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Introduction:: Congenital unilateral lower lip palsy is an infrequently encountered condition that manifests as lower lip asymmetry during smiling, laughing, and crying. Treatment options are not well characterized., Methods:: The authors present the case of a 51-year-old woman who was referred for surgical intervention for facial paralysis. Physical examination demonstrated a symmetric face at rest that became asymmetric when smiling. The asymmetry, evident by inappropriate inferior displacement of the lower lip, was secondary to unilateral contraction and presence of the depressor labii inferioris. The depressor anguli oris was symmetric bilaterally. Her presentation was consistent with congenital unilateral lower lip palsy., Results:: Lidocaine was injected into the depressor labii inferioris on the side of the face that demonstrated unilateral presence and contraction. This resulted in symmetry of the smile and lower lip without untoward effect. Onabotulinum toxin A was thereafter injected into the depressor labii inferioris. In-office treatment with botulinum toxin injection resulted in a 4-month improvement in smile symmetry., Conclusion:: Chemodenervation is a safe and minimally invasive method to improve smile symmetry and lower lip position in cases of congenital unilateral lower lip palsy.

Pregnancy pyogenic granuloma is considered a benign common growth that usually develops on the gingiva in the second and third trimester of gestation, in response to local irritation, trauma or hormonal factors. Here, the authors report a case of a primigravida who presented an extragingival pyogenic granuloma with a rapid progression in the post-partum. The occurrence on the lower lip in the first few days after delivery was a relatively rarity in the present case which provoked a meaningful state of anxiety and cancerophobia to the female. Complete excision was curative and brought immediate relief of pain and discomfort. This clinical report highlights the possibility of pyogenic granuloma presenting like a rapid-growing mass on the lip and the importance of clinical differential diagnosis of such presentation in this atypical location.

When providing dental treatment, the dental clinician (DC) is expected to be knowledgeable in recognition and emergency management of an allergic response. Common manifestations of localized allergic responses can present as a rash or hives (urticaria), running of the nose, and swelling of the lips, eyes, face, respiratory and gastrointestinal mucosa. More critically, there is the potential for breathing difficulties from laryngeal swelling. Airway obstruction can be potentially life threatening.' Anaphylactic shock can be another serious reaction. Although most of these allergic responses can be minimal and managed with an antihistamine (diphenhydramine), more serious allergic reactions (marked breathing difficulty, anaphylaxis) may require the use of an intramuscular injection of epinephrine. This case report describes a patient who had what appeared to be a common allergic response to some aspect of dental materials or treatment but was subsequently diagnosed with an allergic condition known as angioedema (AE) that had the potential to be non-responsive to dental office emergency medications. AE may be due to the more common histamine generated process as described below. However, if the patient's AE is due to alternate pathophysiology, the DC may not be able to manage breathing difficulties due to airway swelling, which could be rapidly fatal.

The incidence of inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Objective: This study aimed to describe the results of a retrospective analysis of a specific cohort of patients with benign lip lesions encountered in the last 15 years in the School of Medicine at Karadeniz Technical University., Method: A total of 312 patients were managed for lip lesions during the period 2000-2014. Data from 160 samples of benign lip biopsies were retrieved from the pathology laboratory records., Results: The study group included 20 different histopathological types of lesions, with mucocele being the most frequent lesion (43.13 per cent). The other frequent lesions were chronic inflammatory infiltrate (11.25 per cent), intradermal naevus (5.63 per cent), pyogenic granuloma (5.63 per cent), fibroma (5 per cent) and papilloma (5 per cent). Mucocele was significantly more common in younger patients (p < 0.001)., Conclusion: Knowledge of the epidemiology and distribution of oral mucosal lesions is essential to promote early diagnosis and treatment. Further epidemiological studies exploring the causal relationships and risk factors for lip lesions are necessary for a better understanding of lip diseases.

