Contour correction of the vermilion of the upper lip by island flap of the lower lip

A method is shown to correct contour defects of the upper lip vermilion by an island of vermilion of the lower lip. A muscle bundle of the orbicularis oris is used to carry the island. It is tunneled around the commissure to the upper lip defect. Three cases are shown.     

The short-lip deformity after triangular flap repair: a lengthening technique

A method for lengthening of the short lip after triangular-flap repair of the unilateral cleft lip is documented. This technique offers a minimal additional scar line and a maximum effect.     

培养于天然冷杉木片的黄孢原毛平革菌木质素过氧化物酶基因表达的RT-PCR分析

利用RT-PCR方法分析了生长于冷杉木片上的黄孢原毛平革菌木质素过氧化物酶基因lipA2(GLG3)、lipC1(GLG2)、lipC2(GLG5)、lipD2(GLG1)、lipE(LPO811)的表达。结果发现在不同的培养时间里仅有特定的基因表达,在第2周时仅有lipA2(GLG3)基因表达,在第4周时未检测到任何基因的表达,在第6周时lipD2(GLG1)和lipC1(GLG2)基因表达,在第8周时仅有lipA2(GLG3)基因表达。这些结果说明,在冷杉木片上培养的黄孢原毛平革菌的lip基因表达具有明显的时间特异性,并且与限定培养基中得到的结果明显不同。     

Reduction cheiloplasty for upper lip hemangioma

A technique for reconstruction of the upper lip following excision of a cavernous hemangioma is presented. An apron-vermilion flap from the inner third of buccal side is elevated, allowing good exposure of the hemangioma. Following removal of the hemangioma, the excessive mucosa-vermilion flap is reduced to form an accurate upper lip shape. This method achieves a pleasing contour of the upper lip.     

Unilateral gate flap for reconstruction of the lower lip

A unilateral gate-flap technique consisting of a nasolabial island flap is presented for the reconstruction of defects in the lower lip after excision of large, laterally located epidermoid tumors. The amount of healthy tissue resected is optimal. The reconstructed lower lip retains sensation and muscle function and is continent with a satisfying appearance. Temporary flap edema and a vermilion notch at the apex of the flap are both avoidable problems. This method may be used in selected patients with large advanced epidermoid cancers of the lower lip.     

Excision of precancerous lesions of the lip

A method of surgical treatment of precancerous lesions of the lip, by excision of the vermilion border and the advancement of the inner mucosa of the lip to cover the defect, satisfactorily removes the entire lesion and restores normal tissue to the lip surface.     

Staged sequential flap reconstruction for large lower lip defects

A method for the reconstruction of total or nearly total defects of the lower lip is described that utilizes a staged sequence of flaps that are familiar to most plastic surgeons. The recommended sequence is an extended Karapandzic flap to reestablish the oral sphincter, then two sequential Abbé flaps from the upper lip to restore balance and augment the central lower lip, and finally a commissureplasty using a sliding myomucosal flap in conjunction with final revision of the scars. Intervals of 3 weeks separate the surgical procedures. Using this strategy, essentially normal lip function and a relatively normal appearance have been obtained in four patients with large lip defects.     

Correction of major defects of the vermilion with a cross-lip vermilion flap.

A method is described to correct major vermilion defects by using a transverse, cross-lip, vermilion flap. Sizable defects can be easily filled in to obtain an upper lip with better contour and simultaneously reduce the unpleasant fullness of the lower lip to produce better balance between the two lips.     

Thyroxine-induced differential mortality of cleft lip mouse embryos: dose- and time-response studies of the A/WySn strain

