Clinical features of microinvasive stage I oral carcinoma

Oral Diseases (2011) 17 , 298–303 Background: This study aimed to analyse a case series of microinvasive (tumour thickness <4 mm) stage I oral squamous cell carcinoma (OSCC), with an emphasis on the clinical features of the tumours. Methods: In total, 32 microinvasive and 67 non‐microinvasive stage I lesions, which had been surgically treated, were retrospectively studied and compared. The data analysed included gender, age, risk habits, clinical appearance, lesion site, symptoms, nodal involvement and outcome. Results: The clinical features of microinvasive lesions meant that, more often than not, they resembled premalignant lesions (P = 0.008), and diagnosis was mainly based on accurate clinical examination rather than the presence of symptoms (P = 0.029). During a median follow‐up of 4.5 years, one nodal involvement and one cancer‐related death were observed in patients with microinvasive lesions. A significantly higher (P = 0.044) level of nodal involvement was observed in the non‐microinvasive lesion group. Conclusions: Stage I OSCC has a favourable prognosis overall, but nodal recurrence is more common in non‐microinvasive cancers. As microinvasive lesions tend to present clinically as premalignant lesions, accurate clinical examination is essential if misdiagnosis of early lesions is to be avoided.     

Revisiting lip shave: a solution for disorders of the vermilion border

Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, “lip shave”, which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. We describe our experience of the technique and evaluate the functional and aesthetic outcomes in 20 patients treated between January 2011 and January 2016. The follow-up period ranged from 24 to 60 months. Three-quarters of the patients had dysplasia or superficially invasive malignancy. Resected lesions were about 63 mm long, 13.7 mm wide, and 3.9 mm deep. No patients had recurrence or secondary lesions during follow up, functional disturbance was minimal, and the cosmetic outcome pleasing. Lip shave can efficiently reconstruct the vermilion of the lower lip with minimum deformity.     

Relationship of tumor thickness in punch biopsy and subsequent surgical specimens in stage I squamous cell carcinoma of the lower lip.

OBJECTIVE: Among the histologic features of squamous cell carcinoma of the lower lip, maximum tumor thickness in particular is a predictor of regional nodal metastatic spread and thus an important parameter in treatment planning. The purpose of this study was to investigate the relationship between maximum tumor thickness in punch biopsies and maximum tumor thickness in subsequent surgical specimens. STUDY DESIGN: This retrospective study examined the relationship between maximum tumor thickness in punch biopsies with that in subsequent surgical specimens obtained in 72 patients with clinical stage I squamous cell carcinoma of the lower lip. RESULTS: A correlation between maximum tumor thickness in punch biopies and in subsequent surgical specimens was found only for tumors with a thickness less than 3 mm. CONCLUSIONS: Reliable predictive information could be obtained from punch biopsies with a maximum tumor thickness less than 3 mm. When the maximum tumor thickness exceeds 3 mm, better information may be obtained from either a large incisional biopsy or the surgical specimen.     

Effects of retraction of anterior teeth on horizontal and vertical lip positions in Japanese adults with the bimaxillary dentoalveolar protrusion

The purposes of this study were to evaluate the upper and lower lip changes after orthodontic treatment of bimaxillary protrusion in adult Japanese. We also intended to predict the upper and lower lip positions from the changes of the maxillary and mandibular incisor positions in both the horizontal and vertical planes. Pre-treatment and post-treatment cephalograms of 38 patients (6 males and 32 females, aged 24.2 ± 2.9 and 22.8 ± 4.1 years, respectively) who had four first premolars extracted, were taken with lips in their voluntary relaxed position, traced and compared between them. Stepwise multiple regression analysis revealed that a 1 mm retraction and a 1 mm intrusion of the maxillary incisor cervical point would produce a 0.22 mm retraction of the upper lip, a 1 mm retraction of the mandibular incisor tip would produce 0.76 mm retraction of the lower lip, and a 1 mm mandibular incisor tip retraction would produce a 0.50 mm retraction of Stomion. Moreover, a 1 mm maxillary incisor tip intrusion would produce a 0.56 mm upward movement of the upper lip and a 1.00 mm upward movement of the lower lip. The predictability of this study may be beneficial for orthodontists in planning and discussing treatment plans and options with patients.     

Frozen section examination of the margins for resection of squamous cell carcinoma of the lower lip.

