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Unusual herpes simplex virus infection mimicking foreign body reaction after cosmetic lip augmentation with expanded polytetrafluoroethylene threads.

BACKGROUND: Adverse reactions after cosmetic lip augmentation with synthetic implant materials include inflammation, infection, and extrusion of and foreign body reaction to the implant. Clinically, all of them are characterized by pain, erythema, swelling, and formation of papules and/or pustules. OBJECTIVE: To describe an unusual herpes simplex virus infection in a 48-year-old female patient after cosmetic lip augmentation with expanded polytetrafluoroethylene threads clinically resembling a foreign body reaction. METHODS: Case report and literature review. RESULTS: A histopathologic examination showed no signs of a foreign body reaction. Instead, herpes simplex virus-specific DNA was demonstrated by polymerase chain reaction from lesional tissue. CONCLUSION: Cosmetic lip augmentation with expanded polytetrafluoroethylene threads may be complicated by a delayed local herpes simplex virus infection clinically mimicking a foreign body reaction to the implant.

Female↗

Soft tissue changes of the upper lip associated with maxillary advancement in obstructive sleep apnea patients.

PURPOSE: This retrospective study evaluated the horizontal and vertical soft tissue changes that occur with maxillary advancement surgery with a Le Fort I osteotomy with concomitant anatomic reorientation of the nasolabial musculature. SUBJECTS AND METHODS: Fifteen OSA patients who underwent maxillary advancement with a Le Fort I osteotomy without adjunctive nasal soft tissue procedures were studied after a minimum of 8 months of follow-up. The V-Y technique was used to close the maxillary vestibular incision. Only cases with minimal vertical movement (< 3.5 mm) in which no orthodontics were used were included. The average maxillary advancement was 8.0 +/- 2.5 mm, measured at the upper incisor (UPI) and the average vertical movement was 0.7 +/- 1.8 mm. The horizontal and vertical soft tissue change in subnasale (SN), labrale superiorus (LS), superior stomion (SS), nasal tip (NT), nasolabial angle (NLA), and lip length were measured in each patient and correlated with hard tissue measurements at anterior nasal spine (ANS) and UPI. The effect of lip thickness on these soft tissue changes also was evaluated. RESULTS: Using mean data, the horizontal soft-to-hard-tissue ratio for LS to UPI was 0.80:1, with a concomitant vertical (superior) soft tissue change to hard tissue advancement of 0.16:1. Lip length did not change significantly. All patients except 1 showed a slight decrease in nasolabial angle. The average decrease was 5 (range, -10 to +7 ). There was no statistically significant correlation between the degree of change in NLA and the amount of maxillary advancement. CONCLUSION: This study showed that advancement of the maxilla when controlling vertical movement resulted in the a hard-to-soft-tissue ratio of LS:UPI of 0.80:1. NLA did not change significantly.

Adult↗

Surgically repaired cleft lips depicted in paintings of the late Gothic period and the Renaissance.

Paintings and drawings by Lucas Moser, Leonardo da Vinci, Albrecht Dürer, and Jacob Cornelisz van Oostsanen suggest that they employed people who had had cleft lips operated on as models for their works of art. Created between 1431 and 1520, the portraits show diagnostic facial profiles with a curved nasal dorsum, short columella, maxillary retrusion, and pseudoprogenia. The first medical illustration of cleft lip surgery was published in 1564 by Ambroise Paré. It was therefore late Gothic and Renaissance artists who depicted the conspicuous signs of surgically treated patients with cleft lip more than 130 years before the surgeons.

Art↗

Secondary repair of unilateral cleft lip nose deformity with bilateral reverse-U access incision.

Unilateral cleft lip is often accompanied by bilateral deformity. We use bilateral reverse-U incisions for the primary repair of unilateral cleft lip nose. This principle can also be applied to achieve symmetry of the nose in the secondary correction of the unilateral cleft lip nose. By the use of bilateral reverse-U access incisions and an inverted trapezoid suture between alar cartilages and nasal dome, it has become possible to achieve nasal symmetry and clearly defined alar groove. The surgical procedure is presented along with some representative cases.

Adolescent↗

Prenatal diagnosis of cleft lip and palate.