Purpose: The purpose of this study was to evaluate the factors affecting the recovery period of lower lip hypoesthesia after sagittal split ramus osteotomy (SSRO) in mandibular prognathism patients using multivariate analysis, retrospectively., Subjects and Methods: The subjects were 222 patients (444 sides) who underwent bilateral SSRO setback surgery with and without Le Fort I osteotomy. Trigeminal nerve hypoesthesia at the region of the lower lip was assessed bilaterally by the trigeminal somatosensory-evoked potential (TSEP) method pre- and post-operatively. Recovery period was determined as the time when TSEP was first measurable post-operatively. Age, sex, presence or absence of third molars, setback amount and osteotomy type and fixation method were selected as covariates in the multivariate analysis. The factor affecting the recovery period in lower lip hypoesthesia was examined with Cox's proportional hazard regression., Results: Sex and osteotomy fixation method affected the recovery period in lower lip hypoesthesia significantly (P = 0.0132 and P = 0.0394). However, the other factors did not affect the recovery period., Conclusion: This study suggested that sex and osteotomy type and fixation method may affect the recovery period in lower lip hypoesthesia after SSRO setback surgery., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: An asymmetric smile, caused by loss of function of the lip depressors, can be functionally and cosmetically debilitating. Although some surgeons report excellent results with muscle transfer to the lower lip, many facial reanimation surgeons find that dynamic techniques do not consistently address the lower lip. Our objectives were to retrospectively review our outcomes after treatment of the asymmetric lower lip, and to propose a progressive, stepwise algorithm for the management of lower lip asymmetry in facial paralysis., Material/methods: Retrospective chart review was performed on all patients treated in a multidisciplinary facial nerve center with lower lip asymmetry over an eighteen month period. Treatment ranged from a temporary trial of lidocaine, to chemodenervation with botulinum toxin, to pedicled digastric muscle transfer, and/or resection of the nonparetic depressor labii inferioris (DLI)., Results: Fifty-seven patients were treated with chemodenervation with botulinum toxin, four with anterior belly of the digastric transfer, and 3 with DLI resection. All patients with DLI resection had undergone chemodenervation to the contralateral lower lip with botulinum toxin and were pleased with the appearance of their smile., Conclusions: We have found that lower lip asymmetry is optimally managed by adherence to a standardized protocol that offers patients insight into the likely outcome of chemodenervation or surgery and progresses systematically from the reversible to the irreversible. We present our algorithm for the management of the asymmetric lower lip, which reflects this graduated approach and has resulted in high patient satisfaction., (Published by Elsevier Inc.)

Objective: Lip paralysis is associated with eating, speaking, and appearance impairments. The lip reanimation outcome questionnaire is designed to assess these functional impairments after lip reanimation., Study Design: Cross-sectional validation study., Setting: Tertiary care academic center., Subjects and Methods: Patients who underwent lip reanimation and control subjects. A disease-specific instrument was created by systematic literature review and expert opinion. The 15-item patient completed subscale was administered to 20 lip reanimation patients. Photographs of 19 patients and three control subjects were taken in four poses and rated by six raters (2 surgeons, 2 residents, and 2 novices) by the use of a external rater subscale, and reliability was determined by the use of intraclass correlation coefficients (ICC). Content and construct validity were assessed., Results: Internal consistency (ICC range 0.813-0.915 for each domain), test-retest reliability (ICC range 0.616-0.981 for each item) for the patient completed subscale, and interrater (ICC = 0.852) and interlevel reliability (ICC = 0.929) for the external rater subscale were substantial to excellent. The content validity index was 0.87. Construct validity was demonstrated by poorer scores in patients with transected nerves versus intact nerves for appearance (P = 0.04) and oral competence (P = 0.011). Photographs of control patients had lower asymmetry scores (P < 0.001), and the instrument detected greater asymmetry in patients with progressively more exaggerated smile (P < 0.001)., Conclusion: The lip reanimation outcome questionnaire has promising reliability and validity in this preliminary study, but additional psychometric testing with larger samples is required before the survey can be recommended for clinical use., (Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: Assess the long-term effect of sensory retraining exercises, age, gender, type of surgery, and pre-surgical psychological distress on patients' perception of the interference related to altered sensation 2 years after orthognathic surgery., Setting and Sample Population: A total of 186 subjects with a developmental dentofacial disharmony were enrolled in a multicenter randomized clinical trial: one center was a community-based practice and the other a university-based center., Methods and Materials: Subjects were randomly allocated to two groups: standard of care mouth opening exercises after BSSO or a progressive series of sensory retraining facial exercises in addition to the opening exercises. At 1, 3, 6, 12, and 24 months after surgery, subjects scored unusual feelings on the face, numbness, and loss of lip sensitivity from 'no problem (1)' to 'serious problem (7)'. A marginal proportional odds model was fit for each of the ordinal outcomes., Results: Up to 2 years after surgery, the opening exercise only group had a higher likelihood of reporting interference in daily activities related to numbness and loss of lip sensitivity than the sensory retraining exercise group. The difference between the two groups was relatively constant. Older subjects and those with elevated psychological distress before surgery reported higher burdens related to unusual facial feelings, numbness, and loss of lip sensitivity (p < 0.02)., Conclusion: The positive effect of sensory retraining facial exercises observed after surgery is maintained over time. Clinicians should consider the patient's age and psychological well-being prior to providing pre-surgical counseling regarding the impact on daily life of persistent altered sensation following a mandibular osteotomy.