OBJECTIVES: Our goal was to evaluate the role of frozen section margin examination in the surgical management of squamous cell carcinoma of the lower lip. MATERIALS AND METHODS: We reviewed frozen section examination of the resection surfaces of 131 consecutive patients surgically treated for squamous cell carcinoma of the lower lip during the period January 1980 to January 1999. When invasive carcinoma or carcinoma in situ was present at the resection surface, the margin was defined as positive and re-resection was performed. RESULTS: A peroperative positive margin was seen in 18 of 131 (14%). In 8 patients (6%), a local recurrence developed. CONCLUSIONS: Frozen section examination for margin assessment in the surgical treatment of lip cancer is a reliable technique to control the radicality of the procedure; a secondary surgical procedure or postoperative radiotherapy can be reduced. However, a tumor-free resection surface does not guarantee that local recurrence will not occur.     

42例老年人唇癌的临床分析

对42例老年唇癌的临床资料进行了分析。结果:15年中共有住院唇癌患者103例,其中老年唇癌患者42例(40.8％),男女之比为5∶1,60～69岁为发病高峰年龄(69.1％),农民居多(78.6％),下唇多见(83.3％),下唇癌∶上唇癌=5∶1,多为鳞状细胞癌(95.2％)。40例(95.2％)患者采用了手术治疗。由于老年人皮肤松弛,肌张力差等特点有利于唇癌缺损修复。并对有关问题作了讨论。     

Management of patients with squamous cell carcinoma of the lower lip and N0-neck.

AIM: For lower lip carcinoma, an incidence of 15% of cervical lymph node metastasis at presentation is generally accepted. This is an argument in favour of an expectant approach. The purpose of this study was to compare the results of the different approaches to the clinically negative neck: prophylactic neck dissection, prophylactic neck irradiation and follow-up. MATERIAL AND METHOD: The retrospective study included 200 patients with lower lip carcinoma. The following data were evaluated: (1) the incidence of cervical lymph node metastasis in patients with a clinically negative neck; and (2) pathological confirmation of cervical lymph node metastasis. RESULTS: In the group undergoing prophylactic neck dissection, lymph node metastasis was found microscopically in 20% of the cases. More than half of the patients receiving prophylactic radiotherapy developed bulky neck lymph node metastases. Out of the patients attending the 2-year follow-up 64% developed a clinically positive neck. Cervical lymph node metastases in these patients was proven microscopically in 88% of cases. CONCLUSION: The high incidence of a clinically positive neck, along with the high incidence of neck node metastasis found in neck dissection specimens suggest that elective neck dissection is the treatment of choice for the neck in patients with lower lip carcinoma.     

The Lower Lip Position and Incisor Overjet

Abstract

1147 children aged 11–12 years were examined to determine the mean overjet values relative to five defined postural lower lip/maxillary central incisor relationships.

A mean overjet of 3·025 mm was found in those children having a postural lower lip position related to the middle third of the maxillary central incisor; and those having no lower lip cover had a mean overjet of 4·26 mm. In contrast, the mean overjet value was 9·18 mm for those children having a “negative” lip position.

The observed differences between the mean overjet values relative to each lower lip position are statistically significant, but the only lower lip/maxillary central incisor relationship which appears to have any marked clinical significance is the one defined as—1 (i.e. the trapped lower lip).     

Unpredictability of soft tissue changes after camouflage treatment of Class II division 1 malocclusion with maximum anterior retraction using miniscrews

Objective:To compare soft and hard tissue responses based on the degree of maxillary incisor retraction using maximum anchorage in patients with Class II division 1 malocclusion.Materials and Methods:This retrospective study sample was divided into moderate retraction (<8.0 mm; n = 28) and maximum retraction (≥8.0 mm; n = 29) groups based on the amount of maxillary incisor retraction after extraction of the maxillary and mandibular first premolars for camouflage treatment. Pre- and posttreatment lateral cephalograms were analyzed.Results:There were 2.3 mm and 3.0 mm of upper and lower lip retraction, respectively, in the moderate group; and 4.0 mm and 5.3 mm, respectively, in the maximum group. In the moderate group, the upper lip was most influenced by posterior movement of the cervical point of the maxillary incisor (β = 0.94). The lower lip was most influenced by posterior movement of B-point (β = 0.84) and the cervical point of the mandibular incisor (β = 0.83). Prediction was difficult in the maximum group; no variable showed a significant influence on upper lip changes. The lower lip was highly influenced by posterior movement of the cervical point of the maxillary incisor (β = 0.50), but this correlation was weak in the maximum group.Conclusions:Posterior movement of the cervical point of the anterior teeth is necessary for increased lip retraction. However, periodic evaluation of the lip profile is needed during maximum retraction of the anterior teeth because of limitations in predicting soft tissue responses.     

