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Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures. 20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (±8.13) to 18.77% (±6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (±8.03) vs. 18.27% (±5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners' professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance. [ABSTRACT FROM AUTHOR]

Smiling expresses emotions and affects interpersonal relationships, influencing self‐esteem and social life. Nowadays, concerns about aesthetics and access to the Internet have made people more informed and demanding about treatments for gingival smile. Excessive gingival display (EGD) is caused by a variety of factors that can act alone or in combination. These factors may include altered passive eruption (APE), vertical maxillary excess, a short upper lip, and hyperactive upper lip, among other factors that cause gingival hyperplasia. In this case report, the EGD was caused by vertical maxillary excess, hypermobility of the upper lip, and APE. The proposed treatment included two procedures: the Modified Lip Repositioning Surgery (Modified LipStat) Technique, with internal sutures to attempt to restrict the traction of the upper lip elevator muscles, and Esthetic Crown Lengthening (ECL) from the right first premolar to the left first premolar for the treatment of APE. The result provided an aesthetic improvement of the smile, with harmonization in relation to the size of the teeth. The mobility of the upper lip in spontaneous smiles remained reduced up to 6 months of follow‐up; however, there was a partial relapse in the position of the upper lip during spontaneous smiling at the end of 6 years of follow‐up. [ABSTRACT FROM AUTHOR]

With increasing age and edentulism, numerous esthetic changes occur to the perioral region. The upper lips lose definition, flatten, and lengthen, the cupid's bow is lost, and the oral commissures descend. The nasolabial folds deepen, marionette lines become prominent, vertical rhytids around the lips form, and chin rhytids form. Chronic exposure to UVA radiation from the sun can lead to photodamage, characterized by wrinkles, lentigines, actinic keratoses, and other pigment changes. In addition, edentulism leads tojaw atrophy, which often compromises soft tissue support. Removable dentures, the conventional treatment to restore missing teeth, not only replace teeth, but also provide support to the lips via the labial flange. Implant-supported Axed prostheses are a very popular option to restore completely edentulous arches; these prostheses are flangeless, providing no bulk to the lips. Addressing changes in the perioral region due to aging and edentulism requires a combination of treatments, with each addressing different issues. Onabotulinum toxin A can be used to treat dynamic perioral and chin rhytids, and upturn the corners of the mouth. Hyaluronic acid filler can be used to treat deep nasolabial folds, marionette lines, and re-volumize the lips. Chemical peels can treat photodamaged skin, static rhytids, and other dermatologic pathologies. The subnasal lip lift, developed by Cardoso and Sperli in 1971, has become an increasingly common technique used to rejuvenate the upper lip in elderly and edentulous patients. This case report describes an elderly patient who was treated with a combination of subnasal lip lift, hyaluronic acid filler, onabotulinum toxin A, and chemical peel to achieve superior perioral esthetics. This case highlights the synergy of each procedure when done in combination to achieve highly effective results. [ABSTRACT FROM AUTHOR]

Background: The skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia. Case presentation: An 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful. Conclusions: Concerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis. [ABSTRACT FROM AUTHOR]

Background: Lower lip avulsion is a separation between the lip and the associated soft tissue from the mandible. The degree of these types of injuries varies and heavily affects the outcome of the case. Case Description: This study reported an extensive lower lip avulsion managed by surgery and stem cell metabolite preparation. A one year and nine month-old domestic cats was referred for lower lip avulsion surgery to the Veterinary Teaching Hospital Airlangga University. Owing to the limited amount of tissue, immediate successful results cannot be achieved after the first surgery. Furthermore, tissue necrosis and lack of physical restraint to the cat at home contributed to the delayed union between the soft tissue and mandible, resulting in repeated surgery. Stem cell metabolites preparation was applied at the surgical site and was incorporated into the therapy to support tissue growth. Conclusion: The combination of surgical treatment and stem cell metabolite preparation resulted in good wound healing in the present case. [ABSTRACT FROM AUTHOR]

Objectives: Oronasal fistulas are common sequelae following cleft lip and palate surgery and can significantly impact a patient's quality of life. They result from various factors, including surgical techniques, tissue management, and patient‐specific factors. This case report explores the modern approach to oronasal fistula closure using periodontal plastic surgery principles. Materials and Methods: The report presents two cases of patients with oronasal fistulas due to previous maxillofacial surgical intervention. These patients underwent microsurgical procedures that involved partial flap thickness preparation of the fistula areas, the use of connective tissue grafts from the palate, and meticulous suturing techniques to ensure graft integrity. The procedures were performed in stages, and postoperative care was provided. Results: Both cases demonstrated successful fistula closure and graft survival. The patients reported improvements in breathing, speech, aesthetics, and quality of life. The second case also included guided bone regeneration and implant placement. Conclusions: Oronasal fistulas resulting from maxillofacial surgery can be effectively treated using periodontal plastic surgery techniques, significantly improving patients' quality of life and aesthetic outcomes. This approach represents a valuable addition to the existing repertoire of oronasal fistula closure methods. Summary: In this case report, we present two adult patients who underwent oronasal fistula closure procedures applying principles of periodontal plastic surgery, highlighting successful outcomes and the potential application of these techniques in similar cases. [ABSTRACT FROM AUTHOR]

Background: Surgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population. Case presentation: A total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients. Conclusion: Dexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair. [ABSTRACT FROM AUTHOR]

