La vertical verdadera al punto A´(blando), al Pg´(blando), al Labrale superior y al Labrale inferior en posición ideal asistida de la cabeza (PIAC) / The true vertical from point A´(soft), to Pg´ (soft), to superior Labrale and inferior Labrale in Ideal Assisted Head Position (PIAC)

El 81,3% de una encuesta realizada a 96 ortodoncistas y ortopedistas calificados y técnicos radiólogos consultados informan que ubican la cabeza del paciente en una posición ideal, subjetiva del profesional instruido que lo asiste, ya que muchas de sus fotografías y telerradiografías no son posiciones naturales de la cabeza genuinas. Se ha utilizado la vertical verdadera como parámetro para mediciones, todas angulares, para definir la disposición ánteroposterior del punto A´ (de construcción) para el cuerpo del labio superior, el punto Pg´para el mentón, el Labrale superior y el Labrale inferior para el bermellón de cada labio, con la finalidad de planificar correcciones ortopédicas, ortodóncicas u ortodóncicas-quirúrgicas de acuerdo a la anomalía detectada (AU)

Application of kite subcutaneous pedicled skin flap to repair philtrum skin defects / 中华整形外科杂志

Objective@#To evaluate the clinical effect of subcutaneous pedicle skin flap for repairing skin and soft tissue defect in the philtrum area.@*Methods@#From November 2015 to July 2016, 6 patients with pigmented nevus and basal cell carcinoma were treated with regional subcutaneous pedicled flaps. The functional and aesthetical outcomes were evaluated.@*Results@#Follow-up was performed at 6-12 months postoperatively. All 6 flaps survived. The wounds healing was good, and the postoperative appearance was satisfactory.@*Conclusions@#The kite subcutaneous pedicled flap is an ideal method for repairing the skin and soft tissue defects in philtrum area, and it can produce satisfactory clinical results.

Aesthetic repair of medial upper lip defects / 中华医学美学美容杂志

Objective To explore the aesthetic results of medial upper Iip repair for skin and soft tissue defects using local flap.Methods According to the location and the size of upper lip defect,the modified rhomboid flap of 60 ° above the defect was designed to repair the wound in philtrum;the O-L flap along philtral column to vermilion border was designed to cover the wound close to the peak and lateral to philtral column.Results Twenty-one postoperative patients that underwent pigmented nevus removal (12 female,9 male;ages 16-33 years) had defects in philtrum for 10 cases and close to the peak and philtral column for 11 cases.The diameter of the defect ranged from 0.5 cm to 1.0 cm.All flaps survived primarily without any complications and follow-up was for 1 to 18 months with excellent outcomes in all cases.All patients were satisfied with contour and functions.No pigmented nevus recurrence occurred.Conclusions The flap designed according to the aesthetic principle could be used to repair medial upper lip defect of medium-sized,which not only obtains functional reconstruction,but also satisfies aesthetic results,with aesthetic subunits saved and scar concealed.

Correction of Secondary Cleft Lip Deformities by Scar Excision and Abbe Flap Coverage: Photogrammetric Analysis

PURPOSE: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. METHODS: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom- shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. RESULTS: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. CONCLUSION: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

A Case Report of Chondroid Syringoma of Philtrum

PURPOSE: Chondroid syringoma is a rare mixed tumor of the skin that was first described by Hirsch and Helwig (1961). Characteristically, it is composed of the proliferation of epithelial cells in a myxoid and chondroid matrix. Most lesions occur on the head and neck region, and their size may range from 0.5~3 cm. Since a chondroid syringoma presents similar characteristics to other masses on the head and neck region, it is significantly important to distinguish with other masses by a surgical biopsy. METHODS: A 51-year old woman presented with a painless nodular mass (0.5 x 0.5 x 0.5 cm) on the philtrum, which appeared during the previous year. The mass was treated with a laser without a surgical biopsy. However, the size of the mass showed no changes. Surgical excision under local anesthesia was performed and sent for histopathology. RESULTS: Gross examination showed a mass surrounded by a well developed capsule within the dermal layer. After complete excision without injury to the orbicularis oris muscle, the wound was covered with a local flap. The histology examination revealed numerous cuboid epithelial cells with tuboalveolar structures and keratinous cysts within a chondroid stroma. No recurrence or metastasis was observed at the follow-up visits. CONCLUSION: Chondroid syringoma is a rare mass on the face. An accurate diagnosis is essential for optimal treatment. This paper reports a case of a chondroid syringoma on the philtrum with a brief review of the relevant literature.