不同观察者对唇部突度影响面部美学评价的差异比较

目的: 使用3dMD立体摄影技术采集面部立体图像,模拟改变唇部突度,比较口腔正畸医师、口腔全科医师与普通人3组观察者对面部美学评价的差异。方法: 选择1名女性志愿者,拍摄自然头位面部三维图像,利用软件模拟唇部沿矢状向离开VSL线向前后移动,移动幅度为2 mm,最大幅度在VSL线前、后6 mm。观察者纳入口腔正畸医师组、口腔全科医师组、普通人3组共268人,进行视觉模拟评分法（visual analogue scale/score,VAS）评价。使用固定效应模型进行统计,分析3组观察者对面部美学评分的差异。采用SAS 9.4软件包进行数据分析。结果: 上、下软组织唇突点在VSL线上时,3组观察者评分最高且无统计学差异。唇前突于VSL线前6 mm和线后6 mm时,3组观察者的评分低且无显著差异。唇后缩每2 mm,3组评分平均下降1.3861;唇前突2 mm,3组评分平均下降1.8961;每一幅度变化均有统计学差异（P<0.05）。以VAS评价中位数5分以下作为不可接受的面部美学得分,口腔正畸医师组和普通人组在唇前突于VSL线前4 mm时评分低于5分,3组观察者在唇前突于VSL线前6 mm时评分低于5分。3组观察者在唇后缩于VSL线后4 mm以上时,评分均低于5分。以观察者不同性别分析唇前突对面部美学的影响,男性观察组在唇前突于VSL线前2 mm时,平均评分较女性观察组低;女性观察组在唇后缩于VSL线后4 mm以上时,评分较男性观察组低。结论: 唇部位置对面部美观评价有显著影响,不仅唇前突影响面部美观,唇部后缩同样影响面部美观。不同观察者对唇部突度影响面部美观的评价有显著差异,提示口腔正畸医师在确定正畸治疗目标时,需要更多与患者沟通,以提高治疗满意度。     

Prospective comparative study of lower lip defects reconstruction with different local flaps

Squamous cell carcinoma is the most common malignancy related to the lips (95%), and the lower lip is more commonly involved. Loss of tissue in the lower lip is treated with a variety of techniques, depending on the extension and location of the defect. This was a prospective case series. In this study, 41 patients with squamous cell carcinoma (30 males, 11 females) who were referred to Razi Hospital of Tehran University of Medical Sciences between 2007 and 2008 and underwent lower-lip reconstruction were included. Defects were divided into 4 groups: less than 30%, between 30% and 50%, between 50% and 80%, and more than 80%. Five different local flaps were used for lower-lip reconstruction. Karapandzic flap was used for 9 patients, double reversed-Abbe flap for 6 patients, Abbe-Estlander and step-ladder flaps for 8 patients, and 10 patients underwent reconstruction operation with reversed-Abbe flap. In comparison to reversed-Abbe flap and step-ladder flap, there were no differences functionally and aesthetically except that the step-ladder flap was a single-stage procedure, but the reversed-Abbe flap had 2 stages. There were no functional problems in patients with Estlander flap, but these patients complained of lip asymmetry. There were no functional complaints and aesthetic problems in patients with double reversed-Abbe flap at 3 months after the operation. In patients with 30% to 50% defect of the lower lip, there was no functional and aesthetic difference between Abbe flap and step-ladder flap. Estlander flap is a good choice for reconstruction of lateral or commissural defects of the lower lip. In patients with 50% to 80% defect, it is better to use bilateral reversed-Abbe instead of the Karapandzic flap.     

Flap designs for lower lip reconstruction

Lower lip reconstruction is ideally achieved with innervated flaps that supply mucosa, functional muscle, and skin. These flaps should be capable of being used when vermilionectomy is necessary. The size and shape of the defect determine the optimal flap. This article illustrates the flaps used by the authors for particular reconstructive problems.     