Objective: This study was conducted to evaluate salivary dehydroepiandrosterone (DHEA) levels, salivary flow rate (SFR), depression, and hopelessness in patients with the complaint of burning mouth (BM)., Study Design: Thirty female patients with BM and 30 age-matched control women without any complaint of burning mouth were enrolled. After anamnesis and oral examination, the salivary flow rate was determined. Depression and hopelessness were evaluated by the application of inventories. Two saliva samples were collected for DHEA analysis., Results: Dysgeusia (P = .045) and xerostomia (P = .003) were significantly higher in the BM group. The BM patients showed significantly lower salivary flow rate, both under stimulation (P = .001) and at rest (P < .001). Significant differences between the groups were not found in the depression (P = .416) or hopelessness (P = .597) scores. The BM group revealed significantly lower salivary DHEA levels in the morning samples (P = .003)., Conclusion: Patients with BM exhibit decreased morning salivary DHEA as well as dysgeusia and hyposalivation more frequently than control subjects. Additional investigations are needed to clarify this association.

Introduction: Bite wounds of the oral mucosa heal after eliminating the causative irritant, but there are serious exceptions from the rule. We present the case of a 37-year-old woman with an ulcer of the mucosa of the lower lip, which had been present for 10 days, and leucopenia., Discussion: Agranulocytosis after the use of metamizole is part from leukaemia and lues, a rare reason for non-healing ulcers of the mucosa of the oral cavity without fulminant signs for inflammation., Conclusion: As this is a life-threatening disease, medical therapy must begin immediately.

Objective: Use of botulinum toxin is expanding as clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is predominantly used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations., Case History: A 73-year-old man had a severe sub-arachnoid haemorrhage following the rupture of a giant aneurism of the middle left cerebral artery. Clinically, the patient presented a vegetative state and an oro-mandibular dyskinesia that produced a chronic ulcer on the lower lip. As treatment for this dyskinesia, a total of 320 U botulinum toxin type A were injected into the upper and lower orbicularis oris and masseter muscles., Results and Discussion: This treatment allowed for application of topical medication and subsequently, ulcer healing. Botulinum toxin type A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by dyskinesia.

Background: Congenital unilateral lower lip palsy or congenital hypoplasia of the depressor anguli oris muscle, also known as asymmetric crying facies, characterized by deformity of the lower lip, lacks aggressive surgical intervention methods. Although several dynamic and static reconstruction methods have been reported, textbooks introduce only passive surgical intervention, of weakening the unaffected side through techniques such as selective marginal mandibular neurectomy which, however, tends to produce lack of emotive movement. Therefore, a new surgical intervention for the reconstructive treatment of asymmetric crying facies is presented., Methods: A bidirectional (horizontal and vertical) fascia was grafted to restore the aesthetic appearance of the asymmetric lower lip. The horizontal fascial strip achieves restoration of the center of the lower lip to its proper position, whereas the vertical fascial strip achieves aesthetic symmetry of the lower lip at mouth opening. Each end of the vertical strip is anchored to the lower lip and the mandibular bone, respectively, thereby allowing simultaneous movement of the mandible and lower lip., Results: The reconstruction of unilateral lower lip palsy has been successfully performed on seven patients, with ages ranging from 2 years 9 months to 11 years 1 month, since June of 1996., Conclusions: The aim of this procedure is not to achieve complete dynamic reanimation. However, with regard to its simplicity and minimal invasiveness and the satisfaction of the patients, it is considered to be a well-balanced surgical intervention.