Establishing a successful perioperative technique for better outcomes remains a priority in cleft surgery. In the present review, the safety and efficacy of nerve blocks for cleft lip and cleft palate are evaluated. A systematic review of randomized controlled trials (RCTs) involving the perioperative nerve block was conducted. PubMed, Google Scholar databases, and manual searching were performed to screen the eligible RCTs. Dosage and the route of administration of anesthetics were considered for all the studies. A total of nine RCTs with 568 children were included in our review. Six out of nine studies reported cleft lip surgery, only two reported cleft palate surgery, and one study reported both cleft lip and palate surgery. Lignocaine, ropivacaine, or bupivacaine was used as anesthetics. Adrenaline or epinephrine was used as adjuvants. Post-operative pain was lower in the perioperative nerve block group compared to the comparison group, resulting in fewer emergency analgesic prescriptions. Physiological factors like heart rate, blood pressure, and respiratory rate did not differ between groups. There were fewer adverse outcomes linked with perioperative nerve blocks. Perioperative nerve blocks can be a useful adjunct to general anesthesia in cleft lip and palate surgeries to provide additional pain relief and reduce opioid use, but they should be used judiciously and with consideration of potential risks and complications. [ABSTRACT FROM AUTHOR]

Pre-nasoalveolar molding (PNAM) was developed to reduce the severity of the initial cleft alveolar and nasal deformity. The nasoalveolar moulding appliance (NAM) consists of an intraoral moulding plate with nasal stents to mould the alveolar ridge and nasal cartilage concurrently. Use of the NAM technique also reduces surgical columella reconstruction and the resultant scar tissue in bilateral cleft lip and palate. The nasoalveolar moulding technique has been shown to significantly improve the surgical outcome of the primary repair in cleft lip and palate patients compared to other techniques of presurgical orthopaedics. But the adaptability of nasal stent with support from NAM plate is cumbersome for many cleft patients due to its bulkiness, interfere with feeding and difficult for parents to manage at home. The Modified Indigenous Nasal Elevator (MINE) is a novel innovation for nasal correction for cleft lip and palate patients. This innovative design, non-invasive, precision, fewer visits, cost effective and adaptability make it a valuable tool to help surgeons to achieve optimal correction in lip repair surgeries in cleft lip & palate patients. MINE's innovative design allows for customization based on the patient's specific nasal anatomy. This adaptable feature ensures optimal fit and function for each patient, maximizing the surgical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Folinic acid and botulinum toxin A have shown promising results in wound healing in different studies. This study aimed to compare the effects of these approaches on wound healing after simulating cleft lip surgery in rats. Methods: In this experimental animal study, after creating lip defects, 30 rats were randomly divided into three groups and received normal saline (CTL), botulinum toxin A (BOT), and folinic acid (FOL). Biopsy from the skin wounds was performed after 14‐ and 28‐days. These samples were stained with haematoxylin and eosin and Masson trichrome staining. Finally, each pathological parameter of wound healing was rated in this study. Results: While the inflammatory response was not different among the study groups, fibroblast proliferation and collagen deposition were significantly higher in FOL group compared to BOT group. Moreover, both BOT and FOL facilitated epithelial healing and 14‐day angiogenesis as compared with normal saline. Conclusions: Improved wound healing was observed using both botulinum toxin A and folinic acid in rat animal models. However, the application of botulinum toxin A caused less fibroblast proliferation and collagen deposition which can potentially lead to less scar formation, which can be particularly important in the aesthetic zone. [ABSTRACT FROM AUTHOR]

Objectives: To observe the age at primary cleft surgery among charity organizations such as Smile Train in helping Indonesia manage patients with OFC. Materials and Methods: A retrospective analysis of medical records was conducted to identify patients with orofacial clefts who underwent primary surgery between 2001 and 2021. The age at the time of surgery was recorded for each patient. Descriptive statistics were used to analyse the data and determine the average age at primary surgery. Results: In the period between 2001 and 2021, a total of 34 239 individuals in Indonesia underwent primary lip surgery, while 16 768 individuals received primary palatal surgery, as recorded in the Smile Train database. Notably, a significant proportion of these surgeries were classified as delayed primary repairs. Approximately 65.3% of primary lip surgeries were performed beyond the recommended timeline of 6 months of age, indicating a delay in the surgical intervention. Similarly, 67% of primary palatal surgeries were also delayed, occurring after the recommended timeline of 18 months of life. Conclusions: This study provides insights into the age at primary surgery among individuals with orofacial clefts in Indonesia. The findings highlight the need for timely intervention and the importance of considering individualized treatment plans based on the specific type of orofacial cleft. Further research is warranted to explore factors influencing the age at primary surgery and their impact on treatment outcomes and long‐term functional outcomes in this population. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether administering botulinum toxin type A (BT) prior to surgery would stabilize surgical lip repositioning. A randomized controlled parallel-group clinical trial was performed. A total of 18 participants with excessive gingival display (EGD) were divided into two groups. For the test group (TG), BT was injected into the smile muscle locations 15 days before the surgical procedure. For the control group (CG), only lip repositioning surgery was performed. Gingival display (GD) and upper lip displacement (LD) were measured 3 and 6 months postoperatively. Data were submitted to ANOVA, Tukey, and t tests. For GD and LD, the changes were statistically significant between the measurements taken at the baseline, 3-month, and 6-month marks. The GD presented a reduction of 5.2 ± 1.1 mm in TG and 3.2 ± 1.4 mm in CG after 6 months. The LD measurements reduced 45% for TG and 26% for CG in 6 months. The injection of BT 15 days before lip repositioning surgery provided more stable results and effectively reduced the GD at 6 months. [ABSTRACT FROM AUTHOR]

Copyright of Health & Society is the property of Instituto de Ensino e Pesquisa Periodicojs and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Maxillary palatal defects due to tumor resection require immediate reconstruction to prevent morphological/functional disorders. Reconstruction options ranges from obturator placement to free flap. We adopted a surgical maxillary exposure using nasolabial groove incision in contrast to classical Weber Ferguson incision. This has the added advantage of simultaneous reconstruction of the resultant defect using nasolabial flap, with a good cosmetic and functional outcomes. We hereby present our experience in ten cases with palatal defects post maxillectomy for carcinoma of the upper gingivobuccal sulcus and upper alveolus reconstructed with this technique. This is a case series of ten patients (7 males and 3 females) who underwent partial maxillectomy using nasolabial groove incision with simultaneous reconstruction of palatal defect with nasolabial flap from January 2019 to June 2021 in our department. The primary disease was squamous cell carcinoma (SCC) in all ten patients with clinically N0 and M0. No necrosis, infection, or severe scar contracture in grafts was found in any patient. The wound stabilized, ingestion was started, and rehabilitation was performed with appropriate denture within 10 days after surgery in these patients. The postoperative oronasal communication (5×5 mm in size) in the posterior midline end was found in two cases, seen 1 month after surgery. All patients have good extra oral cosmetic outcomes. No radiation therapy was given in any case. This is a feasible surgical option utilizing nasolabial groove incision for partial maxillectomy along with simultaneous reconstruction of the resultant defect using nasolabial flap. It is a simple surgical procedure with reduced operative time with good cosmesis. [ABSTRACT FROM AUTHOR]

