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Reconstruction of the severely burned lip may require both reconstitution of the tissue bulk and an increase in size of the vermilion. We present two patients in whom a bipedicled lip flap was used to transpose both bulk and vermilion from the relatively normal donor lip to the atrophic burned lip.
A survey of cleft lip and palate in 160 Nigerians is presented. In clefts of the lip alone, there was no sex predilection whereas cleft lip and palate cases showed a slight male preponderance. 119 (74.4%) cases presented below the age of 12 years and 41 (25.6%) cases were first seen above 12 years of age. Only a few cleft lip and palate cases survived to adulthood possibly because of malnutrition combined with the lethal effects of associated congenital abnormalities. This study confirms the view that late primary repair of clefts is less likely to produce impaired growth of the maxilla due to contraction of scar tissue commonly seen in early surgery. The importance of early primary repair is emphasised.
Application of WGA-HRP to the mandibular lip and buccal gingiva of the cat resulted in retrograde labeling in the ipsilateral otic ganglion (OG), whereas labeled neurons appeared in the pterygopalatine ganglion (PPG) as well as in the OG when the tracer was injected into the maxillary lip and buccal gingiva. The results suggest that both the facial and the glossopharyngeal preganglionic vasodilator fibers supplying the mandibular lip and buccal gingiva mediated in the OG, and those innervating the maxillary lip and buccal gingiva are mediated in the PPG and the OG.
With the use of pretreatment and posttreatment lateral cephalograms and study models, lip bumper therapy for two groups of 20 patients was evaluated. One group was treated with lip bumpers fabricated from stainless steel round wire covered with shrink tubing and activated every 2 to 3 months. The second group was treated with larger prefabricated lip bumpers covered with acrylic shields from canine to canine and activated every 4 to 5 weeks. Yearly rates of treatment change indicate that the type of lip bumper used and the method of clinical manipulation have no effect on mandibular incisor position. Both groups showed similar rates of controlled incisal tipping with the center of rotation at the apex. Dental movements of the posterior segment were significantly different between groups. The second group displayed significantly more molar tipping than the first group. The second group also showed significantly greater transverse expansion of the canines, first premolars, and first molars.
Craniofacial birth defects are the fourth most common congenital anomaly in newborns. Cleft lip and cleft palate (CL/CP) are the most common and immediately recognizable craniofacial anomalies. Some are diagnosed prenatally on ultrasound; more often, they are first noted in the delivery room. The infant may have a cleft that is unilateral, bilateral, complete, or incomplete, and it may involve the lip only, the palate only, or both. Cleft lip and/or cleft palate are often isolated nonsyndromic occurrences; however, when associated with other abnormal physical findings, a recognizable syndrome may be present. Part 1 of this 2-part article describes the incidence of CL/CP. The embryology of the face, lip, and palate are reviewed to enhance the understanding of the timing, complexity, and factors that may influence the development of this lesion. The emerging genetic links, environmental influences, and potential teratogens that may interact to contribute to CL/CP are discussed. Part 2 of this series will provide clinicians with tools to perform a focused risk assessment and obtain a detailed family and pregnancy history to evaluate for known associated risk factors for CL/CP. The article provides a guide for a systematic physical examination of infants with CL/CP. Careful assessment for other midline defects or physical findings consistent with associated syndromes is also discussed. Pictorial examples of a variety of forms of CL/CP are provided to enhance understanding of the spectrum of this defect. Treatment and long-term complications of CL/CP are reviewed with an emphasis on family support, identifying educational resources, and counseling.
INTRODUCTION: Soft tissue analysis is a basic tool in planning orthodontic treatment. However, the components of a well-balanced Japanese facial profile have not yet been established. The purpose of this study was to assess the most-favored or most well-balanced profile from a series of facial silhouettes with varying anteroposterior lip positions by a group of Japanese orthodontists and a group of young adult Japanese dental students. METHODS: Average female and male profiles were constructed from the profiles of 30 Japanese men and women with normal occlusions. The lips in each average profile were protruded or retruded in 1-mm increments, and the 13 images were arranged with the average profile in the center. Forty two orthodontists and 42 dental students were asked to select the 3 most-favored, well-balanced profiles for each sex and rank them in order of preference. RESULTS: Both the orthodontists and the students preferred a profile with slightly retruded lips. The dental students favored a more retruded lip position for women. The least-favored profile was the most protrusive. CONCLUSIONS: These findings suggest that Japanese orthodontists and young adults prefer a retruded profile, even though Japanese profiles have historically been characterized by more convex facial features.
Sclerosing sweat duct carcinoma (SSDC) is a rare cutaneous neoplasm. A 28-year-old man presented with 2-3 years history of a tetter on his upper lip, and a 3 cm x 4 cm lymph node was palpable in the left submandibular area. MRI showed a mass in the upper lip extending into the buccal mucosa and orbicular muscle, and multiple cervical lymph nodes metastasis on both sides was suspected. A biopsy was performed to have revealed syringomatous carcinoma. The patient underwent operation of extended removal of the upper lip along with right upper neck dissection and left radical neck dissection. 8 cm x 6 cm sized free forearm flap was used for the reconstruction of the lip. Postoperative course of the patient was uneventful and he has no signs of recurrence so far. Pertinent literatures on this rare tumor are reviewed.