Cornelia de lange syndrome.

BACKGROUND: Cornelia de Lange syndrome (CDLS) is a rare multiple congenital anomaly syndrome characterized by a distinctive facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, and hirsutism. CASE: Here for the first time a case of CDLS from Iran, a 15-week-old male infant who was refereed as a case of multiple congenital anomalies. Clinical investigation showed that the child was a case of CDLS. CONCLUSION: This is the first case report with CDLS in Iran.

Secondary Correction of Wide Philtral Deformity in the Bilateral Cleft Lip

PURPOSE: Deformities after bilateral cleft lip repair usually involve the philtrum and the central upper lip, which presents as wide philtrum, wide Cupid's bow, whistling deformity and prominent prolabium. The object of this study is to introduce a simple method to correct such deformities of bilateral cleft lip, that is the redo-operation following the modified Millard's method. METHODS: We present 2 patients with secondary deformities of the philtrum and central upper lip after bilateral cleft lip repair. A simple design was used to excise the excessive skin and mucosa of the central upper lip, and the philtrum and Cupid's bow were restored to the standard average width of Korean population. RESULTS: The wide central upper lip and philtrum were successfully restored to the appropriate width(10-12mm) and shape. Also the border of the red vermilion was aligned properly resulting in a good contour of the upper lip. Both patients were satisfied with the results. CONCLUSION: In patients with wide philtral deformities, our simple method can be utilized for a satisfying result.

Philtrum Formation in Secondary Unilateral Cleft Lip and Microform Cleft Lip Using Vertical Interdigitation of the Orbicularis Oris Muscle

For patients who have undergone cleft lip surgery, the construction of the philtrum is crucial for restoring a normal appearance of the upper lip. Thirteen patients with unilateral secondary cleft lip deformity and 12 patients with microform cleft lip were treated for the creation of a philtral column between January of 1998 and October of 2002. Fifteen patients were male and 10 patients were female with an age ranges from 6 months to 43 years old. In patients with the depressed philtral column in secondary cleft lip deformity, external approach was used. The scar on the philtral column is excised and a full-thickness incision is made down to the orbicularis oris muscle and mucosa. The medial and lateral muscle flaps are exposed and split into two leaves. The two leaves of each muscle flap are sutured together to create a vertical interdigitation. Any excess skin is not excised but rather closed with 6-0 nylon. In patients with microform cleft lip, vertical interdigitation of the orbicularis oris was performed through the intraoral incision to avoid external scarring. The follow-up period ranged from 6 months to three years, with an average of 14 months. Among the 13 patients with secondary cleft lip deformity, 10 patients were satisfied with their surgical results. Two had fair results. One patient experienced a widening of the scar and no improvement in the philtral column. A possible cause for the lack of improvement in one patient was a partial disruption of the interdigitated muscle before wound healing. On the other hand, all patients with microform cleft lip were satisfied with their surgical results. In conclusion, the advantage of this procedure includes the creation of an anatomically natural philtrum through preserving the continuity and function of the muscle, sufficient augmentation of the philtral column by the vertical interdigitation of the muscle, relief of skin tension, and no donor-site morbidity. In addition, in microform cleft lip, the external visible scar was avoidable through the intraoral incision.

Configuration of Upper Lip in Newborn

Millard presented the concept of rotation advancement for unilateral cleft lip repair, and today this method of cleft lip closure is acknowledged by most as optimal in principle. However, it has been noted that this procedure occasionally can produce a scar that is symmetrical on the lower two-thirds of philtral column. The scar crosses the upper one third of the philtrum obliquely. The purpose of our study is to determine the configuration of the philtrum. 200 newborn infants were examined from June 1998 to September 1998. Mean gestational ages were 39 weeks and 5 days. Mean birth weight was 3226 gm. Multiple parameters such as philtral shape, nostril sill shape, vermilion shape, curvature of Cupid's bow, mean philtral length, mean white roll length, mean Cupid's bow length, and mean distance between both commissures were applied. An arbitrary classification of the philtrum was established to divide these infants into five groups. As a result, the parallel philtral column from nostril base to vermilion border(Type lla) was found to be the most popular type. Most common vermilion shape was protrusion type. Normal curve of Cupid's was most common. Mean values of philtral length, white roll length, Cupid's length, and distance between commissures were 8.3+/-1.1 mm, 13.9+/-1.3 mm, 5.7+/-1.0 mm, 24.7+/-2.3 mm, respectively. We believe this classification system will be useful for newborn infants evaluation and analysis, systemic planning and application of proper cleft lip repair procedure.