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PubMed1975

Lip and jaw motor control during speech: responses to resistive loading of the jaw.

Resistive loads were applied to the jaw during speech production. Loads were initiated during the jaw closing movement associated with the production of bilabial stops, creating a situation in which bilabial closure would be disrupted if motor control were independent of peripheral feedback. Three subjects were observed during control and experimental conditions. In all utterances in which a load was appropriately introduced, closure of the lips was achieved and the bilabial stop was adequately produced. To assess the nature of this control, displacement of the upper lip, lower lip, and jaw, in the inferior-superior dimension, were recorded along with EMG from medial pterygoid, anterior temporalis, masseter, and orbicularis oris superior muscles. Based on observation of these variables, it appears that the muscles of the lips and jaw are capable of on-line compensatory motor reorganization.

Adult↗
PubMed1987

Reflex responses in human jaw, lip, and tongue muscles elicited by mechanical stimulation.

Reflex responses in human jaw, lip, and tongue muscles were elicited with brief, innocuous mechanical stimuli. Stimuli were applied to the masseter (and overlying tissue), the lower lip vermilion, and the tongue dorsum. Reflex responses occurred in masseter, orbicularis oris inferior, and genioglossus muscles upon direct stimulation of the sites associated with each of these muscles. In contrast, reflex responses to stimulation of "distant" sites occurred almost exclusively in masseter; that is, stimulation of the lip and tongue produced responses in masseter, but, stimulation of jaw muscle spindle afferents and overlying cutaneous receptors had no observable effect on activity in genioglossus or orbicularis oris inferior muscles. It could be hypothesized that the motoneuron pools controlling jaw muscles are more sensitive to synaptic inputs generated by reflex pathways originating in other structures. The sensitivity of the masseter muscle to inputs from the lip and tongue may serve to link these structures functionally.

Adult↗
PubMed1989

Lip movement in apraxia of speech.

Peak articulatory velocity of the lower lip and temporal coordination between the upper and lower lips were studied in 5 neurologically impaired subjects with speech behaviors consistent with a diagnosis of apraxia of speech. Differences in velocity and the timing between the movement onset of the two lips were compared for accurate and inaccurate productions of words. Peak articulatory velocity also was measured during the productions of the syllable [pae] and during a nonverbal movement. There were no systematic differences across accurate and inaccurate productions of words in peak articulatory velocity or movement onsets of the two lips. Furthermore, there were no systematic changes in movement velocity related to speech rate. We conclude that some apraxic speakers do not have a defect in the ability to produce high movement velocities.

Adult↗
PubMed1996

Reflex responses of lip muscles in young and older women.

The perioral reflex in response to innocuous mechanical stimulation of the lip vermilion was studied in 20 young and 20 older women. Responses to stimuli at the right and left sides of both the upper and lower lips were recorded. Results show significant specificity of response, especially for upper lip sites. Reflex response at the site of stimulation was greatest in amplitude and shortest in latency, followed by response at sites ipsilateral to the site of stimulation. Younger subjects showed greater localizing tendency than older subjects. Stimulation was significantly less likely to produce a reflex response in the older group. When reflex responses did occur, they were significantly lower in amplitude and longer in latency than the responses of the younger group. Nonetheless, reflex responses were common in both groups, with responses at the site of stimulation occurring 78% of the time in older women and 90% of the time in younger women. Every participant showed at least one reflex response to lip stimulation. Results suggest decreasing complexity of synaptic drive to the perioral system in old age but also show that reflexive response does not deteriorate completely, remaining an available element for motor control in normal older women.

Adult↗
PubMed1996

Tactile perception of spatial stimuli on the lip surface by young and older adults.

Although older adults are subject to both subtle changes and major disorders of the oral sensorimotor system, relatively little is known about oral sensory function in old age. Accurate assessment of oral tactile perception is needed to document disability, aid prognosis, and plan treatment for older adults with disorders affecting speech or feeding. However, normative information currently available for older adults is mainly based on two-point discrimination, a problematic measure of tactile spatial resolution. Grating orientation discrimination, a technique developed to provide a clear and reliable measure of spatial resolution, was used to test sensitivity of the upper and lower lip vermillion, on right and left sides, in a sample of 40 young adults and 40 adults age 66-85. Results indicated that spatial acuity at the lip vermilion declines significantly in old age and that women tend to have better acuity than men. No significant differences were found in acuity between the upper and lower lips or between right and left sides for either age group. Peripheral changes in receptor density and lip tissue composition are suggested as likely causes for the age-related decline.