This article discusses the use of intralesional radiofrequency ablation followed by lip reduction surgery as a treatment for infantile haemangioma of the lip. The case study involves an 11-year-old girl with a haemangioma of the upper lip that caused significant deformity. The patient underwent six sessions of radiofrequency ablation, which resulted in a 50% reduction in the size of the swelling. However, minimal improvement was observed in the last two sessions, so lip reduction surgery was performed to further improve the aesthetic outcome. The combination of these techniques resulted in a successful treatment outcome with minimal cosmetic morbidity and scarring. [Extracted from the article]

Purpose: To determine whether a significant dimensional difference in labial soft tissue could be produced by maxillary anterior tooth restorations with diverse labial thicknesses.Materials and Methods: Changes in the contour of the lips in each participant produced by provisional restorations with different labial thicknesses (1-4 mm) compared to baseline (0 mm) were assessed using 3D software and using a visual analog scale by a group of prosthodontists and a group of laypeople.Results: Significant enhancements in 3D deviation compared to baseline were present when the participants were wearing the labial provisional restorations. Negative correlations for labial thickness with nasolabial angle and distance from upper lip to E-plane measurements were found. However, the changes were most pronounced for the prosthodontist and laypeople groups when the labial veneer thickness was 2 mm or more.Conclusion: Prosthodontists and laypeople hardly recognized the lip profile changes when labial provisional restorations were below 2 mm. Therefore, restorations with limited labial thickness had a weak esthetic impact on lip morphology. [ABSTRACT FROM AUTHOR]

Excessive display of the gums when smiling, known as gummy smiles, can lead to aesthetic concerns and emotional discomfort for individuals. In recent times, there has been a notable rise in the popularity of gummy smile surgery as a cosmetic procedure aimed at addressing this problem. A novel technique known as lip repositioning has emerged and gained recent popularity, either on its own or in conjunction with other approaches. In specific situations, it offers a simpler, less intricate alternative to more extensive surgical procedures, resulting in a pleasing and satisfactory camouflage effect while reducing postoperative complications. This case report illustrates the effective treatment of a gummy smile in a patient with excessive gum exposure using a lip repositioning technique. The procedure involved the removal of a partial thickness strip of mucosa lining in the maxillary buccal vestibule, without including the labial frenulum, and suturing the lip lining to the gum line. Our aim was to present lip repositioning as an effective method for reducing excessive gum exposure and addressing any unevenness in a minimally invasive manner. We sought a solution that offers long-lasting results over time while minimizing the chances of the issue recurring, with a 14-month follow-up. [ABSTRACT FROM AUTHOR]

Background: To ensure optimal exposure and enable precise tissue manipulation, cleft lip and palate abnormalities require surgical repair utilizing retractors. Different retractors may affect surgical outcomes; however, this is not yet evident. Examining surgeon preferences for retractors in cleft lip and palate surgery and assessing their impact on patient outcomes were the goals of this study. Materials and Methods: The patients who underwent primary cleft lip and palate repair were retrospectively analyzed. This study evaluated three widely used retractors: the Langenbeck, Gelpi, and Moult Mouth Gag retractors. This study looked at demographic information, surgical results (including scarring, aesthetic outcomes, and wound healing issues), and surgeon preferences for retractors. Results: The study identified differences in surgical outcomes related to various retractor types. Both Group A (Langenbeck retractor) and Group B (Gelpi retractor) demonstrated similar favorable results, such as little wound healing issues, less scarring, and pleasing cosmetic results. The wound healing issues, scarring, and cosmetic outcomes were all worse in Group C (Moult Mouth Gag retractor). Conclusion: Retractors were not always preferred by surgeons doing cleft lip and palate surgery. The type of retractor had an impact on the surgical results; the Moult Mouth Gag retractor performed less well than the Langenbeck and Gelpi retractors. These results highlight the value of using evidence-based criteria to select retractors more effectively and enhance surgical methods for better patient outcomes in cleft lip and palate repair. [ABSTRACT FROM AUTHOR]

Background: The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal‐ or cheek‐tie. Restrictive buccal frena are often treated during tongue‐ and lip‐tie procedures, yet widely accepted classification, diagnostic and treatment guidelines are lacking. Objective: Provide a scoping review on the evaluation and management of buccal‐ties, including diagnosis, classification, symptoms and treatment, by surveying healthcare providers with experience evaluating and managing oral restrictions. Methods: Literature review and IRB‐approved survey to assess practice patterns among healthcare providers identified from online directories of tongue‐tie release providers and associated allied health professionals. Results: A multidisciplinary group of 466 providers responded. About 87% indicated that they assess buccal restrictions. Evaluation methods included finger sweep (89.1%), visual inspection (76.4%), tissue blanching (66.5%) and functional assessment (53.4%). Around 94% of providers reported that objective and subjective findings are both needed for diagnosis and that an estimated 5%–10% of infants may be affected. About 70% of providers release buccal‐ties (if needed) simultaneously with tongue‐ties, and 76.8% recommend post‐operative stretches as necessary for optimal healing. Respondents indicated a need for further research, evidence‐based assessments, a classification system and treatment protocols. Conclusion: Evaluating a buccal frenum to diagnose a symptomatic buccal‐tie relies upon visual inspection, palpation and assessment of oral function. Survey data and clinical experience are summarized to review classification systems, diagnostic/evaluation criteria and treatment recommendations as a foundational cornerstone for future works to build upon. [ABSTRACT FROM AUTHOR]

