The three layered structure of orbicularis oris and buccinator complex with partial connection at the modiolus and partial direct continuation

PURPOSE

This study aimed to clarify the structural arrangement of the orbicularis oris (OOr), the buccinator, and the other perioral muscles around the modiolus.

METHODS

The perioral muscles in seventeen cadavers fixed with formalin were dissected in situ and/or in isolated muscle specimens, and their layers were reconstructed schematically upon pantomographic view of the skeleton to evaluate their actions.

RESULTS

The buccinator was composed of three parts including upper and lower oblique parts in its superficial layer and a middle transverse part in its deep layer. The superior and inferior OOr were composed of an inner marginal part (IM) and an outer labial part (OL) in each. The perioral muscles as a whole were arranged in three layers. The first layer consisted of the depressor anguli oris and the OL of superior OOr connected at the modiolus in a vertical direction. The second layer consisted of the upper and inner oblique part of buccinator and a part of the OL of inferior OOr connected at the modiolus in a horizontal direction. The third layer contained the middle transverse part of buccinator continuous with the IM of both OOr and a part of the OL of inferior OOr without connection to the modiolus.

CONCLUSIONS

The different arrangement of the three layers of perioral muscles around the modiolus could serve as a good basis to predict the actions of the individual perioral muscles on the movement of lips in open/close of the oral fissure and widening/narrowing of the lip width.

Tips for the Perfect Lips

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.

Influence of facial width on the perception of lip protrusion and its differences between profile and 3-dimensional video clip

INTRODUCTION

This study evaluated the influence of facial width on the perception of lip protrusion and investigated the concordance between 2-dimensional (2D) profile images and 3-dimensional (3D) video clips in assessing lip protrusion.

METHODS

An Asian female standard head model was created using 3D modeling software. Eight head models were constructed by modifying the standard head model in terms of facial width (broad, neutral, and slim) and lip protrusion (retrusive, straight, and protrusive). Overall, 97 Asian raters rated the lip protrusion from the 2D profiles and 3D rotation video clips of the 9 models.

RESULTS

No significant differences were found in the perception of lip protrusion in terms of sex, age, or occupation. Compared with the 2D profiles, the 3D video clips were rated as more protrusive in 8 of the 9 head models, with the retrusive broad, retrusive neutral, straight broad, and straight slim faces showing statistical significance (P <0.01). The rating is significantly higher in slim faces than in broad faces across the 3 groups of 2D profiles (P <0.01). For 3D video clips, the rating was higher in slim faces than in broad faces in all 3 groups, whereas differences were significant in the straight and protrusive groups only (P <0.01).

CONCLUSIONS

In this study, 3D video clips were more sensitive to the perception of lip protrusion than were 2D profiles to some extent. The lips were rated relatively more protrusive in a slim face than in a broad face. Therefore, the relationship between facial width and lip protrusion should be considered in orthodontic treatment goals and treatment plans.

A Novel Rat Model for Muscle Regeneration and Fibrosis Studies in Surgical Lip Repair

OBJECTIVE

Lip muscle undergoes suboptimal regeneration after surgical repair, but the mechanism underlying this observation remains obscure. This study provided a rat model to investigate lip muscle regeneration after surgical intervention.

DESIGN

This work provided a detailed description of the rat orbicularis oris muscle anatomy, and a surgically injured model was established based on the muscle anatomy.

MAIN OUTCOME MEASURES

Morphological and histological features of the rat orbicularis oris muscle were characterized. The processes of myogenesis and fibrogenesis were examined between the untreated and surgically injured groups.

RESULTS

Rat orbicularis oris muscle is encapsulated by the vermilion and oral mucosa. Although it remains a thin layer of flat muscle with tight myocutaneous and myomucosal junctions, if accessed properly, the rat orbicularis oris muscle could be isolated as a cylindrical muscle bundle with considerable size, facilitating further surgical manipulations of the muscle fibers. Muscles in steady state and after surgical intervention demonstrated distinct molecular features in the myogenesis and fibrogenesis processes, which were quantifiable in tissue section analysis.

CONCLUSION

The orbicularis oris muscle dissection procedures and injury model provided in this work clarify the rat lip muscle anatomy. The injury model offered a platform to analyze the effects of surgical interventions commonly used in lip repair on orbicularis oris muscle regeneration.

Lip Print Pattern among Children Visiting Dental Out patient department

BACKGROUND

Lip print patterns are unique in every individual. The uniqueness of lip print pattern assists in the personal identification. The objectives of the present study were to study the different lip print patterns among the children visiting Kanti Children's Hospital, and to compare the distribution of lip print patterns based on gender and race.

METHODS

A cross-sectional study was conducted among 300 children visiting the Dental Outpatient Department of Kanti Children's Hospital, Kathmandu, Nepal. Convenience sampling method was used to choose the study subjects. Digital photography method was used to record the image of lips.

RESULTS

The study showed 'Long vertical' (Type I) as the most frequent (41%) type of lip print pattern, whereas 'Unspecified' (Type V) was the least frequent (2.7%) type. Prevalence of 'Type I' pattern was significantly higher in males as compared to females (p=0.007) whereas prevalence of 'Type IV' pattern was significantly higher in females as compared to males (p=0.006). 'Type I' pattern was the commonest lip print pattern among both Caucasians and Mongolian, whereas 'Type V' (2%) and 'Type IV' (3.7%) were the least common lip print patterns in Caucasians and Mongolian children respectively.

CONCLUSIONS

'Long vertical' (Type I) was the most common lip print pattern among the children visiting the Dental Outpatient Department of Kanti Children's Hospital, Kathmandu, Nepal. Nevertheless, in higher or lesser numbers, all kinds of lip print patterns as described by Suzuki and Tsuchihashi were seen in the study population.

Lip color diversity: An intricate study

BACKGROUND

Lip investigations and characterizations in the literature are less prevalent than for skin, particularly on the topic of color diversity. However, as the consumer demand increases for a nude lip makeup result, that is, shades close to the bare lip color, the identification and modification of lip color is essential for the cosmetic industry.

OBJECTIVE

The objective was to highlight lip color diversity among three ethnicities (Caucasian, African and Hispanic), through the use of a spectral color measurement device especially adapted to the lip area, and to consider lip color ethnic specificities and overlaps.

MATERIALS AND METHODS

The inferior natural lip color was measured with a full-face hyperspectral imaging system, SpectraFace (Newtone Technologies, Lyon, France), on 410 healthy women aged 19 to 68 (Caucasian French, Caucasian American, African American, and Hispanic American women). A hierarchical ascending classification, was deployed to determine clusters based on the lip colorimetric parameters along two strategies to identify the best statistical analysis to preserve the lip color diversity.

RESULTS

Lip color is a continuous color space, with great intra-ethnic and inter-ethnic diversity, especially for African American women in terms of chroma and lightness. Among the two strategies of data analysis, our two-step statistical clustering analysis yielded 11 groups (i.e., 11 lip tones), revealing an accurate representation of the scope of diversity, but also of the overlaps.

CONCLUSION

The 11 lip tones/colors could potentially serve as target shades for the development of a more diverse and inclusive range of lip cosmetics, such as nude lipsticks.

Using a structured light scanner to evaluate 3-dimensional soft-tissue changes after extracting 4 premolars in young adult female patients

INTRODUCTION

Facial esthetics have always received much attention in orthodontic treatment, especially in young adult female patients. Three-dimensional (3D) soft-tissue changes after orthodontic extraction have not been fully explained. This study evaluated the 3D morphologic changes after orthodontic extraction in young female patients using a structured light scanner.