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.

Masticatory muscle activity is coordinated with perioral muscle during chewing. Subjects with competent lips usually chew with the lips in light contact, whereas subjects with incompetent lips possibly have dysfunctional chewing. In this study, the electromyographic (EMG) activities of the lower lip and masseter muscles were recorded when chewing with the lips in contact and apart. At first, 37 subjects were divided into an incompetent lip group and competent lip group on the basis of EMG activity of the lower lip muscle at rest. The durations of the masseter nonactive phase and total phase when chewing with lips in contact were shorter in the incompetent lip group than in the competent lip group. In the incompetent lip group, when chewing with the lips apart, the EMG activity of lower lip in the masseter nonactive phase was significantly (P < .05) higher than in the competent lip group, but there was no difference in the EMG activity in the masseter active phase between two groups. Our results suggest that subjects with incompetent lips have difficulty chewing while their lips are relaxed. We conclude that the inability of sealing the lips and lip dysfunction could possibly affect masticatory function.

Objective: We describe the treatment of 4 patients (median age, 53.5 years) with incapacitating perioral dystonia and insufficient response to peroral medication. Their general treatment with clonazepam and anticholinergics was supplemented by intramuscular injections with botulinum toxin A (20-40 U) in the orbicularis oris muscle, guided by electromyography (EMG)., Study Design: Perioral dystonia and treatment effect were assessed by using subjective global and visual analog scales, examiner-based video movement counts and rating scales, and quantitative EMG. t Tests were used for statistical analysis., Results: The result of the intramuscular botulinum toxin A injections was characterized by the patients as "much improved"; correspondingly, dystonia was significantly reduced in visual analog scale scores, on examiner-based assessments, and in recordings of EMG. The side effects were few and short-lasting., Conclusion: Incapacitating perioral dystonia in Meige's syndrome may be safely controlled by recurrent EMG-guided botulinum toxin A injections in the orbicularis oris muscle, in combination with general medication.

The mechanisms of lip wound healing after bilateral crossing of the inferior alveolar nerve (IAN) were studied on Chinchilla rabbits in 3 experimental series, 6 animals per series. In group 1 bilateral crossing of IAN was carried out, in group 2 bilateral crossing of IAN was paralleled by removal of a mucous flap in the middle of the lower lip, and in group 3 the same wound as in group 2 was created, after which the wounds in this group were daily treated with a special ointment and a single injection of lidocaine (1% solution) under the wound. The nerve crossing led to development of ulcer on the lip with degenerative changes in the vascular walls, destruction of nerve fibers, and fragmentation of some axial cylinders. Crossing of IAN simultaneously with removal of the lower lip flap led to more severe degenerative changes in the tissue. Daily treatment of the lip with the ointment and lidocaine blocking normalized wound healing. A possible mechanism of the changes observed is discussed.

There are many lips kinetic disorders whose clinical appearances greatly differ. An acute examination directs toward the diagnosis on a neurologic, neurogenous, muscular, myogenous, medicamentous, dermatological or psychiatric etiology. The authors review the different etiologies that have to be discussed, in order to choose the appropriate further investigations and specialized examinations, before a possible surgical treatment.

