Application of double V-Y advancement of mucosal flap procedure for lower-lip paramedian tubercles plasty / 中华医学美学美容杂志

Objective:To prove the effect of double V-Y procedure for paramedian tubercles plasty in patients with thin lower lips and dissatisfied appearance of lower lips.Methods:From 2013 to 2019, 127 Chinese cases of thin and dissatisfied appearance of lower lips were included. A double V-Y procedure for paramedian tubercles plasty was performed. Objective data of lip morphology before and after operation were measured, and subjective satisfaction survey and long-term follow-up were conducted.Results:The midline lower red lip height, the height of paramedian tubercles of lower-lip and the protrusion of lower-lip were significantly higher than that before the operation. The time of apocatastasis, scar softening of incision, natural expression recovery and local numbness relief were evaluated by following up at 7 d, and 3-24 months after operation, and it showed 73.2% of subjective satisfaction. The time of detumescence was 6-32 (15.2±3.5) days; the time of incision scar softening was 2-10 (5.1±2.3) months; the time of expression recovery was 1-7 (3.1±0.9) months; the time of numbness disappearance was 5 d-2 years (158.2±82.6) days.Conclusions:The double V-Y advancement of vermilion mucosa flap procedure for paramedian tubercles plasty displays a significant effect in improving volume and shape of lower lips. It is recommended for further clinical application.

Managing lip large papilloma extirpation defect by arterialized advancement vermilion flap

The close resemblance of squamous papilloma with verrucous carcinoma and the chief etiological factor associated with its development, the human papillomavirus (HPV) raises a doubt about its close association with malignancy. The best way to treat HPV growths is surgical removal and assessment of lesion by histopathology. The defect needs reconstruction with full function and aesthetic outlook. Thirty-seven years old young man with history of tobacco chewing developed slow growing papilloma in upper lip in one year. It was excised fully and the defect was repaired by arterialized lip vermilion mucosal flap based on slightly tortuous labial vessel and so the flap could be elastically stretched even up to fifty percent of lip length and applied successfully. Same patient developed papilloma in lower lip as a separate primary after two years of nonrecurrence of previous operated upper lip papilloma. Lower lip lesion was excised similarly and repaired with same type of vermilion mucosal advancement flap from adjacent part of lower lip defect created. The post-operative period was uneventful and after three years of last operation there is no recurrence in either lip. Vermilion flap which is based on labial artery containing composite tissue comprising of mucosa and portion of orbicularis muscle mainly has been utilized to reconstruct the post excision papilloma lip defect with excellent functional and aesthetic results. There was no microstomia. It is single stage not involving donor site like tongue or cheek mucosa and is good upto half of lower lip defects.

Surgical correction of unilateral macrostomia with modified square vermilion flap / 中华整形外科杂志

Objective@#To evaluate the outcome of unilateral macrostomia repairment, using modified square vermilion flap for commissuroplasty and straight-line suture for buccal defect repair.@*Methods@#Forty-six patients (29 male, 17 female) with unilateral macrostomia underwent surgical interventions. All cases underwent the same surgical procedures: the commissuroplasty using modified square vermilion flap, cross-over lapping suture to reconstruct orbicularis oris muscle, and straight-line suture to repair buccal defect. Patients had the surgeries at the age of 3 months to 19 years (median age of 6.6 months). The static and dynamic facial appearance were recorded both preoperatively and postoperatively. The appearance of ipsilateral oral commissure, the symmetry of bilateral commissures, the appearance of transferred square vermilion flap, and the recovery of the buccal scar were observed.All patients were followed for more than 6 months (ranging from 6 months to 3 years, with an average of 11.5 months).@*Results@#All 46 patients healed well at stage I. The commissures of 42 cases were basically symmetrical in both horizontal and vertical directions.Forty patients had symmetrical mouth when smiling and mouth opening. The vermilion flap was transferred to the lower lip in 45 cases. Their scars were smooth, and almost invisible. However, 18 patients had different local mucosal protrusion. All the buccal wound showed straight lines, without distorting or deforming the nasofacial grooves, when smiling or mouth opening. The buccal scar of 43 cases is smooth and not obvious.@*Conclusions@#The modified square vermilion flap can effectively reconstruct commissure caused by macrostomia. A small local mucosal protrusion is very common at the site of transferred vermilion flap, which might need secondary surgical correction. The buccal wound can be closed by the straight-line suture method, without obvious scar left, and avoid asymmetrical commissures and distorted nasolabial grooves. The fine muscle reconstruction and stratified sutures are important for a good surgical outcome.