METHODS

Forty-five adult female patients aged 20-25 years were enrolled in our study. The treatment group consisted of patients who received orthodontic treatment with 4 premolar extractions, and the control group was composed of young female volunteers who had not undergone any orthodontic treatment. To monitor the soft-tissue changes, 9 morphologic regions and 12 landmarks were identified for the 3D deviation analyses. The spatial deviations of landmarks and regions in the x, y, and z directions were constructed for quantitative analysis. Color map images were constructed to visualize soft-tissue displacement as a qualitative evaluation. The paired sample test was used to compare differences at the beginning of the experiment (T0) and after 24 months (T1) in both groups. An independent t test with Bonferroni correction was performed to compare differences between the treatment and control groups. A linear regression test was performed between incisor retraction and changes in the perioral tissues.

RESULTS

Subtracting the effect of aging from the lip changes in the control group, the treatment group showed a statistically significant difference in the displacement of labrale superius (-1.37 mm), labrale inferius (-1.89 mm), the upper lip region (-0.98 mm), and the lower lip region (-1.36 mm) along the z-axis. No significant differences were found between the treatment and control groups in the temporal, parotideomasseteric, and buccal regions. Pearson correlation tests indicated a positive correlation between incisor tip retraction and changes in soft tissues (two-dimensional cephalometric analysis, 3D landmark measurements, and 3D regional measurements). The correlation coefficient ranged between 0.45 and 0.55.

CONCLUSIONS

Three-dimensional soft-tissue changes were mainly concentrated in the upper and lower lip regions in adult female patients after the 4 premolars were extracted. For female patients aged 20-25 years with 4 extracted premolars, soft-tissue changes in the temporal, parotideomasseteric, and buccal regions were not clinically significant.

Facial profile evaluation and prediction of skeletal class II patients during camouflage extraction treatment: a pilot study

BACKGROUND

The evaluation of the facial profile of skeletal Class II patients with camouflage treatment is of great importance for patients and orthodontists. The aim of this study is to explore the key factors in evaluating the facial profile esthetics and to predict the posttreatment facial profile esthetics of skeletal Class II extraction patients.

METHODS

124 skeletal Class II extraction patients were included. The pretreatment and posttreatment cephalograms were analyzed by a trained expert orthodontist. The facial profile esthetics of pretreatment and posttreatment lateral photographs were evaluated by 10 expert orthodontists using the visual analog scale (VAS). The correlation between subjective facial profile esthetics and objective cephalometric measurements was assessed. Three machine-learning methods were used to predict posttreatment facial profile esthetics.

RESULTS

The distances from lower and upper lip to the E plane and U1-APo showed the stronger correlation with profile esthetics. The changes in lower lip to the E plane and U1-APo during extraction exhibited the stronger correlation with changes in VAS score (r = - 0.551 and r = - 0.469). The random forest prediction model had the lowest mean absolute error and root mean square error, demonstrating a better prediction accuracy and fitting effect. In this model, pretreatment upper lip to E plane, pretreatment Pog-NB and the change of U1-GAll were the most important variables in predicting the posttreatment score of facial profile esthetics.

CONCLUSIONS

The maxillary incisor protrusion and lower lip protrusion are key objective indicators for evaluating and predicting facial profile esthetics of skeletal Class II extraction patients. An artificial intelligence prediction model could be a new method for predicting the posttreatment esthetics of facial profiles.

Comparison of Effects between Total Maxillary Setback Osteotomy and Anterior Maxillary Segmental Osteotomy on Nasolabial Morphology

BACKGROUND

The authors aimed to compare the effects of total maxillary setback osteotomy (TMSO) and anterior maxillary segmental osteotomy (AMSO) on nasolabial morphology.

METHODS

This retrospective clinical trial enrolled 130 patients undergoing maxillary surgery using TMSO or AMSO. Ten nasolabial-related parameters and nasal airway volume were measured preoperatively and postoperatively. The soft-tissue digital model was reconstructed using Geomagic Studio and Dolphin image 11.0. Statistical analysis was performed using IBM SPSS Version 27.0.

RESULTS

A total of 75 patients underwent TMSO, and 55 underwent AMSO. Both techniques achieved optimal repositioning of the maxilla. Except for the dorsal nasal length, the dorsal nasal height, the length of the nasal columella, and the upper lip thickness, the remaining parameters were significantly different in the TMSO group. In the AMSO group, only the nasolabial angle, the alar base width, and the greatest alar width showed significant differences. There was a significant difference in the nasal airway volume for the TMSO group. The results of matching maps are consistent with the statistical results.

CONCLUSIONS

TMSO has a more significant impact on both nose and upper lip soft tissues, whereas AMSO has a more significant impact on the upper lip and less on the nasal soft tissue. There is a significant decrease in nasal airway volume after TMSO, whereas AMSO showed less decrease. This retrospective study is helpful for clinicians and patients to understand the different changes in nasolabial morphology caused by the two interventions, which is essential for effective intervention and physician-patient communication.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Hard and soft tissue shape variation and changes in Class II division 1 malocclusion during orthodontic treatment: a geometric morphometric analysis

BACKGROUND

This study aims to determine the hard and soft tissue shape variation and its changes in Class II division 1 malocclusion before and after orthodontic treatment using Geometric Morphometric Analysis.

METHODS

This retrospective study included 141 pre-treatment and near-end treatment lateral cephalometric radiographs of Class II division 1 malocclusion patients aged 16-40 years with a skeletal II pattern (ANB > 4o). 32 landmarks in Cartesian coordinates were created and identified using MorphoJ software to establish a shape analysis.

RESULTS

The vertical dimensions (hypodivergent to hyperdivergent facial profiles) showed the largest variation in the general shape of hard and soft tissue, followed by the anteroposterior dimensions (mild to severe skeletal II patterns). Variations of lip shape (long to short), lip protuberance (everted to inverted), and nasolabial angle (obtuse to acute) were present. Orthodontic treatment affected the shape of the hard and soft tissue significantly (p < 0.0001). T2 showed significant uprighting of upper incisors (17.5o) and lower incisors (3.7o), improved NLA (8o), an increase in upper lip thickness (1.5 mm), and a reduction in lower lip thickness (0.7 mm) (p < 0.05).

CONCLUSION

Vertical and anteroposterior shape variations were found. Orthodontic treatment had an impact on both hard and soft tissue shapes. Hence, understanding both the hard and soft tissue shape variations and the orthodontic treatment changes is crucial for an accurate diagnosis and treatment plan to achieve a successful outcome and excellent patient satisfaction.

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population

BACKGROUND

Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment.

OBJECTIVES

This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol.

METHODS

Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients.

RESULTS

Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results.

CONCLUSIONS

Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

LEVEL OF EVIDENCE: 4

Perspectives and challenges in lip rejuvenation: a systematic review

OBJECTIVE

There is an abundance of information on facelifts, blepharoplasties, rhinoplasty, and other cosmetic surgical procedures for the upper third of the face, but little is known about perioral lip rejuvenation. The aim of this article is to examine the existing literature on lip rejuvenation and perioral procedures related to lip rejuvenation. Additionally, this article aims to highlight the importance of addressing perioral areas alongside lip rejuvenation procedures, rather than solely focusing on lip rejuvenation. We also discussed the extensive procedures and materials used for lip rejuvenation, such as hyaluronic acid, botulinum toxin A, abobotulinum, onabotulinum, incobotulinum, prabobotulinum, fat grafts, silicone fillers, human collagen, collagen stimulating procedures such as derma pens and derma rolls, radiation frequency, stem cells, and plasma therapy, as well as the underlying factors that contribute to varying success rates.

MATERIALS AND METHODS

A thorough literature search was done using PubMed, Cochrane, Ebsco search, Google Scholar, Scopus, and Web of Science for the articles pertaining to facial and lip cosmetic surgeries 1995-2020. Keywords for the search included anatomy of the face, facial aging, perioral areas, lip rejuvenation, botox, grafts, facelift, plastic surgery, stem cell therapy, plasma treatment, and cosmetic surgery.

