• The Journal of Korean Academy of Prosthodontics
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• v.31 no.4
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• pp.533-541
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• 1993

This study was designed to help to be given esthetics in construction of denture and prosthodontic rehabilitation of anterior tooth region. The author took the facial straight photograph of 100 old aged people(male 50, female 50) above 55 years of age, who have natural teeth in anterior tooth region, in a resting and a smiling position. And the author measured and analyzed the lip shape, the relation between the lip and the teeth and the change of lip length and height when they were smiling. The results of this study were as follows : 1. In the shape of the upper lip, when the upper lip curved downward, it was 53%, straight was 28% and curved upward was 9%. 2. In the relation between the upper lip and the teeth, average smile was 53% , high smile was 26% and low smile was 21%. 3. In the parallel relation between the lower lip and maxillary anterior incisal curvature, the group of straight was 54%, the group of parallel was 40% and the group of reverse was 6%. 4. In the relationship between maxillary anterior incisor and lower lip, the group of not-touching was 92%, the group of touching was 5% and the group of the maxillary anterior incisor were slightly covered by the lower lip was 3%. 5. In the teeth displayed in a smile, displayed to second premolar was 50%, displayed to first molar was 34%, displayed to first premolar was 12%, and displayed to canine and second molar were 2%. 6. At smiling, the width of the mouth was 0.94 times of the interpupillary distance and 0.45 times of the full face width. 7. At smiling, the length of the upper lip was 0.73 times and lower lip was 0.98 times of the length in a resting postion and the width of the mouth corner was 1.19 times of the resting position.

• Korean Journal of Head & Neck Oncology
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• v.12 no.1
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• pp.52-57
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• 1996

Since the upper lip does not receive direct actinic radiation, only 5% of lip tumors develop in the upper lip, while the lower lip is the site of the remainder. Among the lower lip cancer, squamous cell carcinoma is the most common tumor, especially the vermillion border of lower lip is the most common site. The aims of reconstruction of the lip are both aesthetic effect and functional restoration and the ideal procedure must produce a aesthetically normal, not-tao-tight lip and a good sensation and muscle tone of the lip. We have a satisfactory reconstruction of a subtotal loss of lower lip after squamous cell carcinoma extirpation using Gillies fan flap and the case is presented with reviewing a many published reports.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.390-396
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• 2022

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.5
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• pp.311-319
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• 2012

Purpose: The aim of this study is to evaluate the vertical changes of the lip and perioral soft tissue, following orthognathic surgery in skeletal class III patients by a cephalometric analysis of a cone beam computed tomography (CBCT). Methods: A total of 20 skeletal class III patients, who had bimaxillary surgery with Le Fort 1 osteotomy and bilateral sagittal split ramus osteotomy, were included in this study. The surgical plan for maxilla was posterosuperior impaction with the anterior nasal spine, as the rotation center. Further, the surgical plan for mandible was also posterosuperior movement. The soft tissue changes between lateral cephalogram and CBCT were compared. And the correlations between independent variables and dependent variables were evaluated. Results: There were no significant differences of the soft tissues changes between lateral cephalogram and CBCT. Upper lip philtrum length (SnLs), nasolabial angle increased and upper lip vermilion length (LsStms), lower lip length (StmiB'), lower lip vermilion length (StmiLi), lower lip philtrum length (LiB') and soft tissue lower facial height (SnMe') decreased after surgery. Change of SnLs (${\Delta}$SnLs) was influenced by vertical change of menton (${\Delta}$MeV), and change of LsStms (${\Delta}$LsStms) was influenced by upper lip thickness (ULT). Change of StmiLi' (${\Delta}$StmiLi') were influenced by preoperative overjet. Change of StmiB' (${\Delta}$StmiB') were influenced by preoperative overjet, vertical change of lower incisor (${\Delta}$L1V) and horizontal change of posterior nasal spine (${\Delta}$PNSH). Change of LiB' (${\Delta}$LiB') was influenced by ${\Delta}$L1V and ${\Delta}$PNSH. Change of SnMe' (${\Delta}$SnMe') was influenced by ${\Delta}$MeV, horizontal change of upper incisor (${\Delta}$U1H) and horizontal change of lower incisor (${\Delta}$L1H). ${\Delta}$Nasolabial angle was influenced by change of ULT (${\Delta}$ULT). Conclusion: Both soft tissues and hard tissues can be evaluated by CBCT. Posterosuperior rotation of maxillomandibular complex resulted in increase of upper lip philtrum length and nasolabial angle, while the upper lip vermilion length, lower lip philtrum length, lower lip vermilion length, and soft tissue lower facial height showed a decrease.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.55-62
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• 2007

Radical paring of the cleft edge during primary cleft lip operation or repeated secondary surgeries can result in tightness of the upper lip. In case, the degree of the resulting side-to-side tension is very severe, the possibility of a lip switch flap must be considered. When the lip tightness accompanies a loss of more than two-thirds of the Cupid's bow, an Abbe flap is an alternative. The disadvantages of Abbe flap are scar formation on the lower lip, design of incision line on the upper lip, disharmony of colors, and the dysfunction of the orbicularis muscle. These problems have been recognized in the literature and extreme discretion has been advised in its application. We experienced four cases of Abbe flap operation which were designed differently to correct the secondary unilateral or bilateral cleft-lip nasal deformities. The Abbe flap operations resulted in removal of the scars and tightness of the upper lip, reconstruction of the Cupid's bow, lengthening of the columella, and therefore secondary cleft-lip nasal deformity could be corrected. It is thought that carefully applied Abbe flap is an appropriate method to relieve horizontal tightness or flattening of the upper lip which occured after primary operation of cleft lip.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.38.1-38.10
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• 2016

