Evaluación cefalométrica y electromiográfica de niños y niñas con incompetencia labial y anomalías dentomaxilares

Objetivo: Describir las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y el patrón de actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos de individuos incompetentes labiales y con presencia de anomalías dentomaxilares de 7 a 12 años de edad. Materiales y método: Cuarenta y seis participantes con incompetencia labial fueron sometidos a una toma de radiografía lateral de perfil para el análisis cefalométrico. Para el estudio electromiográfico se consideró el patrón de actividad de los músculos Orbicular superior de los labios, orbicular inferior de los labios y temporal anterior en funciones: reposo, fonoarticulación, deglución, máximo apriete labial. Resultados: Se observó clase II esqueletal y molar, retrusión mandibular, biprotrusión incisal, biprotrusión labial, disminución de vía aérea superior. La mayor actividad muscular fue observada en máximo apriete labial. Conclusión: Los niños y niñas con incompetencia labial y anomalías dentomaxilares presentan alteraciones en las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos.

Objective: To describe craniofacial, dentoalveolar, soft issue and airway features, and the muscular activity, determined through a cephalometric and electromyographic study in individuals with lip incompetence and dentomaxillary anomalies aged 7 to 12 years. Methods: Forty-six participants with lip incompetence underwent lateral profile radiography for cephalometric analysis. For the electromyographic study, the activity of the superior orbicularis oris, inferior orbicularis oris and anterior temporalis muscles was considered in the following functions: rest, speaking, swallowing, and reciprocal compression of the lips. Results: Skeletal and molar class II, mandibular retrusion, labial biprotrusion, incisal biprotrusion, and upper airway dysfunction were found. The highest muscular activity was observed in reciprocal compression of the lips. Conclusion: Children with lip incompetence and dentomaxillary anomalies have alterations in the craniofacial, dentoalveolar, soft issue, and airway features, and in the muscular activity , determined through a cephalometric and electromyographic study.

Blefaroplastia inferior transcutánea con fijación muscular orbicular externa en pacientes con deformidades del párpado inferior / Transcutaneous lower blepharoplasty with external orbicularis oculi muscle fixation in patients with lower eyelid deformities

Objetivo: Describir el resultado de la técnica de fijación muscular orbicular externa en la Blefaroplastia inferior. Método: Se realizó una investigación descriptiva, prospectiva en pacientes que asistieron a la consulta de Cirugía Plástica del Hospital "Camilo Cienfuegos" entre enero 2018 a enero 2019, la muestra estuvo constituida por 43 pacientes. Para diagnosticarlos se utilizó la clasificación de Ginsbach, con criterios de exclusión el hábito de fumar. Se tuvo en cuenta variables como edad, sexo, deformidad palpebral inferior, complicaciones en el post operatorio a las 24 h y a los 30 días, y grado de satisfacción de los pacientes intervenidos. Se utilizaron métodos de revisión documental, observación, análisis y síntesis y empírico (encuesta), utilizadas para evaluar los resultados. La investigación se realizó siguiendo procedimientos éticos. Resultados: Mostraron que la mayor cantidad de pacientes estuvo en el grupo edad entre 46-50 años todos femeninos, el exceso de piel y las patas de gallina fueron las deformidades que predominaron. La complicación que se presentó fue el sangramiento posoperatorio resuelto en las primeras horas, 42 pacientes refirieron estar satisfechos. Conclusiones: La blefaroplastia es una técnica que se ha venido modificando junto a la necesidad de brindar procedimientos que ofrezcan seguridad y efectividad, en cuanto a la corrección de deformidades en el parpado inferior, con un adecuado tiempo de recuperación, resultados con menor riesgo de complicaciones(AU)

Objective: To describe the outcome of the external orbicularis oris muscle fixation technique in lower blepharoplasty. Methods: A descriptive, prospective research was conducted in patients who attended the Plastic Surgery consultation of the Hospital "Camilo Cienfuegos" from January 2018 to January 2019, the sample consisted of 43 patients. In order to diagnose them, the Ginsbach classification was used, with smoking as exclusion criteria. Variables such as age, gender, lower palpebral deformity, postoperative complications at 24 h and 30 days, and degree of satisfaction of the operated patients were taken into account. Documentary review, observation, analysis and synthesis and empirical (survey) methods were used to evaluate the results. The research was carried out following ethical procedures. Results: They showed that the greatest number of patients was in the age group between 46-50 years old, all of them female; excess skin and goose bumps were the predominant deformities. The complication that occurred was postoperative bleeding resolved in the first hours, 42 patients reported to be satisfied. Conclusions: Blepharoplasty is a technique that has been modified along with the need to provide procedures that offer safety and effectiveness, in terms of correction of deformities in the lower eyelid, with adequate recovery time, results with lower risk of complications(AU)

A Systematic Review of the Role of Mitochondria in Cleft Pathology: A Forgotten General?

