells, the space between them enlarges, and the seam breaks apart, leaving mesenchymal cells in its wake. Transformation of the carboxyfluorescein (CCFSE)-labeled epithelial seam is demonstrated in vivo by detection of CCFSE bodies in mesenchymal cells that replace it. This demonstration of EMT in avian lip development lays important groundwork for understanding the causes of human cleft lip and analyzing the mechanism of action of growth factors, such as SHH and BMPs, that have been shown (J. A. Helms et al., 1997, Dev. Biol. 187, 25-35) to be involved in avian lip confluence.

Animals↗

Local interferon therapy for lip carcinoma.

In a prospective non-randomized study 21 patients with lower lip squamous cell carcinoma were treated with human natural leukocyte interferon (HNLI). The response rate was measured by a size reduction of more than 25% and was 81%. A complete response rate was considered to be a cure according to histopathological and clinical findings and was 48%. The response rate of six lower lip squamous cell carcinoma cases treated with recombinant interferon alpha 2c was 67% and the complete response rate was 17%. Three patients with basal cell carcinoma of the upper lip were also treated with HNLI. All three patients were cured, as determined by histopathological and clinical findings. These findings indicate that interferon can be a useful alternative therapy for lip carcinoma either with or without surgery.

Adult↗

Evidence for suppression of lip muscle reflexes prior to speech.

The early component of the mechanically evoked lip muscle reflexes was studied in order to determine whether a consistent form of modulation occurs in associated neural pathways during the preparation to speak. Electromyograms (EMG) were obtained of upper and lower lip muscle while subjects were presented simultaneously with a visual instruction stimulus and a mechanical reflex stimulus every 4 s. On alternating trials, they were to produce either a single word or maintain their lip posture when they felt the mechanical stimulus. Consistent reductions in reflex amplitude were observed across subjects in lower lip muscle in the speech condition compared with the no-response condition. Statistical analyses suggest that this suppression effect occurred independently of variations in prestimulus EMG. These results are consistent with the idea that trigeminal sensory pathways innervating the perioral region are suppressed in preparation for orofacial movements associated with simple speech utterances.

Adolescent↗

Treatment of hypertonicity in muscles of lip retraction.

An EMG biofeedback program was developed for a 56-year-old Parkinsonism patient who exhibited pathological lip hypertonia and retraction. The program was designed to achieve the following goals: (1) to demonstrate a reduction in postural lip hypertonicity and (2) to demonstrate a reduction in lip hypertonicity during a series of increasingly complex speech activities. To achieve the first goal, contrastive tasks of full contraction and relaxation were utilized. Each posture was sustained while voltage measurements were made at specific intervals. Procedures to modify lip retraction during speech included five tasks in which the patient was to monitor the audio feedback signal. The tasks involved: prolongation of a neutral vowel, consonant-vowel combinations, monosyllabic words, sentences, and a paragraph-reading task. Data collected over six biofeedback sessions are presented. Trend analyses showed consistent muscular reduction within each task. The following explanations for the decrease in the patient's hypertonicity were discussed: (1) reduction of anisometric contraction, (2) reduction of isometric contraction, (3) relearning of agonistic-antagonistic muscle balance.

Biofeedback, Psychology↗

Anatomical pathways connecting lip sensory structures and central nervous system in hirudinid leeches visualized by carbocyanine dyes and laser scanning confocal microscopy.

Chemoreception in Hirudo medicinalis is thought to be mediated by ciliated cells grouped in sensory structures, the sensilla, arranged in bands on the animal's dorsal lip (Elliott, 1986; Zipser et al., 1994). Furthermore, chemical and/or thermal stimulation of the dorsal lip in reduced preparations evokes changes in the electrical activity of the cephalic nerves that connect the head with the central nervous system. However, the complete trajectory by which the sensory afferents reach the cerebral ganglia has not been demonstrated anatomically. In this study, we traced these pathways following retrograde and/or anterograde transport of carbocyanine dyes (DiI, DiA and DiD) in the cephalic nerves of Hirudo medicinalis and a closely related species, Macrobdella decora. While information regarding Macrobdella's chemoreception is scarce, the two species show some differences with regard to their chemical preferences. Dyes were applied to the sensillar structures along the dorsal lip, or to the cut ends of individual cephalic nerves in fixed preparations that included the lip and attached nerves with or without the head ganglia. After a two week incubation, specimens were mounted and imaged using a confocal microscope. The results show that the axons of the sensory neurons in the sensilla project through the four pairs of cephalic nerves. The sensillar projections are however more numerous in the dorsal nerves than they are in the ventral ones. In addition, the organization of the sensillar bands, the morphology of the pathways and the sensory structures themselves appear to be identical for Hirudo and Macrobdella and therefore the behavioral differences in response to appetitive stimuli cannot be readily explained by differences in morphology.

Animals↗

Effectiveness of brachytherapy in the treatment of lip cancer: a retrospective study at the istanbul university oncology institute.