A prospective study was conducted over a period of 8 years to compare the severity of the cleft lip and palate detected by ultrasound scanning of the foetus with the severity at birth. In the UK all pregnant women undergo a routine perabdominal ultrasound scan at 20 weeks' gestation. There were approximately 250000 scans performed in our catchment area during the study period. A total of 270 children were born with cleft lip and/or palate, of which 130 had cleft lip with or without cleft palate. Out of these, 23 were positively diagnosed by the ultrasound scan. The specificity was 100% and the sensitivity was 17.5%. Only two diagnoses led to termination of the pregnancy.

Cleft Lip↗

Midfacial morphology in children with unilateral cleft lip and palate treated by different surgical protocols.

The purpose of this study was to compare cranio-facial, particularly midfacial morphology, in two groups of children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centres (Hannover. Germany and Brussels, Belgium) following different surgical treatment protocols. A total of 62 children (40 males; 22 females) with non-syndromic UCLP were included in this study at approximately the age of 10. The Hannover group comprised 36 children, who had repair of the lip at a mean age of 5.83 +/- 1.16 months, followed by repair of the hard and soft palate at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months. respectively. The Brussels group consisted of 26 children who underwent surgical treatment according to the Malek protocol: the soft palate was closed at a mean age of 3.04 +/- 0.20 months, followed by simultaneous repair of the lip and hard palate at a mean age of 6.15 +/- 0.68 months. Midfacial morphology was evaluated by means of cephalometric analysis according to Ross. The children in the Hannover UCLP group did not differ significantly from those in the Brussels group in the anteroposterior dimension of the midface. However, the maxillary plane was significantly more open in the Brussels group due to less posterior vertical maxillary development.

Age Factors↗

4p- syndrome and 9p tetrasomy mosaicism with cleft lip and palate.

Chromosome 4p- syndrome is a multiple malformation syndrome associated with partial deletion of the short arm of chromosome 4 (4p-). It is characterized by dysmorphic features and retarded development. Cleft lip and/or palate are the major clinical manifestations. Cases of tetrasomy 9p are extremely rare; the principal clinical manifestations of this condition are characteristic craniofacial abnormalities, generalized hypotonia and severe mental retardation. We present the first case of a female infant with 4p deletion and tetrasomy 9p mosaicism, exhibiting a left-sided cleft lip, alveolus and soft palate. Karyotype analysis of lymphocytes cultured from the patient revealed that she was mosaic: 86% of the cells were 46, XX, add (4) (p15.32) and 14% were 47, XX, add (4) (p15.32), +idic (9)(q12). The G-banding pattern appeared consistent with either translocation or partial proximal deletion of 4p. In order to make a definitive cytogenetic diagnosis of isodicentric chromosome 9, fluorescence in situ hybridization (FISH) was applied. At 8 months, when the patient weighed 4.3 kg, her cleft lip was repaired. Before and after surgery there were no seizures, and the postoperative course was uneventful.

Abnormalities, Multiple↗

[Isolated congenital lower lip fistulas].

BACKGROUND: Congenital lip fistulas are very rare and may occur alone or in combination with oral clefts and other dysontogenetic malformations. The etiology of congenital lip fistulas is not yet known. PATIENT AND METHOD: We present a 7-year-old boy with recurrent infections of bilateral congenital fistulas of the lower lip. There were no associated congenital anomalies and a negative family history. An elliptical excision of the fistulas under microscopic control gave satisfactory functional and esthetic results. There was no recurrence two years after surgery. CONCLUSION: Since the possibility of additional severe malformations exists for the patient and the patient's children patients should undergo careful ENT and pediatric assessment, and genetic counselling should be considered. In order to achieve good functional and esthetic results, the corrective operation must be planned carefully taking into consideration important surgical principles.

Child↗

The current understanding of cleft lip malformations.

Cleft lip with or without cleft palate is one of the most common congenital malformations. Epidemiology differentiates between cleft malformations connected with syndromes and the more common nonsyndromic forms not associated with other deformities. Although many syndromes with cleft lip with or without cleft palate are known, the majority of orofacial clefts are of the nonsyndromic form. These are known to be of multifactorial origin, with both environmental and genetic factors in their etiology, most of which remain to be fully investigated. Recent literature reveals that wide ethnical and racial variations in the occurrence of cleft lip and/or palate exist. The purpose of this overview is to show the current standing of research in this field. Genetics, environmental factors, and morphogenesis of the primary and secondary palate in normal development and cleft malformations are especially emphasized.