ABSTRACT@#Orofacial clefts (OFC) are one of the most common birth defects that affects the lip, palate, or lip and palate of an infant. The deterioration of clefts is multifactorial involving multiple genes, various interactions from environmental factor and most forgotten, mitochondrial abnormality. The aim of this review is to highlight the importance of mitochondrial activity related to non-syndromic OFC deformity. Despite its important role in cells, the study on mitochondrial activity in cleft pathology was scarce and almost forgotten compared to other genetic investigations. This systematic review was completed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The literature search was done via the following databases: Google Scholar, Pubmed and Scopus with a total of nine studies of mitochondrial abnormalities were included. We hypothesise that mitochondria play an important role in early craniofacial development. A decreased in its function or activity may result in cleft lip formation. Hence, we would like to shed light on the remarkable role of mitochondria activity in the pathogenesis of non-syndromic OFC.

Study on the method of microelectrodes implantation of artificial facial nerve prosthesis in closed mouth of orbicularis oris muscle in monkeys with facial nerve paralysis / 中华口腔医学杂志

Objective@#To explore the optimal method of microelectrode implantation that can produce efficient mouth closure with microelectrode for orbicularis oris muscle (OOM) in rhesus monkeys with unilateral peripheral facial paralysis (UPFP) in order to provide basis for the research and development of artificial facial nerve prosthesis (AFNP).@*Methods@#Right lateral peripheral facial paralysis model on four healthy rhesus monkeys (two males and two femles, aged 5-6 years, weighed 2.0-3.0 kg) were prepared. AFNP electric stimulation was used to induce closed-mouth reaction of the affected OOM with a one-way rectangular pulse, 50 Hz frequency and 0.2 ms pulse width in vitro. Around the affected lateral OOM, four stimulus electrodes implantation positions were selected at the upper lip (position A), the lower lip (position B), the connection with the corner of the mouth to the ipsilateral tragus (position C), and the horizontal line of the mouth angle (position D). According to the different implantation positions of three stimulation electrodes on the stimulation side of AFNP and the results of our previous study, six groups of microelectrode implantation methods were designed. In Group A, two microelectrodes were implanted at position A and one microelectrode was implanted at position B; in Group B, one microelectrode was implanted at position A, B and C respectively; in Group C, one microelectrode was implanted at position A and two microelectrodes were implanted at position B; in Group D, one microelectrode was implanted at position A, B and D respectively; in Group E, one microelectrode was implanted at position A, C and D respectively; in Group F, one microelectrode was implanted at position B, C and D respectively. The minimum stimulating current (threshold current) required for effective mouth closure were recorded. The threshold and peak current values were compared using one-way ANOVA and LSD-t multiple comparisons.@*Results@#The microelectrodes of the AFNP stimulating side in Group E and F failed to induce a smooth mouth closure. The microelectrodes in A, B, C and D group induced smooth mouth closure. The threshold current value of OOM contraction on affected side in the Group A, B, C, and D were (1.35±0.05), (1.02±0.04), (1.40±0.04) and (1.10±0.02) mA, respectively (F=295.302, P<0.001), with the lowest value in Group B and there was significant difference between the current value in Group B and those in the other groups (all P<0.05). The peak current value of OOM contraction on affected side in the four groups were (3.95±0.02), (2.95±0.03), (3.99±0.05) and (3.51±0.01) mA, respectively (F=1 014.985, P<0.001). Group B showed the best lip-closure morphology observed with naked eyes.@*Conclusions@#When three output microelectrode of the AFNP stimulated side are separately imbedded into the upper lip, the lower lip and the connection with the corner of the mouth to the ipsilateral tragus, AFNP can sufficiently induce closed-mouth reaction. These positions are suitable as priority options microelectrodes implantation positions for the microelectrodes of the AFNP stimulated side.

Importance of various skin sutures in cheiloplasty of cleft lip

Last week, after our receiving online journal regarding Journal of the Korean Association of Oral and Maxillofacial Surgeons, we found a recently published original article by Alawode et al., entitled “A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures”. Although this clinical article was well written and provided a great deal of information regarding the suture materials in the cleft lip repair, I would like to add a few additional comments based on the importance of skin suture during cheiloplasties in the primary cleft lip or secondary revision patients with representative figures.

