ABSTRACT
Hyaluronic acid (HA) dermal fillers are widely used in aesthetic treatments for facial and lip modeling. Despite HA fillers has largely known to be use in procedures for augmentation the lip volume, their application to management lip abnormalities is not widespread. This study reviewed the use of HA fillers for reconstruction of congenital and acquired li p asymmetries and deformities, searching to expand knowledge about this treatment modality. To undertake this narrative review, the Medline-Pubmed, Web of Science, Scopus, Embase, Google Schoolar e Lillacs databases were searched. Several studies have reported positive results in the use of HA fillers for the treatment of lip deformities caused by different factors such as: Insatisfactory dermal fillers, permanent lip implants, excision of lip carcinoma, post-operative scars and electrical burns. HA fillers are also an alternative for the management of lip asymmetries and residual surgical scars in patients with cleft lip. Moreover, injection of HA fillers in individuals with facial paralysis and facioscapulohumeral muscular dystrophy can also improve lip incompetence. Additionally, HA fillers can be used as a complementary treatment in cases of severe malocclusion associated with skeletal changes, helping to maintain the seal and refine the lip appearance. Therefore, HA fillers can be used as alternative treatment for several types of congenital and acquired lip deformities and asymmetries. However, it is necessary to carry out randomized clinical trials with a greater number of patients and follow-up time, in order to investigate the benefits of the HA fillers for carriers patients of lip abnormalities.
Los rellenos dérmicos de ácido hialurónico (AH) son muy utilizados en tratamientos estéticos para el modelado facial y de labios. A pesar de que se sabe en gran medida que los rellenos de HA se utilizan en procedimientos para aumentar el volumen de los labios, su aplicación para el tratamiento de anomalías labiales no está muy extendida. Este estudio revisó el uso de rellenos de HA para la reconstrucción de asimetrías y deformidades labiales congénitas y adquiridas, buscando ampliar el conocimiento sobre esta modalidad de tratamiento. Para realizar esta revisión narrativa, se realizaron búsquedas en las bases de datos Medline-Pubmed, Web of Science, Scopus, Embase, Google Schoolar y Lillacs. Varios estudios han reportado resultados positivos en el uso de rellenos de HA para el tratamiento de deformidades labiales causadas por diferentes factores tales como: rellenos dérmicos insatisfactorios, implantes labiales permanentes, escisión de carcinoma labial, cicatrices postoperatorias y quemaduras eléctricas. Los rellenos de HA también son una alternativa para el manejo de asimetrías labiales y cicatrices quirúrgicas residuales en pacientes con labio hendido. Además, la inyección de rellenos de HA en personas con parálisis facial y distrofia muscular facioescapulohumeral también puede mejorar la incompetencia de los labios. Además, los rellenos de HA se pueden usar como un tratamiento complementario en casos de maloclusión severa asociada con cambios esqueléticos, lo que ayuda a mantener el sellado y refinar la apariencia de los labios. Por lo tanto, los rellenos de HA se pueden utilizar como tratamiento alternativo para varios tipos de deformidades y asimetrías labiales congénitas y adquiridas. Sin embargo, es necesario realizar ensayos clínicos aleatorizados con mayor número de pacientes y tiempo de seguimiento, para investigar los beneficios de los rellenos HA para pacientes portadores de anomalías labiales.
ABSTRACT
OBJECTIVES@#Short-term outcome evaluation for the correction of unilateral cleft lip deformity with a new technique.@*METHODS@#Forty-four patients with unilateral cleft lip deformity were included in the study and in which the orbicularis oris muscle was reconstructed to achieve the optimal force balance of reconstructed orbicularis oris. The photometric two-dimensional indexes, including the philtrum oblique angle and asymmetry ratios (lip height, lip width, vertical distance from the white roll to the vermilion bottom at the Cupid's bow point, and vertical distance from the Cupid 's bow points to facial midline), were employed to measure and evaluate the outcome.@*RESULTS@#Several indexes showed statistically significant difference, and they included the philtrum oblique angle, asymmetry ratio of the lip height, and asymmetry ratio of the vertical distance from the white roll to the vermilion bottom at Cupid ' s bow points (@*CONCLUSIONS@#The results suggested that the new muscle reconstruction technique can significantly improve the short-term outcome of the correction of unilateral cleft lip deformity.
Subject(s)
Humans , Cleft Lip/surgery , Facial Muscles/surgery , Lip , Mouth Mucosa , Plastic Surgery ProceduresABSTRACT
OBJECTIVE@#This study aims to explore the effect of cosmetic technique on the modification of lip deformity after cleft lip surgery.@*METHODS@#A total of 35 patients with postoperative cleft lip and who needed two-stage repair due to the nasolabial deformity were selected. Cosmetic technique was used to modify their lip deformities prior to the surgery. Front photos of the patients were taken before and after modification of their lip deformities. These photos were subsequently assessed by both the patients and the medical staff. The visual analogue method, Asher-McDade aesthetic index, and Mortier PB scale were used by patients and medical staff to evaluate changes in the lip shape by the cosmetic technique.@*RESULTS@#Prior to the cosmetic technique application, the mean self-score of the patients and the mean scores of the medical staff were 56±13 and 3.22±1.11 points, respectively. After the cosmetic technique application, the mean self-score of the patients and the mean scores of the medical staff were 67±12 and 2.85±1.03 points, respectively. The differences were statistically significant for both the patients and the medical staff (P<0.05).@*CONCLUSIONS@#Appropriate use of the cosmetic technique can modify the lip deformity after the cleft lip surgery to a certain degree. The use of this technique exerts evident effects in restoring the symmetry of lip peak and the continuity of the labial arch and in highlighting the philtrum column.