Le but de cette technique est d'offrir aux patients souhaitant une restauration labiale sans changements morphologiques une méthode simple, rapide, discrète, confortable, adaptable et réversible par l'association des deux composés les plus utilisés en médecine esthétique que sont la toxine botulique et l'acide hyaluronique. L'originalité de cette association repose sur leur mélange et leur administration par canule par un abord paracommissural qui permet de traiter toute la lèvre supérieure de manière très homogène. La toxine botulique diffuse directement dans la couche musculaire sous-jacente ; l'acide hyaluronique permet de déplier l'éventail cutané crevassé. La dose réciproque utile des deux produits reste intuitive ; pour les codes barre débutants la dose de toxine botulique sera de 8 à 10 unités Speywood (4 unités Allergan), pour ceux déjà marqués au repos 10 à 20 unités Speywood (4 à 8 unités Allergan) ; l'acide hyaluronique sera choisi en fonction de la profondeur des rides. Nous présentons une série de 63 patientes d'âge moyen de 67 ans avec un résultat jugé positif dans 79 % des cas. Les incidents rapportés tiennent généralement aux doses excessives de toxine botulique pouvant entraîner les classiques incidents de fuites liquidiennes dans ce secteur (6 %). L'efficacité attendue du traitement tient à celle des produits employés (quatre à six mois) mais on a observé régulièrement des résultats prolongés (jusqu'à 18 mois) par synergie des composants. Tous les traitements complémentaires de resurfaçage ont été écartés ici puisque le but poursuivi est celui d'une restauration labiale naturelle permettant un retour immédiat aux activités socioprofessionnelles. The purpose of this technique is to offer patients wishing a labial restoration without morphological changes a simple, fast, discreet, comfortable, adaptable and reversible method by combining the two compounds most used in aesthetic medicine, botulinum toxin and hyaluronic acid. The originality of this combination is based on their mixing in the same syringe and their injection with cannula through a paracommissural approach which makes it possible to treat the entire upper lip in a very homogeneous manner. Botulinum toxin diffuses directly into the underlying muscle layer; hyaluronic acid allows to unfold the damaged cutaneous fan. The useful reciprocal dose of the two products remains intuitive; for starting barcodes the dose of botulinum toxin will be 8–10 Speywood units (4 Allergan units), for those already marked at rest 10–20 Speywood units (4–8 Allergan units); the hyaluronic acid will be chosen according to the depth of the wrinkles. We present a series of 63 patients with an average age of 67 years with a result deemed positive in 79% of cases. The incidents reported are generally due to excessive doses of botulinum toxin which can lead to the classic incidents of fluid leaks in this location (6%). The expected efficacy of the treatment depends on that of the components used (four to six months) but prolonged results have been regularly observed (up to 18 months). All complementary resurfacing treatments have been discarded here since the aim pursued is that of a natural labial restoration allowing an immediate return to socio-professional activities. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: The lips are a common location for skin cancer, and thus, a common site for Mohs micrographic surgery (MMS). As an important cosmetic and functional facial unit, MMS defects and reconstruction can affect patient perception on functional and aesthetic outcomes. OBJECTIVE: The objective of this study was to compare aesthetic and functional outcomes after upper lip MMS between patients with vermillion sparing repairs (VSR) versus vermillion crossing repairs (VCR). MATERIALS AND METHODS: Patients from a single institution from 2018 to 2022 undergoing MMS of the upper lip with linear or select flap repairs were included. Patients were assessed at a minimum of 6-week follow-up for self-assessment of functional and cosmetic outcomes, as well as physician assessment of scar cosmesis using validated Patient and Observed Scar Assessment Scale and Scar Cosmesis Assessment and Rating scale. The results were compared between VSR and VCR groups. RESULTS: Forty-five patients were included in this study. No significant difference between patient assessment of functional and cosmetic outcome was identified between VSR and VCR. CONCLUSION: Patient satisfaction with lip reconstruction can be high. Crossing the vermillion border does not affect patient assessment of aesthetic and functional results and should be considered if needed to optimize reconstructive outcomes. [ABSTRACT FROM AUTHOR]

This study evaluated long-term clinical and patient satisfaction outcomes following a modified lip repositioning technique that utilized periosteal sutures in a twin population. Twin sisters diagnosed with maxillary lip hypermobility were randomly assigned to either the control group (original LipStaT technique) or test group (addition of periosteal sutures). The participants (n = 12; 6 per group) were evaluated at intervals for up to 3 years postoperative. Clinical measurements, digital images, and patient satisfaction surveys were collected. Descriptive statistics were used to assess outcome variables: average lip width at rest (ALW), vertical lip translation (VLT), and average gingival display (AGD). Student t test, one-way analysis of variance, and Spearman rank correlation tests were used to compare mean values of variables at five time points for both groups. The level of significance was a = .05. In the control group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 7.0 mm, respectively) to 2 years (5.7 mm and 2.4 mm, respectively), but a slight increase was seen at 3 years (7.5 mm and 5.0 mm, respectively; P < .0001). In the test group, mean VLT and AGD values showed statistically significant decreases from baseline (14.8 mm and 6.9 mm, respectively) to 3 years (5.5 mm and 3.5 mm, respectively; P < .0001). A higher participant satisfaction score at 3-year follow-up was observed in the test group. The modified lip repositioning technique in a population of twins resulted in more stable outcomes that lasted up to 3 years postoperatively. [ABSTRACT FROM AUTHOR]

Lip augmentation can correct lip asymmetries, reduce fine lines, define lip shape and Cupid's bow, and add natural fullness to the lips. Achieving a perfect result when injecting lip filler is an art that combines the desire of the patient with the skill of the practitioner and the practitioner's understanding of the surrounding anatomy. It is essential for aesthetic practitioners to prioritize open communication, provide custom-tailored treatments, and have a strong commitment to achieving natural and harmonious results. By following these principles, patients can enjoy the benefits of enhanced lips that boost their self-confidence while maintaining their unique beauty. [ABSTRACT FROM AUTHOR]

