Application of Oral Retractor for Lip Injury Protection in Oral and Maxillofacial Surgeries: A Randomized Controlled Trial.

PURPOSE: Iatrogenic lip injury may occur during oral and maxillofacial surgical procedures. This study aimed to evaluate the effect of oral retractors on iatrogenic lip injury prevention during intraoral procedures of oral and maxillofacial surgery. METHODS: We conducted a randomized controlled trial and included patients who underwent intraoral procedures of oral and maxillofacial surgery. Patients were randomly allocated to receive oral retractor (intervention group) or traditional procedure without lip protection (control group). The incidence of lip injury was the outcome variable. Other study variables included surgical time and satisfaction of patients and surgeons with treatment experience evaluated by visual analog scale (VAS). Student t test and χ 2 test were used to compare both groups' variables and measure the relationship between the predictor variable and the outcome variable. P <0.05 was considered significant for all analyses. RESULTS: A total of 114 patients were included, with 56 allocated to intervention group and 58 to control group. The results showed that the application of an oral retractor did not significantly increase surgical time ( P =0.318). A total of 12 patients had lip injury, with 1 in the intervention group and 11 in the control group ( P =0.003). For the assessment of satisfaction with treatment experience, the intervention group had significantly higher VAS scores for doctors and patients ( P <0.05). CONCLUSIONS: We found that the oral retractor was a good tool for iatrogenic lip injury prevention in oral and maxillofacial surgical procedures and could be considered in clinical treatment.

Triangular Fossa Graft for Philtral Reconstruction After Facial Burns: A 34-Year Experience.

BACKGROUND: Upper lip burns and skin grafts used for the resulting deformities all contract, leading to distortion of regional tissues and producing a flattened upper lip devoid of normal anatomic landmarks. Absence of the philtral contour draws attention to the upper lip and can accentuate other reconstructive inadequacies. Philtral restoration requires a 3-dimensional reconstruction capable of resisting contractile forces to restore and maintain normal relationships between the upper and lower lips. METHODS: This was a 34-year retrospective review of a single surgeon's experience using a composite triangular fossa graft from the ear for philtral reconstruction. Ten patients were identified and analyzed using records of follow-up examinations, long-term clinical evaluations, and photographic documentation. RESULTS: Five males and 5 females were identified with 2- to 34-year follow-up. Age at operation ranged from 14 to 52 years. Percent total body surface area ranged from less than 1% to greater than 90%. Previous upper lip grafts prior to the auricular graft included 5 full-thickness skin grafts and 5 split-thickness skin grafts. No significant complications were noted. All patients were satisfied with the end aesthetic result and donor site morbidity. CONCLUSIONS: A triangular fossa composite graft restores and preserves the philtral dimple and corrects the obvious visible deformity of a featureless upper lip. Addition of tissue loosens the lip transversely, and the cartilage component provides a consistent and predictable upper lip position. This results in improved projection, a concave shape to the upper lip, and a better relationship with the lower lip. Restoration of this anatomic landmark creates a more normal-appearing upper lip and helps to minimize the negative impact of other abnormalities in this vitally important area. The overall improvement in total facial appearance can be profound.

Binky Bites and Other Oronasal Pressure Injuries.

Initial examination and exploration of childhood injuries may not lead to an obvious explanation of abuse. Although abusive oronasal injuries have been described, ones including nasal destruction are rare. We describe 4 children abused using implements that ultimately were thought to have caused significant nasal tissue destruction. In 2 of the cases, a forced pacifier placement was implicated in causing pressure injuries. In the other 2 cases, gags were part of the children's injuries. All 4 children had other findings of abuse and neglect.

Upper Lip Reconstruction With Modification for Creating a Philtrum With Single-Stage Full-Thickness Skin Graft in Burned Face Injury.