Clinical efficacy of different operative techniques for reconstruction of vermilion tubercle after primary repair of cleft lip / 中华医学美学美容杂志

Objective To evaluate the clinical repair effects of the reconstruction of different vermilion tubercle after primary cleft lip repair.Methods According to the tight lip deformity and dif ferent degrees of defect of the vermilion tubercle and exposing the gums and the crown of the anterior incisors,178 patients after primary repair of the cleft lip from Department of Oral and Maxillofacial Surgery of Xiangya Hospital,Central South University were classified into the tight lip deformity and four grades of whistling deformities.According to different deformities and defects,the different operative techniques were used as follows:classic Abbé flap and modified Abbé flap were used for tight lip deformity;the bilateral advanced myomucosal flaps of lip were used for the grade Ⅰ;modified Abbé flap was used for repairing the grade Ⅱ and the grade Ⅲ whistling deformities;for grade Ⅳ whistling deformity,we mainly used classic Abbé flap.The follow-up after operation was performed,all patient's Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip were observed.The scarring of the upper lip was also observed.Results The follow-up after operation was performed from six months to ninteen years,all the 187 patient's anatomical structures of the upper lip were nearly normal after recovery.The all patients showed an obvious Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip.The relation of the upper lip and lower lip was harmonious.The scarring of the upper lip was not obvious 2 years after operation.Conclusions The different repair methods are chosen to repair different deformity and defect that has an important clinical value.

Clinical aesthetic effect of vermilion repair on cleft lips after using double-line reconstruction / 中华医学美学美容杂志

Objective To discuss the clinical aesthetic effect of vermilion repair on cleft lips after using double-line reconstruction.Methods 68 children with cleft lip were repaired according to the principle of double-line reconstruction,and two contents including 7 projects,such as shapes of upper lips,vermilion borders of lips,vermilion shapes and lips,etc,were evaluated comprehensively within one month after operation for assessing the postoperative effect.Results 68 cases were followed up,with the follow-up rate of 100％,and 62 cases (91.2％) were satisfied with the vermilion repair.Six cases (8.8％) had a common effect of vermilion shapes after repair.In the 7 contents evaluated,satisfactory results were achieved in the projects except the relatively poor symmetry vermilion borders of lips.Conclusions The double-line reconstruction helps to improve the aesthetic effect of vermilion repair on cleft lips.

Reconstruction of unilateral cleft lip with vermilion musculomucosal flap: a clinical study / 中华医学美学美容杂志

Objective To design a new vermilion musculomucosal flap to reconstruct the normal appearance of unilateral cleft lip,and to analyze the clinical effects.Methods All patients were repaired with Millard method,and vermilion musculomucosal flap was formed with fixed point method to repair vermilion.Normal function and morphology were recovered by reconstructing lip beads and forming a peak of cupid's bow.Results 78 cases were enrolled in this study.They were followed-up for 6 to 36 months after operation.Except for 6 cases of nasal deformity and 5 mild lift of vermilion of affected side,67 cases obtained satisfied nasolabial form and function,with full decline and symmetry of cupid's bow peak,and well form of nasolabial fold,and natural transition of vermilion,and significance of lip beads,and inconspicuous scars.Conclusions Appling vermilion musculomucosal flap for reconstructing vermilion of unilateral cleft lip has good effect,and it is simple and feasible.It can be a regular surgery method,and is worthy of clinical promotion.

Application of bilateral lip mucosa flaps for central defect reconstruction of upper-lip vermilion / 中华医学美学美容杂志