Objective: To test the hypothesis that maxillary growth and lower lip form in patients with van der Woude syndrome (VDW) is different from patients with non-syndromic cleft lip and palate., Design and Setting: Retrospective, case-control study at a tertiary cleft center, Chang Gung Memorial Hospital, Taipei, Taiwan., Patients and Participants: Records of 53 patients with VDW, who presented for treatment during the years 1968 through 1998 were obtained. Twenty-three of 53 patients had received at least one lateral cephalogram during the course of their treatment. Of these 23, in 17 it was possible to find non-syndromic case controls with identical cleft type, sex, and method of cleft palate repair, with year of birth matching within 1 year of the corresponding VDW patient. For these 17 pairs of VDW and non-syndromic cleft controls, cephalogram acquisition dates were checked to see how well the corresponding pairs matched. A total of 43 pairs of cephalograms were deemed to be acceptably matched because the ages at acquisition differed by less than 15% of the VDW patient's age., Main Outcome Measures: Thirteen measurements were derived from the 11 standard lateral cephalometric landmarks recorded on each cephalogram. The data were classified into five groups according to age at time of cephalogram, and sets of paired non-syndromic cleft and VDW measurements were tested for differences using a Wilcoxon signed rank sum test in two ways, first including all cleft types and then including only those patients with complete bilateral cleft lip and palate. A longitudinal growth analysis considering the movement of the skeletal A and B points was performed on the patients with complete bilateral cleft lip and palate., Results: For the osseous measurements, anteroposterior maxillary length as described by the anterior nasal spine (ANS)-posterior maxillary point distance was statistically significantly shorter in the VDW patients of age 13 years and older, by 5.3 mm. Maxillary height, as described by the nasion-ANS distance was shorter in the VDW patients, closely approaching statistical significance in the age range 7 through 11 years. The lip soft tissue measurements showed significantly greater protrusion over several age ranges in the VDW patients. The longitudinal growth analysis showed a significantly more inferior vertical position of the B point in the controls., Conclusions: This study demonstrates a few statistically significant differences in maxillary growth and lip conformation between VDW and matching controls. Small sample sizes for each age group hamper the ability to fully interpret or generalize the pattern of these differences.

The epulis gravidarum, or granuloma of pregnancy, represents a vascular lesion observed during gravidism. While histologic features may mimic those of generic pyogenic granulomas, the management may differ. Remarkably, the plastic surgical literature is conspicuously void of information concerning this common entity, with approximately 40 new cases being diagnosed and treated annually at our institution. With a review of the literature, we offer four typical and representative case reports that serve to highlight the pertinent physiology and treatment options. Guidelines are proposed to assist in the management of this disease process.

Forty-eight patients with dysgnathia brought about by tongue dyskinesia underwent myofunctional therapy leading up to and at the beginning of orthodontic treatment. Short- and long-term results of this therapy were studied with the help of indirect palatography. Palatographs of empty swallowing and the test consonants "L", "N", "S" and "T" were evaluated visually and metrically. The palatographs were made prior to myofunctional therapy and thereafter first at the end of the therapy, then at the end of the control or supervision period, and finally, after on average 4 years. Visual evaluation revealed a clearly recognizable change in all functions when compared with the physiological palatographs. A change in the "S" consonant sound was the least conspicuous. Metric evaluation revealed for the 4 out of 5 of the test functions, namely, empty swallowing and the consonants "L", "N", and "T", marked long-term dorsal orientation of the tongue. The short-term changes in tongue function were more prevalent than the long-term.

The lips constitute an anatomic, physiologic and aesthetic specific entity which is integrated between nasal and chin areas. Inocclusion of the lips at rest forms an anomaly which affects mandibular growth, lip function and facial morphology. This vertical labial dysharmony implies on one hand an architectural skeletal unbalance at inferior third of the face, mostly associated with dento-alveolo-maxillary disturbance, on the other hand a disorder of oro-facial muscular behaviour. The treatment's aim is the restoration of a spontaneous lip seal at rest. It will be institute as early as growth-hood using functional orthopaedic devices. In adolescent and adult, the correction of existing dento-alveolar dysharmonies by orthodontic means will be completed, if necessary, by surgical procedures either orthognathic correcting retrognathism or maxillary anterior alveolar hyperplasia with dental extrusion, or morphologic to achieve elongation of congenital upper short lip or elevating of lower lip attracted towards the chin. Orthopaedic and morphologic analyses are necessary to locate the site of the responsible anomalies and indicate particular surgical technics relative to the magnitude of functional and aesthetic repercussion.

