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Q-switched alexandrite laser therapy for pigmentation of the lips owing to Laugier-Hunziker syndrome.

BACKGROUND: Laugier-Hunziker (LH) syndrome is a rare benign condition in which hyperpigmentation of the lips and buccal mucosa occurs with no systemic associations. OBJECTIVE: We report the response to treatment with the Q-switched alexandrite laser (QSAL) because there are few reports on therapy for LH syndrome. METHODS: The QSAL was used for pigmentation of the lips in a 63-year-old woman with LH syndrome. Laser irradiation was done at 5.0 J/cm2 with a 3 mm spot size. RESULTS: There was 100% clearance of pigmentation of the lips with a single laser treatment, and recurrence was not observed after 6 months. CONCLUSION: The QSAL is very effective for pigmentation owing to LH syndrome.

Beryllium↗

Periodontal conditions in adolescents with cleft lip, alveolus and palate following treatment in a co-ordinated team approach.

The aim of the present investigation was to evaluate the oral hygiene habits and the periodontal conditions of a group of cleft lip, alveolus and palate patients at the end of a longitudinal multidisciplinary treatment. From a total of 120 patients who had been supervised at the University of Berne, Clinic for Pediatric Surgery for at least 18 years in a co-ordinated team approach, 80 were selected on the basis of availability. Plaque control record (PCR), calculus index (CI), gingival bleeding index (GBI), pocket probing depth (PD), loss of attachment (LA) and furcation involvement were recorded. Using the technique and the ruler described by Schei et al., the radiographic height of the alveolar crest from the cemento-enamel junction was determined. Between the different groups of deformities, no statistically significant differences were found for all the clinical parameters with the exception of the mean PD orally and the mean PD bucally which were shallower in the isolated cleft lip group. These differences were attributed to the long-term orthodontic therapy with fixed appliances. When the PD and the LA at the sites adjacent to the cleft region were compared to two "unaffected" control sites, no statistically significant differences were found, whereas the comparison with the radiographic bone loss showed a statistically significant lower bone height. These results may indicate the presence of a long connective tissue attachment without bony support in the cleft region. As a result of inadequate oral hygiene, the patients with cleft lip, alveolus and palate showed beginning periodontitis with loss of attachment and beginning furcation involvement in most of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Epidemiological aspects of lip cancer in Scotland.

The purpose of this paper is to present the descriptive epidemiology of lip cancer in Scotland. The incidence and mortality of lip cancer are found to be higher in men than in women and to have fallen remarkably among men. This decline has been the result of cohort effects indicating that the risk of lip cancer is decreasing among successively younger people.

Adult↗

Angiogenesis in invasive squamous cell carcinoma of the lip: tumor vascularity is not an indicator of metastatic risk.

BACKGROUND: Recent studies have shown that tumor growth beyond a certain size requires angiogenesis. Microvessel density has, moreover, correlated with metastatic risk in some tumors. Invasive squamous carcinoma (SCC) can develop in the epithelium of the lip and metastasize even when relatively small. This study investigates neovascularization and its relationship to metastatic risk in this tumor. METHODS: All 41 primary SCCs of the lip diagnosed at our institution from 1960 to 1991 were immunostained for factor VIII. Microvessel grade (Mv) from 1+ to 4+ and the average number of vessel profiles (TMvD) in the highest density 200 x (0.785 mm2) and 400 x (0.196 mm2) microscopic fields were determined. TMvDs were compared with those of adjacent non-tumor tissue (NTMvD). Normalized counts (TMvDns) were calculated as TMvD/NTMvD. TMvDs and TMvDns of metastasizing (N = 10) and non-metastasizing (N = 31) tumors were compared (student t-test). RESULTS: In all SCCs TMvDs exceeded NTMvDs (50 vs. 35 at 200 x, P = 0.0014, and 26 vs. 14 at 400 x, P < 0.0001). Metastasizing and non-metastasizing tumors did not, however, differ in Mv, TMvD, or TMvDn. CONCLUSIONS: Angiogenesis develops, but is not quantitatively related to metastatic risk, in primary invasive squamous cell carcinoma of the lip.

Biomarkers, Tumor↗

Prevalence and risk of traumatic gingival recession following elective lip piercing.

