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At least 1,081 records · Page 60Linked to original sources
PubMed1987

A mucosal island flap to repair vermilion defects of the lips.

This article describes a one-stage technique to reconstruct up to one-third of the vermilion after full-thickness excision of the lips. It is based on a mucosal elliptically shaped random island flap from the inner lip, combined with a conventional skin flap from the surrounding area. The procedure can be performed under local anesthesia. Healing is achieved in 8 days. The technique has been employed in 9 patients, both on lower and on upper lips and even on different sides of the same lip. The results are aesthetically and functionally good.

Female↗
PubMed1987

Aesthetic reduction of the upper lip.

The upper lip, given its surface anatomy and morphology, should be no more than 2 cm high. Therefore, to reduce the upper lip we propose an incision at its highest portion similar to the letter M which extends into the nasal vestibula. We aim at a real reduction of the height of the lip as well as restoration of its natural concavity through a scar situated obscurely, and which tends to disappear within a few months postoperatively. In patients in whom the upper lip is less than 2 cm high but the vermilion is minimal, we use Gillies' technique and make curvilinear incisions. We have also observed correction of the perioral wrinkles using this technique.

Humans↗
PubMed1996

A reposition of Tennison's triangular flap in long lip deformity.

The authors have used a new technique in 5 cases with severe long lip deformity and drooping of the Cupid's bow, who all have undergone Tennison's triangular flap method for unilateral cleft lip at primary repair. We corrected this deformity by repositioning Tennison's triangular flap back into its original site and then obtained (1) effective shortening of a vertical lip length, (2) restoration of a symmetric Cupid's bow, (3) prevention of tight upper lip, (4) refinement of the transverse scar, and (5) low recurrence.

Adolescent↗
PubMed1998

Staged sequential reconstruction of a total lower lip, chin, and anterior mandibular defect.

The combination of a total lower lip, chin, and anterior mandibular defect following cancer resection is an extremely complex problem that requires a sequence of operations to optimize functional and aesthetic results. One patient is presented in whom the defect was reconstructed with a free fibular flap followed by a series of ancillary procedures using both modern and traditional techniques. At the time of tumor ablation, the through-and-through oromandibular defect was reconstructed with a fibular osteocutaneous flap. The lower lip and gingivolabial sulcus was reconstructed later with a tongue flap. Tissue expansion was subsequently used to replace the fibular skin with expanded submental hair-bearing skin. A polyethylene implant was added later to the fibular bone for chin augmentation. Subsequently the lower lip was supported with a tendinous graft suspended to the anterior masseter bilaterally. Lastly, the vermilion border was elevated by removing a rim of the tongue flap and covering the secondary wound with a full-thickness skin graft. At the end of the reconstructive procedures, lip seal and oral aperture were good with no drooling and excellent speech.

Carcinoma, Squamous Cell↗
PubMed1998

Epidemiology of cleft lip and palate in Thailand.

During the years 1989 to 1991, a survey for the epidemiology of cleft lip and palate was carried out in Thailand using detailed forms. One thousand ninety-six patients were recorded and 593 patients were operated during that period. All records were analyzed. Six hundred forty-seven patients (59%) lived in northeastern Thailand. Of the 593 operated patients, 26% had cleft lip only, 48% had cleft lip and palate, and 25% had cleft palate only. Men predominated all groups except for the cleft palate-only group. Twenty-six of 593 patients had associated congenital anomalies. Two hundred thirty-seven of 1,096 patients had a history of cleft lip and palate in their first- and second-degree relatives (21.62%). Five hundred seventy-eight of 1,096 mothers (52.74%) had a history of taking drugs. Analgesics were among the drugs taken most often.

Abnormalities, Drug-Induced↗
PubMed1999

Palatoalveolar outcome at 18 months following simultaneous primary cleft lip repair and posterior palatoplasty.

It is frequently reported that early repair of the soft palate induces narrowing of the remaining palatal cleft and thus facilitates later hard palate closure. However, to the best of our knowledge, there have been no comparative studies to test this hypothesis. The purpose of this retrospective study was to evaluate the change of palatoalveolar morphology following primary lip repair and posterior palatoplasty. Dental plaster models of patients with complete unilateral cleft of lip and palate (UCLP) were used to measure the width of the cleft and palatal arch. Twenty-six patients received simple posterior palatoplasty (PP group) simultaneous with primary lip repair, and 20 patients did not (NPP group). The dental models included one preoperative cast at 2 months (T1) and two or three casts at 6 (T2), 12 (T3), and 18 (T4) months before final palate closure. The linear measurements performed were width of alveolar cleft (Ca); width of palatal cleft between the canines (Cc), molars (Cm), and tuberosities (Ct); the palatal arch distance between the canines (Dc); the widest distance between molars (Dm) and the tuberosities (Dt); and the palatal height between the canines (Hc) and tuberosities (Ht). The raw measurements and the calculated cleft-to-arch ratios of Cc/Dc, Cm/Dm, and Ct/Dt were compared between the two groups. The results showed gradual narrowing of the width of cleft from T1 to T4. Narrowing of alveolar cleft width (Ca) from T1 to T2 was dramatic. The palatal arch (Dc, Dm, Dt) showed no change to mild increase in width. The cleft-to-arch ratios decreased with time. The palatal height remained the same or slightly increased over time. There were no significant differences observed between the PP and NPP groups among these measurements except for the Ct and Ct/Dt at T4. In conclusion, after initial lip repair, there was a decrease of the width of cleft in patients with complete UCLP during the 18-month period, and simple posterior palatoplasty did not further narrow the cleft nor influence palatal arch development.

Chi-Square Distribution↗
PubMed2001

Modified bilateral neurovascular cheek flaps: a new technique for reconstruction of extensive upper lip defects.

The authors present a modified bilateral neurovascular cheek flap as a new technique for extensive upper lip reconstruction. The technique is modified from the bilateral neurovascular cheek flap for lower lip reconstruction described by Vatanasapt and colleagues in 1987 by designing rectangular and triangular flaps in the cheek tissues lateral to the lip defect on both the skin and the mucosal sides. This method has the advantage of preserving neurovascular structures as well as the original position of the oral commissure. Five patients are presented with acceptable surgical results. The technique is a good choice for functional reconstruction of near-total or total upper lip defects.

Aged↗
PubMed1992

Immediate unrestricted feeding of infants following cleft lip and palate repair.

Postoperative feeding regimens after cleft lip and palate repair continue to be a controversial issue. This study was designed to test the feasibility of immediate unrestricted feeding after lip and palate closure with attention to operative outcome or complications. A retrospective analysis of two feeding protocols involved 80 infants with both unilateral and bilateral defects. Protocol A utilized tube and syringe feedings, and protocol B utilized unrestricted bottle or breast feedings. There were no instances of lip or palate wound complications in the unrestricted group. We conclude that immediate unrestricted feeding may be instituted safely, thus improving and simplifying postoperative management after cleft lip and/or palate repair.

Bottle Feeding↗
PubMed1995

Intrauterine repair of cleft lip-like defects in lambs with a novel microclip.

Potential for scarless wound healing in fetal surgeries has aroused interest in fetal repair of malformations such as cleft lip. However, current protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenetrating, and is well suited for endoscopic use. Using standardized intrauterine surgical techniques, we compared suture versus microclip in the repair of surgically created cleft-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyzed with bilateral cleft lips; the right cleft was repaired by microclip, seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar formation after repair by either microclip or suture. The most striking result, however, was in the comparison on intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore, its endoscopic application has the potential for making endoscopic fetal surgery a more viable option.

Animals↗
PubMed1999

Maxillary distraction in cleft lip palate patients: a review of six cases.

Cleft lip and palate patients can present with a maxillary retrusion with tendency to Class III malocclusion after cleft repair. Maxillary distraction osteogenesis is a technique that provides simultaneous skeletal advancement and expansion of the soft tissues. Six nonsyndromic cleft lip and palate patients, ages 12 to 16 years (mean, 13.8 years), underwent maxillary distraction; four had a unilateral and two a bilateral cleft lip and palate. After an incomplete LeFort I osteotomy; a latency period of 3 days was respected. On Postoperative Day 4, distraction was initiated through anterior traction on a Delaire facial mask using distraction forces of 900 gm. Photographs and lateral cephalometric radiographs were obtained preoperatively and 4 months after distraction. A cephalometric analysis was performed to compare the sagittal dentocraniofacial morphology before and after distraction. The aesthetic improvement obtained by maxillary distraction osteogenesis during the permanent dentition to correct maxillary retrusion in our cleft lip and palate patients was impressive. Skeletal advancement varying from 1 to 3.5 mm (mean, 1.7 mm) was found. However, significant dentoalveolar compensations occurred in three patients. This was due to the dental anchorage of the distraction device and can be avoided only by the use of skeletal fixation.

Adolescent↗
PubMed2003

Repair of bilateral cleft lip: review, revisions, and reflections.

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.

Alveoloplasty↗
PubMed2004

A case of lower lip defect reconstructed with buccal mucosa and a tongue flap.

The use of buccal mucosa and a tongue flap in reconstruction of full-thickness defects of the lower lip is described. The patient's face received a heavy blow in a traffic accident. Necrosis caused by hematogenous disturbance occurred in more than half of the entire lower lip vermilion. The patient underwent a two-stage operation for reconstruction of the lower lip. First, vestibuloplasty was performed using a buccal mucosal flap. Subsequently, the vermilion was surgically reconstructed using a flap from the tip of the tongue. This operative method is less risky because of its favorable prognosis. An effective way to recover motor function of the lower lip is to practice a rehabilitation program against scar contraction. An extension movement with the fingers that requires two or three repetitions every day was selected. Rehabilitation was started 7 days after the tongue flap was divided. The patient had a favorable recovery after the operation and is now able to wear a denture and to eat without slobbering.

Facial Injuries↗
PubMed2005

Natal teeth: a potential impediment to nasoalveolar molding in infants with cleft lip and palate.

The purpose of this article is to describe two cases of bilateral cleft lip and palate with natal/neonatal teeth. Clinical features, prevalence, possible complications, and treatment modalities are discussed. Two patients with cleft lip and palate and natal/neonatal teeth are described. The first patient was a 4-week-old infant with bilateral cleft lip and palate. On initial inspection an odontogenic vestige was noticed on the right lateral border of the premaxillary segment, bordering the cleft. The second patient was a newborn with a vestige on the right side of the premaxilla. At 20 days, another swelling representing a neonatal tooth on the left side was found. Because the teeth interfered with the fabrication and application of the nasoalveolar molding (NAM) appliance, they were removed from both patients. In the first patient, at 1 week after extraction, the NAM device was placed without difficulty. At 8 months, the infant had adapted well to the NAM device and nursed without problems. The second patient did not follow-up for the placement of the NAM device. In patients with cleft lip and palate with natal/neonatal teeth who require NAM, the tooth must be removed to facilitate the fabrication and placement of the device. Natal/neonatal teeth must be extracted with caution because the tooth buds of neighboring teeth may be damaged and remnants of the dental papillae may be left behind. Although general anesthesia is not always indicated for the removal of these teeth, in cases in which the premaxilla is loose, such as the current cases, general anesthesia is warranted.

Cleft Lip↗
PubMed2004

Sensory mapping of lip representation in brass musicians with embouchure dystonia.

Embouchure dystonia is a focal task-specific disorder involving abnormal non-coordinated movements and involuntary muscle contraction around the mouth. In professional brass players it is often so disabling that patients have to limit or give up their occupation. We examined the somatosensory homuncular representation and measured gap detection sensitivity of the lips in eight former professional musicians affected by embouchure dystonia and eight control subjects. Relative to controls, the patients' digit, and especially the thumb, representations were shifted in a lateral direction towards the lip representational zone. Patients' upper lips showed decreased sensitivity compared to their lower lips (p < 0.01). This asymmetry result was absent in controls. Abnormal somatosensory reorganization may contribute to the disorder.

Adult↗
PubMed1985

The superficial musculoaponeurotic system in the upper lip: an anatomic study in cadavers.

Ten cadavers were employed to demonstrate the presence of the SMAS in the upper lip using macroscopic and microscopic techniques. The relationships and attachments of the SMAS to the dermis of the upper lip are described. In cadavers, medial traction on the SMAS in the upper lip in conjunction with superolateral traction on the SMAS in the cheek is found to decrease the depth of the nasolabial fold. Superior traction on the SMAS in the upper lip elevates the interlabial line, reestablishes the convexity of the lateral vermilion border, and partially increases concavity of the profile.

Adult↗
PubMed1986

Restoration of the upper lip and nasolabial area by means of an intraoral approach.

Superomedial repositioning of the superficial musculoaponeurotic system (SMAS) in the upper lip is accomplished by means of intraoral incisions. The procedure reestablishes the convexity of the lateral vermilion border, elevates the upper lip, and restores a more youthful appearance to the upper-lip profile. Depth of the nasolabial folds are reduced. We have performed this procedure on 14 patients. Follow-up intervals range from 6 to 20 months, averaging 14 months. All patients received concomitant rhytidectomy; usual operative time was increased by 20 minutes. Results have been rated good to excellent by patients and surgeons. There have been no recurrences of nasolabial fold deepening or upper lip depression, and there have been no complications. In selected patients, this procedure, along with rhytidectomy, may provide a more youthful appearance.

Female↗
PubMed1987

Further refinements on the triangular flap closure of the cleft lip.

Refinements in the triangular flap closure of the unilateral cleft lip are presented. Randall's mathematical interpretation of the Tennison repair has been extended by using a series of arcs to determine the crucial points which form the triangular flap. Using this easily taught method, an isosceles triangular flap can be plotted which will interdigitate into the noncleft side of the lip. Two symmetrical vertical distances on either side of the cleft are thus formed. This allows for a standardized repair which may be more readily taught than the rotation-advancement technique. In addition, flaps are created which are turned medically toward the cleft and are used to accentuate the philtral pout, close the nostril floor, and reinforce the lip repair, allowing closure of even extremely wide clefts in one stage. These refinements in using the triangular flap closure for the repair of the unilateral cleft lip are diagrammatically presented. We believe that these refinements enhance the results of this closure.

Cleft Lip↗
PubMed1989

Pathophysiology of cleft lip muscle.

Although attention has been focused for decades on the correction of cleft lip deformities, our knowledge about the etiology of such deformities has remained presumptive. Sixty-six muscle biopsy specimens from cleft lip infants were obtained at the time of primary closure. Histochemical stains, histographic analysis, and electron microscopy were performed. A nonneurogenic muscle atrophy was seen that varied in severity, with muscle fibers near the cleft being the most atrophic and disorganized. Muscle fibers stained with the modified Gomori trichrome technique also demonstrated "ragged red" fibers typical of a mitochondrial myopathy. Electron microscopy confirmed large accumulations of mitochondria distorting the fibrils. These mitochondria also were increased in size and densely packed with cristae. This study thus demonstrates that the muscles in cleft lip deformities are not normal. Instead, they reflect either myopathy in the facial mesenchymal mitochondrion or at least a delay in maturation. We hypothesize that some of the morphologic deformities associated with cleft lip may cause a failure of mesenchymal reinforcement of the facial processes at a critical time in development.

Cleft Lip↗