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Ultrasound images with corresponding histological sections from the upper lips of cadavers without detectable subepithelial discontinuities of the OO muscle: (A, B) subject/specimen 1; (C, D) subject/specimen 2; and (E, F) subject/specimen 3. E = epidermal surface; CT = connective tissue; OOM = orbicularis oris muscle; V = vestibule; A = alveolar ridge. In each ultrasound image, the OOM is represented as a hypoechogenic (dark) band. In contrast, connective tissues and skin are echogenic (bright). In the histology of specimen 1 (B), a small area of separation artifact (black arrowhead) within the OO muscle is present. Note that on ultrasound, the horizontal orientation is reversed (e.g., image right = subject left).
Source publication
To determine if there is an anatomic basis for subepithelial orbicularis oris muscle defects by directly comparing ultrasonographic images of the upper lip with corresponding histological sections obtained from cadavers.
Ultrasound was performed on the upper lips of previously frozen, unpreserved cadaver heads (n = 32), followed by dissection and s...
Contexts in source publication
Context 1
... more than 1000 lip ultrasounds. Each ultrasound was classified as normal (negative), affected (positive), or unknown, and any unusual or interesting features on the ultrasound were noted. In general, a muscle was considered normal if a continuous hypoechogenic (dark) band of uniform thick- ness could be visualized, with no obvious discontinuities (Fig. 1A). Alternatively, a muscle was considered affected if one or more discontinuities were present. On ultrasound, discontinuities manifest as localized echogenic (light) areas within the hypoechogenic muscle tissue, indicating paucity or even complete absence of muscle. Muscles with isolated areas of thinning but no clear discontinuity were ...
Context 2
... ultrasound, the OO muscle was present as a continuous, hypoechogenic band of generally uniform thickness (Fig. 1A). Because no discernible discontinuities were present, this subject's ultrasound was scored as negative for an OO muscle ...
Context 3
... ultrasound findings were confirmed by histology (Fig. 1B). Overall, the lip was thinner inferiorly and became much thicker in the middle and superiorly. The OO muscle was continuous across the entire transverse length of the lip. Longitudinally oriented fibers were present in a continuous, thick band across the deep portion of the lip, whereas transversely cut fibers were present ...
Context 4
... the ultrasound, the lip appeared to have a relatively flat contour. The OO muscle was visible as a continuous, hypoechogenic band (Fig. 1C). There was also some evidence of muscle fibers decussating across the midline toward the contralateral philtral columns. The ultrasound was scored as ...
Context 5
... revealed a continuous OO muscle across the entire transverse length of the lip (Fig. 1D). Longitudinally oriented fibers were present in a continuous, thick band across the deep portion of the lip with scant obliquely oriented fibers scattered between the longitudinally orient- ed fibers near the midline. A thick area of transversely cut fibers was present superficially, lateral to the philtral columns. The pattern of ...
Context 6
... the ultrasound, the lip appeared to have an angled contour, which may relate to the shape of the subjacent alveolar arch. Similar to the two previous subjects, the OO muscle was present as a continuous, hypoechogenic band of uniform thickness (Fig. 1E). The ultrasound was therefore scored as negative for an OO muscle ...
Context 7
... above findings were confirmed from histology; the OO muscle was continuous across the entire transverse length of the lip (Fig. 1F). Longitudinally oriented fibers were present in a continuous, uniformly thick band across the deep portion of the lip. A small area of transversely cut fibers was present superficially, lateral to the philtral columns. Decussating longitudinal fibers were apparent at the most superior portion of the specimen at the base of the ...
Citations
... Upper lip imaging was performed, and the scar width through the orbicularis oris muscle was measured by 2 different observers. The average value was then calculated and recorded (Van Hees et al., 2007;Rogers et al., 2008;Nuridinovich, 2015). ...
... Previously, the OOr morphology has been studied both sonographically and histologically. [4][5][6][11][12][13][14] However, it is difficult to find an anatomical study on the OOr patterns for aesthetic purposes. Based on the conventional injection guideline, BoNT-A can be injected into the hockeystick point, where the pars peripheralis meets the pars marginalis, but it results in patients' severe pains and lip elongation due to the weakness of the pars marginalis. 2 Therefore, BoNT-A should be injected intradermally at 2 to 4 mm above the vermilion border, targeting the pars peripheralis only. ...