RESULTS

37 articles met the study criteria. 14 out of 37 studies included procedures for lip and perioral region rejuvenation. The remaining 23 studies either involved lip procedures alone or lip procedures in conjunction with facial cosmetic procedures. Lip rejuvenation with perioral enhancement with hyaluronic acid gel demonstrated a 94.3% improvement on the lip fullness scale (LFS) one month after re-treatment. The amalgamation of lip and perioral region rejuvenation produces a synergistic effect. Whereas, sole lip rejuvenation procedures showed short-term results with less patient satisfaction, calling for secondary lip rejuvenation procedures. It was also observed that hyaluronic acid was the most commonly used agent for lip rejuvenation procedures with minimal or no side effects.

CONCLUSIONS

In conjunction with perioral rejuvenation, lip rejuvenation procedures produce more aesthetically appealing results. However, any cosmetic surgical or non-surgical procedure is limited by the nature and composition of the products used. The use of FDA-approved products for rejuvenation is strongly advised to avoid undesirable side effects. Further extensive research is required on the long-term outcomes and adverse effects of stem cell transplants, such as tumor development.

Lip and facial training improves lip-closing strength and facial morphology

OBJECTIVE

Childhood is an important period for lip-closing strength (LCS) development, and failure to acquire LCS during childhood leads to various adverse health effects, such as mouth breathing. The purpose of this study was to examine the effectiveness of device-free lip and facial training in preschool children.

DESIGN

The participants were divided into training and control groups. Both groups comprised 123 children aged 3-4 years, and only the training group received lip and facial training (i.e., opening and closing the lips and protruding the tongue) for 1 year. A two-way repeated measures analysis of variance was applied to compare the interaction effects of LCS and facial linear distance and angle by year (initial year vs. 1 year later) and group (training vs. control group). In addition, paired t-tests were used to test the changes in LCS and facial linear distance and angle after 1 year in both groups. Furthermore, the same analysis was performed in children with weak LCS in both groups (incompetent lip seal [ILS]).

RESULTS

The LCS of children in the training group significantly increased after training compared with that in the control group, whether the analysis included all children or children with ILS alone. Lip and facial training for children with ILS reduced both the upper and lower lip protrusion; children with ILS without training had increased lip protrusion after 1 year.

CONCLUSIONS

Lip and facial training for children with ILS effectively improved LCS and lip morphology, thereby preventing increased lip protrusion.

Differences in the 3-dimensional aging changes of the lips among female adults with skeletal Class I, II, and III malocclusion

INTRODUCTION

The objective of this study was to evaluate and compare the 3-dimensional (3D) aging changes of the lips among adult skeletal Class I, II, and III malocclusion.

METHODS

Female adult orthodontic patients aged 20-50 years with pretreatment cone-beam computed tomography scans were retrospectively classified according to age (20s [20-29 years], 30s [30-39 years], and 40s [40-49 years]) and then subclassified by malocclusion into skeletal Class I, II, and III relationship (9 groups; n = 30 per group). Positional differences in midsagittal and parasagittal soft-tissue landmarks and 3D morphologic aging changes of the lips were evaluated using cone-beam computed tomography scans.

RESULTS

Labiale superius and cheilion for patients in their 40s indicated a significant downward and backward position compared with those in their 20s, regardless of skeletal classifications (P <0.05). Accordingly, the upper lip height decreased, and the mouth width increased significantly (P <0.05). For Class III malocclusion, the upper lip vermilion angle was greater for patients in their 40s than those in their 20s (P <0.05), whereas the lower lip vermilion angle was only lower for patients with Class II malocclusion (P <0.05).

CONCLUSIONS

Middle-aged adult females (40-49 years) had a lower upper lip height and greater mouth width than those in their 20s, regardless of skeletal malocclusion. However, prominent morphologic aging changes of the lips were noted on the upper lip for skeletal Class III malocclusion and the lower lip for skeletal Class II malocclusion, implying that the underlying skeletal features (or malocclusion) may influence 3D aging changes of the lips.

XGBoost-aided prediction of lip prominence based on hard-tissue measurements and demographic characteristics in an Asian population

INTRODUCTION

Prediction of lip prominence based on hard-tissue measurements could be helpful in orthodontic treatment planning and has been challenging and formidable thus far.

METHODS

A machine learning-based cross-sectional study was conducted on 1549 patients. Hard-tissue measurements and demographic information were used as the input features. Seven popular machine learning algorithms were applied to the datasets to predict upper and lower lip prominence. The algorithm that performed the best was selected for the construction of the prediction model. Evaluation of feature importance was conducted using 3 classical methods.

RESULTS

Among the 7 algorithms, the XGBoost model performed the best in the prediction of the distances between labrale superius or labrale inferius to the esthetics plane (UL-EP and LL-EP distances), with root mean square error values of 1.25, 1.49 and r2 values of 0.755 and 0.683, respectively. Among the 14 input features, the L1-NB distance contributed the most to the prominences of the upper and lower lips. A lip prominence predictor was developed to facilitate clinical application by deploying the prediction model into a downloadable tool kit.

CONCLUSIONS

The XGBoost model performed well with high accuracy and practicability in predicting upper and lower lip prominence. The artificial intelligence-aided predictor could serve as a reference for orthodontic treatment planning.

Different Techniques and Quantitative Measurements in Upper lip lift: A Systematic Review

BACKGROUND

The upper lip area is an important component of facial aesthetics, and aging produces an increase in the vertical height of the upper lip. Different upper lip lifting techniques are described in the literature.

OBJECTIVES

This systematic review aimed to assess both invasive and noninvasive upper lip lifting techniques with patient satisfaction, adverse effects, and quantitative measurements of lifting efficiency.

METHODS

This study was conducted per PRISMA guidelines. MEDLINE (via PubMed), EMBASE (OvidSP), and Cochrane Library database were searched from September 14, 2022, to October 12, 2022. Inclusion criteria were reporting on upper lip lift efficiency with quantitative measurements of the lifting degree.

RESULTS

Out of 495 studies through the search strategy, nine articles were included in the systematic review, eight for surgical procedures and one for nonsurgical. Surgical procedures seem to have better longevity than nonsurgical techniques. Reported patient satisfaction for both surgical and nonsurgical treatments was good with no severe complaints. The quantitative measures differ between researches and may be classified into two metrics: anatomy ratio computation using photographic analysis or direct height measurement with a caliper and precise parameters utilizing a three-dimensional method.

CONCLUSION

In general, surgical therapies seem to have a longer-lasting lifting effect on upper lip lifts with an inevitable scar, while nonsurgical techniques are minimally invasive but temporary. There was a lack of consistency in the measurements used to assess lifting efficiency. A consistent quantitative assessment can be beneficial for both clinical decision-making and high-level evidence research.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Development and Validation of a Photonumeric Scale for Evaluation of Lip Fullness

BACKGROUND

The shape, proportion, and fullness of one's lips are associated with overall facial beauty and attractiveness. Lip augmentation, due to personal preference or to reverse natural aging, has become a standard clinical procedure to improve lip volume or proportion. Several options are available to redefine the lips. To objectively evaluate treatment-related improvements in clinical practice and research, a validated photonumeric scale is needed.

OBJECTIVE

To present scale-development methods for the Merz Lip Fullness Assessment Scale (MLFAS) and establish its reliability.

METHODS

A 5-point photonumeric scale was developed to objectively assess loss of lip volume using male and female subjects of various ages and skin types. To establish intra- and interrater reliability, 8 board-certified dermatologists and plastic surgeons evaluated 64 subjects live in 2 sessions, 2 weeks apart.

RESULTS

The weighted kappa for intra- and interrater agreement were &ge; 0.6 in all cases. Intrarater agreement between the 2 rating sessions was nearly perfect (median weighted kappa = 0.911 and 0.930 for the upper lip and lower lip, respectively). Substantial interrater agreement between each rater pair was also demonstrated for both rating sessions, and ratings of upper and lower lip fullness showed comparable reliability.