Background: The aims of this study are to evaluate the lip morphology and change of lip commissure after mandibular setback surgery (MSS) for class III patients and analyze association between the amount of mandibular setback and change of lip morphology. Methods: The samples consisted of 14 class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalogram and cone-beam CT were taken before and about 6 months after MSS. Changes in landmarks and variables were measured with 3D software program $Ondemand^{TM}$. Paired and independent t tests were performed for statistical analysis. Results: Landmarks in the mouth corner (cheilion, Ch) moved backward and downward (p < .005, p < .01). However, cheilion width was not statistically significantly changed. Landmark in labrale superius (Ls) was not altered significantly. Upper lip prominence angle (ChRt-Ls-$ChLt^{\circ}$) became acute. Landmarks in stomion (Stm), labrale inferius (Li) moved backward (p < .005, p < .001). Lower lip prominence angle (ChRt-Li-$ChLt^{\circ}$) became obtuse (p < .001). Height of the upper and lower lips was not altered significantly. Length of the upper lip vermilion was increased (p =< 0.01), and length of the lower lip vermilion was decreased (p < .05). Lip area on frontal view was not statistically significantly changed, but the upper lip area on lateral view was increased and change of the lower lip area decreased (p > .05, p < .005). On lateral view, upper lip prominent point (UP) moved downward and stomion moved backward and upward and the angle of Ls-UP-Stm ($^{\circ}$) was decreased. Lower lip prominent point (LP) moved backward and downward, and the angle of Stm-LP-Li ($^{\circ}$) was increased. Li moved backward. Finally, landmarks in the lower incisor tip (L1) moved backward and upward, but stomion moved downward. After surgery, lower incisor tip (L1) was positioned more superiorly than stomion (p < .05). There were significant associations between horizontal soft tissue and corresponding hard tissue. The posterior movement of L1 was related to statistically significantly about backward and downward movement of cheilion. Conclusions: The lip morphology of patients with dento-skeletal class III malocclusion shows a significant improvement after orthognathic surgery. Three-dimensional lip morphology changes in class III patients after MSS exhibited that cheilion moved backward and downward, upper lip projection angle became acute, lower lip projection angle became obtuse, change of upper lip area on lateral view was increased, change of lower lip area decreased, and morphology of lower lip was protruding. L1 was concerned with the lip tissue change in statistically significant way.

• Archives of Plastic Surgery
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• v.49 no.3
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• pp.423-426
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• 2022

Reconstruction of the upper lateral lip subunit is challenging, and use of several classical local flaps have been previously reported. However, these methods have drawbacks such as visible scarring, anatomic distortion, and functional disability. To obtain satisfactory results, preservation of perioral function is important. We report a case of functional upper lip reconstruction after tumor resection using a reverse facial-submental artery island flap with a reinnervated anterior belly of the digastric muscle (ABDM) without sacrificing the perioral structure. A 73-year-old man presented with basal cell carcinoma on the left upper lip which was widely excised, including the orbicularis oris muscle. The remaining 4 cm × 3.5 cm defect was reconstructed using a reverse facial-submental artery island flap with ipsilateral ABDM. The motor nerve of the ABDM was sutured with the stump of the buccal branch of the ipsilateral facial nerve. The postoperative course was uneventful, and good functional and esthetic recovery were observed at 12-month follow-up. This procedure may be an alternative option for reconstruction of lateral upper lip defects.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.747-754
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• 2011

Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

• The Journal of Korean Academy of Prosthodontics
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• v.30 no.2
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• pp.259-271
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• 1992

This study was designed to investigate the criteria of the perfect smile that was necessary to improve the esthetic problem in oral and maxillo-facial region and treating the anterior tooth region. The author took the facial straight photograph of 240 university students(male : 129, female : 111) in a resting and a smiling position, measured and analized the lip pattern and the relation between the lip and the teeth when they were smiling. Besides, 10 members of committee for appraisal (dentist : 5 persons, professor of the college of fine arts : 5 persons) estimated the smiling pattern. After that the author have compared and analyzed the obtained results. The results obtained were as follows : 1. In the shape of the upper lip, when the upper lip curved downward, it was 42.92% , straight was 45.00% and curved upward was 12.08%. The group in which the upper lip curved upward was the most esthetic. 2. In the relation between the upper lip and the teeth, high smile was 29.17%, average smile was 55.83% and low smile was 15.00%. The group of average smile was the most esthetic. 3. In the parallel relation between the lower lip and maxillary anterior incisal curvature, the group of paralled was 60.42%, the group of straight was 34.17% and the group of reverse was 5.41%. The group of parallel was the most esthetic. 4. In the relationship between maxillary anterior incisor and lower lip, the group of the maxillary anterior incisor were slightly covered by the lower lip was 10.42%, the group of the maxillary anterior teeth touched to the lower lip was 35.83%, and the no-touching was 53.75%. The group of the maxillary anterior teeth touched to the lower lip was the most esthetic. 5. In the teeth displayed in a smile, displayed to the canine was 0.84%, displayed to the first premolar was 19.17%, displayed to the second premolar was 57.92%, displayed to the first molar was 20.00% and displayed to the second molar was 2.08%. The group of displayed to the first molar was the most esthetic. 6. At smiles, the width of the mouth corner was 0.46 times of the full face width, 0.95 times of the interpupillary distance, and 1.23 times of the resting position. 7. At smiles, the lengh of the upper lip was 0.71 times and lower lip was 0.93 times of the length in the resting position.