Animals↗

Lip augmentation.

Lip augmentation has become increasingly popular in recent years as a reflection of cultural trends emphasizing youth and beauty. Techniques to enhance the appearance of the lips have evolved with advances in biotechnology. An understanding of lip anatomy and aesthetics forms the basis for successful results. We outline the pertinent anatomy and aesthetics of the preoperative evaluation. A summary of various filler materials available is provided. Augmentation options include both injectable and open surgical techniques. The procedures and materials currently favored by the authors are described in greater detail.

Adipose Tissue↗

[Tactile-kinesthetic responsiveness in children with cleft lip palate].

BACKGROUND: Literature provides ample evidence that tactile-kinesthetic responsiveness is of basic importance for a normal speech development. The purpose of this study was to examine tactile-kinesthetic functions in children with cleft lip palate as they are suspected to be at risk to develop disturbances in this respect because of their anatomic defect. MATERIALS AND METHODS: Tactile-kinesthetic responsiveness was measured using the specific DEF-TK questionnaire as previously proposed by Kiese-Himmel. Twenty-seven children aged 1;3 to 7;11 years with cleft lip palate were examined. Forty-two children with an isolated speech development disorder served as age matched controls. RESULTS: The results of both the study and the control group did not differ on a statistically significant level (p > 0.05). Compared to the data taken from the test manual both groups exhibited a significant number of questionnaires which could not be analyzed because of too many unobservable (not missing!) items, yet, this number did not differ between the two groups. So a "best case" and a "worst case" were calculated but did not reveal significant differences either. CONCLUSION: Surprisingly and in contrast to the results reported in the literature the DEF-TK questionnaire exhibited methodical shortcomings with a significant number of cases in which it could not be analyzed due to too many unobservable items. So, the results obtained can only be discussed under reserve: They indicate that children with cleft lip palate do not exhibit more tactile-kinesthetic problems than children with an isolated speech development disorder and thus do not require specific therapy in this field.

Chi-Square Distribution↗

Restoration of lower-lip sensation: neurotization of the mental nerve with the supraclavicular nerve.

Trigeminal nerve palsy resulting from cerebrovascular accidents can result in significant disability for patients. Loss of lip and chin sensation may involve lip biting, impaired speech, and diminished salivary retention. Neurotization of the mental nerve with the supraclavicular nerve can restore sensibility to the lower lip for patients with central dysfunction of the trigeminal nerve. The authors report a case describing this procedure and document recovery of sensation with quantitative sensory testing. This recovered sensation came from the ipsilateral inferior alveolar nerve and not the contralateral mental nerve, as demonstrated by nerve block. An algorithm outlining the treatment options in the management of trigeminal nerve palsy is also presented.

Adult↗

[Coping behavior and supplying medical information--a study of mothers having delivered a child with a lip-jaw-palate cleft].

To be delivered of a child with cleft lip and palate is an extreme psychic stress factor for the mother. In coping with this, she is left to the support of the caring medical staff. Therefore, the aim of the present study was 1. to ascertain, to what extent mothers of children with cleft lip and palate are given information on the malformation, and receive emotional support by the medical staff; and 2. to determine the effect such experiences have on their ability to cope. For this purpose we developed a special questionnaire, which was completed by 154 mothers of such children. Retrospectively, a relevant part of them criticised not only the communication and the contents of information, but also the emotional support as deficient. A correlation between these determinants and largely insufficient coping was statistically confirmed. Our results should be taken into account in respect of the practical requirements when caring for mothers of children with a cleft lip and palate.

Adaptation, Psychological↗

Sonographic imaging of the fetal face and the establishment of normative dimensions for chin length and upper lip width.