CONCLUSION

The MLFAS is a validated and reliable photonumeric scale for rating loss in lip volume. The scale maintains its reliability with reproducible results across a diverse group of males and females of various ages and Fitzpatrick skin types. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.7309.

Hispanic adolescent lip response to extraction and nonextraction orthodontic treatment

INTRODUCTION

In orthodontics, treatment aims to improve the patient's occlusion and overall facial appearance. Extraction of 4 first premolars may improve the occlusion, but it may negatively impact a patient's facial harmony and create a "dished-in" appearance. Although many studies in orthodontic literature reviewed Caucasian patient soft-tissue change throughout extraction treatment, there is a void in the literature regarding Hispanic patients, who have different soft-tissue characteristics and may respond differently to extraction therapy. This study aimed to determine the influence of first premolar extractions on soft-tissue profile in Hispanic adolescents and whether there is a correlation between pretreatment lip strain and lip movement throughout treatment.

METHODS

Lateral cephalograms and study models of 60 Hispanic patients were evaluated at pretreatment and posttreatment stages. Patients were divided into nonextraction and extraction groups and further subdivided on the basis of pretreatment lip strain. Cephalometric analyses were compared between the groups and subgroups, and a correlation analysis was conducted.

RESULTS

There was a significant difference in lip position change between nonextraction and extraction groups. There was a significant increase in upper vermillion lip thickness in the extraction group. There was no significant difference in lip position change between the minimal and moderate-severe lip strain extraction groups. There was no significant correlation between pretreatment crowding or lip strain and lip position change.

CONCLUSIONS

Hispanic patients' lips may retract less than Caucasian patients' lips in response to extraction treatment. Pretreatment lip strain and crowding may have less effect on retrusive lip movement than in Caucasian patients.

Association of gingival exhibit with lip dimensions, intercommissural width, and gingival and interdental smile lines - a gender-based evaluation

OBJECTIVE

The present study aimed to evaluate the gender-based association of gingival exhibit with lip dimensions, intercommissural width (ICW), interdental smile line (ISL), and gingival smile line (GSL) in periodontally healthy patients.

MATERIALS AND METHODS

120 patients aged between 20 and 40 years were divided equally into two groups based on gender. The parameters of lip length (LL) at rest and on smiling, ICW, and the intraoral parameters of gingival exhibit in ISL and GSL were measured on digitized photographs in the maxillary anterior teeth.

RESULTS

The LL positions at rest and on smiling differed significantly: 23.50 ± 3.31 mm and 19.89 ± 1.91 mm, and 16.53 ± 2.94 mm and 13.91 ± 1.93 mm for males and females, respectively. The gingival exhibit of the interdental papillae in ISL was 3.01 ± 1.85 mm for males and 4.26 ± 1.85 mm for females, while the midfacial exhibit in GSL was 0.62 ± 1.01 mm for males and 1.24 ± 1.44 mm for females; both the differences were statistically significant.

CONCLUSION

The gender variability in LL, the interdental papillae exhibit in ISL, and the midfacial exhibit in GSL can provide constructive guidelines that can be implemented in the esthetic zone.

Impact of facial components on the attractiveness of face: A perception-based study

INTRODUCTION

Magazines and television displays are not merely crammed with faces-they are filled with appealing faces, and both men and women are interested in a suitable partner's appearance. This study investigated what makes a face attractive and whether perception-related differences exist between facial attractiveness and facial components.

METHODS

In this descriptive-analytical study, frontal and lateral view photographs of 18 young adults (9 male and 9 female) in Class I, II, and III malocclusions were assessed by 90 orthodontists, dentists, models, and laypeople using a 7-point Likert scale in terms of attractiveness. Based on scores, attractive and unattractive groups were formed. Using image analysis software, a range of defined length, angles, perimeter, and area for lips, nose, and chin were measured for the attractive group. For statistical analysis, each group was compared using a 1-way analysis of variance. Logistic regression was performed to analyze the factors of different parameters to the attractiveness of facial components.

RESULTS

Overall full-face width, upper lip angle, lip area, and mentolabial angle was significantly different in all the 3 classes (P ≤0.05). In Class I malocclusion, nasolabial angle among orthodontists, nasofrontal angle among dentists, lower lip among models, and full-face width among laypeople were responsible for facial attractiveness variation. In Class II malocclusion, nose to upper lip among orthodontists, Cupid's bow among dentists, wider face among models, and upper lip among layperson were responsible for variation in facial attractiveness. In Class III malocclusion, lower lip angle among orthodontists and dentists, Cupid's bows among models and layperson was responsible for variation in facial attractiveness.

CONCLUSIONS

In Class I faces, lips (Cupid's bows, lower lips, lip areas), nose (nasolabial, nasofrontal, and nasomental angles), and chin (lower lip to chin) contributed to the overall attractiveness of the face, while in Class II faces, lips (upper lip length, interbow distance, lower lip angle), nose (full facial convexity), and chin (mentolabial sulcus), as well as a greater full-face width contributed to the overall attractiveness of the face. In Class III faces, lips (lower lip angle, upper lip length), nose (nose tip angle, full facial convexity), and chin (mentolabial sulcus depth) contributed to the overall attractiveness of the face.

Visualising trends in dentition to lip mouth morphology using geometric morphometrics

Linear measurements taken from bony landmarks are often utilised in facial approximation (FA) to estimate and plan the placement of overlying soft tissue features. This process similarly guides craniofacial superimposition (CFS) practices. Knowledge of how hard and soft tissue features spatially relate around the mouth region is, however, limited. Geometric morphometric techniques have thus been used to investigate size and shape variation in dentition-to-lip mouth morphology in a South African population. Twenty landmarks (twelve dentition, eight lips) were digitised, using cone-beam CT images of the anterior craniofacial complex in a Frankfurt/Frankfort position, for 147 individuals aged between 20 and 75 years. Principal Component Analysis and Canonical Variate Analysis established that much shape variation exists. A two-way ANOVA identified significant (p < 0.0001) population and sex variation with mouth shape. Black individuals presented with thicker lips, with the oral fissure aligning closely to the dental occlusion. Oral fissure position for white individuals corresponded to the inferior one-quarter (females) or one-sixth (males) of the maxillary central incisor crowns. Males presented larger dimensions than females, but females had a greater lip-to-teeth height ratio than their male counterparts. A pooled within-group regression analysis assessed the effect of age on the dentition and lips and found that it had a significant (p < 0.0001) impact on mouth shape. Ageing was associated with a reduced lip and teeth height, increased mouth width, and a lowered oral fissure and cheilion placement. The generated mean shape data, with metric guides, offer a visual and numerical guide that builds on existing FA and CFS standards, enhancing our understanding of hard and soft tissue relationships.

Analyzing the effects of tooth extraction on the lip in orthodontic treatment

INTRODUCTION

The aim of this study was to analyze changes occurring in the lip and facial soft-tissue profile after fixed orthodontic treatment, with or without tooth extraction, in patients with dental class II malocclusion.

MATERIALS AND METHODS

Measurements were made on cephalometric films of 75 individuals with dental class II malocclusion before and after fixed orthodontic treatment. The patients were divided into three groups: no extraction, extraction of upper two premolars, or extraction of four premolars. The parameters measured were: basic upper lip thickness (BULT), vermilion upper lip thickness (VULT), upper lip inclination (ULI), basic lower lip thickness (BLLT), vermilion lower lip thickness (VLLT), lower lip inclination (LLI), face axis angle (Ba-N/PtmGn), labiomental angle, facial convexity angle, and total face convexity angle. The results were analyzed statistically using the Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests.