The aim of this study was to analyse the immunohistochemical differentiation profile of the stratified squamous epithelium of the adult human lip. Full-thickness lower lips taken from 31 cadavers were analysed. Sections were stained with haematoxylin and eosin, periodic acid-Schiff (PAS), cytokeratins (CK), loricrin, involucrin, profilaggrin and filaggrin. The stratified squamous epithelium covering the lip could be divided into: (i) appendage-bearing, orthokeratinised epidermis; (ii) orthokeratinised vermilion which had a more prominent rete pattern than the epidermis; (iii) parakeratinised, PAS-positive intermediate zone; and (iv) non- or parakeratinised labial mucosal epithelium. Epithelial thickness increased gradually from the skin to the mucosal aspect. The CK pattern changed across the intermediate zone, with gradual loss of CK 1 and 10 from the skin, and CK 4, 13 and 19 from the mucosal, aspect. CK 5 and 14 were consistently expressed basally, and variably expressed suprabasally. Apart from labelling Merkel cells, CK 8, 18 and 20 were negative. Involucrin, which was present at all sites, was restricted to the stratum granulosum in skin, but extended into the stratum spinosum, and gradually into parabasal keratinocytes, across the vermilion and mucosa. Loricrin, profilaggrin and filaggrin were present in the stratum granulosum of orthokeratinised sites, but expression was abruptly lost at the junction between the vermilion and the intermediate zone. In conclusion, the phenotype of the stratified squamous epithelium covering the lip changes at, or across, the intermediate zone of the adult vermilion. It is possible that changes in the composition of the stratified squamous epithelium affect the colour of the vermilion.
AIM: To investigate the psychological impact on mothers of an early neonatal cleft lip repair. METHODS: Between January and December 2004 mothers of 24 infants born with a cleft lip completed psychological interviews and questionnaires 1 month after neonatal repair. We evaluated the psychological impact on mothers of antenatal and postnatal diagnosis. We noted the parental preferences for the timing of cleft repair and their satisfaction after neonatal repair. RESULTS: Stress, incomprehension and anxiety were often noted. Most mothers preferred their infant to receive neonatal repair. We noted a great satisfaction after neonatal cleft lip repair. DISCUSSION: We are currently encouraging early repair in the full-term baby as the optimum, reliable and safe method of management of newborns with cleft lip. Mothers expressed a preference for and greater satisfaction with neonatal repair. Parental preferences should routinely be considered in deciding the timing of this procedure.
A congenital cleft lip is a deformity that has significant physical and psychologic impact. Many surgical repairs have been proposed for reconstruction of unilateral cleft lip deformities, including straight-line repairs and various forms of geometric flap repair. This article classifies cleft deformities and describes the history and specific techniques of unilateral cleft lip repair. Understanding and application of these techniques can aid the cleft surgeon in maximizing function and appearance of a child born with a cleft lip deformity.
Cleft lip and/or palate (CL/P) are caused by many factors. The aim of this study was to investigate the effects of genetic point mutations in CL/P pathogenesis. ICR and AJ strain mice were used. Ethylnitrosourea (ENU) was injected into 10-week-old male mice (G0) intraperitoneally at a dose of 250 mg/kg. The males were bred with two untreated virgin females of the same strain on day 100 after injection. The uterine contents (G1) of one female were examined on day 18.5 of pregnancy. From the other female, the offspring were delivered naturally, and F3 mice (G3) were also examined in the same way. In ICR strain mice, cleft palate only (CPO) was increased in both the G1 and G3. The frequency was significantly higher in the G3 than the G1 generation. Cleft lip was not observed. In AJ strain mice, CL/P increased in both the G1 and G3. In the G3, the frequency of CPO was increased significantly. Genes related to CPO may be recessive in phenotype. CPO and cleft lip differ from a genetic viewpoint. Point mutations play a significant role in cleft lip and palate.
Chronic edema of the lips is rare but disabling. We present 3 illustrative cases of chronic edema involving the lips. The causes were (1) idiopathic, (2) lymphedema occurring after radiation therapy, and (3) cheilitis granulomatosa. The edema subsided with compression therapy in the first 2 patients. Surgical decompression was helpful in the second patient, and dapsone therapy was initiated in the third. Chronic edema of the lips can be a clinically significant problem. These 3 cases illustrate the various causes and an approach to the management of chronic edema of the lips.