Background
Purse string lips, which include the vertical wrinkles over the lips are frequently observed in aged individuals. Botulinum toxin (BoNT-A) and fillers are routinely injected into these areas to remove the wrinkles; however, the anatomy of the orbicularis oris muscle (OOr) near the vermilion border area has not been well defined.
Objectives
The aim of this study was therefore to identify any morphological differences of the upper OOr via sonographic imaging.
Methods
The upper lip muscles as observed using an ultrasound device were divided into two muscles (pars peripheralis and pars marginalis) that were subsequently divided into a further two types (Type I and Type II) associated with the development of the pars marginalis. Type II was further divided into Type IIa and Type IIb depending on whether the muscle fibers were well developed and connected.
Results
On the midline of the lip, Type I, in which the pars marginalis was rarely observed and only appeared in traces, was observed in 20.0% of the volunteers. Type IIa, in which the pars marginalis was well-developed and appeared continuous, was observed in 42.9% of the volunteers. Type IIb, in which the pars marginalis was observed but appeared discontinuous, was observed in 37.1% of the volunteers.
Conclusions
The shapes of the upper pars marginalis of the OOr varied markedly between volunteers. Type classification of the OOr based on its shape and the lip appearance serves as a reliable source of reference information to be used when injecting BoNT-A into the upper lip.
... Upper lip imaging was performed, and the scar width through the orbicularis oris muscle was measured by 2 different observers. The average value was then calculated and recorded (Van Hees et al., 2007;Rogers et al., 2008;Nuridinovich, 2015). ...
Objective
To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique.
Hypothesis
An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function.
Design
Blind, randomized, controlled clinical trial.
Patients
From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups.
Intervention
All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection.
Outcomes Measures
Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs.
Results
Scar width showed a significant improvement in the study group.
Conclusions
Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.
... The orbicularis oris muscle and nasal cartilages were digitally constructed, referencing the lead surgeon's experience and anatomical and histologic studies in the literature. [10][11][12][13][14][15] An iterative process was undertaken to identify haptically acceptable materials. ...
Simulation is becoming an increasingly important tool for hands-on surgical education in a no-risk environment. Cleft lip repair is a common procedure where precise technique is needed to achieve optimal outcome, making it an ideal candidate for simulation. A digital simulated patient with a typical unilateral complete cleft lip and alveolus was constructed using existing three-dimensional imaging studies. Key surface and internal anatomical elements were characterized in detail. A prototype high-fidelity simulator was constructed with silicone and synthetic polymers over a supportive scaffold, piloted by three surgeons using multiple techniques, and digitally compared to real patients. All surgeons completed key steps of a cleft lip repair on the simulator and found it approximated the haptics and anatomy of a cleft lip. Surface change and anthropometric movements accomplished on the simulator were similar for all three surgeons. In digital comparison to analogous real patient data, the simulator anthropometric movements and topographic change were similar to real nasolabial movement. A high-fidelity cleft lip simulator provides "on-demand" opportunity to realistically practice all steps of a cleft lip repair, with implications for overcoming volume-outcome relationship challenges of diminishing operative experience for resident surgeons.
... Worldwide, the prevalence rates of all genetic birth defects combined range from a high of 82/1,000 live births in low income regions to a low of 39.7/1,000 live births in high income regions [16]. These malformations have multi-factorial etiologies and 40% of cases are idiopathic but there is an impression that they are more prevalent in populations with consanguineous marriages [17]. ...
