Functional and Aesthetic Lower Lip Reconstruction With Depressor Anguli Oris Muscle Flap and Reverse Superior Labial Artery Flap.

BACKGROUND: The lower lip is an important anatomical structure involved in daily activities such as eating, drinking, and speaking, as well as in facial expressions. Lower lip defects should be repaired to preserve lip function without disrupting the aesthetic harmony of the lips within the face. This goal is difficult for plastic surgeons because, for functional and aesthetic repair, it is necessary to replace the mucosa, muscle (especially contractile), and skin tissues present in the lip. METHODS: Subtotal lower lip repair was performed using an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap in seven male patients with a mean age of 63 years. A depressor anguli oris muscle flap was used to repair the orbicularis oris muscle defect. The desepithelialized part of the reverse superior labial artery flap was used for mucosal defect repair, whereas the remaining part was used for skin defect repair. Patients were followed up for an average of 15 months. Patient lips, epithelialization, sensation, and sphincter function were clinically evaluated. Electromyography (EMG) was performed at 6 and 12 months to evaluate the function of the depressor anguli oris muscle flap. RESULTS: All the reverse superior labial artery flaps survived without any loss. Trapdoor deformity developed in the flaps of two patients. The desepithelialized parts of the flaps were completely epithelialized (covered with mucosa) by approximately 6th week. In the EMG controls of the patients at 6 months, the depressor anguli oris muscle was contractible. Sensation regained in the operated lip during the follow-up period. CONCLUSIONS: The combination of an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap is an important surgical option for the functional and aesthetic repair of subtotal lower lip defects.

Facial soft tissue changes in adolescent patients treated with three different functional appliances: a randomized clinical trial.

INTRODUCTION: Patients with Class II, division 1 malocclusion generally seek treatment to improve facial esthetics. Therefore, the orthodontist needs to know the changes in the soft profile produced by functional appliances. OBJECTIVE: This study evaluated the soft tissue profile changes in patients treated during the peak of the pubertal growth spurt. METHODS: Thirty selected patients were randomized into three treatment groups: Twin Block (TB), Herbst with dental anchorage (HDA), and Herbst with skeletal anchorage (HSA). All patients had computed tomographic images: pretreatment (T1) and after 12 months of active treatment (T2). Twenty-four soft tissue cephalometric measures were analyzed. The normality of all data was assessed by the Shapiro-Wilk test. Intragroup comparisons were analyzed using the t-paired test; the inter-group comparisons were determined through ANOVA and the post-hoc Tukey test. RESULTS: At T1, no significant differences were observed between groups. At T2, in the intragroup comparison, facial soft tissue changes were statistically significant in the three groups for the lower lip, sulcus inferioris, facial soft tissue convexity in HDA group and TB group, and H angle in HDA group and HSA group, and soft tissue pogonium in TB group. In the inter-group comparison, no statistically significant differences were observed. CONCLUSION: It can be concluded that there were significant changes in soft tissue measurements that benefited Class II, division 1 patient's facial profile treated with the functional appliances Twin Block, Herbst, and Herbst with skeletal anchorage. Nevertheless, no significant differences were detected among the effects obtained by the three treatment protocols.

Single-cell transcriptome and chromatin accessibility mapping of upper lip and primary palate fusion.

Cleft lip and/or primary palate (CL/P) represent a prevalent congenital malformation, the aetiology of which is highly intricate. Although it is generally accepted that the condition arises from failed fusion between the upper lip and primary palate, the precise mechanism underlying this fusion process remains enigmatic. In this study, we utilized transposase-accessible chromatin sequencing (scATAC-seq) and single-cell RNA sequencing (scRNA-seq) to interrogate lambdoidal junction tissue derived from C57BL/6J mouse embryos at critical stages of embryogenesis (10.5, 11.5 and 12.5 embryonic days). We successfully identified distinct subgroups of mesenchymal and ectodermal cells involved in the fusion process and characterized their unique transcriptional profiles. Furthermore, we conducted cell differentiation trajectory analysis, revealing a dynamic repertoire of genes that are sequentially activated or repressed during pseudotime, facilitating the transition of relevant cell types. Additionally, we employed scATAC data to identify key genes associated with the fusion process and demonstrated differential chromatin accessibility across major cell types. Finally, we constructed a dynamic intercellular communication network and predicted upstream transcriptional regulators of critical genes involved in important signalling pathways. Our findings provide a valuable resource for future studies on upper lip and primary palate development, as well as congenital defects.