The aims of this study were to evaluate the prevalence, risk and odds ratios of gingival recession defects associated with elective lip piercing and wearing of stud jewelry, and to attempt to identify risk factors that might permit the incidence of recession and its severity to be predicted, using Miller's classification. Ninety-one subjects with lip piercing and labrets were evaluated with regard to gender, age, smoking history, orthodontic history, and labret characteristics. An age-matched group of 54 individuals without peri-oral piercing provided the control. Gingival recession was recorded on teeth opposing a labret in 68.13% of pierced subjects. By contrast, only 22.2% of unpierced individuals demonstrated recession. The odds ratio between pierced and control groups indicates a likelihood of recession 7.5 times greater in a pierced individual wearing a labret than in an unpierced individual. Logistical regression analysis showed that age, gender, smoking and labret configuration did not significantly influence the development of recession. Furthermore, an illustrative example indicates that piercing and provision of a labret might typically increase the risk of recession occurring from 34.4% (pre-piercing) to 80.8 %. Recession severity was greater in the pierced group, with Miller's class 2 and 3 defects observed in 18.7% of the pierced but not at all in the unpierced group. Ordinal regression identified previous orthodontic treatment as the only significant predictor of Miller's grade. We concluded that a clear link exists between lip piercing, labret use and gingival recession. Belief that labret placement and configuration can be modified to provide protection is unfounded.

Adult↗

Surgical removal and immediate reattachment of coronal fragment embedded in lip.

This case describes a patient with a traumatic crown fracture of an upper incisor, associated with a laceration wound in the lower lip, showing local oedema. While palpating the tissues of the lower lip we felt the presence of a foreign body. This was confirmed by a radiograph of the lip that showed a radiopaque material, being similar to the coronal fragment of the fractured incisor. It was successfully surgically removed and immediately reattached using a composite adhesive technique. At the follow-up of 1 year later the vitality test on the teeth was positive and neither one of the two traumatized teeth showed any sign of discoloration.

Adolescent↗

Birth prevalence of cleft lip and palate in Colorado by sex distribution, seasonality, race/ethnicity, and geographic variation.

An epidemiologic study was designed to describe the association of potential risk factors with the occurrence of cleft lip and palate (CL/P) births in Colorado for the years 1982-1988. There were 307 children out of 381,175 live births identified, through birth certificate data, with a diagnosis of cleft palate or cleft lip with or without cleft palate. For this period, the birth prevalence was 0.81/1000. Male gender [odds ratio (OR) = 1.62, 95% confidence interval (CI) = 1.28, 2.04], white race (OR = 2.87, 95% CI = 1.52, 5.44), and non-metropolitan residence (OR = 1.59, 95% CI = 1.23, 2.05) were each associated with an excess risk of having a cleft abnormality of any type at birth. No differences in the occurrence of cleft lip and palate were observed by month of birth, altitude of county of residence, or in Hispanic compared with non-Hispanic newborns. Using information from the 1989 Colorado Registry for Children with Special Needs, there was little evidence of ascertainment bias on major factors of interest for the birth certificate data. Further studies are required to define the factors associated with excess risk of CL/P in non-metropolitan areas.

Altitude↗

Interarticulator programming: effects of closure duration on lip and tongue coordination in Japanese.

This paper examines the coordination of lip and tongue movements in sequences of vowel-bilabial consonant-vowel where the duration of the oral closure for the consonant is varied for linguistic purposes. Native speakers of Japanese served as subjects. The linguistic material consisted of Japanese word pairs that only differed in the duration of the labial consonant, which was either long or short. Recordings were made of lip and tongue movements using a magnetometer system. Results show a robust difference in closure duration between the long and short consonants. The tongue movement from the first to the second vowel had a longer duration in the long than in the short consonants, and its average speed was slower in the long consonant. The size of the tongue movement path between the vowels did not consistently differ between the long and short consonants. The tongue movement almost always started before the oral closure for the consonant, while the onset of the lip movement towards oral closure mostly started before that of the tongue movement. The offset of the tongue movement occurred after the release of the closure, but there was no clear pattern for the long and short consonants.

Female↗

Different phase-stable relationships of the upper lip and jaw for production of vowels and diphthongs.

Relational invariants have been reported in the timing of articulatory gestures across suprasegmental changes, such as rate and stress. In the current study, the relative timing of the upper lip and jaw was investigated across changes in both suprasegmental and segmental characteristics of speech. The onset of upper lip movement relative to the vowel-to-vowel jaw cycle during intervocalic bilabial production was represented as a phase angle, and analyzed across changes in stress, vowel height, and vowel/diphthong identity. Results indicated that the relative timing of the upper lip and jaw varied systematically with changes in stress and vowel/diphthong identity, while remaining constant across changes in vowel height. It appears that modifications in relative timing may be due to adjustments in the jaw cycle as a result of the compound nature of jaw movement for diphthongs as compared to vowels, with further modifications due to the effect of stress on these compound movements.

Adult↗

Nature of the lip reed.