A cephalometric analysis was carried out to see if the presence of a Simonart's band at birth was associated with a detectable difference in subsequent craniofacial form. Mixed longitudinal data from 5 through 18 years of age was analyzed for 257 individuals with complete UCLP included in the Oslo CLP Growth Archive, 80 with a Simonart's band and 177 without. No major differences were detected between individuals with or without Simonart's band, though the presence of a Simonart's band was associated with a larger cranial base angle and a slightly more favorable maxillomandibular relationship. The findings are discussed in relation to embryogenesis, primary surgery, and secondary surgery. It is recommended that cephalometric studies of UCLP involving group comparisons should avoid major imbalance with respect to the proportion of individuals with a Simonart's band at birth.

The study aimed at evaluating how training of the lips with an oral screen affects the strength of the lips and the pressure of the lips on the teeth. In addition, the effect of the treatment with an oral screen on the dentition was studied. The treatment and lip training programme was instituted for 9 months in 16 children, 7-11 years old, with protruding maxillary incisors. The effect on the dentition was studied on dental casts made before and at the end of the treatment, and 5 months thereafter, as well as on lateral cephalograms. The lip strength was recorded with a dynamometer. The pressure from the lips on the upper and lower central incisors at rest, and during chewing and swallowing was measured with an extra-oral pressure transducer incorporated in a water-filled system with an intra-oral measuring point. Measurements of lip strength and pressure were made regularly before and during the treatment, and continued for up to 10 months thereafter. The treatment resulted in a decrease of the overjet and upper dental arch length, but with some relapse after the treatment. The strength of the lips increased during the treatment, but decreased afterwards. The pressure from the lips on the teeth at rest and during swallowing was unaffected by the lip training. The pressure from the lower lip during chewing increased temporarily during the treatment period.

Oral continence is achieved through the harmonious interplay of several factors of which the most important are the lip sensitivity, the strength of the orbicularis oris muscle and the height of the lip curtain. Forty-four persons with varying degrees of oral incontinence and diverse lip disorders were then examined and compared against the normal values. Significantly low values for all three factors found in the orally incontinent patients supported our hypothesis that the normality of these factors is essential for the maintenance of the oral seal. Central causes of dribbling, such as mental retardation and salivary over-secretion, irrespective of etiology, are not considered here.

Clinicians should distinguish between hereditary and non-hereditary angioedema, as management of patients varies significantly with each. As many patients with hereditary angioedema have had serious episodes of edema associated with dental procedures, it is important that dentists understand the nature of this disease and its treatment. The potential for airway obstruction by laryngeal edema requires a knowledge and preparedness for initiation of life-support measures.

Erythema multiforme is a chronic, inflammatory mucocutaneous disease that can occur in both genders at any age. Although the cause remains obscure, a wide range of antigens and factors, including herpesvirus and other infections, has been suggested as triggering the disease. In the present study of 95 patients, we found that patients with oral involvement alone tend to predominate over those who have oral and lip, or oral, lip, and skin disease. There were also more women than men. Our study further confirmed that erythema multiforme cannot be characterized solely as a disease that is cyclical and self-limiting. The dramatic response to corticosteroids and to the immunoregulating agent levamisole, as well as the fact that patients with erythema multiforme are otherwise essentially healthy, suggests that erythema multiforme may be caused by a transient autoimmune defect, possibly triggered by multiple factors. Because 19 patients with oral candidiasis responded to antifungal therapy, a possible antigenic role for these organisms is suggested.

The effect of lip training was studied in 15 children with incompetent lips, who were compared with a control group of 10 children who also had incompetent lips. Lip function was evaluated by electromyography of the activity of the lips in resting posture and during swallowing and chewing. The morphology of the dentition, facial skeleton and lips were studied on dental casts and profile radiographs. Lip training was performed for one year and was found to maintain lip function in the test group, in contrast to impairment of lip function in the control group. Lip training favorably influenced lip morphology, increasing the height of both lips and decreasing the interlabial gap. In the control group, the interlabial gap increased. The beneficial effect of the training on the function and morphology of the lips could not be shown to affect tooth position during the one-year study period.