Introduction: The gummy smile (GS) or excessive gum visibility (EGV) is an aesthetic concern that affects an individual's attractiveness and personality. Treatment Planning: Lip Repositioning surgery (LRP) is a less invasive surgery that can be attributed to treating EGV due to hypermobile lip muscles or mild-to-moderate vertical maxillary excess (VME). Three patients went through LRP surgery by stripping overlying mucosa from the buccal vestibule, followed by suturing the lip mucosa to the mucogingival junction (MGJ), creating shallow vestibule and restricted muscle pull and reducing gingival visibility (GV) during a smile. Follow-up: Three months of follow-up showed a satisfactory result with 3.67 ± 0.58 mm mean reduction in GV. [ABSTRACT FROM AUTHOR]

Cleft lip with or without cleft palate is one of the most common congenital malformations, with an average prevalence of 1 in 1000 live births. Cleft lip and/or palate is incredibly phenotypically diverse, with constant advancements and refinements in how we care for patients. This article presents an in-depth review of the latest advances and current evidence in cleft lip and palate surgery. This includes presurgical infant orthopedics, perioperative practice patterns including use of enhanced recovery after surgery (ERAS) protocols, patient-reported outcome measures, and the latest adjuncts in cheiloplasty and palatoplasty. [ABSTRACT FROM AUTHOR]

Background: Unilateral cleft lip surgery is a complex procedure, and the outcome depends highly on the surgeon's experience. Digital simulations and low-fidelity models seem inadequate for effective surgical education and training. There are only few realistic models for haptic simulation of cleft surgery, which are all based on synthetic materials that are costly and complex to produce. Hence, they are not fully available to train and educate surgical trainees. This study aims to develop an inexpensive, widely available, high-fidelity, ex vivo model of a unilateral cleft lip using a porcine snout disc. Methods: A foil template was manufactured combining anatomical landmarks of the porcine snout disc and the anatomical situation of a child with a unilateral cleft. This template was used to create an ex vivo model of a unilateral cleft lip from the snout disc. Millard II technique was applied on the model to proof its suitability. The individual steps of the surgical cleft closure were photo-documented and three-dimensional scans of the model were analysed digitally. Sixteen surgical trainees were instructed to create a unilateral cleft model and perform a unilateral lip plasty. Their self-assessment was evaluated by means of a questionnaire. Results: The porcine snout disc proved highly suitable to serve as a simulation model for unilateral cleft lip surgery. Millard II technique was successfully performed as we were able to perform all steps of unilateral cleft surgery, including muscle suturing. The developed foil-template is reusable on any porcine snout disc. The creation of the ex vivo model is simple and inexpensive. Self-assessment of the participants showed a strong increase in comprehension and an eagerness to use the model for surgical training. Conclusions: A porcine snout disc ex vivo model of unilateral cleft lips was developed successfully. It shows many advantages, including a haptic close to human tissue, multiple layers, low cost, and wide and rapid availability. It is therefore very suitable for teaching and training beginners in cleft surgery and subsequently improving surgical skills and knowledge. Further research is needed to finally assess the ex vivo model's value in different stages of the curriculum of surgical residency. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

More careful consideration and screening should be employed when assessing patients for lip filler and lower face treatments. It is common to dismiss the lips as simple treatment areas, however their variability can predispose patients to many complications. Furthermore, filler treatments cannot be an exercise in simply balancing ratios for results to look natural. It is important to learn the utility of both topical and injectable dissolving agents, as well as a multilayering filler approach in resolving and treating the lower face. [ABSTRACT FROM AUTHOR]

Lip repositioning surgery is a predictable surgical technique that provides a solution for patients with excessive gingival smile. This case series presents four patients with 6 to 8 mm of excessive gingival display who received a modified surgical technique using internal horizontal mattress sutures to immobilize the labial superior elevator muscle. None of the patients exhibited complications, and their healing was uneventful. All patients demonstrated predictable results and presented with stability over an average of 3.5 years of follow-up. The modified lip repositioning surgery with internal horizontal mattress sutures seems to provide reliable long-term results in patients with an excessive gingival display. [ABSTRACT FROM AUTHOR]

Patients these days are increasingly conscious of personal appearance, and much attention is being focused on the smile. Cosmetic dentistry is also in the race to become the most advanced and demanding dental subspecialty. Recently, aesthetic lip surgeries have been introduced, like lip repositioning, lip reduction and lip enhancement surgeries, to improve facial aesthetics. The authors present a case of a 28-year-old healthy male who reported to the Department of Periodontics with the chief complaint of poor aesthetics and large lips. His lower lip was double the size of the upper lip. Therefore, an aesthetic lip reduction surgery was planned. The lip reduction operation could successfully manage the large lower lip with no intra or postoperative complications. No recurrence was observed within a period of 12 months. Cheiloplasty balances the look of the top and lower lips, improving the appearance of the face as a whole. [ABSTRACT FROM AUTHOR]

The aim of this case series was to describe the successful treatment of excessive gingival display (EGD) using a lip repositioning technique (LRT) and botulinum toxin injections (BTIs) for long-term stability. Eight patients diagnosed with EGD were enrolled. A partial-thickness horizontal incision was made from the right first molar to the left first molar along the mucogingival line, leaving the midline frenum intact. The next day, all patients received BTIs. Mean reductions in gingival display between baseline and 3, 6, 12, 18, 24, and 36 months after surgery were considered. BTIs prevent movement of the upper lip during the healing phase of the LRT, improving the results and offering long-term outcomes with a follow-up period of 3 years. [ABSTRACT FROM AUTHOR]