Reed instruments have been categorized into two families since Helmholtz: the "striking inward" and the "striking outward" reeds. In an attempt to clarify the question to which family the lips of the brass player belong, a Helmholtz resonator with active feedback was used as a single-mode brass instrument and the playing frequencies generated by three trumpet players were measured. By adjusting the gain and the phase in the feedback loop, the resonant frequency and the quality factor of the resonator can be varied. The acoustic impedance at the mouthpiece is measured by a novel method without removing the play's lips. The results show that with extreme efforts the players can generated playing frequencies both lower and higher than the corresponding air column resonance, but that the playing frequency under normal playing conditions (the "most comfortable note") is almost always higher than the corresponding air column resonance. This supports the view that human lips function as "striking outward" reeds.

Acoustics↗

Genetic evidence for the role of loci at 19q13 in cleft lip and palate.

BACKGROUND: Clefts of the lip and palate are common birth defects, affecting approximately 1 in 700 births worldwide. The aetiology of clefting is complex, with multiple genetic and environmental influences. METHODS: Genotype based linkage disequilibrium analysis was conducted using the family based association test (FBAT) and the likelihood ratio test (LRT). We also carried out direct sequencing of the PVR and PVRL2 candidate genes based on their homology to PVRL1, a gene shown previously to cause Margarita Island clefting. Participants included 434 patients with cleft lip with or without cleft palate or cleft palate only and their mothers from eight countries in South America, 205 nuclear triads (father-mother-affected child) from Iowa, 541 nuclear triads from Denmark, and 100 patients with cleft lip and palate from the Philippines. RESULTS: An allelic variant in the PVR gene showed statistically significant association with both South American and Iowa populations (p = 0.0007 and p = 0.0009, respectively). Direct sequencing of PVR and PVRL2 yielded 26 variants, including two rare amino acid changes, one in each gene, which were not seen in controls. CONCLUSIONS: We found an association between a common variant in a gene at 19q and isolated clefting in two heterogeneous populations. However, it is unclear from our data if rare variants in PVR and PVRL2 are sufficient to cause clefting in isolation.

Alleles↗

Median cleft of upper lip and pedunculated skin masses associated with de novo reciprocal translocation 46,X,t(X;16)(q28;q11.2).

We describe a de novo apparently balanced reciprocal translocation, 46,X,t(X;16)(q28;q11.2), in a 13 year old girl with median cleft of the upper lip, pedunculated skin masses on the nasal septum, short stature, and mental retardation. Pai syndrome is characterised by median cleft of the upper lip, pedunculated skin mass(es) on the face, and midline lipoma(s) of the central nervous system. The cause of this syndrome is unknown, although autosomal dominant inheritance has been proposed. The translocation breakpoints in the present patient may be candidate regions for a gene responsible for median cleft of the upper lip and pedunculated skin mass(es) on the face, including Pai syndrome.

Abnormalities, Multiple↗

T1 and T2 lip cancer: a superselective method of facial arterial infusion therapy--preliminary experience.

PURPOSE: To formulate and evaluate a facial arterial infusion chemotherapy for squamous cell lip carcinoma. MATERIALS AND METHODS: The study included six patients (age range, 46-84 years) with squamous cell carcinoma of the lower lip. There were two T1 tumors, three T2 tumors, and one T1-compatible postoperative recurrent tumor. A 4-F, double-lumen balloon catheter was inserted into the external carotid artery through the superficial temporal artery and placed for selective infusion into the tumor-feeding facial artery. Patients received a combination of mitomycin C (4.4 mg/m2 per body surface area) on day 1 and 3.2 mg/m2 of peplomycin sulfate on days 1-7 (22.4 mg/m2 per week), or, when peplomycin sulfate was contraindicated, 16 mg/m2 of cisplatin only on days 1-5 (80 mg/m2 per week). Two to three cycles of chemotherapy were given until tumor disappearance was histologically confirmed. RESULTS: Complete tumor disappearance was achieved in all cases. One patient had a self-limiting asthma attack during peplomycin sulfate treatment, and another had transient partial hair loss. No disfigurement, recurrence, or late complications were observed at a mean follow-up of 5.0 years (range, 2.3-11.2 years). CONCLUSION: The described facial arterial infusion chemotherapy appears to be a safe and curative treatment for T1 and T2 squamous cell lip carcinomas.

Aged↗

Involvement of trigeminal spinal nucleus in parasympathetic reflex vasodilatation in cat lower lip.

