A Technique for Preoperative Identification of the Facial Nerve Mandibular Branch Using a Nerve Stimulator.

We established the method of preoperative identification to facial nerve marginal mandibular branch (FNMB) identification using a nerve stimulator with bipolar probe for upper-neck surgery. The bipolar electrode is placed on the region while patients were awake; the patient should be in the same position and posture as during the surgery, with the neck skin stretched. A nerve course is confirmed by observing the movement of the lower lip. In this study, 5 upper-neck surgeries were conducted. Preoperative analysis revealed that 4 of the 5 cases had 2 branches of FNMB, and 1 with 3 branches. All FNMB immediately confirmed preoperatively were identified during surgery. We performed this method in much surgery including the surgery of the upper neck. It was easy to identify the facial nerve by this method and came to be able to do it precisely, and an operative time was shortened. We concluded that the preoperative FNMB identification using a nerve stimulator is most useful and benefit for upper-neck surgery patients and lead to avoid lower lip paralysis.

3-D based minimally invasive one-stage lateral sinus elevation - a prospective randomized clinical pilot study with blinded assessment of postoperative visible facial soft tissue volume changes.

OBJECTIVE: The purpose of this prospective and randomized clinical study was to assess differences in patient morbidity between minimally invasive lateral sinus elevation (study group, n = 14) and conventional one-stage lateral sinus elevation (control group, n = 12). It was hypothesized that trauma to soft tissue was reduced in the study group. MATERIALS AND METHODS: Optical 3-D imaging was assessed blinded on days 1 and 7 after surgery to determine the visible soft tissue swelling of the upper lip and cheeks. Postoperative pain and discomfort were evaluated by a visual analogue scale (VAS; scale 0-10). RESULTS: Immediately and on day 1 after surgery, the study group patients rated pain and discomfort as 2.4 [SD 1.7] and 3.1 [SD 2.1], respectively, on the VAS; while, the controls rated 4 [SD 1.6] and 5.6 [SD 1.7], respectively. The mean facial soft tissue volume change, assessed on day 1 after surgery, was 5.0 cm(3) [range: 0.2-9.2] for the study group and 15.5 cm(3) (9.3-21.55) for the controls (p = 0.00). CONCLUSIONS: Despite the small number of patients in this prospective study, 3-D based minimally invasive one-stage lateral sinus elevation resulted in favourable patient morbidity with less postoperative visible facial soft tissue volume changes.

Effect of infrared laser in the prevention and treatment of paresthesia in orthognathic surgery.

Orthognathic surgery is the surgical procedure that makes correcting deformities of the bones in the region of the maxilla and mandible a reality in the Brazilian dentistry. However, this type of surgery usually involves paresthesia in the postoperative period, concerning the surgeons who perform them and generating discomfort to patients. This study aimed at evaluating the effect of infrared laser (830 nm) in the prevention and treatment of paresthesias after orthognathic surgery. Six patients underwent orthognathic surgery: the experimental group composed of 4 patients and the control group that did not receive laser therapy composed of 2 patients. The experimental group received laser applications during the transoperative and 12 postoperative sessions. Tests for mechanical (deep and shallow) and thermal (cold) sensitivity were performed in the preoperative and postoperative period (during 12 sessions) in the lip and chin areas by the same operator. The paresthesia was classified into 1, strong; 2, moderate; 3, mild; and 4, absent, through the patient's response to stimuli. The results showed that all patients had no disturbance of sensitivity in the preoperative period, but paresthesia was presented at various levels in the postoperative period. Both groups showed recovery of deep mechanical sensitivity within a shorter time interval compared with the superficial mechanical and thermal sensitivity. However, at the 12th assessment, patients who underwent the laser therapy showed better reduction in the level of paresthesia or even complete regression of this. The laser, therefore, brought benefits to the treatment of paresthesia, accelerating the return of neurosensorial sensitivity.

Advances in local anesthesia in dentistry.

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

[Labial sequels after uni- and bilateral cleft lip repair]. / Les séquelles labiales dans les fentes uni- et bilatérales.

Children born with labial-alveolar-velopalatine clefts must be managed by multidisciplinary teams in order to decrease the frequency and the importance of sequels, by implementing a true therapeutic strategy. It is indeed easier to avoid a secondary deformation than to correct it. Labial sequels are often associated to nasal sequels, and are managed in a single surgical intervention, with total revision of the cheilorhinoplasty. Some less important labial deformities can be corrected without total and simultaneous revision of the lip-nose complex. The goal of correction is functional and aesthetic, and the choice of the moment depends mainly on the psychological impact of the deformation for the child, and his motivation for reoperation.