Adolescent↗
PubMed2000

The physiologic development of speech motor control: lip and jaw coordination.

This investigation was designed to describe the development of lip and jaw coordination during speech and to evaluate the potential influence of speech motor development on phonologic development. Productions of syllables containing bilabial consonants were observed from speakers in four age groups (i.e., 1-year-olds, 2-year-olds, 6-year-olds, and young adults). A video-based movement tracking system was used to transduce movement of the upper lip, lower lip, and jaw. The coordinative organization of these articulatory gestures was shown to change dramatically during the first several years of life and to continue to undergo refinement past age 6. The present results are consistent with three primary phases in the development of lip and jaw coordination for speech: integration, differentiation, and refinement. Each of these developmental processes entails the existence of distinct coordinative constraints on early articulatory movement. It is suggested that these constraints will have predictable consequences for the sequence of phonologic development.

Child↗
PubMed1999

Etiological aspects on craniofacial morphology in twins with cleft lip and palate.

The craniofacial morphology of 39 Finnish twin pairs concordant or discordant for cleft of the lip (CL), unilateral cleft lip and palate (UCLP), or cleft palate only (CP) was studied by means of lateral cephalometric radiographs. The intrapair differences between various cleft and twin subgroups were compared by means of univariate analysis; multivariable analysis of cleft discordant pairs and the variance components were estimated with the TWINAN program. Larger values for intrapair differences were found, especially in linear measurements in older twin pairs. Heritability estimates for the cranial base measurements and, to a lesser extent, for the mandibular measurements were high. Comparisons on the basis of cleft type revealed more differences between twin pairs when clefting was more severe. Concordant and discordant CP twin pairs showed similarity in their intrapair craniofacial morphology, indicating that surgery seemed to have no major effect on their craniofacial morphology. A similar comparison in discordant UCLP showed that, in addition to clefting itself, external factors, i.e., the repaired cleft's direct effects on craniofacial morphology, have a strong influence on craniofacial morphology, especially in the maxillas of the UCLP twins. The craniofacial morphology in these Finnish twins supports the hypothesis of different genetic behavior for cleft lip and cleft lip and palate (CL(P)) and CP in Finland.

Adolescent↗
PubMed2003

Facial asymmetry--3D assessment of infants with cleft lip & palate.

OBJECTIVES: To determine the degree of facial asymmetry in infants with unilateral cleft lip and/or palate, and quantify improvements following primary surgery, in three dimensions. DESIGN: The faces of 20 infants with unilateral clefts (10 UCL; 10 UCLP), and 20 age-matched, non-cleft controls, were captured using the C3D stereophotogrammetry system prior to primary lip/nose repair (at 3 months), at 6 months and at age 1 year. METHODS: Procrustes techniques were applied to 3D landmark configurations to its mirror image. Mean squared distances between landmarks and their antimeres were calculated and expressed as asymmetry scores for each 3D configuration. Full-face, nose and lip median scores were compared and changes with time evaluated (P < 0.01). RESULTS: There were no significant changes in asymmetry scores in the control group from 3 months to 1 year. The UCLP group was more asymmetric than the UCL group, displaying greatest improvement in nasal symmetry following primary repair. The lips continued to improve over time. The UCL group had significant nasal asymmetry, which did not appear to improve with primary surgery. CONCLUSIONS: Immediate improvement in asymmetry scores in children with UCLP is related to the production of a more symmetrical nasal form after primary surgery. In contrast, the nasal asymmetry seen in children with UCL is unchanged despite surgery. Full face asymmetry scores may mask subtle changes over time. Nasal and lip asymmetry should be considered individually.

Case-Control Studies↗
PubMed2001

Squamous cell carcinoma of the lip. Patterns of relapse and outcome: Reporting the Westmead Hospital experience, 1980-1997.