Objective To investigate the value of the new method with bilateral lip mueosa flaps for central defect reconstruction of upper-lip vermilion. Methods On both sides of the central defect of upper lip vermilion, reverse triangular flaps was designed below the junction between vermilion and mucosal. These two flaps had the common pedicle of vermilion depression site. Incisions of "(λ)" shape were de-signed below the defect area and the flaps included mucosa and submucous tissue. This mueosa flaps were raised and orbicularis otis muscles under the flaps were free moderately. Bilateral orbicularis oris muscles were sutured under the common pedicle of the two mucosa flaps. Then the bilateral mucosa flaps were ro-tated down 90° and inserted into the " (λ)" shape incisions to increase the tissue volume of the middle upper lip and deepen the labiogingival sulcus. The common pediele of the bilateral mucosa flaps was formed to the vermilion tubercle and then the incisions were sutured layer by layer. Results The technique was per-formed on 26 patients including 18 cases of upper-lip vermilion defect after repair of bilateral cleft lip,4 ca-ses of upper-lip vermilion defect after repair of unilateral cleft lip and 4 cases of congenital malformation. All the lip mucosa flaps survived completely without any complications. The vermilion, tubercle and shape of the lips were satisfactory after all cases were repaired and all incision scars were concealed. Con-clusions Using the lip mucosa flaps transfer to repair vermilion defect with the same tissue can obtain satisfactory appearance. The lip mucosa flaps are ideal for repairing of the lip vermilion defect and recove-ring of the profile of labial arch and vermilion tubercle. It can be used widely in any cases with the central defect of upper lip vermilion.

The frontal characteristics of esthetic lips and lips after anterior segmental osteotomy in Korean females / 대한치과교정학회지

OBJECTIVE: The aim of this study was to determine firstly the characteristics of esthetic lips in Korean females and secondly to measure the changes of the lips before and after anterior segmental osteotomy in bimaxillary protruded patients. METHODS: Samples consisted of 30 models and 26 nonmodels, and 10 patients who had received anterior segmental osteotomy. Twelve linear measurements, 5 angular measurements, and the lip perimeter and area were measured. These results were compared for each group using unpaired and paired t-tests. RESULTS: Full face width, nose to chin, upper vermilion height and angle, lateral heights at the point of the tips of Cupid's bow, central bow angle, and the lower lip to chin lengths were significantly greater in nonmodels than in models. However, overall lip width, lower vermilion height and angle, tip-to-tip of Cupid's bow lip perimeter, and lower vermilion area were greater in models than in nonmodels. Comparison of before and after anterior segmental osteotomy revealed that the values for the upper vermilion and lateral heights, the angle to Cupid's bow tip lengths, and upper vermilion area of post-operative patients had become similar to those of Korean female models. Our findings demonstrated that Korean female models have a fuller lower vermilion & thinner upper vermilion compared with nonmodel controls, as determined by the vermilion heights, angles, and areas. CONCLUSIONS: It will be helpful for clinicians to use these measurements as guidelines for improving patients' facial esthetics.

Vermilion Reconstruction with Mucosal Island Flap

The purpose of this article is to review the method using the mucosal island flap for the reconstruction of upper and lower lip defect and introduce its versatile applications and advantages. This flap is based on the inferior labial artery as the axial pedicle and is composed of musosa only, excluding muscle to give a sufficient rotation arc of the flap. Mucosal island flap is effective for the reconstruction of vermilion, because the mucosa of the flap is similar to the lip, with its color and texture matched well. Four patients with various large defects of vermilion underwent the reconstruction with mucosal island flaps. Two patients were presented with venous malformations and others were admitted with lip deformities caused by traffic accident or operation for basal cell carcinoma. Elevation of flap is simple and safe in maintenance with the interdental wire fixation to prevent the pedicle from being stretched and, primary closure is available in donor site under local anesthesia. Therefore, mucosal island flap can be recommended as an effective and reliable method for the reconstruction of over one-third defect of vermilion.

Vermilion Augmentation of Secondary Cleft Lip and Nose Deformity by AlloDerm(R)

Secondary deformities can exist after repair of cleft lip by sophisticated method of primary cheiloplasty and can affect some or all of the previously cleft regions. There may be lip scar, nasal deformity, vermilion deficiency, and maxillary hypoplasia. The correction of secondary cleft deformities is difficult and requires efforts of a multidisciplinary team. There are many operative techniques for correction of the vermilion deficiency, for example double V-Y advancement mucosal flap or double pendulum flap etc. But, these methods are very complex and can remained the scar on vermilion. Twenty six patients of secondary cleft lip and nose deformity with vermilion deficiency were operated in our department from January 1999 to June 2002. The secondary cleft lip and nose deformity was corrected by various operative methods, and the vermilion deficiency corrected by using acellular human dermis(AlloDerm(R), Life Cell Corp., Woodlands, Texas). The three cases suspected for AlloDerm(R) to be absorbed showed that the augmentation of vermilion was poor but another cases showed satisfactory result with good augmentation of vermilion and minimal scar. In conclusion, vermilion augmentation using AlloDerm(R) has the several advantages such as simplicity, shorter operation time, and effectiveness compared with other surgical methods.

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.