BACKGROUND: The philtrum plays an important role in determining the shape and form of the upper lip and creates individual identity. Postburn scar contracture in this area often leads to severe functional and aesthetic disfigurement. In this report, we present a novel method of philtrum reconstruction using full-thickness skin grafts (FTSGs) after burn injury. METHODS: Between August 2011 and October 2017, 8 patients with postburn philtrum deformity who underwent FTSG for replacement of the whole upper lip unit with a silastic tube for creation of the philtral dimple were included. A review of photographic documentation was used to evaluate the aesthetic results. RESULTS: The size of FTSG ranged from 4 × 9 to 6 × 17 cm. No patient had immediate postoperative complications, such as hematoma, infection, or necrosis. The crests of the ridges preserved their height and length, and the dimple remained visible after an average follow-up of 30.4 months (range, 3-69 months). All patients were satisfied with both functional and aesthetic results. CONCLUSIONS: This technique of single-stage reconstruction of the upper lip and philtrum with FTSG and silastic tube produced favorable results in the formation of the philtral ridges and the dimple. Through thoughtful preoperative design, meticulous scar release, and skin grafting, satisfactory functional and aesthetic results are achievable.

Review of Risk Assessment of Major Anatomical Variations in Clinical Dentistry: Accessory Foramina of the Mandible.

Most of the studies of the mandible's anatomical variations have presented the authors' speculations, and only a limited number has provided evidence that demonstrated the actual complications injury to the variant structures caused. To our knowledge, no study has evaluated the risks associated with these variant anatomical structures' injury. We reviewed articles that described clinical cases of the injury to, and anatomical studies of, three anatomical variants of the mandible-the accessory mental, lingual, and retromolar foramina-with which dentists are relatively familiar and that are mentioned often in the context of implant and third molar surgeries, to describe risk assessment methods with which to evaluate potential complications preoperatively. Only a limited number of the clinical reports of injury to the mandible's accessory foramina were available. The potential severe complication of injury of the accessory mental foramen (AMF) is sensory disturbance of the lower lip. Risk of neurosensory disturbance of lower lip can be assessed by AMF/MF ratio and positional relations to the MF. Potential severe complication of injury of the lingual foramen is bleeding and hemorrhage in the oral cavity's floor. Risk of bleeding can be assessed by diameter and positional relation between the mental spine/mylohyoid line. A risk assessment of the retromolar foramen could not be made because of inadequate data. We hope the risk assessments suggested will encourage dentists to predict intraoperative/postoperative complications caused by damaging the mandible's accessory foramina. Clin. Anat. 32:672-677, 2019. © 2019 Wiley Periodicals, Inc.

A proclaimed accidental fall of an infant-an experimental case reconstruction study.

The differentiation between a non-accidental injury and injuries resulting from accidents, such as falls to the ground or onto various objects, is a challenge not only for forensic experts but also for all clinicians caring for children. The forensic-biomechanical analysis of accidents in infants aims at the assessment of the loading characteristics based on the reconstruction of the particular incident. It includes an evidence-based analytical comparison between the actual injuries presented and the injuries that should be expected as a result of the proclaimed accident. With the help of kinematical and dynamical parameters of the described actions and the resulting loading situations, the forensic-biomechanical analysis can assess the plausibility of the proclaimed course of the event and thus contribute to the differentiation between accidental and non-accidental injuries. The quality of such a forensic-biomechanical expert opinion depends on the accuracy and quantity of available data regarding biomechanical tolerance of tissues, organs, and body parts. Case-specific measurements can contribute significantly to the insight of the kinematics and dynamics of the proclaimed event, its feasibility, etc. The present article demonstrates, based on one case report, the potential as well as the limits of such an analysis of proclaimed accidental fall injuries.

Dripped Lidocaine: A Novel Approach to Needleless Anesthesia for Mucosal Lacerations.

BACKGROUND: Oral lacerations represent a unique challenge for anesthesia in the emergency department. Many options exist for local anesthesia, but these options are often associated with pain from injections or anxiety from anticipated needle injection. CASE SERIES: We introduce a novel and needleless approach to achieving local anesthesia for oral mucosa repair by dripping injectable lidocaine directly onto mucosal wounds prior to repair. This method is well tolerated and achieves appropriate anesthesia without undesirable side effects. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Dripped injectable lidocaine may be an alternative method for mucosal anesthesia in the pediatric population.

Dog Attack Causing Lip Wound.