Exposure of maxillary gingiva more than 3 mm while smiling is referred to as "excessive gingival display" or "gummy smile." Various treatment options for excessive gingival display are published in the literature, including lip repositioning, crown lengthening, botulinum toxin-A injections, and orthognathic surgeries. This case report aims to present a novel approach to the lip-repositioning procedure for treatment of excessive gingival display. The patient, who visited the department to demand a more esthetic smile, was diagnosed with excessive gingival display caused by hyperactivity of upper lip muscles. Lip repositioning procedure was considered. While evaluating the patient's smile, the amount of gingival display for each tooth region varied. A novel tooth-based modification was planned for the patient for a more precise result. No complication was noted during 10- and 30-day follow-ups. The amount of gingival display while smiling was less than 3 mm for each tooth region. The tooth-based lip-repositioning technique may provide an opportunity to more precisely treat patients with gummy smile. [ABSTRACT FROM AUTHOR]

Excessive gingival display (EGD) is a common esthetic concern. Lip repositioning surgery (LRS) was introduced as one of the treatment options to manage EGD. LRS can be used for skeletally and/or muscularly induced EGD. The present case series applied LRS using an Er,Cr:YSGG laser to treat 24 patients with minor vertical maxillary overgrowth or a hypermobile lip. At 6 months, the gingival display had decreased by 3.79 ± 1.59 mm (mean ± standard deviation), and the visible lip body when smiling had increased by 1.23 ± 0.74 mm. A questionnaire revealed that the level of satisfaction with the smile increased among the patients and that they had a positive attitude toward Er,Cr:YSGG laser-assisted LRS. [ABSTRACT FROM AUTHOR]

Background: Bilateral cleft lip surgery is very challenging and requires a high level of skill, knowledge and experience. Existing high-fidelity simulation models that can be used by novice cleft surgeons to gain experience and expand their knowledge are rare and expensive. In this study, we developed a bilateral cleft lip model using porcine snout discs, which are available anywhere and inexpensive. Methods: Anatomic reference points of a patient with a bilateral cleft lip were superimposed with landmarks of the porcine snout disc on a foil template. The template was used to construct an ex vivo bilateral cleft lip model. Surgery was performed on the model according to Millard and the surgical steps were photodocumented analogous to two clinical cases of bilateral cleft lip surgery. The suitability of the model was further tested by twelve participants and evaluated using self-assessment questionnaires. Results: The bilateral cleft lip ex vivo model made of a porcine snout disc proved to be a suitable model with very low cost and ease of fabrication, as the template is reusable on any snout disc. The Millard procedure was successfully performed and the surgical steps of the lip plasty were simulated close to the clinical situation. Regarding the nasal reconstruction, the model lacks three-dimensionality. As a training model, it enhanced the participants comprehension of cleft surgery as well as their surgical skills. All participants rated the model as valuable for teaching and training. Conclusions: The porcine snout discs can be used as a useful ex vivo model for bilateral cleft lip surgery with limitations in the construction of the nose, which cannot be realistically performed with the model due to anatomical differences with humans. Benefits include a realistic tissue feel, the simulation of a multi-layered lip construction, a wide and rapid availability and low cost. This allows the model to be used by novice surgeons also in low-income countries. It is therefore useful as a training model for gaining experience, but also as a model for refining, testing and evaluating surgical techniques for bilateral lip plasty. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of the existing treatment protocols on the dental arches of children with unilateral cleft lip and palate treated with or without pre- and post-surgical orthopedics in the first year of life. Methods: Ninety-six dental models were divided into three groups: Group one–orthopedic intervention: Hotz plate; Group two–orthopedic intervention: nasoalveolar molding and Hotz plate; and Group three–without orthopedic intervention. The participants were evaluated before and after cheiloplasty (lip repair surgery), respectively, at time point one and time point two. The sample was analyzed using a 3D stereophotogrammetric imaging system. Linear measurements, segment and cleft areas, and angles were quantified. The Shapiro-Wilk test, Wilcoxon test, paired t-test, analysis of variance/Tukey’s test, Kruskal-Wallis test, and Pearson’s correlation were used (α equals five percent). Results: Intergroup analysis of the growth changes showed that children treated without pre- and post-surgical orthopedics (group three) had a smaller growth percentage of segment area (P=0.013), cleft area (P=0.012), and anterior angle of the greater palatal segment (P=0.002) than those treated with it. Group three had the worst asymmetry of the dental arches after lip repair surgery at time point two (P<0.001). Conclusions: Pre- and post-surgical orthopedics may help achieve a more optimal palatal shape. Participants treated with the Hotz plate alone and those treated with nasoalveolar molding and the Hotz plate had the greatest transverse reduction in the anterior part of the palate without experiencing a collapse of the palatal segments. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cleft lip and palate is a common congenital facial malformation that significantly impacts developmental, physical, and psychological aspects of patients and their families. It is essential to measure treatment outcomes in cleft surgery to evaluate cleft management in the era of evidence-based medicine. OBJECTIVES: This review aimed to analyze and compare outcomes of two primary unilateral cleft lip repair techniques, such as triangular flap and rotation-advancement. MATERIAL AND METHODS: Articles were retrieved from PubMed, Medline, Cochrane Library, and ScienceDirect based on PRISMA guidelines, to find relevant articles published between 1990-2021. Two reviewers independently appraised articles in separate rounds. A total of 1,241 articles were retrieved. However, only eight studies were selected based on inclusion criteria. RESULTS: The rotation-advancement technique group showed better results in the shape of nostril and the length of Cupid's bow, but with a higher finding of notching and nasal deformities. Meanwhile, the triangular flap technique group showed better results in philtral height, Cupid's bow shape, vermilion height, lip height, and nasal width, despite having a more significant number of nasal defect formations compared with the rotation group. CONCLUSIONS: The triangular flap and rotation-advancement techniques have their respective advantages and disadvantages. Nevertheless, post-operative deformities can be found in some cases, including asymmetry of Cupid's bow, flattened philtrum, elongated white lip, tilted columella, and flattened ala nasi. Further systematic review studies should be conducted to analyze treatment outcomes of primary cleft lip surgery in other techniques, according to various measurement methods. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to compare the effect of the classical bull horn excision pattern lip lift technique (group I) and the lip suspension technique (group II) which was performed using a dermal flap prepared on the upper lip with the same pattern incision, on patient satisfaction and scar appearance in lip lift surgeries. Patients and Methods: Twenty-eight female patients aged 48-66 years, operated by the author between 2016 and 2023, were analyzed in two groups. The first group included 14 patients who were operated on with the classical bull horn excision pattern lip lift technique, and the second group included 14 patients who were operated with the lip suspension technique using a dermal flap prepared on the upper lip with the same pattern incision. All patients were operated under local anesthesia. At the end of the 6th month, the patients in both groups, who were followed up for 6 months, were asked about their satisfaction with the overall aesthetic result using the global aesthetic improvement scale. In addition, an evaluator surgeon scored the postoperative scar using the Vancouver scar scale. All results were evaluated statistically. Results: Overall patient satisfaction was clinically significantly higher in group 2 when compared with group 1 and the scar was found to be clinically significantly less in group 2 when compared with group 1, even though there is no statistical significance (p>0.05). Conclusion: It has been concluded that lip lift surgeries performed using the dermal suspension flap technique can contribute as a valuable alternative to the classical excision method, due to both higher overall aesthetic patient satisfaction and less scarring in our patients. [ABSTRACT FROM AUTHOR]