Subject(s)
Humans , Cleft Lip , General Surgery , Cosmetic Techniques , Esthetics, Dental , Postoperative Period , Plastic Surgery Procedures , Treatment OutcomeABSTRACT
Objective According to the fine artery anatomy of the lower lip, we developed an innovative partial-thickness myocutaneous flap based on the vascular network of the submucosal and subcutaneous layers of the lower lip.We attempted to treat the secondary bilateral cleft lip deformities using this innovative cross-lip flap.Methods From July 2009 to June 2015, this new technique was used in 98 patients with secondary bilateral cleft lip deformities.The central defects usually occurred in these patients.The defects were reconstructed partially or completely according to the severities of the defects.The operative procedures were as follows: The split flap was elevated from the posterior portion of the oris orbicularis muscle after the inferior labial arteries were divided.Then the partial-thickness flap was rotated 180 degrees horizontally and inverted 180 degrees upward to the upper lip defect.Results All 98 musculomucosal pedicle flaps were viable.The upper lips were reconstructed according to the severities.Conclusions This myocutaneous cross-lip flap with musculomucosal-pedicle has a more reliable blood supply, better flexibility and plasticity.It is an effective method for aesthetic reconstruction for the secondary bilateral cleft lip deformities.
ABSTRACT
Objective To explore the surgical method of double flag-shaped flap to correct the shortened middle part of upper lip deformity of post burn.Methods From January 2009 to December 2013,9 cases of shortened middle part of upper lip post burn deformity were corrected by double flag-shaped flap,including 4 males and 5 females who aged from 18 to 37 years.They received the surgery from 1 to 3 years after burn.The main clinical manifestations included the upper lip eversion,too short middle part of upper lip,the destruction of the normal anatomy philtrum,philtrum column deformity and poor continuity vermilion border.Results The height of the middle of upper lip of 9 patients enrolled in the experimental treatment was lengthened by 4 to 6 mm after operation,which fundamentally corrected the shortened middle part of upper lip deformity of post burn.The patients were followed up for a period of 3 months to 2 years and received satisfactory results.The operative incisions of 9 cases were primary healing,with no flap blood supply disorders,wound infection,dehiscence and other complications.Conclusions Double flag-shaped flap of the upper lip at the nostrils bottom is a simple and good effective method to correct the shortened middle part of upper lip deformity of post burn.
ABSTRACT
Objective To investigate the approach and clinical efficacy of second repair surgery according to the nose and mouth contour design of unilateral cleft lip.Methods Based on the characteristics of anatomy,mechanics and deformity of the cleft lip,we designed a surgical incision of nasolabial contour lines with reference to the horizontal and central vertical lines and the contour.After careful investigation of classic procedures and clinical practice,unilateral cleft lip was repaired by overall stage Ⅱ surgical procedures.Results Application of this surgical method with satisfactory clinical efficacy had been achieved.Conclusions The second stage repair personalized surgical methods of unilateral cleft lip designed according to the nose and mouth contour can achieve maximal correction of malformation and beautiful appearance.
ABSTRACT
Objective To report the experience on the modified Abb? flap for correction of mild tightness of the corrected cleft lip deformity. Methods Forty-two patients with a mild or moderately tight lip deformity after primary unilateral cleft lip repair were performed a modified Abb? flap for correcting tight upper lip. The operative technique was that the pocket was creased for the vermilion tubercle by splitting the lip. The skin was incised several millimeters beyond the vermilion-skin border and was moved laterally for a distance equal to the breadth of the vermilion tubercle. The orbicularis oris muscle and the full length of the upper lip vermilion were incised. By releasing the tension, the slight concavity, expressed in profile by the slight pout which a normal upper lip had in cross section, was obtained. The Abb? flap that was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid's bow. The flap was approximately 8 mm in width. The full length of the lower lip vermilion and the orbicularis oris muscle were incorporated. A ting portion of skin was included, which facilitated closure of the donor site, The flap, based on the labial vessels, was rotated 180?and sutured into the created defect of the upper lip. The pedicle was divided 10 days after operation. Results Forty-two patients all showed an obvious Cupid's bow, Cupid's bow peak, the median tubercle and the height and width of the upper lip. The scarring of the base of the nose was not obvious. Conclusion Use of modified Abb? flap to reconstruct the contour of the upper lip is successful in patients with cleft lip.
ABSTRACT
The tissue deficiency in the upper lip after cleft lip repair produces a tight lip, and an Abbe flap procedure is indicated. In order to increase the mobility of the pedicle and decrease the distortion of the lips at transfer, a procedure has been developed in which the pedicle is cut all around soft tissue leaving only a inferior labial artery. Therefore, the Abbe flap which is an arterial flap has been converted to an island flap. The authors performed 15 cases(14 men and 1 woman) of the correction of a tight lip in cleft lip deformities between 1986 and 2000. The patient ranged in age from 18 years to 33 years at the time of surgery, with a mean age of 24.4 years. From 1 to 14 years(mean, 9.7 years) postoperatively, the patients were evaluated by the photogrammetric analysis using preoperative and postoperative photograph, and the ordinary scale method. By the photogrammetric analysis, the upper vermilion contour index and the lip protrusion index were measured. The upper vermilion contour index is the percentage of the surface distance of the upper vermilion ridge to the mouth width. The lip protrusion index is the percentage of the labiale superius-tragion to the labiale inferius-tragion. One represented the correction of the horizontal deficiency in the upper lip, and the other showed the protrusion of the upper lip in relation th the lower lip. By the ordinary scale method, "excellent" aesthetic results were noted. In conclusion, the Abbe island flap provides maximal flexibility without reducing its viability and an accurate adaptation in the defect of the upper lip can be made. The upper vermilion contour index and the lip protrusion index represent objectively the effects of the Abbe island flap.