RESULTS

It was found that the VULT value in the group with no extraction was lower than the four-extraction group (P = 0.001; P < 0.05). The VULT value in the upper-two extraction group was significantly lower than that in the four-extraction group, and the Ba-N/PtmGn in the no-extraction group was lower than that in the four-extraction group (P = 0.001; P < 0.05).

CONCLUSIONS

These findings suggest that tooth extraction in orthodontic treatment may affect the vermilion upper lip thickness and facial axis, but that this does not have any negative effects on the soft-tissue facial profile. Premolar tooth extraction can be performed by establishing an accurate diagnosis and treatment plan to avoid undesirable and negative effects on the facial soft-tissue profile.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

PURPOSE

The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population.

METHODS

Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20 years), group II (20 to 39 years), group III (40 to 59 years), and group IV (over 60 years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ² test, and analysis of variance were used for statistical analysis according to age and gender.

RESULTS

The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P = .281) and female (P = .442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank.

CONCLUSIONS

An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

The weak evidence of lip print analysis for sexual dimorphism in forensic dentistry: a systematic literature review and meta-analysis

This study aimed to assess the prevalence of lip print patterns among males and females, and to test the diagnostic accuracy of lip pattern analysis for sexual dimorphism in forensic dentistry. A systematic literature review was performed following the PRISMA guidelines. The search was performed in six primary databases and three databases to cover part of the grey literature. Observational and diagnostic accuracy studies that investigated lip print patterns through cheiloscopy for sexual dimorphism were selected. Risk of bias was assessed with the Joanna Briggs Institute (JBI) tool. Proportion meta-analysis using random effects was fitted to pool the accuracy of cheiloscopy. The odds of correctly identifying males and females was assessed through a random effects meta-analysis. GRADE approach was used to assess certainty of evidence. The search found 3,977 records, published between 1982 and 2019. Seventy-two studies fulfilled the eligibility criteria and were included in the qualitative analysis (n = 22,965 participants), and twenty-two studies were sampled for meta-analysis. Fifty studies had low risk of bias. Suzuki and Tsuchihashi's technique was the most prevalent among studies. The accuracy of sexual dimorphism through cheiloscopy ranged between 52.7 and 93.5%, while the pooled accuracy was 76.8% (95% CI = 65.8; 87.7). There was no difference between the accuracy to identify males or females (OR = 0.71; 95% CI = 0.26; 1.99). The large spectrum of studies on sexual dimorphism via cheiloscopy depicted accuracy percentage rates that rise uncertainty and concern. The unclear performance of the technique could lead to wrong forensic practice.

Testing regression and mean model approaches to facial soft-tissue thickness estimation

Average facial soft-tissue thickness (FSTT) databanks are continuously developed and applied within craniofacial identification. This study considered and tested a subject-specific regression model alternative for estimating the FSTT values for oral midline landmarks using skeletal projection measurements. Measurements were taken from cone-beam computed tomography scans of 100 South African individuals (60 male, 40 female; M_age = 35 years). Regression equations incorporating sex categories were generated. This significantly improved the goodness-of-fit (r²-value). Validation tests compared the constructed regression models with mean FSTT data collected from this study, existing South African FSTT data, a universal total weighted mean approach with pooled demographic data and collection techniques and a regression model approach that uses bizygomatic width and maximum cranial breadth dimensions. The generated regression equations demonstrated individualised results, presenting a total mean inaccuracy (TMI) of 1.53 mm using dental projection measurements and 1.55 mm using cemento-enamel junction projection measurements. These slightly outperformed most tested mean models (TMI ranged from 1.42 to 4.43 mm), and substantially outperformed the pre-existing regression model approach (TMI = 5.12 mm). The newly devised regressions offer a subject-specific solution to FSTT estimation within a South African population. A continued development in sample size and validation testing may help substantiate its application within craniofacial identification.

[Dynamic esthetic analysis of the anterior teeth in normal occlusion in individuals aged 18-49 years]

Objective: To investigate the relationship between age, sex, length of upper lip and the exposure of maxillary central incisor. Methods: A total of 304 participants in normal occlusion (154 males, 150 females, aged 18-49 years) were recruited in this study from patients, visited the Medical Examination Center, Affiliated People's Hospital, Shanxi Medical University from January 2019 to August 2020. Participants were divided into 18-29 years old group (104, 53 males, 51 females), 30-39 years old group (110, 56 males, 54 females) and 40-49 years old group (90, 45 males, 45 females). Facial photography was used to record the facial state during the mandibular postural position, "che" pronunciation position and posed smile. The upper lip length, upper lip thickness and the exposure of maxillary central incisor were measured by ImageJ. The differences of measurement items in each group and the gender differences of each measurement item were analyzed. The length of upper lip and the exposure of upper central incisor in the mandibular postural position were analyzed by Pearson correlation. Results: In the mandibular postural position, the length of upper lip was (21.9±2.2), (22.5±2.5) and (23.1±2.2) mm in the 18-29 years old, 30-39 years old and 40-49 years old groups, and the length of upper lip in the 40-49 years old group was significantly larger than that in the 18-29 years old group (P<0.05). The exposure of upper central incisor in the 40-49 years old group during the mandibular postural position, "che" pronunciation position and posed smile [(1.4±1.2), (4.7±2.4), (7.7±2.4) mm, respectively] were significantly lower than those in the 18-29 years old group [(2.3±1.4), (5.5±2.2) and (8.8±2.0) mm] (P<0.05). The exposure of upper central incisor in the 30-39 years old group during the mandibular postural position and posed smile [(1.8±1.4), (8.2±2.0) mm, respectively] was significantly lower than those in the 18-29 years old group (P<0.05). With the increase of age, the exposure of upper central incisor decreased gradually. In the same group, the exposure of upper central incisor in the female during the mandibular postural position and "che" pronunciation position (except 40 to 49 years old group) were significantly larger than those in the male (P<0.05), and there was no statistically significant difference between the sexes in the posed smile (P>0.05). There was a significant linear correlation between the exposure of upper central incisor and the length of upper lip at the mandibular postural position in normal occlusion aged 18-49 (r=-0.325, P<0.01). Conclusions: Gender factor should be considered in the esthetic design of anterior teeth. The exposure of anterior teeth in the mandibular postural position and "che" pronunciation position is more valuable than that in the posed smile. The length of upper lip in normal occlusion aged 40-49 was significantly shorter than that aged 18-29, and the exposure of upper central incisors was significantly reduced.

Three-dimensional virtual planning in mandibular advancement surgery: Soft tissue prediction based on deep learning

The study aimed at developing a deep-learning (DL)-based algorithm to predict the virtual soft tissue profile after mandibular advancement surgery, and to compare its accuracy with the mass tensor model (MTM). Subjects who underwent mandibular advancement surgery were enrolled and divided into a training group and a test group. The DL model was trained using 3D photographs and CBCT data based on surgically achieved mandibular displacements (training group). Soft tissue simulations generated by DL and MTM based on the actual surgical jaw movements (test group) were compared with soft-tissue profiles on postoperative 3D photographs using distance mapping in terms of mean absolute error in the lower face, lower lip, and chin regions. 133 subjects were included - 119 in the training group and 14 in the test group. The mean absolute error for DL-based simulations of the lower face region was 1.0 ± 0.6 mm and was significantly lower (p = 0.02) compared with MTM-based simulations (1.5 ± 0.5 mm). CONCLUSION: The DL-based algorithm can predict 3D soft tissue profiles following mandibular advancement surgery. With a clinically acceptable mean absolute error. Therefore, it seems to be a relevant option for soft tissue prediction in orthognathic surgery. Therefore, it seems to be a relevant options.

Three-dimensional analysis of lip soft tissue changes and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry

OBJECTIVE

To investigate three-dimensional soft tissue changes of lips and related jaw changes in patients with skeletal class III malocclusion and facial asymmetry using cone-beam computerized tomography (CBCT).