Pregnant A/WySn mice, 20 to 30% of whose offspring have spontaneous cleft lip, were treated with thyroxine. Following treatment, cleft lip and normal embryos died, but cleft lip embryos died at a higher rate. The increased liability of cleft lip embryos to thyroxine-induced death was considered as a possible experimental route to identify the basic genetic defect that causes cleft lip. A time-response study indicated that cleft lip embryos responded more than normals following treatment on any of days 7 to 12 of gestation, that there is no sharply defined critical period, and that normal and cleft lip embryos do not differ in time of maximum sensitivity. A dose-response study showed linear responses of normal and cleft lip embryos on a probit-log dose scale, with a common slope and LD50's of 1.9 and 1.3 mg respectively. These dose-response properties indicate that normal and cleft lip embryos are probably killed by the same mechanism, but differ in dosage tolerance. That is, they differ quantitatively, not qualitatively. Thyroxine did not significantly change the cleft lip frequency, and the difference between normal and cleft lip embryos that leads to cleft lip itself is therefore not in the same pathway as that which leads to thyroxine-induced death. A hypothetical example of the defect basic to both pathways is presented.     

Rectangular flap for horizontal upper vermilion tightness in secondary cleft lip deformity

Radical paring of the cleft edge during a primary cleft operation or repeated secondary surgeries can result in tightness of the upper lip. The degree of the resulting side-to-side tension can vary, from mild cases for which improvement is sought through realignment of the misplaced oral sphincter muscle in secondary revision, to severe cases for which the possibility of a lip switch flap must be considered. When the lip tightness accompanies more than three-quarters loss of the Cupid's bow, an Abbé flap is an alternative. However, the lip switch flap is far from ideal, in both artistic and functional perspectives, and should be avoided if at all possible in mild to moderate degrees of lip tightness. This study presents a method of correcting horizontal cleft upper lip tightness, especially of the vermilion. The method involves local transfer of an inferiorly based rectangular flap from the relatively redundant upper two-thirds to the lower one-third of the upper lip and vermilion. Primary indications for the technique include vermilion tightness with half to three-quarters loss of Cupid's bow. The method has the advantage of supplementing the horizontal lip dimension on the cleft side and restoring a natural Cupid's bow, thereby repositioning the shifted philtral column and adding fullness to the lower one-third of the upper lip. Incorporation of the upper lip scar in the rectangular flap removes ugly scars and spares the lower lip from surgical violation. The orbicularis sphincter function, as seen in facial animation, was well regained. Twenty unilateral and three bilateral cases with a maximal follow-up period of 4.5 years are presented.     

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited

The purpose of this retrospective study was to review the method of using the Abbé flap for correction of secondary bilateral cleft lip deformity in selected patients with tight upper lip, short prolabium, lack of acceptable philtral column and Cupid's bow definition, central vermilion deficiency, irregular lip scars, and associated nasal deformity. A total of 39 patients with the bilateral cleft lip nasal deformity received Abbé flap and simultaneous nasal reconstruction during a period of 6 years. Mean patient age at the time of the operation was 19.1 years, and ranged from 6.6 to 38.5 years. The average follow-up period was 1.8 years. Fourteen patients had prior orthognathic operations. The Abbé flap was designed 13 to 14 mm in length and 8 to 9 mm in width and contained full-thickness tissue from the central lower lip, with a slightly narrow reverse-V caudal end. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. Part of the prolabial skin was preserved and mobilized for columellar elongation, if indicated. Open rhinoplasty was carried out with or without cartilage graft for columella and nasal tip reconstruction. Reduction of the alar width and nostrils was achieved by a Z-plasty or excision of scar tissue at the nostril floor. The Abbé flap was then transposed cephalad, insetting into the median defect and sutured in layers. The results demonstrated no flap problems or perioperative complications. Seven patients needed further minor revisions on the nose and/or lip. Laser treatment was used to improve the lip scars in three patients. The patients were satisfied with the final outcome and found the lower lip scars acceptable. In conclusion, the described technique of Abbé flap and simultaneous rhinoplasty is an effective reconstructive method for select patients with bilateral cleft lip and nasal deformity.     

Primary reconstruction of complex midfacial defects with combined lip-switch procedures and free flaps.