We examined whether the trigeminal spinal nucleus (Vsp) forms part of the central mechanism by which electrical stimulation of the central cut end of the lingual nerve (LN) evokes parasympathetic reflex vasodilatation in the lower lip in artificially ventilated, cervically vagosympathectomized cats deeply anesthetized with alpha-chloralose and urethane. For this purpose, we made microinjections within the brain stem to produce nonselective, reversible local anesthesia (lidocaine) or soma-selective, irreversible neurotoxic damage (kainic acid). Local anesthesia of Vsp by microinjection of lidocaine (2%; 1 microl/site) reversibly and significantly reduced the ipsilateral-LN-evoked parasympathetic reflex vasodilatation. Unilateral microinjection of kainic acid (10 mM/site; 1 microl) into Vsp ipsilateral to the stimulated LN led to an irreversible reduction in the reflex vasodilatation but had no effect on the vasodilatation elicited by stimulation of the contralateral LN. Such microinjection of kainic acid into Vsp had no effect on the vasodilatation evoked by electrical stimulation of the ipsilateral inferior salivatory nucleus. Electrical stimulation of Vsp elicited a blood flow increase in the lower lip in an intensity- and frequency-dependent manner, regardless of whether systemic arterial blood pressure rose or fell. Hexamethonium (1.0 mg/kg iv) significantly reduced the vasodilator responses elicited by electrical stimulation of the central cut end of LN or of Vsp, each to a similar degree. After hexamethonium, both vasodilator responses showed time-dependent recovery. These results strongly suggest that Vsp is an important bulbar relay for LN-evoked parasympathetic reflex vasodilatation in the cat lower lip.

Anesthetics, Local↗

Microvascularisation of the lips in the fetus and neonate.

The differences observed in the microvascularisation of the lips in the perinatal period correspond to the differences in the histological structures of the cutaneous, glabra, intermediate cutaneous, villous, intermediate mucosal and mucosal parts. A basic pattern is found in each part: on the surface, a papillary or mucosal network, at a deeper level, reticular or submucosal networks and their pedicles. The vascular changes correspond to the transition of tissue (mucocutaneous junction) and are indicative of the functional aspect. The same histological and microcirculatory structures were found in all the preparations, irrespective of the subject's age. Knowledge of the microvascularisation makes it possible to interpret magnetic resonance imaging of the lip better and finds its application in the surgery of the lips.

Fetus↗

No evidence of linkage for cleft lip with or without cleft palate to a marker near the transforming growth factor alpha locus in two populations.

Nonsyndromic cleft lip with or without cleft palate is a common birth defect, affecting approximately 1 in 1,000 Caucasian newborns. Thirty-five multiplex families from the mid-Atlantic region of the United States and 22 families from central Mexico with a nonsyndromic form of cleft lip with or without cleft palate were selected for a linkage analysis. A tetranucleotide repeat marker (D2S443) located on the same yeast artificial chromosome as the transforming growth factor alpha locus was tested for linkage to a putative susceptibility Mendelian locus under varying levels of pentrance. No evidence for linkage between D2S443 and a susceptibility locus for cleft lip with or without cleft palate was found. Insight is given to explain this outcome in spite of the statistically significant associations found by other investigators.

Chromosome Mapping↗

HSV1 latency sites after inoculation in the lip: assessment of their localization and connections to the eye.

PURPOSE: To localize the sites of HSV1 latency in mice after a primary infection induced by injection into the lip and to assess their connection to the eye. METHODS: The SC16 strain of HSV1, or a recombinant virus containing the HSV1 latency-associated transcript (LAT)-promoter driving expression of the LacZ reporter gene, were injected into the left upper lip. Tissues from animals killed at 6, 28, 180, and 720 days postinoculation (dpi) were analyzed for LATs, either by in situ hybridization (ISH) or by identifying LAT-promoter-driven transgene expression. HSV1 antigens were detected by immunochemistry. RESULTS: At 28 dpi, all the neurologic structures that were acutely infected at 6 dpi exhibited a pattern of virus gene expression consistent with HSV1 latency--that is, LATs with no detectable HSV1 antigens. LAT staining differed among structures: intense and widespread within trigeminal neurons, intermediate within the sympathetic intermediolateral cell group of the spinal cord and the facial motor nucleus, and weak in other sites. Long-term expression of LATs (positive at 180 and 720 days) was observed only in tissues where the staining was intense or intermediate at 28 dpi. CONCLUSIONS: After inoculation into the upper lip of mice, HSV1 established latency in several nervous system structures that have direct or indirect connections with ocular tissues. These results suggest that after an oral primary infection, the most frequent in humans, HSV1 may establish latency in several sites connected to the eye and may finally result in herpetic ocular disease involving the cornea, the iris, or even the retina.

Animals↗

Surgical treatment of the "marginal mandibular lip" deformity.

Unilateral permanent paralysis of the lower lip after section or compression of the marginal mandibular branch of the facial nerve is not rare. It may occur after trauma or as a result of parotid, ear, or upper neck surgery. Surgical treatment of the deformity--which we term the marginal mandibular lip--is indicated to improve cosmesis and restore oral competence during eating and speech. We describe our experience with partial resection of the paralyzed lower lip as an effective yet simple method of surgical correction. We also review the alternate methods of treatment for comparison.

Facial Paralysis↗