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Microstomia, an abnormally small oral orifice, is a complication of perioral facial burns. In this case, contraction of the circumoral tissues and hypotonia of the musculature is responsible for this microstomia, which can produce aesthetic and functional impairment with eating, swallowing, communication (speech and facial expressions), compromised dental care and maintenance due to limited oral access, social interactions, and psychological well-being. Conservative management involves providing physical resistance to scar contracture, with opposing horizontal and vertical circumoral forces by means of appliances that aim to stretch the commissures and fibrotic muscles. Numerous appliances, either intraoral or extraoral, have been described to prevent or treat microstomia by delivering a static or dynamic stretch horizontally or vertically, with most designed to stretch the mouth horizontally. Finding a comfortable effective way to stretch the mouth vertically has proved to be a challenge. This article describes the fabrication of a dynamic commissural appliance, constructed using acrylic resin and expansion screws, which provide simultaneous horizontal and vertical circumoral forces. This appliance is constructed easily and inexpensively without the need for taking impressions, can be adjusted so that it is almost painlessly inserted, and is progressively activated. It is convenient for use because the patient controls the pressure that is applied by the appliance. Its use in a case is described where the appliance has improved mouth opening and consequently functional outcomes.

The lips are two flaps surrounding the oral orifice. As they are located at the entrance to the digestive tract, the external surface is covered with skin and the internal surface with mucosa. Externally, the appearance of the lip can vary because of syndromes affecting the face. Lip shape is usually defined by the shape of the philtrum. The lateral border of the lip and the nasolabial fold differ among individuals in shape and length. Internally, the labial salivary glands can be affected by disease and aging. The muscles in the lips can also be altered by certain diseases. In this chapter, we describe the anatomy and variations of the lip.

Facial duplication, in whole or in part, is a very rare malformation. It may be symmetrical or asymmetric. Those cases that have been reported in the literature constitute a spectrum extending from simple nasal duplication to complete separation of 2 faces. Up to now there are some reports of eye, nose, mandible, or maxilla duplication separately. But there is no report of oral orifice or lips duplication. The present article reports a case of a newborn girl who presented with 2 mouths and also duplication of zygoma and maxilla. Then, we describe her stages of treatment from birth through now that she has 20 years.

Introduction: Lips are two fleshy folds surrounding the oral orifice. Grooves in the zone of transition of the human lips were named as “sulci labiorum rubrorum”. Study of lip prints is called as “cheiloscopy”. The morphological patterns of the two fleshy folds vary grossly in both sexes. Aim: The study was aimed to find the most common patterns, sexual variations, anthropometric measurements and the morphology of lips. Material and Methods: The present study was conducted on 300 subjects in the age group between 18 - 65 years. The impressions of the vermellion border were obtained. Morphometric analysis of the obtained impressions was done by using scale. The height, width of the mouth was measured. The wrinkles and grooves on the impressions obtained were studied with help of a magnifying lens using Suzuki’s classification. The prints of an individual subject were repeated each year for seven years. Results and discussion: The range in the width of mouth varied from 35-75 mm. The observed widths in males and females subjects varied. The male lips were wider compared to the females. In all age groups studied, in the maximum number of subjects (male and females), the height was ranging between 16-20 mm. the morphometric description of labial folds recognizes, the lips as thin, medium, thick and puffy. The present study on the subjects was medium variety in both sexes i.e. 40% each. The analysis of wrinkles and grooves on the impressions reveals that no impression matches with each other. There was no change observed in the impression of the study subject after seven years. Conclusion: The measurements of width of mouth, height of upper and lower lips and total lip height was greater in males as compared to females. It was concluded that males have a larger mouth and bigger lips than female. The medium types of lips were common in both sexes. There was no change in the lip prints patterns and the anthropometric measurements during seven years of duration. The knowledge of the patterns and measurements can be used as an instrument to identify subject under in the court of law.

An abnormally small oral orifice is referred to as microstomia, although the intraoral structures may be of normal size. Making impression in microstomia patients is often cumbersome. Prosthetic rehabilitation of microstomia patients present difficulties at all stages, right from preliminary impressions to insertion of prostheses. To rehabilitate a patient with microstomia successfully, the methods and designs incorporated in the fabrication of prosthesis have to be modified to achieve favorable esthetics, mastication and retention. This clinical report describes the method of fabrication of sectional denture for completely edentulous patient with microstomia resulting from scleroderma with modified primary impression procedure without using tray and also method of fabricating a sectional complete denture. Fabricating the denture in two pieces enable the patient to insert and remove the denture with ease. How to cite this article Basavanna JM, Raikhy A. Sectional Denture for Microstomia Patient: A Clinical Report. Int J Prosthodont Restor Dent 2013;3(2):62-67.