[Facial soft tissue changes after full-arch implant-supported fixed prostheses restoration in patients with edentulous maxilla].

PURPOSE: To investigate the changes of nasolabial soft tissues before and after full-arch implant supported fixed restoration in maxillary edentulous patients and the influencing factors of the changes. METHODS: Fifty patients who underwent full-arch implant fixed restoration in the Department of Second Dental Center of Shanghai Ninth People's Hospital from January 2016 to July 2023 were selected. Patient's medical history, CBCT, and three-dimensional facial scan data were collected before and after restoration. Paired t test or Wilcoxon signed-rank test were used to compare the changes in soft tissues before and after restoration. The correlation between changes and patient's basic information, implant protocol and residual bone parameters were analyzed using bivariate correlation analysis. Akaike information criterion was used to select the multivariate linear regression model of each soft tissue index change. RESULTS: After implant fixed restoration, the upper lip height (sn-sto), the upper vermillion height (ls-sto), and the upper vermilion area (UVA) significantly increased (P＜0.01), while the distance from ls to the E-line (ls-E) significantly decreased (P＜0.01), the nasolabial angle (∠cm-sn-ls) significantly decreased (P＜0.01), and the cutaneous upper lip height(sn-ls) did not change significantly(P＞0.05). Except for sn-sto and sn-ls, the remaining soft tissue changes were positively correlated with age (P＜0.01). Other residual bone parameters, implant protocol, and gender were not significantly related to each soft tissue change. Multivariate stepwise regression analysis showed that each soft tissue change was broadly related to age and preoperative soft tissue condition, and partially related to bone morphology. CONCLUSIONS: The nasolabial soft tissues of maxillary edentulous patients change significantly after implant fixed restoration, mainly the expansion and protrusion of the red part of the lip. The changes in facial soft tissues are primarily related to the patient's age and pre-existing soft tissue condition, with older patients and those with more atrophic original soft tissue morphology observing more apparent improvements in fullness. The change in lip prominence is also related to the residual bone shape.

[The effect of Frankel â ¢ orthodontic appliance combined with lip muscle training in the treatment of malocclusion during mixed dentition].

PURPOSE: To exploring the clinical effect of lip muscle training combined with Frankel Ⅲ orthodontic appliances in correcting Class Ⅲ malocclusion during the mixed dentition period. METHODS: One hundred children with Class Ⅲ malocclusion during the mixed dentition period admitted to Hangzhou Greentown Stomatological Hospital from June 2018 to December 2022 were selected. The children were randomly divided into a combination group (treated with lip muscle training and Frankel Ⅲ orthodontic appliance) and a control group (treated with Frankel Ⅲ orthodontic appliance), with 50 cases in each group. X-ray cephalometric indicators, temporomandibular joint parameters, upper airway measurement parameters and 12 month follow-up of the two groups of children were compared before and after treatment. SPSS 21.0 software package was used for statistical analysis. RESULTS: Before treatment, there was no significant difference of SNA, SNB, ANB, U1-NA, L1-NB, ANS-Ptm, S-Ptm, Co Po, Co-S, MP-SN, MP-FH and NP-FH between the combination group and the control group (P＞0.05). After treatment, ANB, U1-NA, L1-NB and MP-SN in the combination group were significantly higher than those in the control group, while NP-FH were significantly lower than that in the control group(P＜0.05). Before treatment, there was no significant difference of the joint space, anterior joint space and posterior joint space between the combination group and the control group patients(P＞0.05); after treatment, the joint space and the joint space in the combination group were significantly higher than those in the control group(P＜0.05). Before treatment, there was no significant difference of Ba PNS, Ad1 PNS, Ad2 PNS, Mc1 Mc2, SPP-SPPW, U-MPW, PAS and V-LPW between the combination group and the control group(P＞0.05); after treatment, Ad2-PNS in the combination group was significantly higher than that in the control group(P＜0.05). After 12 months of follow-up, the recurrence rate of the combination group was 2.00%, which was significantly lower than that (16.00%) of the control group (P＜0.05). CONCLUSIONS: The combination of lip muscle training and Frankel III orthodontic appliances is more conducive to correcting Class III malocclusion during the replacement period, improving upper airway morphology, and reducing the recurrence rate after treatment.

Mucosal leishmaniasis of the lips and cheeks: a first concomitant presentation of visceral and mucosal leishmaniasis in a patient living with HIV/AIDS in Monastir, Tunisia.