Australia has one of the highest rates of squamous cell carcinoma of the lip in the world. Despite a high cure rate, many studies report relapse rates of between 5% and 20% with an associated mortality of 5-10%. The aim of this study was to review the patterns of relapse and outcome for patients treated at Westmead Hospital, Sydney. Ninety-three eligible patients were identified in a retrospective review of all lip cancer patients referred to Westmead Hospital between 1980 and 1997. Relevant data were extracted from the treatment files and included contact with referring doctors and utilizing the Cancer Council Registry. Equal numbers of patients were treated with radiotherapy alone or surgery (+/- adjuvant radiotherapy). The majority of patients were male (78.5%) with T1N0 cancers (64.5%) of the lower lip. A minority (5.4%) had nodal disease at diagnosis. Following treatment, 31 (33.3%) patients relapsed, 11 at the primary site, 18 at the regional nodes and two at both sites simultaneously. Patients treated with a combined approach (RTx/Sx) experienced a better outcome. Overall cancer-specific survival at 5 years was 85%. These findings highlight a disturbing relapse rate and mortality for a subgroup of patients diagnosed with a more aggressive form of lip cancer. Treatment and follow up of these patients should accordingly be more aggressive.

Adult↗
PubMedDate not supplied

Congenital lower lip pits (Van der Woude syndrome): presentation of 10 cases.

Congenital lower lip pits are a rare developmental malformation of the lower lip. Clinically they present as bilateral depressions in the vermilion zone of the lower lip. It is important to be aware of this disorder because lower lip pits have also been reported in a variety of other congenital disorders and are associated with other malformations. Ten cases of this entity are presented. Nine of the 10 patients are members of two related families. The clinical and pathologic picture as well as some of the genetic and therapeutic aspects of this peculiar condition are discussed.

Adult↗
PubMed2002

Lymphatic mapping and sentinel lymph node biopsy in squamous cell carcinoma of the lower lip.

AIMS: The risk of metastases to the submandibular and submental lymph nodes in squamous cell carcinoma (SCC) of the lower lip is closely related to the primary tumour size and the differentiation of the tumour. In order to determine the feasibility of the technique and the possible metastatic lymph nodes in SCC of the lower lip, intraoperative lymphatic mapping and sentinel lymph node biopsy was performed in patients with tumour size greater than 2 cm (T2) and clinically non-palpable regional lymph nodes (N0). METHODS: Intraoperative lymphatic mapping with patent blue dye was performed in 20 patients with SCC of the lower lip. The stained lymph node (sentinel) was identified in each patient and sent for frozen section analysis in order to verify tumour metastasis. All patients had undergone bilateral suprahyoid neck dissection at the same stage. RESULTS: Three of the patients were female and 17 were male. The median age was 66. Sentinel lymph nodes were identified in 18 of the patients (90%). Intraoperative or post-operative histopathologic examination of the sentinel lymph node showed tumour metastasis in three of the patients (16.6%). The histopathologic examination of the remaining 15 patients whose sentinel lymph nodes were free of metastasis, showed no metastasis in the non-sentinel lymph nodes. In two of the three patients with metastatic sentinel lymph nodes, non-sentinel lymph nodes were free of metastases. There were no false negative results and no local or systemic complications of the technique were seen among the patients. CONCLUSIONS: Intraoperative lymphatic mapping and sentinel lymph node biopsy is feasible in patients with SCC of the lower lip who have large tumour size and non-palpable regional lymph nodes. The technique may help to avoid neck dissection when the patient has negative sentinel lymph node and when positive provides useful information for more effective radical treatment.

Adult↗
PubMed2001

Upper lip asymmetry in adults during smiling.

PURPOSE: This study examined the incidence of upper lip asymmetry in adults while smiling. PATIENTS AND METHODS: Two-hundred ten students between the ages of 21 and 44 years were examined. Subjects determined to have an occlusal plane cant were eliminated from the study. Repeated smiles were then evaluated in the remaining subjects to check for upper lip asymmetry. RESULTS: Fifteen subjects were observed to have occlusal plane cants and were eliminated from the study. Of the remaining 195 subjects, 17 (8.7%) were found to have an asymmetrical smile secondary to canting of the upper lip. CONCLUSIONS: Although there was not a high incidence, the results of this study indicate there is clinically evident upper lip canting associated with smiling in the adult population that needs to be considered in patients undergoing orthognathic and cosmetic surgery.