Laryngoscope blades used to intubate newborn babies are relatively bulky and frequently exert high pressure on the upper jaw. We tested a prototype neonatal offset-blade laryngoscope (NOBL) developed to overcome these limitations. Our aims were to compare the pressure on the upper jaw exerted by a size 0 Miller laryngoscope and the NOBL on a neonatal manikin, as well as the time taken to intubate the trachea and the area of view of the larynx. Twenty healthcare professionals with more than five years of experience in neonatal intensive care took part; the findings were assessed using pressure-sensitive film and photographs. High-pressure indentation occurred in 17 (85%) attempts using the Miller versus 1 (5%) using the NOBL (p = 0.0001). The median (IQR [range]) pressure exerted with the Miller laryngoscope was 455 (350-526 [75-650]) kPa vs 80 (0-133 [0-195]) kPa with the NOBL (p < 0.0001). The area of pressure exerted with the Miller laryngoscope was 68 (32-82 [0-110]) mm(2) vs 8 (0-23 [0-40]) mm(2) with the NOBL (p < 0.0001). The time to intubate was 8.3 (7.3-10.1[4-19]) s for the Miller and 8.0 (5.6-9.6 [4-13.5]) s for the NOBL (p < 0.0001). The area of view blocked by the Miller laryngoscope was 38% of the oral orifice versus 12% with the NOBL. We conclude that the NOBL significantly reduced undesired pressure on the upper jaw during tracheal intubation and improved the view of the larynx compared with a conventional laryngoscope.

Microstomia has been defined as an abnormally small oral orifice associated with various etiopathologic factors. Management of these patients poses extreme difficulties in every procedure during prosthesis fabrication. Restricted mouth opening of the patient makes the insertion and the removal of the tray extremely difficult. So sectioning of the existing stock tray is necessary, so that the trays can be inserted and removed in sections. The main problem encountered during this procedure is the reorientation of the tray back in position. This article presents an innovative technique for the easy handling of the sectioned stock impression trays.

This study presents 17 cases of hanging with some preventative measures, when compared with usual hanging fatalities, between 2002 and 2006 in the province of Konya, Turkey. We observed in 4 cases that the victim had only tied together their hands, whereas in 1 case both the hands (with a clothesline) and mouth (with a plastic bag) had been fastened. In a further case, the oral orifice had been closed using a scarf and in the remaining 11 cases, soft materials such as a scarf, hood, the collar of a coat or shirt had been used as padding against the ligature loop. At first glance, the cases where the victim's hands and/or mouth were found tied were thought to be homicides. However, an investigation of the death scene, together with the autopsy findings and inquiry data, showed the cause of death was from suicide. Thus, in suicidal hanging cases certain precautions and preventative measures were observed. For example, tying the hands together was regarded as a means to make self-release impossible; closure of the oral orifice as a means to prevent the victim from calling out for help, and placing soft material against the ligature loop was thought to be an attempt to lessen the feeling of pain.

Microstomia is defined as an abnormal small oral orifice. Burns and injuries of perioral tissues, perioral surgeries, and genetic disorders can lead to perioral scar formations and restrict mouth opening. Treatment of microstomia requires surgical or conservative approaches. The aim of this report is to assess the effects of surgical commissuroplasty techniques combined with the application of semidynamic mouth splints on 4 microstomia patients with different etiologies. The combination of surgical and conservative techniques proves to be the best method of treating compromised perioral tissues in microstomia patients.

the 66 women choosing this approach and only 48% of the 42 men (P=0.02). Age >50 (P= 0.34), college or graduate level education (P=0.44), history of a prior cholecystectomy (P= 0.85) and an operation in the past 10 years (P=0.19) were not found to be significantly correlated with NOTES preference. The most commonly cited reason for choosing NOTES was less post-op pain (73%), followed closely by less family inconvenience (71%) and less risk of infection (71%). The lack of external scarring ranked fourth out of the six reasons, with 44% of patients selecting this as a factor in their decision. Other less commonly cited reasons were earlier return to work/income (59%) or sports (23%). For patients choosing laparoscopy over NOTES, more available data (86%) and surgical experience (83%) were both commonly selected factors. The oral orifice was most popular, with 64% of all participants preferring this approach. Conclusion: Female gender was significantly associated with a preference for NOTES. Other demographic factors did not correlate significantly with selection of either technique. Decreased pain, family inconvenience and risk of infection were found to be more important than scarring, earlier return to work/income or sports. The oral orifice was preferred by a majority of patients. Patients consider NOTES a reasonable alternative to laparoscopy.

Microstomia is defined as an abnormally small oral orifice which can be due to various factors. Microstomia is a definite prosthodontic hindrance to carry out the different treatment successfully. To rehabilitate a patient with microstomia, successfully, the methods and designs incorporated in the prosthesis have to be modified. In the past, various techniques have been tried, incorporating certain biological and scientific methods to rehabilitate patients with microstomia. This article reviews the previously described treatment modalities in case of patients with microstomia.