Operation theatre (OT) time utilisation rates can be improved with an assessment of the procedure time that will result in effective scheduling of cases. Our study is the first of its kind to audit the amount of OT time required for a particular surgery in lip and oral cavity cancers, depending on the various components of this complex procedure. This prospective cross-sectional study, based on an operative room database of 323 OT sessions, was conducted in the Department of Surgical Oncology at a tertiary care centre on lip and oral cancer patients from January 1st, 2019 to December 31st, 2020. Various components of the surgery, like the primary site, operating surgeon, type of neck dissection, bone resection, and reconstructive procedure, were noted. The time of entry and exit of the patient from the OT was noted. Operative time and OT time utilisation rates were calculated. SPSS 21.0 statistical tool; Students 'T', ANOVA and Games-Howell tests were applied. In 323 OT sessions, while 303 surgeries were done for primary cases (93.8%), the remaining 20 cases were for recurrent cases (6.2%). Buccal mucosa and the floor of the mouth were the most and least common sites, respectively. The mean OT time was 212.42 ± 73.83 min, the maximum being the primary at alveolus. The mean OT late start time was 70.03 ± 23.41 min and the mean OT runover time was 37.62 ± 43.53 min. The mean time varied significantly with the type of neck dissection, bone resection, and reconstructive surgery done and the operating surgeon. The mean OT time was highest for free flap reconstructive surgery (328.71 ± 62.02 min), but it didn't vary with its type. Considering only the lip and oral cancer surgeries, the OT time utilisation rate was 57.1%. Assessment and quantification of the operative duration of lip and oral cancer surgeries will help in accurate prediction of surgical duration, better OT list planning, and thus improved OT time utilisation rate. Our research not only provides data on the historical mean of procedures, but it may also encourage other centres to adopt our quantitative approach to OT scheduling. [ABSTRACT FROM AUTHOR]

Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures. [ABSTRACT FROM AUTHOR]

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: the infraorbital foramen (IOF) is a hole located in the maxillary bone and delivering passage to the infra orbital vascular-nervous bundle. It is an essential structure in the management of orofacial pathologies. Its precise location allows optimal anesthesia of the infraorbital nerve during cleft lip and palate surgery or alcoholization during the management of essential V2 neuralgia. The aim of our research was to determine the morphology and morphometry of the infraorbital foramen in a sample of the Cameroonian population. Methods: we included 208 CT-scans of patients meeting our search criteria. We determined the shape of the IOF and evaluated the transverse and vertical diameters of the IOF. We assessed the distance of the IOF from the maxillary alveolar crest and the infraorbital margin. The Student test was used to determine the association between different variables. The Pvalue of 0.05 was considered significant and the confidence interval was 95%. Results: male subjects represented 52.4% (n=109) of our participants and the mean age of our population was 26 years ± 7.3. The mean transverse diameter of the left IOF was 1.97 mm ± 0.51 while 1.78 mm ± 0.53. The IOF was more often medial to the lateral palpebral commissure-nasal wing line on the left and right (78.8% and 72.6%, respectively). Our sample showed that in 54.6% (n=113) of subjects, the IOF was oval on the left side, whereas on the right side, the IOF was oval in 52.3% (n=109) of patients. Conclusion: our study showed that to locate the IOF in a Cameroonian individual, one must palpate the vestibular mucosa opposite the maxillary first molar. Then, one must follow the line passing over this tooth, the IOF is located at about 7 mm from the infra-orbital border and 16 mm from the lateral nasal wall. We have shown that the IOF is located medial to the line connecting the nasal wing to the external palpebral commissure. [ABSTRACT FROM AUTHOR]

Objective To explore the therapeutic effect of autogenous costal cartilage combined with expanded polytetrafluoroethylene (e-PTFE) in the repair of secondary nasal deformities of unilateral cleft lip based on the principle of structural nasal plastic subunit repair. Methods From August 2016 to December 2022, 25 patients with nasal deformities secondary to unilateral cleft lip were treated. Nasal deformity secondary to unilateral cleft was corrected lip with autologous costal cartilage combined with Polytetrafluoroethylene. The Face-Q scale was used to evaluate patients' satisfaction with nasal aesthetics before and after surgery, and the Nasal Obstruction Symptom Evaluation (NOSE) scale was used to evaluate the nasal obstruction ventilation function after surgery, and the postoperative complications and incidence rates of patients were recorded. Results All incisions healed by first intention after operation, and no complications such as acute infection occurred. All 25 patients during the follow-up period, the shape of the nose remained good, the tip of the nose and the columella were basically in the middle, the dorsum of the nose was raised, the collapse of the nasal alar was reduced, and the difference between the bilateral nostrils was reduced. No cartilage exposure, infection, etc. occurred. Face-Q suggested that patients' satisfaction with postoperative nasal aesthetics was significantly improved, and the NOSE scale proved that the ventilation function of patients was improved after surgery, and the scores were significantly different. Conclusion Autogenous costal cartilage combined with e-PTFE can achieve good postoperative results in the correction of nasal deformity secondary to unilateral cleft lip. [ABSTRACT FROM AUTHOR]