Application of a modified M-shaped flap in defect repair after resection of lower lip cancer / 口腔疾病防治

Objective@# To observe the clinical effect of the modified M-shaped flap for repairing defects following resection of lower lip cancer and to provide a reference for clinical application.@*Methods @#Fourteen cases using modified M-shaped flaps to repair lower lip cancer surgery defects were retrospectively analyzed. The postoperative follow-up patients’ flap survival, mouth opening, denture use, bilateral mouth angle symmetry, recurrence and survival were analyzed.@*Results @#Fourteen patients with lower lip cancer underwent reconstruction immediately after surgery, and the defect range after tumor resection was 30% to 50% of the lower lip. The continuity of the orbicularis oculi muscle is reconstructed by modified M-shaped flap to transfer bilateral residual lip tissue. The blood supply to the flap is stable. All patients’ flaps survived completely without complications, such as hemorrhage, infection or flap necrosis, and their lip movement and sensation recovered well. There were no obvious obstacles in opening and closing or pronunciation and dietary function, and the mean maximum opening was (3.06 ± 0.23) cm. Three patients used active dentures, which could be removed normally. All patients’mouths were preserved. Approximately 85.7% of patients (12/14) had bilateral symmetry of the bilateral mouth, the flaps matched the facial color, and the lower lip was naturally beautiful, as the scar was not obvious. After 6 months to 4 years of follow-up (mean 2 years and 6 months), no recurrence or death occurred.@*Conclusion @#The modified M-shaped valve design is simple and easy to operate. This method can be applied to 30% to 50% defect reconstructions of the lower lip to retain the corner of the mouth.

Cleft lip secondary repair: evaluation and description of the method of orbicularis oris three uints / 中华医学美学美容杂志

Objective Secondary deformities are common in people born with unilateral cleft lip and palate.In recent years,more and more attempts and efforts have been directed toward the restoration of normal muscle anatomy.The authors present a new method of orbicularis oris repair in secondary cleft lip repair.Methods From July 2009 to December 2011,24 patients underwent this procedure in the authors' department.Muscle reconstruction was divided into three units that dealed with the nasal base,white lip and red lip.Common anatomic pathologies including the displacement of upper lip,flared ala,blunted ala-facial groove,depressed nasal floor,lateral bulge,lack of philtrum column,free border deficiency and unapparent vermilion tubercle were corrected in a single operation.Results The average follow-up period was 16.79±6.23 months.No major complications occurred.All the patients were satisfied with their nasolabial appearance.Conclusions "Three-unit" muscle repair has found to be effective and practical in secondary repair.Favorable results demonstrate that improved aesthetic and functional results can be achieved with this comprehensive procedure.

Modified Fisher method for unilateral cleft lip-report of cases / 대한악안면성형재건외과학회지

BACKGROUND: Rehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisher introduced an innovative method, named “an anatomical subunit approximation technique” in unilateral cleft lip repair. According to this method, circumferential incision along the columella on cleft side of the medial flap is continued to the planned top of the Cupid's bow in straight manner, which runs parallel to the unaffected philtral ridge. Usually, small inlet incision is needed to lengthen the medial flap. On lateral flap, small triangle just above the cutaneous roll is used to prevent unesthetic shortening of upper lip. This allows better continuity of the Cupid’s bow and ideal distribution of tension. CASE PRESENTATION: As a modification to original method, orbicularis oris muscle overlapping suture is applied to make the elevated philtral ridge. Concomitant primary rhinoplasty also results in good esthetic outcome with symmetric nostrils and correction of alar web. As satisfactory results were obtained in three incomplete and one complete unilateral cleft lip patients, indicating Fisher’s method can be useful in cleft lip surgery with functional and esthetic outcome. CONCLUSIONS: Clinically applied Fisher's method in unilateral cleft lip patients proved the effectiveness in improving the esthetic results with good symmetry. This method also applied with primary rhinoplasty.