Stage T1 through T3 lip cancers can be treated primarily by brachytherapy (BRTX), with or without external radiotherapy (ERT), with adequate safety margins and good results. In this study, the outcomes of BRTX were reviewed for patients treated at the Brachytherapy Department of the Istanbul University Oncology Institute (IUOE). The medical records of 41 patients registered at IUOE with a diagnosis of lip cancer between 1988 and 2003 were reviewed. The median follow-up time was 88 months (24-160 mo). Among these patients, 21 patients with a primary tumor, 14 with tumors arising postoperatively, and 6 with postoperative recurrence of tumor were treated using BRTX. A total of 33 patients (80%) received BRTX alone and 8 (20%) received BRTX and ERT. The 10-year local control rate was 100%, 93%, and 67% for patients treated with BRTX alone, BRTX and surgery, and those treated for postoperative recurrence, respectively (P<.02). For patients treated with BRTX only and BRTX plus surgery, specific disease-free survival was 95% and 94%, respectively, and overall survival was 93% and 100%, respectively; these differences were not statistically significant. One patient with a postoperative recurrence who had been treated with BRTX died as a result of lip cancer. No patients developed any ulcerations, intra-oral complications, or mandibular necrosis. In the BRTX only group, 83% had excellent or good cosmetic results. In the surgery group, 62% had a contour deformity. In lip cancer management, BRTX results were comparable for local control, survival, and minimal late effects in normal tissue. This is in accordance with current reports in the medical literature. Satisfactory results were observed in patients with stage T1 and T2 lesions who had been treated with BRTX only and in patients with stage T3 lesions who had been treated with BRTX plus ERT, without a need for additional treatment modalities.

Adult↗

[Sunlight-induced granulomatous reaction to permanent lip liner].

The demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, because tattooing is a trade whose results and problems are not monitored and documented, as is the case for medical procedures. A female patient with permanent lip liner experienced no complications for one year. Then, after intensive sun exposure she developed solid, linear papules along the outer margin of her lips. Histology revealed a granulomatous tissue reaction with a marked lymphohistiocytic infiltrate including epithelioid histiocytes. Treatment with topical steroids over three weeks led to a complete healing without relapse. To the best of our knowledge this is the first report on UV-light-induced granulomatous reaction to permanent lip liner.

Female↗

Technique for correction of the retracted columella, acute columellar-labial angle, and long upper lip.

The excess tissue from upper lip vertical length reduction provides bulk for opening the columella-labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella-labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.

Female↗

Aesthetic reconstruction for large upper lip defects in men.

Although many techniques use hair-bearing flaps to repair large upper lip defects in men, few preserve orbicularis sphincter function. Available techniques can also result in an unnatural appearance, because the entire upper lip is covered by a dense region of hair. We have developed a new technique and successfully repaired a large defect in the upper lip of three men. This technique uses flaps pedicled by angular vessels and includes the orbicularis oris muscle. A good outcome can be obtained both functionally and cosmetically when used in men with defects involving more than one-half of the upper lip.

Adult↗

Reanimation of lower lip reconstructed by flaps.

This paper describes a technique of reanimating the reconstructed lower lip. For this the complete masseter on both sides has been used in order to obviate the danger of damaging the motor nerve supply to the muscle. The technique has been suitably modified to use the remaining musculature of the lips (i.e. orbicularis and the levators of the angle and upper lip) to improve the overall efficiency of the remaining upper lip function.

Humans↗

A mirror image of the first and second branchial arch syndrome associated with cleft lip and palate in monozygotic twins.

A rare case of monozygotic twins revealing a mirror image of the first and second branchial arch syndrome with accessory ear and hemifacial microsomia, associated with unilateral cleft lip and palate, is presented. Although the concordance and/or discordance rate of monozygotic or dizygotic twins with cleft lip and palate is well reported, that of twinning of the first and second branchial arch syndrome has been very rarely described. First and second branchial arch syndrome occurs sporadically but cleft lip and palate are strongly related to the influence of environmental factors with a considerable hereditary tendency. The study of twinning of congenital anomalies is important in the investigation of the pathogenesis of genetic and environmental effects. The twins were diagnosed as monozygotic with almost complete certainty by ABO blood typing, HLA typing, finger prints, and DNA typing. Concordance was noticed, which suggests a hereditary tendency. Since concordance in these monozygotic twins was exhibited by a precise mirror image of first and second branchial arch syndrome, spinal scoliosis and cleft lip and palate, it is possible that an environmental factor induced these complex anomalies.

Abnormalities, Multiple↗

Basal-cell carcinoma of the vermilion mucosa and skin of the lip.

In a series of 652 basal-cell carcinomas, twelve were on the upper lip and five were on the lower lip. Three cases of basal-cell carcinoma located on the vermilion mucosa, with only slight involvement of the contiguous skin at the mucocutaneous junction, are reported. Two were on the lower lip and one on the upper lip. The patients were 74, 81, and 81 years of age. All underwent adequate wide local excision. None of the lesions recurred clinically or metastasized over periods of 41 to 80 months.

Aged↗