BACKGROUND: Visceral Leishmaniasis (VL) is the most severe and fatal disease if left untreated. In people living with HIV/AIDS (PLHA), VL is considered an emerging opportunistic infection. The aim of this manuscript was to report a first case in Tunisia of a concomitant presentation of visceral and oral leishmaniasis in a patient LHA. A systematic review of the literature was performed according to PRISMA guidelines, as well. CASE PRESENTATION: The patient, a 43-year-old heterosexual man, treated for HIV/AIDS was referred for macrocheilitis of the upper and lower lips. A noticeable nodular and painless swelling extending to the cheeks' mucosa was noted. The patient's poor oral hygiene was evident due to the presence of multiple dental caries. Histological analysis of the biopsied lower lip sample revealed the presence of numerous Leishmania amastigotes. The diagnosis of VL was clinically confirmed by the presence of a mild splenomegaly and pancytopenia and biologically by the identification of the parasite using PCR Lei and the species L. infantum involved using RFLP-PCR and culture. The treatment consisted of an intravenous administration of liposomal Amphotericin B (Ambisome®, 40 mg/kg/weight) for a period of 6 weeks. A favorable outcome was noted after one year with the resolution of clinical symptoms and a negative Leishmania blood PCR test. After 2 years, the patient remained asymptomatic but showed a positive Leishmania blood PCR test. Dolutegravir® was introduced in the patient's ART regimen. CONCLUSIONS: To the best of our knowledge, this is the first case report in Tunisia of atypical VL diagnosed through an uncommon oral location in an HIV/AIDS co-infected patient . Since VL is a severe and potentially fatal disease, it is essential for dentists to perform a thorough clinical examination and adopt a multidisciplinary approach in order to ensure an early diagnosis and an effective treatment outcome.

Comparison of functional impairments and discomfort with bonded labial and lingual orthodontic appliances - a questionnaire survey.

OBJECTIVE: To compare the levels of functional impairments, discomfort and satisfaction experienced by those treated with full-mouth customized lingual appliances (Lingual appliances), full-mouth self-ligating bracket (Labial appliances), or upper lingual and lower labial appliances (Mixed appliances) using questionnaires. MATERIALS AND METHODS: Patients within one year of the end of treatment were included in the survey and given a questionnaire concerning different kinds of discomfort and difficulties during the treatment process. The questionnaires focused on the following aspects including speech difficulty, pain (lip, cheek or tongue), difficulty in chewing, difficulty in tooth brushing and overall aesthetics and comfortability. Ordinary one-way ANOVA Tukey's multiple comparison tests and Kruskal-Wallis tests were employed to analyze the data. RESULTS: A total of 115 patients participated in the study. In terms of functional impairments and discomfort, the rate and degree of speech difficulty was significantly higher in the Lingual appliances Group than that in the Labial appliances Group. But there was no difference among the three groups for difficulty in chewing and tooth brushing. Both lingual and labial appliances caused a similar level of overall pain, however, those treated with lingual appliances experienced more tongue pain, and those treated with labial appliances experienced more cheek and lip pain. The most common sites of irritation were the tongue lateral and tongue tip in the Lingual appliances Group, tongue lateral and cheek in the Mixed appliances Group, and cheek and lower lip in the Labial appliances Group. In total, patients gave highest scores to mixed appliances for comfortability and lowest scores to labial appliances for aesthetics when it came to satisfaction. CONCLUSIONS: Lingual and labial appliances caused similar level of overall pain. Taking into account the overall comfortability, aesthetics and cost, the mixed appliances may be suitable for some patients who have aesthetic and comfort pursuits.

Full Thickness, Near-Total to Total Lower Lip Reconstruction Using Superficial Circumflex Iliac Artery Perforator Free Flap: A Case Report.