METHOD

This study included 46 CBCT scans of patients with aforementioned character before (T1) and 6-12 months after orthognathic surgery (T2). Subjects were divided into 2 groups according to two types of orthognathic surgery namely, the one-jaw surgery group who underwent bilateral sagittal splint ramus osteotomy (BSSRO) and the two-jaw surgery group who underwent Le Fort I osteotomy and BSSRO. Mimics 19.0 software are used for model reconstruction, landmark location and three-dimensional cephalometric analysis. Descriptive statistics and correlation analyses are used to investigate jaw hard tissue and lip soft tissue changes.

RESULTS

In one-jaw group, the mandible shows changes in contour and position (p < 0.05), and the surgery causes changes of lip structure on the deviated side. While in two-jaw group, jaws only show changes in spatial position, and surgery changes contour of bilateral lips and nasolabial angle (p < 0.05). At the same time, lip symmetry increases significantly in both groups postoperatively.

CONCLUSIONS

Orthognathic surgery can improve lip aesthetics in patients with skeletal class III malocclusion and facial asymmetry. However, changes induced by two surgical approaches are different. Surgeons should have a clear acquaintance with this difference to deal with different situations.

Sucker with a fat lip: The soft tissues underlying the viscoelastic grip of remora adhesion

Remoras are fishes that attach to a broad range of hosts using an adhesive disc on their head that is derived from dorsal fin elements. Research on the adhesive mechanism of remoras has focused primarily on the skeletal components of the disc and their contribution to generating suction and friction. However, the soft tissues of the disc, such as the soft lip surrounding the bony disc and the muscles that control the bony lamellae, have been largely ignored. To understand the sealing mechanism of the disc, it is imperative to understand the tissue morphology and material properties of the soft lip. Here, we show that the soft lip surrounding the remora disc is comprised of discrete multilayered collagen, fat, and elastic tissues which we hypothesize to have specific roles in the viscoelastic sealing mechanism of the remora disc. The central, heavily vascularized fat and collagen layer are infiltrated by strands of elastic tissue and surrounded by crossed-fiber collagen. A newly described jubilee muscle underneath the adhesive disc provides a mechanism for stopping venous return from the disc lip, thereby allowing it to become engorged and create a pressurized fit to the attachment substrate. Thus, the remora lip acts as a vascular hydrostat.

Speckle-free, near-infrared portable confocal microscope

We have developed a portable confocal microscope (PCM) that uses an inexpensive near-infrared LED as the light source. Use of the spatially incoherent light source significantly reduced the speckle contrast. The PCM device was manufactured at the material cost of approximately $5000 and weighed only 1 kg. Lateral and axial resolutions were measured as 1.6 and 6.0 µm, respectively. Preliminary in vivo skin imaging experiment results showed that the PCM device could visualize characteristic cellular features of human skin extending from the stratum corneum to the superficial dermis. Dynamic imaging of blood flow in vivo was also demonstrated. The capability to visualize cellular features up to the superficial dermis is expected to facilitate evaluation and clinical adoption of this low-cost diagnostic imaging tool.

Development of a Photonumeric Lip Health Scale

BACKGROUND

The lips are important facial anatomic features with particular vulnerability to environmental damage, yet they have received little attention in the dermatologic literature. A photonumeric rating scale for clinically assessing lip heath is needed to advance lip research.

OBJECTIVE

To develop a photonumeric lip health assessment scale for clinical use that can evaluate the efficacy of products for improving lip health.

METHODS

The VISIA&reg;-CR 4.3 system was used to photograph the frontal face of 103 subjects with Fitzpatrick skin types I&ndash;III exhibiting a range of lip health status based on the key characteristics of lip shine, texture, and vermilion border. An expert panel comprising 3 dermatologists independently rated the images based on the proposed rating scale. Images with &ge;75% rater agreement were redistributed to the panel for selecting the final images and verification of the final scale.

RESULTS

The panel selected 15 images for the final scale: 5 for each of the key characteristics (lip shine, texture, and vermilion border) and 1 for each ordinal rating of 0&ndash;5 within a characteristic (eg, 0=very shiny, 5=very dull). All of these images achieved 100% agreement among the raters.

CONCLUSION

This scale provides healthcare professionals and researchers a way to evaluate current lip health, track improvement, and evaluate the efficacy of treatments. It can be used to communicate with patients during discussions about lip conditions, recommending treatments, and setting goals. The scale also provides a research tool to evaluate different formulations for developing lip care products. J Drugs Dermatol. 2020;19(6): &nbsp; doi:10.36849/JDD.2020.5139.

Prevalence of Type I Lip Print among Medical Students in a Medical College of Nepal

Introduction: Lip prints, due to their unique patterns are typical to an individual, hence, used for personal identification. They vary in predominance, gender and race among different populations. The objective is to study their distribution among medical students and identify the predominant type. Methods: The descriptive cross-sectional study was conducted on the medical students of Nepalese Army Institute of Health Sciences, from April 2019 to May 2019 after the ethical approval. Convenience sampling was used. The prints were classified according to Suzuki and Tsuchihashi. The collected data was entered in SPSS to determine the frequency and percentage. Sub group analysis was done on basis of gender and types of lip print. Results: Out of 205 participants, prevalence of type I lip print among medical students is 70 (34.1%).  Type I lip print was found to be most common followed by Type II in 57 (27.8%) and Type V in 6 (2.9%). One hundred forty one (68.8%) were male and 64 (31.2%) were female. The predominating pattern in RUQ; LUQ; LLQ; RLQ among male and female is Type I 46 (32.6%) and Type I 39 (27.7%); Type II 39 (27.7%) and Type II 44 (31.2%); Type I 19 (29.7%) and Type II 19 (29.7%); Type I 31 (48.4%)and Type I 27 (42.2%) respectively. Conclusions: Type I was the most common while Type V was the least common lip print. However, there was variation in its frequency and distribution according to the quadrant and sex.

Three-dimensional analysis of lip changes in response to simulated maxillary incisor advancement

OBJECTIVE

To assess the immediate response of lips in three dimensions (3D) resulting from simulated maxillary incisor advancement.

MATERIALS AND METHODS

Incremental maxillary incisor advancement was simulated by placing wax of increasing thickness (+2 mm, +4 mm, +6 mm) on the incisors of 20 participants, and the induced lip changes were recorded using 3D stereophotogrammetry. The induced displacement of lip landmarks was quantified using 3D image analysis software. Data were analyzed using a repeated-measures analysis of variance (ANOVA) after adjusting for age and sex of the study participants.

RESULTS

A large interindividual variation in lip response to simulated incisor advancement was observed. A significant overall effect on 3D lip changes was found for increasing values of simulated incisor advancement (F = 13.2; P < .001) as well as significant differences between anatomical landmarks of the lip (F = 7.4; P < .01). Most points moved outward and anterosuperiorly, except the midpoint and corners of the lip. Greatest movement was observed in the sagittal plane, followed by the vertical and transverse planes.

CONCLUSIONS

Maxillary incisor advancement significantly affects upper lip change in three planes of space: particularly the anteroposterior plane, in which the response to simulated advancement appears to be nonlinear.

Lip Morphology and Aesthetics: Study Review and Prospects in Plastic Surgery

The lip profile plays an important role in the perception of facial aesthetics; lip morphology and aesthetics research is receiving increasing attention. The advancement of research tools such as three-dimensional imaging technology has led to the clarification of lip morphologic and aesthetic characteristics. After studies of lip characteristics according to gender, ethnicity and age provided basic data, studies on lip aesthetics have been conducted by scholars worldwide. These studies could provide a basic theory to support diagnosis and treatment options, as well as the basis for evaluative criteria for precise treatment and technical improvements. According to the conclusions of the above studies, new ideas for cosmetic surgery design, including lip, perioral and labial-facial relationships, have been discovered.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dynamic Nasolabial Growth After Primary Surgery for Patients With Bilateral Cleft Lip: A Five-Year Follow-Up Study

PURPOSE

Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction.

