[Perception of asymmetry smile: Attempt to evaluation through Photoshop]. / Perception de l'asymétrie du sourire : tentative d'évaluation grâce à Photoshop.

UNLABELLED: In the labial palliative surgery of facial paralysis, it can persist asymmetry smile. OBJECTIVE: Evaluate the impact of an augmentation or reduction of the commissural course on the perception of a smile anomaly, and determine from which asymmetry threshold, the smile is estimated unsightly. MATERIAL AND METHOD: We took a picture of two people with a smile not forced; including one with a "cuspid smile", and the another one with a "Mona Lisa" smile. The pictures obtained were modified by the Photoshop software, to simulate an asymmetry labial smile. The changes were related to the move of the left labial commissure, the left nasolabial furrow, and the left cheek using under-correction and overcorrection, every 4 mm. Three pictures with under-correction and four pictures with over-correction were obtained. These smiles were shown to three groups of five people, which included doctors in smile specialties, doctors in other specialties, and non-doctors. Participants were then asked to indicate on which of the pictures, the smile seemed abnormal. RESULTS: Between -8 mm under-correction, and +8 mm over-correction, the asymmetry of the commissural course does not hinder the perception of smile. CONCLUSION: In the labial palliative surgery of facial paralysis, in the case of persistent asymmetry, there is a tolerance in the perception of "normality" of smile concerning the amplitude of the commissural course going up to 8 mm of asymmetric with under-correction or over-correction.

Reconstruction of Surgical Defects of the Labial Commissure.

The main objective of oncologic dermatologic surgery is the complete excision of skin tumors. During reconstruction of the defect, we must attempt to preserve function and cosmetic appearance. At the labial commissure, fibers from the superior and inferior portions of the orbicularis oris muscle intersect and the vermillion inserts onto the modiolus, a complex, cone-shaped structure at the angle of the mouth. Surgical reconstruction of the labial commissure is challenging because of the need to preserve sphincter function and cosmetic symmetry. We present a number of cases of surgical defects at the labial commissure and describe the reconstruction techniques used. We also propose an algorithm to help determine the most suitable technique for different cases.

A Rare Case of Hydrocystoma of the Labial Commissure: Histopathology and Clinical Picture.

OBJECTIVE: Hydrocystomas (HCs) are rare, benign, skin adnexal cystic tumors that may be either eccrine or apocrine. BACKGROUND DATA: Apocrine-HCs are cystic lesions that arise from the apocrine secretory coil, whereas eccrine-HCs are retention cysts of the eccrine duct. The commonest site is around the eyes, on the ears, scalp, chest, shoulders, or feet; HCs of the oral cavity are very rare. METHODS: The case is reported of a 36-year-old man with a nodular lesion that was 7 × 5 mm in size on the labial commissure. The lesion was treated in direct contact with a diode laser that was 980 nm in continuous wave mode, with a 320 µm fiber at 1.8-2.0 W of power. RESULTS: Complete healing occurred within 15 days. There were no adverse effects. The patient was carefully followed up, and there has been no recurrence. Histopathologically, the lesion was a multilocular cyst lined with a single-, and in some areas a double-layered epithelium with eosinophilic cytoplasm. Immunohistochemically, the secretory epithelium was positive for S-100 protein and negative for cytokeratin 5/6. CONCLUSIONS: The histopathological and immunohistochemically diagnosis was of eccrine HC. The report stresses differential diagnosis versus cystic lesions of the labial commisure.

Queilite angular traumática em eqüinos associada à ingestão de Panicum maximum / Angular cheilitis in horses associated with ingestion of Panicum maximum

Uma condição com aumento da fenda bucal de eqüinos por lesão na comissura labial foi estudada. Este aumento tinha extensão variável e era uni ou bilateral. Na mucosa da bochecha da comissura labial exposta havia pequenas erosões. Durante a mastigação havia perda de pequena quantidade de capim e saliva pela fenda bucal aumentada. Os animais apresentavam bom estado nutricional. O exame histopatológico de tecido retirado da comissura labial revelou epidermite superficial. Nas quatro propriedades onde se verificou o problema, constatou-se que os eqüinos eram mantidos em sistema extensivo de criação em pastagem de Panicum maximum (variedades Tanzânia, Mombaça, Tobiatã e Colonião), com folhas maduras, altas, lignificadas e de bordos cortantes. De acordo com os dados epidemiológicos, com os achados clínicos e histopatológicos, concluí-se que essas lesões foram causadas pela ação cortante das folhas de Panicum maximum, associada à forma de apreensão da pastagem alta e mastigação pelos eqüinos.

A condition with enlargement of the oral cleft in horses was studied. The enlargement of varied extension was uni or bilateral. The cheek mucosa of the labial commissure showed slight erosions. During chewing there was loss of small amounts of grass and saliva through the oral cleft. The affected horses were in good nutritional condition. Histopathological studies of tissues obtained by biopsia, revealed a superficial epidermitis. The pastures consisted of Panicum maximum grass (varieties Tanzânia, Mombaça, Tobiatã and Colonião) which was mature, tall, lignified, with leaves of cutting edges. Based on epidemiological, clinical and histopathological data, it was concluded that the lesions were caused by the hard grass, favored by the way horses pull the tall grass and chew it.