A complication of primary herpetic gingivostomatitis.

A complication of primary herpetic gingivostomatitis and its treatment is described in a 7-year-old child. A reminder to recommend lip barrier creams is advised to prevent this complication pain and bleeding when the lips are separated following adhesion.

Effectiveness of small-volume, intralesional, delayed-release triamcinolone injections in orofacial granulomatosis: a pilot study.

BACKGROUND: Orofacial granulomatosis (OFG) is an idiopathic disorder characterized by chronic orofacial swellings causing significant cosmetic and functional problems. Treatment with high-volume triamcinolone injections has been shown to be effective but requires nerve block anesthesia and causes a dramatic temporary increase of lip swelling. OBJECTIVE: We have performed a noncomparative open-label pilot study in 7 patients with OFG in order to evaluate the effectiveness of small volumes of extended-release high-concentrate triamcinolone injections in reducing lip swelling and preventing recurrences. METHODS: Seven patients with OFG were studied. Small-volume, intralesional, high-concentrate, extended-release triamcinolone was injected on the basis of a weekly schedule. A standard cycle consisted of 2 or 3 injection sessions over 14 or 21 days, depending on the clinical response. RESULTS: After cycle completion, all patients remained without recurrences or with cosmetically acceptable slight lip enlargement for a mean time of 19 months (range, 8-30 months). No side effects were observed, except in one patient with hypopigmentation of the skin of the upper lip. CONCLUSIONS: Slow-volume, intralesional, high-concentrate, extended-release triamcinolone injections appear to be effective in reducing lip enlargement in patients with OFG and do not require nerve block anesthesia or cause a temporary troublesome increase of swelling. A long disease-free period is generally obtained.

Hereditary angioedema: a case report and literature review.

Hereditary angioedema is an autosomal dominant condition with a typical presentation of diffuse edematous, painless, and nonpitting swelling of the soft tissues. The disease manifests itself primarily in the extremities, face, airway, and abdominal viscera. Proper diagnosis and treatment are essential as this condition has the capacity of becoming life-threatening due to potential airway embarrassment. This case report demonstrates the complexity of diagnosing and treating hereditary angioedema. Hereditary angioedema often is overlooked on a differential diagnosis of patients suffering from diffuse swelling and/or abdominal discomfort. Nonetheless, the diagnosis of hereditary angioedema should be included when assessing patients who display the proper symptomology and familial history of the condition.

Las comisuras labiales como asiento de procesos patológicos / The corners of the mouth as a site for pathology

Las comisuras de los labios son los dos repliegues cutáneomucosos situados a cada lado de la abertura bucal. Están recubiertos de piel por la parte extraoral y de mucosa por la intraroral, sin que apenas exista bermellón entre ellas. Este paso abrupto de zona mucosa húmeda a zona cutánea seca favorece que ciertas situaciones, como la pérdida de dimensión vertical de los dientes, las arrugas y los hábitos de lameteo conviertan' las regiones comisurales o angulares en áreas intertriginosas, asiento de patología diversa, sobre todo infecciosa. Dado que esta patología se cronifica con frecuencia, predisponiendo al desarrollo de lesiones que pueden evolucionar des favorablemente, nos parece interesante prestarle una atención especial, sobre todo en aras de su prevención (AU)

Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren's syndrome?