Adult↗
PubMed2001

Comprehensive management of cleft lip and palate deformities.

PURPOSE: The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair. PATIENTS AND METHODS: Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months. RESULTS: All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal. CONCLUSION: Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected.

Child↗
PubMed2001

Functional and aesthetic results of various lip-splitting incisions: A clinical analysis of 60 cases.

PURPOSE: This study retrospectively evaluated the functional and aesthetic results of various types of lip-splitting incisions in a group of patients in whom this approach was used to treat intraoral tumors. PATIENTS AND METHODS: Between 1992 and 1998, 87 consecutive patients were subjected to either mandibulotomy or mandibulectomy using a lip-splitting incision. During this period, 4 types of incisions were sequentially used: straight midline incision, lateral lip-splitting incision, midline splitting with extension around the contour of the chin, and the chevron chin-contour incision. Sixty patients with a follow-up of at least 6 months were included in the study. The patients were asked to answer a questionnaire regarding the degree of satisfaction with the cosmetic result of the procedure and were clinically assessed for sensory and functional impairment resulting from the incision. The remaining 27 patients were lost to follow-up or had died of their disease. RESULTS: The lateral lip-splitting incision caused the fewest postoperative problems in patients subjected to either mandibulotomy or mandibulectomy. The best overall results were achieved by the chevron-chin contour incision. The incision that followed the contour of the chin and the straight midline incision showed less satisfactory results. CONCLUSION: The chevron chin-contour incision, along with meticulous soft tissue closure, produces the best aesthetic and functional results.

Aged↗
PubMed2000

Incidence of cleft lip or palate in 303738 Japanese babies born between 1994 and 1995.

To investigate the incidence of cleft lip or palate or both (CLP) in Japan, 303738 babies born in 1532 institutions between 1994 and 1995 were examined and 437 (0.14%) were found to have abnormalities. Of these babies, 32.1% had cleft lip, 43.3% had cleft lip and palate, and 24.8% had cleft palate (Table 2). These results show that the incidence of cleft lip and palate has declined compared with the period from 1981 to 1982.

Cleft Lip↗
PubMed2001

Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate.

Cleft lip and palate affects the child in many ways, particularly appearance, dental arch relationships, growth of the face, and speech development. The key to successful care is management in a multidisciplinary team adhering to a well-designed protocol, and careful audit of results. We present the intermediate outcome audit of 15 patients with complete bilateral and unilateral cleft lip and palate whose condition was managed in a multidisciplinary team according to a strict protocol. We give the results observations of operations of a single surgeon's functional primary surgery over a 6-year period in terms of dental arch relationships, cephalometric analyses, aesthetic assessments, and speech analysis. The results show good early facial growth, with dental arch relationships appropriate for the age and group; we found only minor speech discrepancies, with no patients requiring pharyngoplasty. The results show the importance of multidisciplinary management, the value of keeping to sound surgical protocols, and functional techniques in cleft lip and palate surgery. Our study includes the neglected group of children who have bilateral cleft lip and palate, and it conforms to the style of pan-European projects.

Cephalometry↗
PubMed2000

Left or right hand dominance in children with cleft lip and palate.

The relationship between unilateral cleft lip, bilateral cleft lip, palatal clefting and left-right hand dominance was studied in 337 patients with cleft lip and/or palate aged between 3 and 14 years. There was no statistically significant difference in the laterality of handedness between different types of cleft nor between unilateral left and right sided cleft lip with or without cleft palate.

Adolescent↗
PubMed2004

Abscess formation after lip augmentation with silicone: case report.

This paper describes the development of an abscess after injection of an alloplastic preparation (silicone) for enhancement of the lower lip. The 56-year-old woman presented with a painful swelling of her lower lip which was incised. Pus drained from the incision. A biopsy was taken. Histology revealed homogeneous foreign body inclusions (silicone) with fibrosis, chronic inflammation and multinuclear giant cells. Healing was uneventful with little deformation of the lower lip. Since the number of persons seeking aesthetic lip augmentation is increasing, oral surgeons and dentists should be familiar with adverse effects to filling agents.

Abscess↗