Near-total to total lower lip defects present significant challenges for reconstructive surgeons, requiring restoration of oral competency, maximization of oral aperture, and cosmetic appearance. This report explores a novel reconstructive option addressing all three needs. Traditionally, local flap options restore cosmesis and oral competency by recruiting local tissue of similar thickness, pliability, and appearance, but often result in microstomia. Conversely, free flaps prevent microstomia but can lead to bulky and cosmetically unacceptable reconstructions. We present the first case of using a super-thin superficial circumflex iliac artery perforator (SCIP) free flap for near-total, full-thickness lower lip reconstruction. The patient was a 66-year-old female with recurrent squamous cell carcinoma of the lower lip, requiring wide local excision and resulting in an 80% full-thickness defect with unilateral oral commissure loss. An 8 cm × 5 cm × 5 mm SCIP flap was raised with a 4.5-cm pedicle length and anastomosed to the facial artery and vein. Clear fluids were commenced 7 days postoperatively, wounds healed 2 weeks postoperatively, and a normal diet was resumed at this time. The SCIP flap offers an excellent additional option for managing full-thickness near-total to total lower lip defects. Its thin, pliable nature and minimal donor site morbidity help restore oral competency, maximize oral aperture, and achieve a pleasing cosmetic result.

Philtral Column and Nostril Shape Pattern in Nepalese Population: Comparative Study between Two Ethnic Groups of Nepal.

Background Knowledge of the normal appearance of lip-nose complexes in a particular ethnicity or race helps to plan and modify surgical techniques for their deformity. Objective To determine the shape of the philtral column and nostril in children of two ethnic groups (Aryans and Mongoloids) of the Nepalese population and compare them to see if any variation exists. Method The present prospective study was carried out between December 2021 to January 2023 among 200 children of age 5-12 years. The children meeting our inclusion criteria were divided equally into Aryan and mongoloid groups based on the caste system in Nepal. Facial photographs were obtained in frontal and basal views. They were analyzed to determine the shape of the philtral column and nostril shape based on Mori's classification system. Result Out of 200 children, 123 were males and 77 were females. The most common type of philtral and nostril shape in the Nepalese population was triangular and teardrop respectively. Triangular and concave type philtral shape was predominant in Aryans whereas triangular and parallel type was predominant in Mongoloids however the variation was not significant. Similarly, teardrop nostrils were most common in both ethnic groups. Conclusion The results provide a morphological pattern and variation in the philtral and nostril shape in the two major ethnic group of Nepalese population.

Surgical Lip Repositioning in Search of Aesthetics - A Case Series.

INTRODUCTION: The gummy smile (GS) or excessive gum visibility (EGV) is an aesthetic concern that affects an individual's attractiveness and personality. TREATMENT PLANNING: Lip Repositioning surgery (LRP) is a less invasive surgery that can be attributed to treating EGV due to hypermobile lip muscles or mild-to-moderate vertical maxillary excess (VME). Three patients went through LRP surgery by stripping overlying mucosa from the buccal vestibule, followed by suturing the lip mucosa to the mucogingival junction (MGJ), creating shallow vestibule and restricted muscle pull and reducing gingival visibility (GV) during a smile. FOLLOWUP: Three months of follow-up showed a satisfactory result with 3.67 ± 0.58 mm mean reduction in GV.

Lower lip avulsion: Surgery and management using stem cell metabolites preparation in a domestic cat.

Background: Lower lip avulsion is a separation between the lip and the associated soft tissue from the mandible. The degree of these types of injuries varies and heavily affects the outcome of the case. Case Description: This study reported an extensive lower lip avulsion managed by surgery and stem cell metabolite preparation. A one year and nine month-old domestic cats was referred for lower lip avulsion surgery to the Veterinary Teaching Hospital Airlangga University. Owing to the limited amount of tissue, immediate successful results cannot be achieved after the first surgery. Furthermore, tissue necrosis and lack of physical restraint to the cat at home contributed to the delayed union between the soft tissue and mandible, resulting in repeated surgery. Stem cell metabolites preparation was applied at the surgical site and was incorporated into the therapy to support tissue growth. Conclusion: The combination of surgical treatment and stem cell metabolite preparation resulted in good wound healing in the present case.

Reduction cheiloplasty with lateral wedge excisions in cheilitis granulomatosa.

This case presents a method of reductive cheiloplasty: Conway's method with lateral and bilateral wedge excisions contained to the vermillion. It was performed on a female patient with cheilitis granulomatosa after 4 years of trying different medical therapies without effect. The surgery successfully reduced the increased volume, facilitating improved aesthetics and function while preserving oral function, muscle strength as well as sensitivity with no recurrence at the 15-month follow-up. We encourage early collaboration between dermatologists and plastic surgeons regarding the timing of a potential surgery when treating cheilitis granulomatosa.

Morphological Variation of Lip Patterns among Nepali Adults.