Profile changes following orthodontic treatment of bimaxillary protrusion in adults with the Begg appliance

Thirty-two adult oriental patients aged 18-26 years who sought treatment for their bimaxillary protrusion were treated with the Begg appliance following extraction of four first premolars. A cephalometric study was undertaken to determine the soft tissue changes in lip profile following treatment. Results show that the upper incisors were retracted by 5.6 mm +/- 0.8 mm and the lower incisors by 4.4 +/- 0.8 mm on the average. The nasolabial angle became more obtuse increasing from 80.7 degrees to 90.7 degrees. The upper lip and lower lip lengthened by 1.9 mm and 1.2 mm, respectively. The lower lip to 'E' line reduced from 7.5 mm to 3.7 mm. All the previous changes were statistically significant (p less than 0.01). The upper lip to upper incisor retraction was 1:2.2 while the lower lip to lower incisor retraction was 1:1.4. The correlation coefficients (r) were 0.72 (p less than 0.01) and 0.80 (p less than 0.01), respectively. The changes in the cants of mandibular and occlusal planes were statistically insignificant. This study shows that the Begg appliance has the ability to significantly reduce bimaxillary protrusions and thereby improve facial aesthetics.     

The effect of anterior tooth retraction on lip position of orthodontically treated adult Indonesians.

This study was conducted to determine upper and lower lip changes after orthodontic treatment of bimaxillary dental protrusion in adult Indonesians. Pretreatment and posttreatment cephalograms of 40 patients (6 males and 34 females) who required extraction of 4 premolars, were traced, superimposed, and measured. The changes of anterior tooth position (measured as the horizontal distance from the incisal tip to a constructed vertical through sella) were correlated with changes in the upper and lower lip positions with the Pearson correlation method. Significant positive correlation was found between changes of the maxillary and mandibular incisors with the changes in both the upper lip (r(U1) = 0.39, P <.05; r(L1) = 0.44, P <.01) and the lower lip (r(U1) = 0.44, P <.01; r(L1) = 0.51, P <.01) positions. By using stepwise multiple regression, it was found that for every millimeter of mandibular incisor retraction, 0.4 mm of upper lip retraction and 0.6 mm of lower lip retraction were produced. This study concluded that, for this Indonesian sample, a strong correlation exists between mandibular anterior tooth retraction and the position of both lips.     

Facial soft tissue changes following maxillomandibular advancement for treatment of obstructive sleep apnea.

PURPOSE: The goal of this retrospective study was to evaluate the horizontal and vertical facial soft tissue changes occurring after maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA). PATIENTS AND METHODS: The study group comprised 31 consecutive adult patients with OSA who underwent MMA through Le Fort I osteotomy and bilateral sagittal split ramus osteotomies. Adjunctive maxillary procedures, consisting of piriformplasty, anterior nasal spine recontouring, alar base cinch, and V-Y closure of the upper lip, were used for all patients. A "best-fit" templating cephalometric technique was used to assess dentoskeletal movements and corresponding soft tissue changes. RESULTS: Maxillary movements (measured at point A) averaged 8.77 +/- 2.34 mm horizontally and 2.20 +/- 2.42 mm vertically. Mandibular movements (measured at point B) averaged 11.16 +/- 2.56 mm horizontally and 2.25 +/- 3.02 mm vertically. The horizontal upper lip soft tissue-to-hard tissue ratios averaged >0.90:1 (SLS/A, 0.97:1; Ls/U1fac, 0.96:1; Stm(s)/ls, 0.86:1). Upper lip length (Sn-Ls) increased by a clinically insignificant amount (0.37 mm). The nasolabial complex rotated in a counterclockwise rotation, with the nasolabial angle decreasing (3.87 degrees) due primarily to forward movement of the upper lip. Horizontal lower lip and chin soft tissue-to-hard tissue ratios averaged >0.90:1 (Stm(i)/li, 0.90:1; Li/Ii, 0.89:1; Pg'/Pg, 0.92:1; Me'/Me, 0.91:1). CONCLUSIONS: This study demonstrated that MMA in this selected group of OSA patients results in soft tissue movements producing a soft tissue-to-hard tissue ratio of about 0.90:1 for most anatomic sites of the upper lip, lower lip, and chin.     

微种植支抗矫治成人骨性Ⅱ类突面型患者的矢状向疗效观察

目的 使用微种植支抗矫治成人骨性Ⅱ类突面型,观察矫治前后矢状向牙齿突度和唇突度变化.方法 选取36例治疗结束的成人骨性Ⅱ类突面型患者,所有患者均是拔除4颗第一前磨牙使用自攻型微种植体作为支抗内收前牙.对治疗前、后头颅侧位片进行测量分析.结果 36例患者的切牙、软组织等测量指标发生显著性变化,上切牙内收(5.98±3.8...     