Multichannel pulsatile stimulation is essential for electrotactile presentation of spatiotemporal patterns in sensory substitution through the sense of touch. In this paper, a system for multichannel electrotactile stimulation is presented for studying electrotactile sensation on the lips, a site that has been shown to be highly sensitive but never been assessed for electrotactile applications. The system utilized a demultiplexing scheme to deliver voltage-clamped pulse waveforms to 32 channels corresponding to an array of 4x8 stimulators. Initial testing of electrotactile presentation on the lips was performed in human subject experiments on threshold measurement and two-line separation. For an array of hemispherical stimulators each 700 microm in diameter, the threshold values on the lower lip were averaged at only 8.2 V and intensities for well-perceived stimulation were averaged at around 14.2 V. The testing results suggested that lips were promising sites for electrotactile applications due to their high sensitivity to electrotactile stimulation at extremely low intensities.
Gingival hypertrophy is a well-known and extensively documented undesirable side effect of cyclosporine in posttransplant patients. However, severe lip enlargement associated with cyclosporine is less recognized and has seldom been reported in the literature. Lip enlargement may lead to social, physical, and psychological stress, especially in the older childhood and adolescent age groups. We present a case of marked lip hypertrophy and concomitant gingival hypertrophy secondary to cyclosporine (Neoral) treatment in a pediatric bilateral lung transplant recipient. We also discuss the various side effects and treatment considerations available including more recent substitution therapy. Cyclosporine has most effectively and conclusively enabled transplantation of solid organs by reducing transplant-associated morbidity. We believe clinicians should be knowledgeable and aware of lip hypertrophy associated with cyclosporine use. This rare and less understood adverse effect should be recognized during the clinical evaluation of the posttransplant patient.
Children with cleft lip and palate often have other associated malformations. The reported incidence and types of associated malformations vary between different studies. There is a great paucity of literature on the subject from the region in general and none from Pakistan at all. The purpose of this study was to assess the frequency of associated malformations, particularly congenital heart disease, in children with cleft lip and palate presenting to the Aga Khan University (AKU) and Murshid Hospital (MH). From 1st October 1999 to 31st March 2002, all children with cleft lip and palate who presented to AKU and MH were prospectively enrolled in the study group. Socio-demographic characteristics and a number of other variables were documented. All children underwent a thorough clinical examination and an echocardiogram as part of the study protocol. 123 children formed the study group. Thirty-five (29%) of these children were found to have associated malformations. The most common of these was congenital heart disease, which accounted for 51% of all associated malformations. Thirty percent of cleft palate children had associated anomalies while 27% of cleft lip, with or without cleft palate, children had associated anomalies. There was a significant association between children born of a consanguineous marriage and the risk of associated malformations (p-value: 0.001). Consanguinity was present in 74% of children with associated anomalies as compared to 40% of children with no associated anomaly. Dysmorphic features and the presence of associated anomalies were also significantly associated (p-value: 0.009). Dysmorphic features were present in 46% of children with anomalies as compared to 21% of children with no associated anomaly. Fifty percent of children with associated anomalies had a low birth weight compared to 34% of children with no anomalies, but the difference was not statistically significant. The presence of consanguinity in a child with dysmorphic features should raise the suspicion of an associated anomaly. The likelihood of this being a cardiac defect is high and should be ruled out with a thorough clinical examination, supplemented with an echocardiogram in certain cases.
Individual features of the face combine to capture the idealized image of youth and sensuality. In Western cultures, well-contoured lips contribute to this standard and are considered desirable attributes. In contrast, thin or drawn lips project a picture of aging and a severe countenance. In recent years, an increasing number of interventions have been introduced that seek to enhance lip fullness and shape. This article reviews the options available for lip augmentation with a focus on injectable and implantable materials.
The electromyographic activity (EMG) of the upper lip muscle (m. orbicularis oris) during sucking on a cigarette was examined as a potential new measure of smoking behaviour. This parameter was examined under conditions of actual smoking, sham smoking and sucking on a straw. We applied psychophysical procedures (methods of magnitude production), normal and paced smoking, two conventional means to confirm puffing (video recording and changes in air pressure in a cigarette holder) on different groups of smokers (heavy and light). The data revealed that lip-EMG is a valid and reliable means to quantify sucking on a cigarette in a variety of situations common to the study of smoking. It was concluded that lip-EMG may be a sensitive and selective measure of motor activity associated with smoking. The lip-EMG may also be applied together with hand activity and breathing to identify individual puffing, particularly in heavy smokers and during actual smoking. Discussed were several applications of this method to the study of smoking and other motivated behaviour such as consumption of water and palatable fluids.
The surgeon's objectives are normal nasolabial appearance and normal speech. The principles for synchronous repair of bilateral cleft lip have been established, and the techniques continue to evolve. Primary repair impairs maxillary growth, but little can be done at this time except to practice gentle craftsmanship and to minimize tension on the lower labial closure. The cutaneous lip should never be reopened for revision, and the number of secondary procedures involving the nasal cartilages should be kept to a minimum. Many adolescents with repaired bilateral cleft lip need maxillary advancement to improve projection of the nasal tip, to protrude the upper lip, and to attain normal sagittal skeletal harmony. With expected improvements in the technology of distraction osteogenesis, maxillary advancement may someday become as acceptable as orthodontic treatment.