Análise eletromiográfica do músculo orbicular da boca em jovens com Classe II, 1ª divisão, e jovens com oclusão normal / Electromyographic analysis of the orbicularis oris muscle in youngsters with Class II, Division 1 and normal occlusion

OBJETIVO: comparar, eletromiograficamente, os potenciais de ação do músculo orbicular da boca, segmentos superior e inferior, bilateralmente, em jovens com Classe II, 1ª divisão, e em jovens com oclusão normal, verificando a ocorrência ou não de diferenças na atividade eletromiográfica entre os grupos. MÉTODOS: a amostra consistiu-se de 50 jovens do sexo feminino, com idades entre 8 e 10 anos, com ausência de tratamento ortodôntico prévio, distribuídas em dois grupos: 25 com Classe II, 1ª divisão; e 25 com oclusão normal. Para a captação dos sinais eletromiográficos, utilizaram-se eletrodos de superfície passivos de Ag/AgCl. Registrou-se a atividade muscular na situação de repouso, na contração isométrica e na contração isotônica, determinando-se o valor da RMS de cada movimento. Submeteu-se os dados coletados à análise estatística de variância e ao teste de Tukey (α=0,05). RESULTADOS: os resultados revelaram que ocorreram diferenças nas atividades eletromiográficas entre as jovens com Classe II, 1ª divisão, e as com oclusão normal. As atividades musculares mostraram-se maiores nas jovens com Classe II, 1ª divisão. CONCLUSÃO: observou-se uma menor competência do músculo orbicular da boca nas jovens do sexo feminino com Classe II, 1ª divisão.

AIM: The purpose of this study was to make an electromyographic comparison of the action potentials of the upper and lower segments of the orbicularis oris muscle, bilaterally, in youngsters with Class II, Division 1 malocclusion and youngsters with normal occlusion in order to verify whether or not there is a difference between the two groups with regard to the electromyographic activity that occurs.METHODS: The sample consisted of 50 girls, in the age-range from 8 to 10 years, with no previous orthodontic treatment, divided into two groups: 25 with Class II, Division 1 malocclusion and 25 with normal occlusion. Electromyographic signals of the orbicularis oris muscle were acquired using Ag/AgCl surface electrodes. Muscle activity was recorded in the resting position, in the isometric contraction and in the isotonic contraction and the Root Mean Square (RMS) values of each movement were determined. The data collected were submitted to statistical analyses of variance and Tukey test (α=0.05).RESULTS: The results showed that there was a difference in electromyographic activity between the young girls with Class II, Division 1 malocclusion and those with normal occlusion. Muscle activity was higher in the girls with malocclusion than in those with normal occlusion.CONCLUSION: This suggests lower competence of the orbicularis oris muscle in the girls with Class II, Division 1 malocclusion.

Reconstruction of Philtral Column with Overlapping of Orbicularis Oris Muscle Flap in Secondary Cleft Lip Nose Deformity

PURPOSE: Philtral deformity is a stigma of secondary cleft lip nose. It occurs from the false arrangement of orbicularis oris muscle and the scar of previous operation. Various methods have been used to correct this deformity. We successfully corrected philtral deformity using overlapping of orbicularis oris muscle flap. METHODS: From November 2000 to August 2007, we performed 39 cases of correction of philtral deformity in secondary cleft lip nose with overlapping of orbicularis oris muscle flap. Their age ranged from 5 to 53 years old. Existing scar tissue of previous operation was deepithelialized and preserved as scar flap. Lateral orbicularis oris muscle flap was elevated, advanced and overlapped upon medial muscle flap after dissection of orbicularis oris muscle of both sides. Reconstruction of philtral column was made from overlapping area by fixation of end part of lateral muscle flap to the point between philtral dimple and column. The degree of muscle flap advancement was decided by correction state of lateral muscle bulging. Correction of nostril floor depression or whistle deformity was also performed with preserved scar flap, if necessary. RESULTS: Realignments of orbicularis oris muscle were possible in the majority of the patients and final results of philtral reconstruction were satisfactory mostly. Correction of nostril floor depression and whistle deformity was also achieved. Additional correction was performed later to 4 patients in whom insufficient reconstruction was noted. No significant complication was observed. CONCLUSION: More natural and symmetric philtrum was acquired with overlapping of orbicularis oris muscle flap. To the authors' knowledge, it is an easy and effective method for correction of philtral deformity through anatomical rearrangement of distorted orbicularis oris muscle with relatively simple procedure.

Anatomical reconstructiion of orbicularis oris muscle in the repair of cleft lip / 实用口腔医学杂志

objective: To design a new technique which might be used to reconstruct the orbicularis oris muscle effectively. Methods: The superficial and deep layers of orbicularis oris muscle on the lateral side of the cleft were dissected and sutured to the correspondent layers on the medial side respectively. A small muscle flap from the medial nasal labial bundle below the columella was rotated laterally and sutured with the nasal bundle on the lateral side in 10 cases of cleft lip. Results: Satisfactory results were obtained in all the cases. The postoperative scar was minimal. The lip appearance was satisfactory at rest as well as in motion. Conclusion: This technique is effective in reconstruction the orbicularis oris muscle of cleft lip.