Sonographic imaging of the fetal face is important because a number of chromosomal aberrations are associated with facial malformations. Prenatal diagnosis of abnormalities of the fetal chin and lips have been based on subjective assessment. The purpose of the current study was to establish normative dimensions for the objective assessment of the fetal face. A cross-sectional study was performed in 200 normal healthy singleton pregnancies between 16 and 38 weeks' gestation. Inclusion criteria included performance of a first or early second-trimester scan to confirm gestational age (GA). Exclusion criteria included birth weight < 10th or > 90th percentile for GA, and medical complications of pregnancy. Ultrasound measurements were made in the mid-sagittal plane and included chin length (CL) and upper lip width (ULW). A first-degree linear growth function was observed throughout pregnancy between GA and ULW (r = 0.87) and CL (r = 0.91). All measured data are expressed as mean +/- 2 SD. In conclusion, these results provide normative dimensions throughout gestation for the fetal upper lip and chin. These data are expected to serve as a basis for the objective assessment of the fetal face in high-risk conditions.

Anthropometry↗

[Precancerous conditions and carcinomas of the lower lip. Coincidence with leukoplakia and carcinomas of the oral cavity and larynx].

In a prospective study of 102 patients with pre-neoplasia and/or manifest squamous-cell carcinoma of the lower lip the synchronous occurrence of intra-oral, pharyngeal or laryngeal leukoplakia and carcinoma was assessed. There was a coincidence rate of almost 15% leukoplakias, including individual carcinomas. This high coincidence is probably due to a combination of various "risk profiles" in patients with threatened or manifest lower-lip cancer. Chronic exposure to sunlight, especially in the presence of a genetic disposition, is the most important risk factor in lower-lip cancer and its preceding stages, while chronic alcoholism and smoking abuse have little etiological significance.

Adult↗

The occupation of fishing as a risk factor in cancer of the lip.

To study the role of commercial fishing and related factors in the development of lip cancer, a project that included a case-control study and a cohort analysis was undertaken in Newfoundland. Household survey data were linked with cancer-registry and census data. In comparison with other males, fishermen had a probability of development of lip cancer that was 1.5 times higher (by the case-control method, P less than 0.05) or 4.4 times higher (by cohort analysis, P less than 0.001). Despite the effect of pipe smoking, "outdoorness" and age on the development of lip cancer in general, the occupation of fishing was an additional, independent contribution to the risk. Unexpectedly, using the mouth as a third hand to handle tar-coated nets seemed to protect fishermen from the disease. It was not possible to attribute the higher risk to a particular work activity, nor was a specific responsible carcinogen identified.

Adult↗

Reconstruction of large lower lip defects: a new method.

Lower lip defects may be due to some congenital or acquired problems, such as congenital naevi, hemangiomas, tumors, traumas, or infectious disease. The degree of substance loss may be skin, muscle, or mucoso, or a combination of one or all layers. In large defects of the lower lip, the challenge is to accomplish a result that meets the criteria of successful reconstruction. We present 3 patients with large defects of the lower lip from tumor ablation who underwent satisfactory reconstruction with a new method not previously described in the English-language literature.

Aged↗

Predicting lower lip and chin response to mandibular advancement and genioplasty.

The purposes of this retrospective study were to examine the multidimensional nature of soft tissue changes associated with mandibular advancement and genioplasty and to develop predictive models. Longitudinal lateral cephalograms of 62 nongrowing patients (27 men and 35 women) were taken in centric relation with the lips in repose within 4 weeks before surgery and at least 6 months postoperatively (median postsurgical duration was 11 months). The mandibular incisor and pogonion were advanced surgically approximately 6 mm and 11 mm, respectively. The lower lip lengthened slightly (2.5 +/- 3.8 mm), and its surface contour straightened because of thinning at labrale inferior (-2.8 +/- 2.0 mm); there was a slight thickening at the labiomental fold (1.0 +/- 2.3 mm) and a slight thinning at soft tissue pogonion (-0.8 +/- 2.2 mm). Multiple regression models (explaining from 80% to 94% and 66% to 82% of the variation for horizontal and vertical movements, respectively) showed that soft tissue response to advancement surgery depended on pretreatment tissue thickness, horizontal skeletal movement, vertical skeletal movement, and the position of the maxillary incisors. Similar amounts of variation were explained when the models were applied to an independent validation sample of 15 subjects. It was concluded that lower lip and chin response to mandibular advancement and genioplasty is multifactorial but can be accurately and reliably predicted.

Adolescent↗