Copyright of Cuadernos del Centro de Estudios de Diseño y Comunicación is the property of Cuadernos del Centro de Estudios de Diseno y Comunicacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Double lip is a rare deformity that mainly affects the upper lip. The typical clinical image involves bilateral mucosal pads separated by a central groove that appear superimposed over the maxillary incisors. The deformity is rather noticeable and esthetically disturbing. Most cases of double lip are congenital, but syndromic appearance of double lip has been described. Surgical reduction of the tissue surplus is the treatment method of choice. The literature suggests excision of excess mucosa and the underlying tissues to correct double upper lip. This report discusses the advantages and pitfalls of resective techniques and suggests a novel, mucosa-sparing, transvestibular approach to correct double upper lip. [ABSTRACT FROM AUTHOR]

Upon his retirement, Prof. Nam's insatiable desire to heal led him abroad where he performed surgeries for cleft lip and palate in China and Egypt in 2001 and 2003, respectively. Prof. Nam's legacy in the medical field is immortalized by the "Nam's Method" - a novel approach to mandibular condyle surgery, which entailed the extracorporeal reduction of mandibular condyle fractures (Fig. 2Illustration depicting Prof. Nam's surgical technique As we mourn the loss of Prof. Il-Woo Nam, we also celebrate a life replete with professional excellence, selfless service, and a nurturing mentorship that has left an indelible mark on countless lives. [Extracted from the article]

Lip repositioning surgeries are performed to treat patients with excessive GD (EGD). This study aimed to explore and compare the long-term clinical results and stability following the modified lip repositioning surgical technique (MLRS) with the addition of periosteal sutures compared to the conventional lip repositioning surgery (LipStaT®) in order to address EGD. A controlled clinical trial with female participants (n = 200) intended to improve their gummy smile were divided into control (n = 100) and test (n = 100) groups. The gingival display (GD), maxillary lip length at rest (MLLR), and maxillary lip length at maximum smile (MLLS) were measured at four time intervals (Baseline; 1 Month; 6 Months, and 1 Year) in millimeters (mm). Data were analyzed by t-tests, Bonferroni-test, and regression analysis using SPSS software. At the one-year follow-up, GD for the control and test groups were 3.77 + 1.76 mm and 2.48 + 0.86 mm, respectively, and their comparisons showed that GD was considerably lower (p = 0.000) in the test group compared to the control group. The MLLS measurements taken at baseline, one-month, six-month, and one-year follow-up showed no significant differences (p > 0.05) between the control and test groups. At baseline, one-month, and six-month follow-up, the mean and standard deviation for the MLLR were almost similar, with no statistically significant difference (p = 0.675). The MLRS is a successful and viable treatment option for the treatment of patients with EGD. The current study showed stable results and no recurrence with MLRS until the one-year follow-up compared to LipStaT®. With the MLRS, a 2 to 3 mm decline in EGD is usually to be expected. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for airway obstruction. Design: Retrospective cohort study. Setting: Tertiary Pediatric Hospital during 2004-2020. Patients: 148 patients with RS underwent MDO, 66 met inclusion by having MDO and followed by palatoplasty. 26 patients with RS underwent TLA, 14 met inclusion by having TLA and followed by palatoplasty. Main Outcome Measures: Patient characteristics, hospital/operative details, postoperative complications, and polysomnographic (PSG) data were compared. Results: Groups were well-matched except more patients with syndromes underwent MDO (N = 27, 41%, P ≤.002). In the MDO and TLA cohorts, mean CP repair age was 12.8 ± 1.9 months and 14.6 ± 1.6 months, respectively (P ≤.002). Despite the earlier CP repair in the MDO group, there were no differences in peri-operative complication rates after palatoplasty in either group. All sleep respiratory parameters improved after MDO/TLA prior to palatoplasty P ≤.050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, P ≤.043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, P ≤.050, while no changes in the TLA group, P ≥.500. Conclusions: MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved. [ABSTRACT FROM AUTHOR]

In recent decades, the potential of PRF has been extensively studied. The number of studies about PRF has increased three times since the year 2012, but the full spectrum of its fundamental properties, such as antimicrobial and anti-inflammatory activity, is not clearly described. In oral and maxillofacial surgery, PRF is described in alveolar ridge preservation, orthognathic surgery, cleft lip and palate surgery, maxillary sinus augmentation, and dental implant placement as demonstrating favorable results and its clinical advantages. The structural complexity, inhomogeneous nature, and clotting ability of PRF make its antimicrobial effect evaluation complicated. Nevertheless, most of the used antimicrobial testing methods are based on antibacterial agent diffusion ability in culture media. Because the oral and maxillofacial region is the most frequent area of PRF application, its antimicrobial activity evaluation also prevails in the oral microbiome. PRF's biological potential is highly dependent on the specific preparation protocol and methodology used; it should be carefully prepared and kept under proper conditions to keep cellular content alive. PRF's influence on living cells demonstrates a stimulating effect on bone regeneration, and an angiogenetic effect, and it provides anti-inflammatory activity. According to analyzed studies, PRF demonstrated success in oral and maxillofacial surgery in various methods of application. Antibacterial and anti-inflammatory properties were proven by antibacterial activity against different bacterial species, sustained growth factor, sustained release, and cell activity on the material application. Accurately and correctly prepared PRF can ensure antibacterial and anti-inflammatory properties, and it can be a beneficial clinical tool in oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Background: Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. Objective: To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. Methods: A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. Results: There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5–65) months and 8 (IQR: 5.5–16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59–193.70, P-value = 0.005). Conclusion: There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip. [ABSTRACT FROM AUTHOR]