Free flaps are generally the preferred method for reconstructing large defects of the midface, orbit, and maxilla that include the lip and oral commissure; commissuroplasty is traditionally performed at a second stage. Functional results of the oral sphincter using this reconstructive approach are, however, limited. This article presents a new approach to the reconstruction of massive defects of the lip and midface using a free flap in combination with a lip-switch flap. This was used in 10 patients. One-third to one-half of the upper lip was excised in seven patients, one-third of the lower lip was excised in one patient, and both the upper and lower lips were excised (one-third each) in two patients. All patients had maxillectomies, with or without mandibulectomies, in addition to full-thickness resections of the cheek. A switch flap from the opposite lip was used for reconstruction of the oral commissure and oral sphincter, and a rectus abdominis myocutaneous flap with two or three skin islands was used for reconstruction of the through-and-through defect in the midface. Free flap survival was 100 percent. All patients had good-to-excellent oral competence, and they were discharged without feeding tubes. A majority (80 percent) of the patients had an adequate oral stoma and could eat a soft diet. All patients have a satisfactory postoperative result. Immediate reconstruction of defects using a lip-switch procedure creates an oral sphincter that has excellent function, with good mobility and competence. This is a simple procedure that adds minimal operative time to the free-flap reconstruction and provides the patient with a functional stoma and acceptable appearance. The free flap can be used to reconstruct the soft tissue of the intraoral lining and external skin deficits, but it should not be used to reconstruct the lip.     

Reconstruction of the superior labial sulcus in secondary bilateral cleft lip deformities: an inverted U-shaped flap.

A shallow buccal sulcus deformity following bilateral cleft lip repair is not rare. A variety of techniques are described for the secondary reconstruction of a deficient sulcus. Most of these are associated with a variable amount of contraction with subsequent obliteration of the sulcus. In this article, an inverted U-shaped flap is described for the secondary reconstruction of the deficient sublabial sulcus. In these patients, mobility of the upper lip was severely restricted, so orthodontic treatment was not possible. This technique was used in nine patients whose primary cleft lip repairs were performed in different institutions. The amount of re-adhesion or contraction was negligible, because a bare surface was not left behind and skin or mucosal grafts were not used. By advancing the lateral segments of the lip medially, projection of the upper lip was increased. The procedure resulted in adequate upper lip mobility for all patients, and sufficient sulcus was maintained during 1 to 6 years of follow-up. The patients experienced no difficulty with orthodontic appliances after this reconstruction.     

Partial lip resection with orbicularis oris transposition for lower lip correction in unilateral facial paralysis.

Malfunction of the marginal mandibular nerve, either in combination with a generalized facial palsy or in isolation, can cause an unpleasant and disturbing appearance around the mouth. In total palsy, a cross-facial nerve graft combined with a free vascularized muscle transplant will usually deal with this problem successfully; however, all older procedures used in this situation are unpredictable. For the isolated palsy, procedures such as digastric muscle transfer or sling suspension are not uniformly successful. A method using the contralateral, nonaffected lower lip orbicularis muscle is described. A wedge is removed from the paralyzed lower lip and the orbicularis is advanced to the modiolus to provide a functional orbicularis all the way across the lower lip up to the angle of the mouth. This is a simple outpatient procedure that has produced satisfactory results in most cases.     

Muscle reconstruction in cleft lip repair

This article presents a method of muscle reconstruction in the cleft lip patient that grossly reproduces the interlacing muscle anatomy in the central portion of the upper lip and thereby addresses both the static and the functional requirements of cleft lip repair. This lip repair procedure is combined with paranasal muscle reconstruction, preoperative nasoalveolar molding, and postoperative nasal stenting to constitute a comprehensive approach to cleft lip/nose repair.     

Simultaneous repair of the upper lip and nostril floor after tumor excisions.

A lateral lip flap, with a perialar extension, is described for reconstruction of defects of the upper lip which extend into the columella and/or the nostril floor.     