Background: Inter family cousin marriages carries a risk of increased birth defects. The exact contribution of interfamily to birth defects risk is controversial. The aims of this study were to determine the frequency of birth defects in in relation to interfamily or outside family marriages. Methods: This cross sectional study was conducted in the Civil hospital Sukkur from 9th November 2013 to 13th December 2015. Mothers giving birth to babies married in interfamily or outside family with their consent obtained were included in the study. Mothers not giving consent for study and having any known major illnesses were excluded from this study. Data was analyzed using SPSS version 21.0. Results: The mean age of enrolled participants is 26.72 ± 7.07 years, the mean years of marriage was 5.95 ± 6 years and 49.4% were residents of urban area. Overall 89.9% were Muslims, 8.4% Christians and 2.8% Hindus, 60.7% infant had gestational age of <37 weeks. Overall 11.4% of newborns have congenital malformations. Frequency of congenital malformations among interfamily marriages was 15.6% compared to outside family marriages accounted for 3.7% cases (p=0.021). Conclusion: It was concluded from this study that congenital malformations are common among participants of interfamily marriages.
... Computed tomography easily penetrates the entire depth of the orofacial tissues, but it does not allow detailed differentiation of orofacial structures. [4][5][6][7] Vinkka-Puhakka et al. (1989) mentioned that the orbicularis oris muscle is sandwiched between the facial and lingual connective tissues. [3] By comparing the ultrasound images of the upper lip in relaxed and contracted condition in both healthy and repaired cleft lip; it is possible to relate quantitatively function to anatomy. ...
Purpose:
This study is conducted to investigate the feasibility of echographic imaging of tissue thickness of healthy and reconstructed cleft lip.
Design:
Prospective study.
Materials and methods:
The study was conducted in SDM Craniofacial Unit, Dharwad and was approved by Local Institutional Review Board. A total of 30 patients, age group ranging from 4 to 25 years, of which 15 postoperative unilateral cleft lip constituted the test group. The remaining 15 with no cleft deformities, no gross facial asymmetry, constituted the control group. The thickness of the mucosa, submucosa, muscle and full thickness of the upper lip were measured with the transversal images using ultrasonography at midpoint of philtrum, right and left side philtral ridges and vermillion border, at 1, 3, 6 months interval.
Results:
There was an increase in muscle thickness at the vermillion border (mean = 6.9 mm) and philtral ridge (5.9 mm). Equal muscle thickness were found between the normal and test group at 6 months follow-up in a relaxed position, which was statistically significant (P = 0.0404).
Conclusion:
Quantitative assessment of thickness and echo levels of various lip tissues are done with proper echographic calibration. Diagnostic potentials of this method for noninvasive evaluation of cleft lip reconstructions were achieved by this study.
... Currently, domestic and foreign scholars investigate orbicularis oris muscle mainly by gross and microscopic anatomy of human specimen [9][10][11][12][13]. So far, little literature has reported the application of ultrasound technology in upper lip orbicularis oris muscle [14,15]. Ultrasound technology reflects clearly and accurately the upper lip orbicularis oris muscle, measure the scar tissue thickness and understand the adjacent tissue relations. ...
... In the ultrasonic image of superficial tissues, skin layer took on continuous dense hyperechoic line, subcutaneous layer (superficial fascia) being rich in fat tissue was hyperechoic, and muscles fiber shows hypoechoic streak [21]. Rogers CR et al concluded that combination of ultrasound and histology is capable of visualizing upper lip anatomy, thereby validating the use of ultrasound for the assessment of orbicularis oris muscle status [14]. His study provided compelling evidence that discontinuities of the orbicularis oris muscle identified by ultrasound have an anatomical and structural basis. ...
In this study, we aim to understand the morphology and structure of upper lip orbicularis oris muscle, and to provide clinical evidence for evaluating the effect of repair operation in cleft lip. Subjects included 106 healthy people and 36 postoperative patients of unilateral cleft lip. The upper lip orbicularis oris muscle was scanned using ultrasound in natural closure and pout states. Our results showed that the hierarchical structure of upper lip tissue was demonstrated clearly in ultrasonic images. After reconstruction of unilateral cleft lip, the left and right philtrum columns were still obviously asymmetric, their radian displayed clearly and showed better continuity. In the place of cleft lip side equivalent to philtrum columns, orbicularis oris muscle showed discontinuity and unclear hierarchical structure, which was replaced by hyperechoic scar tissue. The superficial layer would become thicker when pouting. In reconstructed unilateral cleft lip, the superficial layer was thinner than that of healthy controls. In normal upper lip orbicularis oris muscle, the superficial layer thickness was no less than 2.89 mm in philtrum dimple and no less than 3.92 mm in philtrum column, and the deep layer thickness was no less the 1.12 mm. Otherwise, the layer thickness less than above reference values may be considered as diagnostic criteria for dysplasia of upper lip orbicularis oris muscle. In conclusions, ultrasound imaging is able to clearly show the hierarchical structure of upper lip orbicularis oris muscle, and will be beneficial in guiding the upper lip repair and reconstruction surgery.