Changes in Lip Contour Following Treatment of Maxillary Protrusion with Esthetic Orthodontic Appliances

With the advent of acid etching techniques and the elimination of unesthetic band materials, direct bonding of orthodontic attachments kindled a desire for cosmetic appliances such as labial ceramic brackets and lingual orthodontics. Owing to the esthetic nature of our combination upper-lingual lower-ceramic orthodontic approach, adults who would have normally avoided orthodontic treatment are now seeking treatment. This study evaluated the cephalometric changes in the soft tissue lip profile following treatment of Class II Division 1 malocclusion with upper first bicuspid extractions with our esthetic orthodontic appliance approach. Serial lateral cephalograms (pretreatment and posttreatment) of 16 adult patients with a mean age of 22.1 ± 3.2 years were studied. The mean upper incisor retraction, upper lip retraction, upper lip lengthening, and lower lip retraction were 5.75 ± 1.91 mm, 2.8 ± 1.4 mm, 1.5 ± 0.6 mm, and 1.4 ± 0.6 mm, respectively. All these changes were statistically significant (p < 0.01). The nasolabial angle increase of 10.8 ± 3.0 degrees was also statistically significant (p < 0.01). The upper lip retraction to upper incisor retraction was 1:2.1, while the upper lip lengthening to upper incisor retraction was 1:3.8. The correlation coefficients (r) were 0.91 (p < 0.01) and 0.57 (p < 0.01), respectively. This study shows that significant esthetic changes in lip profile are possible with this cosmetic orthodontic appliance approach. The treatment results in this study appear comparable to those published with labial metal brackets. With very few exceptions, patients were able to adapt within 2 weeks, with almost no trauma to the tongue.     

The influence of lower lip position on the perceived attractiveness of chin prominence

Objectives:To evaluate the influence of the lower lip prominence for varying degrees of chin prominence in the sagittal plane and to establish whether lower lip prominence affects the perceived desire for surgery. To assess differences in preference between orthodontists and laypeople as well as the effect of age, gender, and ethnicity of observers on perceptions of attractiveness and desire for surgery.Materials and Methods:A silhouette of an idealized profile image was created. The image was manipulated to create six images demonstrating different degrees of retrogenia and progenia altered in 4-mm increments from −12 mm to +12 mm and six images demonstrating chin and lower lip prominence in 4-mm increments from −12 mm to +12 mm. One hundred laypeople and 30 orthodontists ranked the images from the most to the least attractive. A duplicate of one of the images was used in order to assess intraexaminer reliability.Results:The amount and direction of sagittal chin position and the prominence of the lower lip were found to have a significant effect on image rank. Chin protrusion was less attractive than retrusion and surgery was desired more often for these images. The overall direction of opinion was the same for laypeople and orthodontists.Conclusions:The chin prominence observed in a progenic patient is deemed less attractive than the combined chin and lower lip prominence observed in a patient with mandibular prognathism. In profiles with a more prominent chin a more protrusive lower lip position was preferred. When the chin was retrusive, a normal lower lip position was preferred to a retrusive lip.     

下颌支矢状劈开截骨后退术后下唇感觉功能障碍的影响因素

目的：探讨下颌支矢状劈开截骨后退术后下唇感觉功能障碍的发生及其恢复的影响因素。方法：设置性别、远心骨段移动距离、下牙槽神经暴露情况3组变量,对随访时间达术后24周的19例37侧下颌支矢状劈开截骨术患者术后下唇感觉功能障碍情况进行研究。使用触觉检查、痛觉检查和两点辨别觉检查3种检查方法,参照BMRC感觉功能评定标准,观察在不同变量值的情况下,术后4周、12周、24周下唇感觉功能的变化。使用SAS6．12统计软件包,进行多个样本率的χ^2检验,了解下唇感觉功能障碍的发生及恢复情况。结果：性别差异对术后下唇感觉功能障碍程度无显著影响（P〉0．05）。下牙槽神经暴露者的术后下唇感觉优秀恢复率为25．0％,非暴露者为96．6％,两者差异有统计学意义（P〈0．05）。下颌骨远心骨段后退幅度〈6mm者,下唇感觉优等恢复率为100．0％,下颌骨远心骨段后退幅度I〉6mm者为68．2％,两者差异有统计学意义（P〈0．05）。结论：术中完全暴露下牙槽神经以及大幅度的下颌远心骨段后退会显著增加术后下唇感觉障碍的程度。在手术方案的设计中,将下颌后退幅度控制在6mm以内是比较安全的。     

Total lower lip reconstruction using sensate composite radial forearm flap

In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery.