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At least 1,099 records · Page 61Linked to original sources
PubMed1990

Bilateral vermilion flaps for lower lip repair.

A more natural reconstructive procedure of the lower lip using bilateral vermilion flaps was applied in five patients with excellent results. The vermilion defects were about two-fifths to three-fifths. In three patients, the vermilion defect was repaired using bilateral vermilion flaps alone. In the remaining two patients, a narrow horizontal lip defect was repaired by bilateral vermilion flaps and a subcutaneous V-Y advancement flap of the lower lip. A single vermilion flap or bilateral vermilion flaps are considered to be of great value for vermilion reconstruction because of the inherent elasticity and common anatomic unit. The postoperative scars are not remarkable at all. A long and narrow horizontal lip defect (perhaps within 1.5 cm downward from the vermilion border) may be effectively repaired by the combination of vermilion flap(s) and a V-Y advancement flap without sacrificing any additional healthy tissue.

Adolescent↗
PubMed1993

The prolabial unwinding flap method for one-stage repair of bilateral cleft lip, nose, and alveolus.

This paper describes a one-stage reconstruction of the complete bilateral cleft lip, nose, and alveolus using an asymmetrically designed prolabial flap. The columella of the nose and the central lip are produced by "unwinding" the columellar and labial sections of the prolabium around a small central tab, which is used to center the junction between the lip and columella. Only two scars are produced, both of which run vertically along each philtral column. Accurate preoperative orthopedics without lip adhesion is considered essential to this repair. The principal advantage/disadvantage to the method is its asymmetrical design. If asymmetries result, they have been easily corrected. Eight consecutive cases are presented with follow-up ranging from 1.5 to 6.3 years.

Alveolar Process↗
PubMed1995

Lip augmentation using the palmaris longus tendon.

A case is presented in which the upper lip of a 20-year-old woman was augmented by a graft of palmaris longus tendon-muscle. This technique offers several advantages over other lip enlargement techniques. The primary drawback, in my opinion, is the possibility that lip excursion (smiling, animation) might be restricted by tendon-muscle adherence to lip tissues, although this did not occur in this patient. Experience with larger numbers of patients is necessary before this technique can be endorsed for general use.

Adult↗
PubMed1997

Total lower lip reconstruction with a sensate composite radial forearm-palmaris longus free flap and a tongue flap.

The technique of total lower lip reconstruction with a composite radial forearm-palmaris longus free flap was further refined in this report. A ventral tongue flap enhanced the lip aesthetics by recreating the vermilion. Lip suspension was enhanced by securing the palmaris tendon to the malar eminences as well as to the cut ends of the orbicularis oris muscle. The patient achieved oral continence as well as dynamic movement of the lip during speaking and swallowing.

Aged↗
PubMed1998

Maxillary distraction: aesthetic and functional benefits in cleft lip-palate and prognathic patients during mixed dentition.

In the last few years, distraction techniques have been used successfully to correct the hypoplastic human mandible. In patients with cleft lip and palate, normal growth of the maxilla may be impaired by early cleft repair, and many of them do not respond to orthodontic procedures alone. Maxillary distraction is an alternative technique to correct maxillary hypoplasia during mixed dentition. In the last 3 years, the procedure was performed in 38 patients aged between 6 and 12 years; 18 patients had unilateral cleft lip and palate, 9 patients had bilateral cleft lip and palate, 7 patients had unilateral cleft palate, 2 patients had prognathism, and 2 patients had nasomaxillary dysplasia. Photographs, posteroanterior and lateral cephalograms, and dental models are obtained preoperatively (as well as an orthopantomogram) to locate the tooth buds. A subperiosteal dissection is performed exposing the anterior and lateral aspects of the maxilla, and an incomplete horizontal osteotomy is done above the tooth buds. Using a facial mask and an intraoral fixed appliance system as an anchorage, we initiate on the fifth postoperative day the application of distraction forces. Maxillary advancement between 4 and 12 mm is achieved during 3 to 4 weeks, and a satisfactory class I or II molar relationship is also obtained. A combination of forward and downward distraction forces can be used to achieve simultaneous advancement and elongation of the hypoplasic maxilla. The aesthetic results are excellent, and the nasolabial angle is increased, including a more anterior projection of the upper lip. Nasal breathing is improved as well as the air flow and patency of the nasal airway. Velopharyngeal function remains unchanged after the procedure. The follow-up in this series varied from 6 months to 3 years. No relapses have been observed.

Child↗
PubMed1998

A model for the cleft lip nasal deformity.

The underlying pathology of the cleft lip nasal deformity has yet to be fully realized, and cleft lip rhinoplasty continues to challenge the reconstructive surgeon. A new model is proposed, which is composed of elements that represent known anatomical structures of the nose. These structures are considered elemental to the mechanism of the primary cleft lip nasal deformity. The lobule is reduced to four arches. Five points on the skull provide foundations for these arches, which react interdependently to extrinsic forces and positional change. When certain changes are imposed on the model, predictable alterations in the configuration of the model imitate the observed deformities in the spectrum of the cleft lip nasal deformity, unilateral and bilateral, mild through severe. The model is described with illustrations, anatomic dissection, physical models, and selected clinical cases. A better understanding of the mechanisms of the cleft nasal deformities can be obtained through analysis of the model.

Cadaver↗
PubMed1998

Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap: an anatomic approach.

Adult incomplete cleft lip nose deformity is not uncommon in India. Poverty, ignorance, and parental neglect account for its late presentation. Besides the classical features of cleft lip nose deformity, the constant findings observed in this patient population have been a widened and depressed nasal sill. This is attributable to the sparse, hypoplastic, and abnormally orientated orbicularis oris muscle in the region of the sill. Failure to restore the nasal sill symmetry by suitably augmenting the sill frequently leads to unsatisfactory and asymmetric results. However, in the literature, satisfactory restoration of the nasal sill has not been given the importance it deserves while performing cleft lip rhinoplasty. We present a method of augmenting the depressed nasal sill in cases of adult incomplete nose deformity using a superiorly based orbicularis oris muscle flap, which is harvested from the soft tissues between the apex of the cleft and the nostril sill. Following de-epithelialization of the overlying skin, the exposed muscle is raised as a superiorly based flap after dissecting it from the underlying mucosa. It is folded, turned over, and tucked into the nasal sill base and anchored to the anterior nasal spine to give the desired augmentation. Satisfactory results have been obtained in 18 cases of nasal deformity associated with incomplete cleft lip. In our opinion, this technique offers a simple and effective method of augmenting the depressed sill by utilizing locally available tissues and without the need for procuring autologous tissue from distant sites.

Adolescent↗
PubMed2002

Facial artery in the upper lip and nose: anatomy and a clinical application.

Twenty-five facial arteries were examined radiographically in 19 fresh cadavers that had been injected systemically with a lead oxide-gelatin mixture. Major branches of the facial artery in the upper lip and nose were investigated, and the anatomical variations were classified into three types on the basis of the anatomy of the lateral nasal artery, which was determined as an artery running toward the alar base. In 22 cases (88 percent), the facial artery bifurcated into the lateral nasal artery and superior labial artery at the angle of the mouth. In two cases (8 percent), the facial artery became an angular artery after branching off into the superior labial artery and the lateral nasal artery sequentially. In one case (4 percent), the facial artery became an angular artery after branching off into the superior labial artery, and the lateral nasal artery then branched off from the superior labial artery. Branches from the lateral nasal and superior labial arteries were observed stereographically. Vascular anastomoses between those branches were created in the upper lip, columella base, and nasal tip, and an intimate vascular network was formed. With a vascular network in the mucosa of the upper lip, a bilobed upper-lip flap was created for a clinical case with a full-thickness defect of the ala.

Arteries↗
PubMed1995

Epidemiology of cleft lip and cleft palate in Mississippi.

We present an epidemiologic study of the cases of cleft lip and cleft palate in Mississippi from 1980 through 1989. Cases were stratified by race (white and nonwhite) but not by association with a major malformation. During this period, a total of 457 new patients with cleft lip or cleft palate were identified from a population of approximately 439,354 live births. The incidence of total clefts in live-born infants was 1.36/1,000 for whites and 0.54/1,000 for nonwhites. White boys had a higher incidence of cleft lip and palate than white girls; black boys had an extremely low incidence of cleft lip, whereas black girls showed a higher incidence of cleft palate alone. Examination of the rate of cleft malformations for each county in Mississippi revealed no clearly defined pattern, nor were we able to demonstrate that rates were increased in a major agricultural area of the state, in which use of potentially toxic products is high.

Cleft Lip↗
PubMed2004

Conservative management of large avulsions of the lip and local landmarks.

Large lip avulsion injuries that involve significant tissue loss to the lip vermilion and other local landmarks can often pose a surgical dilemma for the reconstructive surgeon. Immediate reconstruction of these injuries are frequently performed using local flaps and adjacent tissue transfer to close the defect, but these repairs frequently suffer from the unfortunate consequence of increased associated scarring and further permanent distortion of the local anatomy. We present 2 patients sustaining dog bite injuries associated with extensive traumatic tissue loss to the lip vermilion and other local landmarks. These patients were treated conservatively with excellent functional and cosmetic results. A single minor surgical revision of 1 patient's cupid's bow was performed 1 year after injury. In cases of significant traumatic avulsion involving the lip vermilion and the perioral composite soft tissue, even with injuries including delicate anatomic landmarks, healing by secondary intention can be instituted as the initial treatment of choice in younger patients, often providing optimal results.

Administration, Topical↗
PubMed2004

Lifting of the upper lip: personal technique.

The authors illustrate a personal technique for lifting of the upper lip with augmentation of the lower lip. With this procedure, a shortening of the "prolabium," an increase of the vermilion, and a natural, nicer mouth are obtained, with the possibility of increasing the volume of the lower lip simultaneously. The operation is carried out as outpatient surgery using local anesthesia, with intravenous sedation if requested. Incisions are made bilaterally beginning at the alar fold of the nose; they then enter the nostrils and rise medially on the skin below the lower margin of the medial crura of the alar cartilage. In this way, the columella is safe, and there are no scars. Then, the two pieces of excess skin and a small, whole strip of orbicular muscle can be cut away, just under the nose. If the goal is to better extrude the vermilion, the skin as far as the Cupid's bow also has to be undermined; if the goal is to shorten the prolabium, a slightly wider amount of orbicular muscle can be removed. The muscle is suspended to the base of the nose with interrupted stitches (absorbable 4-0 suture), the subcutaneous tissue is sutured, and finally the skin is closed with a running suture. The removed muscle is a good graft for increasing the size of the lower lip.

Adult↗
PubMed2005

Maxillofacial morphology in children with complete unilateral cleft lip and palate treated by one-stage simultaneous repair.

BACKGROUND: There is a common belief among the majority of surgeons occupied with cleft lip-cleft palate repair that early one-stage simultaneous repair of hard and soft palates affects maxillofacial development adversely. This proposition has not been proven with long-term clinical studies. In this study, the effects of one-stage repair on the maxillofacial development of children with complete unilateral cleft lip-cleft palate were investigated, and the results were compared with those of the cleft children treated with conventional two-stage repair. METHODS: The study was designed as follows. Group 1 consisted of 19 children (mean age, 85.4 +/- 12.8 months) treated with a one-stage procedure. In this group, cleft lip, palate, and alveolus were repaired simultaneously at a single surgical session in the first 10 months of life (mean age at time of surgery, 6.8 +/- 1.2 months). Group 2 consisted of 22 children (mean age, 90.1 +/- 13.0 months) treated in two stages as follows: lip repair was performed at a mean age of 4.8 +/- 1.0 months and palate repair was performed at a mean age of 14.6 +/- 2.0 months. The follow-up period was approximately 6.3 years for both study groups. Group 3 (control) consisted of 27 children (mean age, 87.1 +/- 11.7 months) without cleft who were matched for age. RESULTS: Compared with the control group, the children in both cleft groups revealed a greater maxillomandibular retrognathism, a more open palatal plane, larger anterior facial heights, and decreased posterior vertical maxillofacial heights. No significant difference was determined between study groups 1 and 2. CONCLUSIONS: Because both of the surgical treatment procedures give rise to similar maxillofacial development outcomes, regardless of the timing of surgery, the one-stage procedure offers several important advantages, such as less psychosocial trauma, low cost, and possibly an improvement in speech results because of less scarred palatal fields and the low rate of palatal fistula.

Cephalometry↗
PubMed2005

Selective marginal mandibular neurectomy for treatment of the marginal mandibular lip deformity in patients with chronic unilateral facial palsies.

BACKGROUND: For unilateral facial palsies, reanimation techniques such as cross-facial nerve grafting with free muscle transfer have been very successful at improving symmetrical lip elevation when smiling. However, these procedures do not address the residual asymmetry with respect to lip depression resulting from an uncorrected marginal mandibular nerve palsy. Techniques that do address this residual lip asymmetry have had variable results. Selective neurectomy of the unaffected marginal mandibular nerve has largely been abandoned as a treatment since it has been reported to result in severe oral functional and cosmetic deficiencies. The authors argue that selective marginal mandibular neurectomy is a reliable technique for treatment of the marginal mandibular lip deformity that does not compromise oral functionality. METHODS: Thirteen patients with unilateral facial palsies underwent selective marginal mandibular neurectomy of the unaffected side; the procedure was performed by the principal investigator. These patients were then evaluated on the basis of symmetry with smiling and oral functionality. Twelve of the patients were contacted and questioned with a standardized questionnaire. Twelve of the patients were evaluated independently for symmetry with smiling using randomized preoperative and postoperative photographs. RESULTS: Eleven of the 12 patients reported either improvement or no change in oral competence. Ten of the 12 patients reported either improvement or great improvement in symmetry with smiling. Improvement in symmetry with smiling was independently observed 77.2 percent of the time. CONCLUSION: These results support selective marginal mandibular neurectomy of the unaffected side in patients with unilateral facial palsies as a means of improving symmetry with smiling without compromising functionality.

Adolescent↗
PubMed2006

Management of unilateral cleft lip nose deformity, with retracted ala of the noncleft side.

BACKGROUND: Traditionally, the goal of management of unilateral cleft lip-cleft nose deformity has been nasal symmetry, with improved nasolabial and nasofacial relationships and the noncleft side as the reference point. However, symmetry does not always ensure an aesthetically desirable form. The retracted ala is characterized by an alar rim to the long axis of the nostril distance greater than 2 mm on lateral view of the nose. In the management of unilateral cleft lip nose deformity in a patient with a retracted ala of the noncleft side, a simple correction of the deformity symmetric to the noncleft side results in bilateral alar retraction, an aesthetically undesirable result. METHODS: The authors present eight cases of managing unilateral cleft lip deformities with retracted alae of the noncleft side between January of 2003 and October of 2004. RESULTS: Correction of alar retraction of the noncleft side with or without the correction of cleft lip nose deformity yielded better aesthetic results that were maintained throughout the follow-up period. CONCLUSIONS: Aesthetic surgery is the natural evolution of reconstructive surgery; in the reconstruction of selected unilateral deformity, the concept of "as symmetric to the contralateral side as possible" should be changed to the pursuit of an aesthetically pleasing appearance of both sides.

Adolescent↗
PubMed1995

Isolated lichen planus of the lip.

Oral lichen planus (LP) is a relatively common disorder of unknown aetiology. Oral LP occurs most often on the buccal mucosa, but the gingivae, tongue, floor of the mouth, retromalar pads and lips may also be affected. Usually, patients have multiple sites of involvement. We report a 44-year-old patient with a 3-year history of isolated swelling of the lower lip, erosions and crusting. Histology of a biopsy from the lip revealed features of LP. Oral treatment with acitretin and low-dose steroid led to complete resolution of the lesions within 10 weeks. This is the first well-documented case of isolated LP of the lip. Diagnostic difficulties and differential diagnosis are reviewed.

Acitretin↗
PubMed1994

Traumatic anterior dental injuries related to incisor overjet and lip competence in 12-year-old Nigerian children.

A study of 1016 12-year-old Nigerian children was carried out to assess the relationship between traumatic injuries of anterior teeth, incisor overjet and lip competence. The prevalence of dental injuries was 10.9% which confirmed the results of previous studies. More boys than girls sustained injuries to their teeth. There were, however, no significant sex differences in increased overjet or lip competence. Of the 111 children with traumatic dental injuries, 71 (64.0%) had increased incisor overjet (> 3 mm) compared to 257 of the 905 children (28.4%) in the non-trauma group. Similarly, 72 (64.9%) of the trauma group had inadequate lip coverage compared to 224 (24.8%) in the non-trauma group. These differences were statistically significant (P < 0.001). It is concluded that incisor overjet of more than 3 mm and incompetent lips are significant predisposing factors to anterior dental injury in Nigerian children.

Child↗
PubMed2006

The self-concept of adolescents with cleft lip and palate: a pilot study using a multidimensional/hierarchical measurement instrument.

OBJECTIVE: To pilot the use of a multidimensional/hierarchical measurement instrument called the self-description questionnaire II to determine whether specific areas of self-concept in a group of adolescents with cleft lip and palate would be affected by their condition when compared with a normative sample. PARTICIPANTS AND DESIGN: The self-concept of 23 adolescents with a cleft of the lip and palate was compared to an Australian normative sample. Adolescents attending the dental department of a paediatric hospital in Australia. MAIN OUTCOME MEASURE: The main outcome measure was a self-report questionnaire (102 items) with 10 domain-specific scales and a global measure of general self-concept. RESULTS: When compared to the normative data the study group showed significant differences in 4 of the 11 domain-specific scales: Parent Relations (P < 0.001), Physical Abilities (P < 0.001), Opposite-Sex Relations (P < 0.01) and Physical Appearance (P < 0.01) self-concepts. These differences were in a positive direction. Global self-concept as measured by the General Self scale was not significantly different from the normative sample. CONCLUSION: These results suggest that adolescents with clefts of the lip and palate have normative if not better self-concept than their peers. The study also suggests that having a cleft of the lip and palate has specific rather than broad associations with psychosocial adjustment. This justifies the use of instruments designed to assess specific areas of self-concept rather than more global measures.

Adolescent↗
PubMed1993

Correlates of genetic risk for non-syndromic cleft lip with or without cleft palate.

Multivariate analysis was used to determine which characteristics: sex of the proband, sibling sex, severity of the proband's defect or family history, are the best predictors of recurrence risk among siblings of individuals with non-syndromic cleft lip with or without cleft palate (CL +/- P). Sibling recurrence risks are not significantly related to the sex of the proband. Severity of the proband's defect, classified by the extent of the lip defect (unilateral versus bilateral), was found to be a significant predictor of sibling recurrence, whereas involvement of the palate in the proband's defect was not. A positive family history of clefting (i.e. at least one affected first-degree relative in addition to the proband) and the sex of the sibling were also found to be significant predictors of sibling recurrence. The associations between sibling risk and family history, and sibling risk and bilaterality of the proband's defect appear to be mildly confounded. After adjusting for the effects of family history, the risk to siblings of probands with bilateral lip defects is twice the risk to siblings of probands with unilateral defects (O.R. = 2.00; 95% C.I. 1.25-3.19). A positive family history of clefting increases the risk to siblings by greater than 4-fold (O.R. = 4.49; 95% C.I. 2.74-7.35), after adjusting for the extent of the proband's lip defect. These results provide a rational strategy for identifying subsets of the 'at risk' population which have markedly different recurrence risks. This information is important for genetic counseling, since it allows for more precise estimation of sibling recurrence risks in individual cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cleft Lip↗