A Geometric Morphometric Approach to the Analysis of Lip Shape during Speech: Development of a Clinical Outcome Measure

Objective assessments of lip movement can be beneficial in many disciplines including visual speech recognition, for surgical outcome assessment in patients with cleft lip and for the rehabilitation of patients with facial nerve impairments. The aim of this study was to develop an outcome measure for lip shape during speech using statistical shape analysis techniques. Lip movements during speech were captured from a sample of adult subjects considered as average using a three-dimensional motion capture system. Geometric Morphometrics was employed to extract three-dimensional coordinate data for lip shape during four spoken words decomposed into seven visemes (which included the resting lip shape). Canonical variate analysis was carried out in an attempt to statistically discriminate the seven visemes. The results showed that the second canonical variate discriminated the resting lip shape from articulation of the utterances and accounted for 17.2% of the total variance of the model. The first canonical variate was significant in discriminating between the utterances and accounted for 72.8% of the total variance of the model. The outcome measure was created using the 95% confidence intervals of the canonical variate scores for each subject plotted as ellipses for each viseme. The method and outcome model is proposed as reference to compare lip movement during speech in similar population groups.     

Lip enhancement: surgical alternatives and histologic aspects

This study included 66 consecutive patients, 58 women and 8 men, who underwent 86 surgical procedures on the lips during 1989-1998. Lip enlargement was performed in 59 patients, and lip reduction was performed in 7 patients. Indications were purely aesthetic in 61 cases and reconstructive in 5 cases. The following surgical techniques were used for lip augmentation: implantation of crystal silicone, polyacrylamide hydrogel, Gore-Tex tubes, autologous fat, and dermis-fat graft. A new instrument originally designed by the author, the dermis-fat graft passer, significantly speeded up and facilitated execution of the latter procedure. Other operations included V-Y plasty, lip lifting by buffalo horn excision, lip lengthening by frenulum plasty, and lip reduction by wavy tangential excision. Eighty-six percent of patients could be followed up; the mean length of follow-up was 4.2 years. Use of silicone microparticles (Bioplastique) was abandoned because of the tendency for lumping. Polyacrylamide gel is promising because of its ease of use, and Gore-Tex tubes are promising because of their ability to create and accentuate the Cupid's bow form for the upper lip. However, these products are new, and follow-up studies with longer observation times are needed to reach definite conclusions. Of these studied methods, autologous fat transplant was found to be particularly useful for enlargement and restoration in cases of age-related atrophy of the lips and perioral tissues. Dermis-fat grafting was the most efficient, versatile, and reliable method of lip enlargement. Long-term survival of transplanted autologous tissues was confirmed by histologic studies of biopsy specimens.     

Surgical treatment of the senile upper lip

Aesthetic changes in the aging upper lip constitute a troublesome problem for modern women. During the process of aging, the following alterations appear in the upper lip: (1) vertical wrinkles, (2) reduction in height of the vermilion border along with lengthening of the skin area of the lip, and (3) "disappearance" of the Cupid's bow. In 1993, Guerrissi and Sanchez described a surgical technique that allowed them to correct the effects of these senile changes in 19 patients. With the use of this surgical technique, a strip of skin on the vermilion border was deepithelialized. The remaining dermal flap was buried in the pocket, which was performed by undermining the superior third of the skin of the upper lip. The short-term results were satisfactory, although a slight reduction in height of the vermilion border and a decrease in the thickness of the lip were observed in five patients (26 percent) 4 years postoperatively. Beginning in 1994, the authors began using a new approach combining dermal flap reshaping with simultaneous lip augmentation using dermal-fat grafts, Gore-Tex (W. L. Gore and Associates, Flagstaff, Ariz.) or AlloDerm (LifeCell Corp., Branchburg, NJ.). No serious or definitive complications were observed. Scars on the vermilion border were not conspicuous. A peel was necessary at the same time for complete elimination of rhytids. With this method, both the patients and the surgeons were satisfied with the results.     

Functional support for flap reconstruction of the lower lip and mandible

A case of functional support for distant flap reconstruction of the entire lower lip and mandibular symphysis following resection of an aggressive recurrent basal cell carcinoma of the lip is presented. Resection of the entire lower lip and mandibular symphysis includes loss of the orbicularis oris and attached muscles of the modiolus as well as the buccinator and masseter muscles. Without the support of these muscles, control of saliva as well as solid and liquid food is lost and articulation is hampered. In this case, fasciae latae strips attached to distally transected temporalis muscle tendons were tunneled bilaterally into the lower lip and chin area, which had been previously reconstructed with deltopectoral and pectoralis major musculocutaneous flaps.