Background Lip patterns are normal lines and fissures in the form of wrinkles and grooves present in the zone of transition of the human lip between the inner labial mucosa and the outer skin. Lip patterns are said to be unchangeable and unique. Objective To determine predominant lip patterns found among the Nepali population and to evaluate whether any sex difference exists. Method This study included 411 healthy adult Nepali comprising 215 males and 196 females in the age group of 18-27 years. The data was collected using an automated mode Canon EOS 3000D 18MP camera with an 18-55 mm lens. Lip patterns were then divided into four quadrants using Suzuki and Tsuchihashi's classification system. Result Lip pattern Type I (29.56%) was found to be the most common lip pattern in the study population. Sex-wise, Type I was the most common pattern with a prevalence of 28.72% in males and 30.48% in females. Applying the Chi-square test, a statistically significant difference (p 0.05) was not achieved in all the quadrants. Conclusion There is a marked variation observed between the findings of the present study when compared to previous Nepali studies. Being insignificant to sex differences, lip patterns should not be used as a useful resource in forensic casework for sex discrimination.

Temporal Coordination of Articulatory Gestures in Nonnative Onset Clusters: Evidence From American English Speakers Using Electromagnetic Articulography.

PURPOSE: Research in cross-language speech production indicates that, although the production of nonnative consonant clusters is often difficult, speakers of American English can produce some nonnative clusters (e.g., /fn/) with high accuracy. This ease of production for select nonnative clusters may occur due to similarity of phonetic structure with native clusters (e.g., nonnative /fn/ and native /sm/ are both fricative-nasal sequences). The current study tested this hypothesis by examining the extent of transfer of articulatory coordination from phonetically similar native onset clusters (i.e., /fl/, /sm/) to nonnative /fn/ clusters. METHOD: Using electromagnetic articulography, lip, tongue, and jaw movements were recorded in nine participants during the production of 22 nonwords (eight tokens per nonword) containing the native and nonnative clusters in different carrier phrases. We examined the temporal lags between each consonantal gesture in a cluster and the flanking vowel gesture, which were compared to the matched singleton conditions. RESULTS: Analyses revealed that, as in native speech, when the syllable onset became more complex (i.e., CV ➔ CCV [C as consonant, V as vowel]), there was an increase in lag (less temporal overlap) between the leftmost consonantal gesture and the vocalic gesture, whereas there was a decrease in lag (more temporal overlap) between the rightmost consonant and the vocalic gesture (i.e., C-center timing). However, the segmental makeup of the cluster and type of carrier phrase used were also found to influence this change in temporal organization, raising new questions for future research. CONCLUSIONS: By and large, the findings are in agreement with the idea that the temporal coordination of articulator movements may be transferred from native clusters to phonetically similar nonnative clusters. However, kinematic measures of a broader range of nonnative clusters in different contexts are needed to fully explore this position.

Dynamic and static nasolabial muscle anatomy of unilateral cleft lip adult patients based on magnetic resonance imaging data.

OBJECTIVES: This study aims to obtain a three-dimensional reconstruction model based on magnetic resonance imaging (MRI) data of patients with different degrees of unilateral cleft lip and analyze the anatomy and changes in multiple groups of nasolabial muscles under dynamic and static conditions. METHODS: One normal person and four adult patients with unilateral cleft lip were included, and MRI was performed under static (upper and lower lips closed naturally) and dynamic (pout and grin) conditions. 3D Slicer software was used to reconstruct the model and draw the anatomic morphology of nasolabial muscles. The distance between the junction (where the muscle merges into the orbicularis oris) of the levator muscle, zygomaticminor muscle, and zygomatic major muscle to the median sagittal plane, the starting point to the junction point, the dynamic and static junction points, and the angle between the connection of dynamic and static junctions and the horizontal plane were measured under three kinds of movements, and the ratio was calculated. RESULTS: In all patients, under dynamic and static conditions, the distance from the muscle junction to the median sagittal plane, their ratios of the cleft side to the non-cleft side were all greater than 1. While the ratio of the distance from the starting point of the muscle to the junction point is less than 1. At static conditions, the two ratios of the same muscle increased gradiently with the severity of the cleft, and the ratio of the zygomatic minor muscle was prominent in the same patient. The ratio of the cleft side to the non-cleft side was greater than 1, and the value for comparison was the angle of the line from the static to the dynamic junction and the horizontal plane. CONCLUSIONS: The symmetry of the insertion site of the orbicularis oris and the linear distance of both sides of the muscle are related to muscle and cleft types. The angle of muscle contraction on the cleft side is greater than that on the non-cleft side.