OBJECTIVES: Prospectively collected computer database information was previously assessed on a cohort of 300 patients who fulfilled the Copenhagen classification criteria for primary Sjögren's syndrome. Analysis of the clinical data showed that patients who smoked had a decreased lower lip salivary gland focus score (p<0.05). The aim of this original report is to describe the tobacco habits in patients with primary Sjögren's syndrome or stomatitis sicca only and to determine if there is a correlation between smoking habits and focus score in lower lip biopsies as well as ciculating autoantibodies and IgG. METHODS: All living patients with primary Sjögren's syndrome or stomatitis sicca only, who were still in contact with the Sjögren's Syndrome Research Centre were asked to fill in a detailed questionnaire concerning present and past smoking habits, which was compared with smoking habits in a sex and age matched control group (n=3700) from the general population. In addition, the patients previous lower lip biopsies were blindly re-evaluated and divided by the presence of focus score (focus score = number of lymphocyte foci per 4 mm(2) glandular tissue) into those being normal (focus score 1). Furthermore the cohort was divided into three groups; 10-45, 46-60 and >/= 61 years of age. Finally the focus score was related to the smoking habits. Seroimmunological (ANA; anti-SSA/Ro antibodies; anti-SSB/La antibodies; IgM-RF and IgG) samples were analysed routinely. RESULTS: The questionnaire was answered by 98% (n=355) of the cohort and the percentage of current smokers, former smokers and historical non-smokers at the time of lower lip biopsy was not statistically different from that of the control group. Cigarette smoking at the time of lower lip biopsy is associated with lower risk of abnormal focus score (p<0.001; odds ratio 0.29, 95%CI 0.16 to 0.50). The odds ratio for having focal sialadenitis (focus score > 1) compared with having a non-focal sialadenitis or normal biopsy (focus score /= 61: odds ratio 0.36, 95%CI 0.10 to 1.43) although there was only statistical significance in the two younger age groups. Moreover, among current smokers at the time of the lower lip biopsy there was a decreasing odds ratio for an abnormal lip focus score with increasing number of cigarettes smoked per week (p trend 0.00). In the group of former smokers, which included patients that had stopped smoking up to 30 years ago, the results were in between those of the smokers and the historical non-smokers (odds ratio 0.57, 95%CI 0.34 to 0.97, compared with never smokers). Present or past smoking did not correlate with the function of the salivary glands as judged by unstimulated whole sialometry, stimulated whole sialometry or salivary gland scintigraphy. Among former smokers, the median time lapse between the first symptom of primary Sjögren's syndrome and the performance of the lower lip biopsy was approximately half as long as the median time lapse between smoking cessation and biopsy (8 versus 15 years). Hence, symptoms of Sjögren's syndrome are unlikely to have had a significant influence on smoking habits at the time of the biopsy. Among the seroimmunological results only anti-SSA/Ro and anti-SSB/La antibodies reached statistical significance in a manner similar to the way smoking influenced the focus score in lower lip biopsies. On the other hand the level of significance was consistently more pronounced for the influence of smoking on the focus score than for the influence on anti-SSA/Ro and anti-SSB/La autoantibodies. CONCLUSION: This is believed to be the first report showing that cigarette smoking is negatively associated with focal sialadenitis-focus score >1-in lower lip biopsy in patients with primary Sjögren's syndrome. Furthermore, tobacco seems to decrea

Oral commissure expansion prosthesis.

An expansion prosthesis to stretch commissures and fibrotic muscles is often essential for patients recovering from head and neck trauma or burns. The prosthesis is easily made in one appointment using Triad resin and a 7 mm expansion screw. Depending on the frequency of use, varying degrees of opening of the jaws can be obtained. The prosthesis is inexpensive to make and can easily be modified as needed. It is convenient for use because the patient controls the pressure that is applied by the prosthesis.

Sunscreen protection for lip mucosa: a review and update.

It has been stated that the key to prevention of oral cancer is to avoid the "five Ss: smoking, spirits, spices, sepsis, and syphilis." There is certainly enough evidence to add another "S"--sunlight. Although there is a paucity of information in the dental literature on the use of sunscreens, the following dermatologic recommendation is noteworthy: "Persons with Skin Types I and II should never sunbathe and should adopt a program of daily application of effective sunscreens (SPF 15) as a habit and from an early age--in much the same manner as daily brushing of the teeth is adopted to prevent dental caries." The dentist should advise patients at high risk for squamous cell carcinoma and those with recurrent herpes labialis to use a sunscreen for the lips of at least SPF 15. The best sunscreen formulation at the present time is a combination of either PABA or an ester of PABA along with a benzophenone. A frequent combination seen on product labels is Padimate O and oxybenzone. Sunscreens should be used year-round on the lips with two applications 1 hour before sun exposure, and hourly reapplication while in the sun. If the convenience of a "lipstick" product is not important to the patient, then a skin product of the liquid or gel type should be used. If the appearance is not important, a white opaque cream containing titanium dioxide, talc, or zinc oxide may be used as a physical barrier. Women may use an opaque lipstick, but should first apply a chemical sunscreen of at least SPF 15.(ABSTRACT TRUNCATED AT 250 WORDS)

An embouchure aid for clarinet and saxophone players.

An embouchure aid was constructed as a means of bringing relief to the many clarinet and saxophone players who suffer chronic lip irritation as the result of playing their instruments. The device, a removable vinyl plastic matrix to be worn while playing, was designed to fit over the mandibular anterior teeth, thus relieving the pressure of the incisal edges of the teeth against the mucous membrane inside the lower lip. Tested in daily use by clarinet and saxophone players for a one-year period, the matrix proved immediately effective in eliminating lip irritation. Its unique design and construction gives it the additional advantages of being highly durable, as well as technically simple to fabricate and easy to fit.