Animal bites are relatively common occurrences reaching about 4.5 millions of people every year. The main aggressor is the domesticated dog, responsible for around 90% of the patients, with children being the most affected, with 70% of the registered patients, while with adults that number is a lot lower (15%). Bites around the head and neck require special attention. Due to the presence of noble structures and the rich local vascularization, any wounds have been immediately addressed to stop bleeding and further complications. The present study shows a woman patient, victim of a dog bite in her face, where the dog is her own, a domesticated Weimaraner. The patient was attended to in the Unidade de Pronto Atendimento, the procedure was to first apply anesthesia, then clean up the wound, debris of borders, and the plane suturation. Two months after the surgery, the patient showed satisfactory healing, with no complaints about pain or esthetics. As final considerations, it has to be remembered that facial trauma has to be assessed and taken care of immediately, in a way that closing the wound in the first hours after the trauma increase the chances of obtaining a better esthetic as physiologic result for the patient, also preventing infections from the wound and external environment. Also, in the case of animal bites, it is important that the professional possess the knowledge to deal with each individual situation, employing the correct prophylactic vaccine and perform the correct notification.

Microvascular Replantation of the Avulsed Lip.

Traumatic facial soft tissue injury often creates both aesthetic and functional deficits. In complete lip avulsions, microvascular replantation is a reconstructive option that has the potential to fulfill both of these goals. However, lip replantations remain rare and there are few reports in the literature. The authors aim to present a clinical report of a young male who sustained a human bite injury and underwent microvascular replantation of a completely avulsed lower lip and to review the literature and management of these complex injuries.

Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery.

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.

Lip and tooth injuries at public swimming pools in Austria.

BACKGROUND/AIMS: There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures. MATERIAL AND METHODS: A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated. RESULTS: The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities. CONCLUSION: Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved.

Joubert Plus Syndrome with Self-Mutilation: A Case report.

BACKGROUND: Joubert syndrome is a very rare condition with dismal prognosis. It is characterized by several abnormalities including molar tooth sign on MRI. When coupled with mega cisterna magna- a feature of the Dandy Walker syndrome- it is categorized as Joubert plus syndrome. CASE REPORT: A 16 month old male child with Joubert syndrome was referred to the Pediatric Dentistry Department Clinic, Faculty of Dentistry Alexandria University, complaining of severe tongue and lower lip injury due to self-mutilation. He required multiple teeth extractions under general anesthesia to prevent further tongue and lip mutilation. CONCLUSION: Joubert plus syndrome is a very rare occurring condition. Because self-mutilation is sometimes fatal, a treatment plan tailored to each patient's need is mandatory. A multidisciplinary approach is recommended.

Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature.

Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries.

Primary W-Plasty Closure for Surgical Repair of the Injured Lip.

PURPOSE: To describe the results obtained using the primary W-plasty closure technique for the surgical repair of lip defects of traumatic etiology. PATIENTS AND METHODS: This study followed both the Declaration of Helsinki on medical protocol and ethics and the Ethical Guidelines of Hospital San Francisco de Asis institutional review board. A retrospective case series study was designed and implemented. The medical status, demographic, etiology, complications, and outcomes associated to the primary W-plasty technique in patients with lip injuries seen at Hospital San Francisco de Asis Oral and Maxillofacial Surgery Department in Quibdó, Colombia between 2010 and 2013 were assessed. Data were collected and analyzed using a statistic package. RESULTS: Eighteen patients were treated, 8 women and 10 men, with ages ranging from 2 to 38 years. Patients presented lip avulsion injuries associated to different etiologies. They underwent surgery under general anesthesia after prophylactic antibiotic therapy and tetanus booster vaccination. Defect repair was performed using the primary W-plasty closure technique, obtaining satisfactory esthetic and functional results. CONCLUSIONS: Primary W-plasty closure is a surgical option that allows the safe and practical restoration of the injured lip, even in lesions exceeding 50% of the normal lip.

Our Treatment Approaches in Severe Maxillofacial Injuries Occurring After Failed Suicide Attempts Using Long-Barreled Guns.

Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

Bipedicled Preexpanded Forehead Flaps for Simultaneous Reconstruction of Total Nasal and Upper Lip Subunits: A Novel Approach to Complex Facial Resurfacing.