PATIENTS AND METHODS

The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6 months and 5 years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05.

RESULTS

A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P = .000 < .05), but the CL had increased nearly as much (P = .270).

CONCLUSIONS

For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5 years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Human sound systems are shaped by post-Neolithic changes in bite configuration

Linguistic diversity, now and in the past, is widely regarded to be independent of biological changes that took place after the emergence of Homo sapiens We show converging evidence from paleoanthropology, speech biomechanics, ethnography, and historical linguistics that labiodental sounds (such as "f" and "v") were innovated after the Neolithic. Changes in diet attributable to food-processing technologies modified the human bite from an edge-to-edge configuration to one that preserves adolescent overbite and overjet into adulthood. This change favored the emergence and maintenance of labiodentals. Our findings suggest that language is shaped not only by the contingencies of its history, but also by culturally induced changes in human biology.

Nasal Parameters, Nostrils Shapes and Philtral Column Shape: A Morphometric Analysis in Nepalese Medical Undergraduate Students

BACKGROUND

The nose is a pyramidal shaped structure situated in the midline of midface being attached to the facial skeleton. The shape, size and spatial location of the nose-philtrum-upper lip complex are important from aesthetic point of view. Hence, to study the nasal parameters, shape of nostril and philtrum among the undergraduate students remained as the main aim of this study.

METHODS

This was a cross-sectional study enrolling 250 students of age 18-25 years. Nasal height, nasal width was measured and the shape of the nostrils and philtrum was recorded separately for each participant.

RESULTS

Out of 250 participants 113 were males and 137 were females. The mean nasal index of male was 75.36 while that of female was 71.72 suggesting that both genders had mesorrhine nasal type. The rectangular shaped nostrils and triangular type of philtrum was the most common types found in the study Conclusions: The study concluded that, the nasal index was mesorrhine type, the nostril was rectangular and the philtrum column was triangular in this study population.

Lip position analysis of young women with different skeletal patterns during posed smiling using 3-dimensional stereophotogrammetry

INTRODUCTION

The aim of this study was to explore the internal relationship between posed smile characteristics, lip position, and skeletal patterns in young women.

METHODS

Fifty women between the ages of 20 and 30 years were enrolled and divided into 3 groups-vertical, average, and horizontal patterns- using the following parameters: FMA, GoGn-SN, and Jarabak ratio. Each subject was scanned in natural head position and with a posed smile. The interlabial gap, intercommissural width, and smile index were calculated. The frontal region was selected as the reference plane for superimpositions. The changes of the lip landmarks in the vertical, sagittal, and coronal directions were investigated.

RESULTS

The smile indexes were listed in the following sequence: vertical < average < horizontal. Significant differences were found in the interlabial gap among the 3 groups. Compared with the average and horizontal groups, the upper lip landmarks of the vertical group showed differences and changed more only in the vertical direction. However, the lower lip landmark showed no differences in any direction.

CONCLUSIONS

Different skeletal patterns have characteristic smile features. The vertical skeletal pattern affects upper lip movements because there is more space for upper-lip elevation. However, the vertical skeletal pattern has no effect on lower lip movement.

An important morphological feature of the face: upper lip length

The oral cavity, including the lips, is considered one of the most important features of the face, taken into consideration when people inter-relate. Upper lip, in particular, can have a great influence on the aspect of a smile, which is why its proportional length and thickness can improve a lot a persons' smile. The aim of this study was to determine the average length of the upper lip in the Caucasian population, considering age and gender. The average upper lip length determined on the lateral skull radiography was 20.25±2.555 mm. The average length of the upper lip was 19.79±1.641 mm in the age category under 12 years and 20.32±2.664 mm in the age category over 12 years. The average length of the upper lip was 19.95±2.4 mm in women and 21.18±2.79 mm in men. We can conclude that women have lower values, while men have higher values of the upper lip length, and that the younger the patient is, the shorter the length of the upper lip is. Moreover, the Caucasian population proved to have a shorter upper lip compared to the Asian or Negroid population.

Phylogenomics of a putatively convergent novelty: did hypertrophied lips evolve once or repeatedly in Lake Malawi cichlid fishes?

BACKGROUND

Phylogenies provide critical information about convergence during adaptive radiation. To test whether there have been multiple origins of a distinctive trophic phenotype in one of the most rapidly radiating groups known, we used ultra-conserved elements (UCEs) to examine the evolutionary affinities of Lake Malawi cichlids lineages exhibiting greatly hypertrophied lips.

RESULTS

The hypertrophied lip cichlids Cheilochromis euchilus, Eclectochromis ornatus, Placidochromis "Mbenji fatlip", and Placidochromis milomo are all nested within the non-mbuna clade of Malawi cichlids based on both concatenated sequence and single nucleotide polymorphism (SNP) inferred phylogenies. Lichnochromis acuticeps that exhibits slightly hypertrophied lips also appears to have evolutionary affinities to this group. However, Chilotilapia rhoadesii that lacks hypertrophied lips was recovered as nested within the species Cheilochromis euchilus. Species tree reconstructions and analyses of introgression provided largely ambiguous patterns of Malawi cichlid evolution.

CONCLUSIONS

Contrary to mitochondrial DNA phylogenies, bifurcating trees based on our 1024 UCE loci supported close affinities of Lake Malawi lineages with hypertrophied lips. However, incomplete lineage sorting in Malawi tends to render these inferences more tenuous. Phylogenomic analyses will continue to provide powerful inferences about whether phenotypic novelties arose once or multiple times during adaptive radiation.

Dentogingival Alterations and Their Influence on Facial and Smile Attractiveness

AIM

This study aimed to evaluate the influence of labial and dentogingival characteristics on facial and smile attractiveness.

MATERIALS AND METHODS

Four different close-up photographs each of six women models with different labial and dentogin-gival characteristics were obtained. One of the models was considered standard. Photographs were arranged in an album were evaluated by 100 laypersons, and 30 dentists who ranked each close-up of the models from according to the degree of attractiveness from first to sixth place, with first being the model considered most attractive and justified the reasons for choosing.

RESULTS

The standard model received the best scores for both lips (7.75) and face (5.18). Medium-sized lips were preferred (p < 0.05), and the smile positively or negatively interfered with esthetic perception depending on the dentogingival alteration present. Diastema was the alteration that had the greatest negative influence.

CONCLUSION

Not all dentogingival alterations interfere with esthetic evaluation. The lips are not decisive in facial attractiveness. Attraction is assessed significantly differently by laypeople than by dentists. The smile directly influences the analysis of facial beauty.

CLINICAL SIGNIFICANCE

Dentogingival alterations may be imperceptible, especially when evaluating the facial joint, so its correction will not always be necessary.

Reconstruction of articulatory movements during neutral speech from those during whispered speech

A transformation function (TF) that reconstructs neutral speech articulatory trajectories (NATs) from whispered speech articulatory trajectories (WATs) is investigated, such that the dynamic time warped (DTW) distance between the transformed whispered and the original neutral articulatory movements is minimized. Three candidate TFs are considered: an affine function with a diagonal matrix ( A_d) which reconstructs one NAT from the corresponding WAT, an affine function with a full matrix ( A_f) and a deep neural network (DNN) based nonlinear function which reconstruct each NAT from all WATs. Experiments reveal that the transformation could be approximated well by A_f, since it generalizes better across subjects and achieves the least DTW distance of 5.20 (±1.27) mm (on average), with an improvement of 7.47%, 4.76%, and 7.64% (relative) compared to that with A_d, DNN, and the best baseline scheme, respectively. Further analysis to understand the differences in neutral and whispered articulation reveals that the whispered articulators exhibit exaggerated movements in order to reconstruct the lip movements during neutral speech. It is also observed that among the articulators considered in the study, the tongue exhibits a higher precision and stability while whispering, implying that subjects control their tongue movements carefully in order to render an intelligible whispered speech.