... The recurrence risk also seemed to be related to cleft severity; 4.6% (95% CI: 3.2-6.1) of sibs with bilateral CLP had recurrences as opposed to 2.5% (95% CI: 1.8-3.2) of sibs of probands born with unilateral defects. 31 Over the past few years, subepithelial defects or discontinuities of the superior orbicularis oris (OO) muscle have been identified in relatives of patients with an OFC as a subphenotype (subclinical trait) for CL/P [158][159][160][161][162] ; but it is not clear how widely applicable or practical OO imaging will be for the average craniofacial clinic population. Genomewide analyses to identify genetic loci associated with the OO muscle defect phenotype have identified BMP4 as one likely candidate. ...
Orofacial clefts (OFCs) include a broad range of facial conditions that differ in cause and disease burden. In the published literature, there is substantial ambiguity in both terminology and classification of OFCs. This article discusses the terminology and classification of OFCs and the epidemiology of OFCs. Demographic, environmental, and genetic risk factors for OFCs are described, including suggestions for family counseling. This article enables clinicians to counsel families regarding the occurrence and recurrence of OFCs. Although much of the information is detailed, it is intended to be accessible to all health professionals for use in their clinical practices.
... Perhaps the best studied are orbicularis oris muscle defects in the absence of a visible cleft. These are assessed by high-resolution ultrasound (20,21) and seem to preferentially occur in immediate relatives of those with cleft lip (19,22). Identification of subclinical phenotypes may expand the search for susceptible genes. ...
Orofacial clefts comprise a range of congenital deformities and are the most common head and neck congenital malformation. Clefting has significant psychological and socio- economic effects on patient quality of life and require a multidisciplinary team approach for management. The complex interplay between genetic and environmental factors play a significant role in the incidence and cause of clefting. In this review, the embryology, classification, epidemiology, and etiology of cleft lip are discussed. The primary goals of surgical repair are to restore normal function, speech development, and facial esthetics. Different techniques are employed based on surgeon expertise and the unique patient presentations. Pre-surgical orthopedics are frequently employed prior to definitive repair to improve outcomes. Long term follow up and quality of life studies are discussed.
... These phenotypes include craniofacial measures [Weinberg et al., 2006], dental anomalies (tooth agenesis, microdontia, and supernumerary teeth) [Vieira et al., 2008], brain structural differences [Nopoulos et al., 2002;Weinberg et al., 2013], and dermatoglyphic lip print whorls . Subclinical phenotypes of the lip and palate include microform clefts (also known as congenital healed CL), defects of the orbicularis oris muscle [Neiswanger et al., 2007;Rogers et al., 2008;Weinberg et al., 2008], bifid uvula, submucous CP, and velopharyngeal insufficiency. These subclinical phenotypes may help explain incomplete penetrance or apparent lack of Orofacial clefts arise from failure of normal craniofacial developmental processes. ...
Orofacial clefts are common birth defects and can occur as isolated, nonsyndromic events or as part of Mendelian syndromes. There is substantial phenotypic diversity in individuals with these birth defects and their family members: from subclinical phenotypes to associated syndromic features that is mirrored by the many genes that contribute to the etiology of these disorders. Identification of these genes and loci has been the result of decades of research using multiple genetic approaches. Significant progress has been made recently due to advances in sequencing and genotyping technologies, primarily through the use of whole exome sequencing and genome-wide association studies. Future progress will hinge on identifying functional variants, investigation of pathway and other interactions, and inclusion of phenotypic and ethnic diversity in studies. © 2013 Wiley Periodicals, Inc.