Background Reconstruction of the central facial subunits is a complex and challenging task. In cases in which both the nasal and upper lip subunits are involved, a technique that can reconstruct both aesthetic units with tissue of similar color and texture from a single donor site will be ideal. In this article we present our experience with the bipedicled preexpanded forehead flap for simultaneous nasal and upper lip resurfacing. Patients and Methods Between January 2012 and January 2015 we used this technique in the simultaneous reconstruction of total nasal and upper lip subunits in five patients. All cases were for burns scar resurfacing. Results Good aesthetic results were achieved in each of our five cases to date and no complications were encountered. All donor sites closed primarily with aesthetically pleasing well-concealed linear scars. In all cases small modifications such as philtral shaping and further flap thinning were performed under local anesthesia between 6 and 12 months postoperatively Conclusion The preexpanded forehead flap provides an unparalleled color and texture match when it comes to facial resurfacing. When both total nasal and upper lip resurfacings are required, it is possible to achieve this in a single sitting from a single donor site by using a bipedicled preexpanded forehead flap.

Silver nitrate burn of the lower lip: a case report.

Silver nitrate is used in medicine to treat a number of conditions because of its cauterizing properties. This case report describes management of a silver nitrate burn of the oral mucosa that resulted in a large mass of necrotic tissue and accompanying pain in a 41-year-old man. The patient bit his lip and received silver nitrate treatment from a physician. Significant swelling and pain occurred over a period of 3 weeks after application. Analysis of a biopsy specimen revealed necrotic tissue with chronically inflamed granulation tissue. The lesion persisted, and it was determined that debridement was necessary to enhance wound healing and prevent significant scar formation. The patient was reexamined 10 days and 1 month after debridement. The lesion had significantly decreased in size, and the patient reported notable reduction of pain. The final follow-up at 3 months showed a desirable result with minimal scar formation. Use of concentrated silver nitrate for cautery can result in significant damage to mucous membranes, including oral mucosa.

Successful treatment of posttraumatic arteriovenous malformation of the lower lip.

Arteriovenous malformations (AVMs) are most commonly reported in the brain. Head and neck AVMs are reported to occur in 0.1% of the general population. On the other hand, posttraumatic AVMs are quite rare. Traumatic AVMs are extremely rare in the head and neck and are mostly seen in the extremities. The management of such lesions may include selective embolization or surgical exploration with ligation. A 13-year-old male adolescent visited our hospital for lower lip swelling, which developed 5 years ago after a lower lip laceration. The AVM was expanded and was graded as stage II. It was fed by the mandibular branch of both facial arteries and drained to the posterior facial vein. The radiologic intervention department performed an embolization before the operation. The main operation was performed 12 days after the embolization. A well-demarcated AVM lesion was found in the oral mucosa and was totally excised under general anesthesia. The authors easily performed the operation owing to the embolization making the AVM definitely demarcated and firmly palpable. The lip closure was done carefully considering the lip contour. No sign of recurrence was seen during 6 months of follow-up. The excellent treatment result of the posttraumatic facial AVMs occurs largely because of a collaboration with the radiologic intervention department using the selective embolization.

Expanded thoracoacromial artery perforator flap for reconstruction of full-perioral scar contracture.

Various types of anterior chest flaps can be recruited in the reconstruction of faciocervical region. Most of them were created based on the internal mammary artery and the lateral thoracic artery, and the thoracoacromial artery (TAA) is usually used in pectoralis major musculocutaneous flap. An anterior chest flap with TAA perforator (TAAP) will have no sacrifice of the pectoralis major muscle, but less reports, especially expanded pedicled one, can be reviewed. Here, we reported a case using expanded pedicled TAAP flap to reconstruct the perioral scar contracture. In this technique, expanded TAAP flap could be easily harvested without the sophisticated microsurgical technology. Acceptable esthetic and functional results were achieved.

Reconstruction of upper lip scar using tissue expander advancement flap.

Some patients who previously underwent burns have upper lip deformities or extensive scars so they seek for treatments.We reported a patient who had extensive scars all over the upper lip. In the patient's case, we reconstructed the entire upper lip using a tissue expander advancement flap from the bilateral lip. This improved the upper lip contracture and appearance. The removal of the scar from the upper lip provided a satisfactory result.The use of 2 large tissue expander advancement flaps from the bilateral upper lip has several advantages, such as inconspicuous scar, nice skin texture, and color match.