Quantitative and perceived visual changes of the nasolabial fold following orthodontic retraction of lip protrusion

OBJECTIVES

The objectives of this study were to evaluate the quantitative and perceived visual changes of the nasolabial fold (NLF) after maximum retraction in adults and to determine its contributing factors.

MATERIALS AND METHODS

A total of 39 adult women's cone-beam computed tomography images were collected retrospectively and divided into the retraction group (age 26.9 ± 8.80) that underwent maximum retraction following 4 premolar extraction and the control group (age 24.6 ± 5.36) with minor changes of the incisors. Three-dimensional morphologic changes of hard and soft tissue including NLF were measured by pre- and posttreatment cone-beam computed tomography. In addition, perceived visual change of the NLF was monitored using the modified Global Aesthetic Improvement Scale. The influence of age, initial severity of NLF, and initial soft tissue thickness was evaluated.

RESULTS

Anterior retraction induced significant changes of the facial soft tissue including the lips, perioral, and the NLF when compared with the controls ( P < .01). Perceived visual changes of the NLF was noted only in women younger than age 30 ( P < .05), with the odds ratio (95% confidence interval) of 2.44 (1.3461-4.4226), indicating greater possibility for improvement of NLF esthetics in young women of the retraction group when compared with the controls.

CONCLUSIONS

Orthodontic retraction induced quantitative and perceived visual changes of the NLF. For adult women younger than age 30, the appearance of the NLF improved after maximum retraction despite the greater posterior change of the NLF.

Dynamic Documentation of the Smile and the 2D/3D Digital Smile Design Process

Medical and dental histories, clinical examination, study models, and photographs provide the data for a proper diagnosis and the treatment plan for esthetic dentistry. However, they do not offer all the information necessary to analyze the smile and create harmony with the lips and face without excessive intraoral adjustments. Dentolabial parameters vary according to lip dynamics and are influenced by both a static posed smile and a smile in motion as captured in video. This article describes a documentation protocol using smartphone videos to improve the analysis, smile design decisions, and elaboration of a 2D smile frame that will guide the 3D digital smile design project. The use of dynamic documentation of the smile (DDS) allows esthetic rehabilitative planning from a facial perspective, improvement of communication with the patient, integration between the specialists, and the predictable quality of the treatments.

The prevalence of facial and dentolabial parameters among students of the Faculty of Dentistry of Lithuanian University of Health Sciences

OBJECTIVE

Nowadays esthetic checklist is an indispensable assistance for the dental clinics. Processing the information recorded on it and integrating the esthetic evaluation with biologic and functional parameters will really allow dentist to formulate a correct diagnosis and to choose most suitable treatment plan for the patient. The aim of this study was to evaluate the prevalence of facial and dentolabial parameters among students of the Faculty of Dentistry of Lithuanian University of Health Sciences and to identify relationship of all facial and dentolabial parameters results.

MATERIAL AND METHODS

The study is carried out at the Department of Dental and Maxillofacial Orthopedics of Lithuanian University of Health Sciences. The facial and dentolabial parameters of students are examined by visual examination using medical gloves and rulers. Participants were sitting on a chair at a distance of 150 cm in front of the researchers.

RESULTS

The thick type of lips was the most popular for normal profile face, of thin lips - concave, of medium lips type - convex. The most popular of profile face types were normal and convex. The most popular tooth exposure among all smile line types was less than half teeth. Type when more than half of teeth was diagnosed in the most of high "Gummy smile".

CONCLUSIONS

Was found relationship between: the profile of face and type of lips; the tooth exposure at rest and type of smile line; the commisural line vs horizon and interpupillary line vs horizon; the facial midline and occlusal plane vs commisural line/horizon; the type of smile line and type of lips; the labial corridor and 10 teeth number of smile width type.

Quantitative Ultrasound Imaging of Healthy and Reconstructed Cleft Lip: A Feasibility Study

Objective:

To investigate the feasibility of echographic imaging of healthy and reconstructed cleft lip and to estimate tissue dimensions and normalized echo level.

Methods:

Echographic images of the upper lip were made on three healthy subjects and two patients using a linear array transducer (7 to 11 MHz bandwidth) and a noncontact gel coupling. Tissue dimensions were measured using calipers. Echo levels were calibrated and were corrected for beam characteristics, gel path, and tissue attenuation using a tissue-mimicking phantom.

Results:

At the central position of the philtrum, mean thickness (SD) of lip loose connective tissue layer, orbicularis oris muscle, and dense connective layer was 4.0 (0.1) mm, 2.3 (0.7) mm, and 2.2 (0.7) mm, respectively, in healthy lip at rest; and 4.1 (0.9) mm, 3.8 (1.7) mm, and 2.6 (0.6) mm, respectively, in contracted lip. Mean (SD) echo level of muscle and dense connective tissue layer with respect to echo level of lip loose connective tissue layer was −19.3 (0.6) dB and −10.7 (4.0) dB, respectively, in relaxed condition and −20.7 (1.5) dB and −7.7 (2.3) dB, respectively, in contracted state. Color mode echo images were calculated, showing lip tissues in separate colors and highlighting details like discontinuity of the orbicularis oris muscle and presence of scar tissue.

Conclusions:

Quantitative assessment of thickness and echo level of various lip tissues is feasible after proper echographic equipment calibration. Diagnostic potentials of this method for noninvasive evaluation of cleft lip reconstruction outcome are promising.

Tongue-Palate Contact during Bilabials in Normal Speech

Objective:

Previous research using electropalatography (EPG) identified a compensatory articulation called bilabial-lingual double articulations. These double articulations were produced for bilabials by some speakers with cleft palate and involved closure at the lips occurring simultaneously with complete tongue-palate constriction. However, no normative English EPG data exist to confirm the abnormal status of these double articulations.

Design:

This study reports normative data for EPG contact during bilabial closure. Acoustic and EPG data were recorded for bilabials in different vowel contexts.

Participants:

Eight normal English-speaking adults.

Measures:

One measure identified complete tongue-palate constriction, and a second measure calculated percent contact.

Results:

There were no instances of complete tongue-palate constriction, though some EPG contact occurred in the lateral regions of the palate. The vowel context significantly affected the amount of contact present, with /i/ having the most and /a/ having the least amount of contact.

Conclusion:

Complete tongue-palate constriction during bilabials of the type found in bilabial-lingual double articulations is not a feature of normal English speech and can therefore be considered an abnormal articulation pattern. Speech-language pathologists who use EPG in their clinical work should be aware that some lateral contact during bilabial closure is normal.

[Changes of soft tissues in patients with functional and skeletal Angel Class Ⅲ malocclusion after FRⅢ appliance therapy]

PURPOSE

To compare the changes of soft tissues before and after treatment of functional and skeletal Angle class Ⅲ malocclusion with FRⅢ appliance.

METHODS

Thirty patients with functional and skeletal Angel Class Ⅲ malocclusion were selected and treated with FRⅢ appliance，SPSS 22 software package was used to analyzed soft tissue changes before and after treatment.

RESULTS

After treatment, FCA,NLA, Pog labial angle,upper lip to E line were increased significantly (P<0.05). Z angle was decreased significantly (P<0.05). Lower lip to E line was decreased significantly (P<0.01). There was no significant difference in H angle, superior sulcus depth, inferior sulcus to H-line, basic upper lip thickness, upper lip strain measurement (P>0.05).

CONCLUSIONS

After FRⅢ appliance treatment of Angel Class Ⅲ malocclusion, the convexity of facial profile was increased, type Ⅲ concave profile tends to be flat, the facial profile of patient become more attractive; the protrusion of upper lip was found, the retrusion of lower lip was also present, the convexity of upper lip was increased.