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Orbicularis Oris

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101. Human Bite Infections (Treatment)

may be reconstructed with mucosal advancement flaps. Wounds measuring up to a third of the length of the lip may be closed by using a wedge or chevron excision and approximating the 2 cut edges. [ ] Perform muscular reapproximation of the orbicularis oris with interrupted, buried, absorbable sutures to assure continuity of the sphincteric muscular ring. Small (< 1.5 cm 2 ) lip segments have been successfully replanted as composite grafts when a segment of lip has been amputated and is available

2014 eMedicine.com

102. Scar Revision (Treatment)

in the RSTL direction. Often, these scars cross from an oblique lateral to a more horizontal orientation and require a combination of lateral Z-plasty and running W-plasty over the mentum. Scar revision. W-plasty in scar parallel to orbicularis oris. Forehead The underlying frontalis muscle creates unusually prominent forehead RSTLs. These well-defined lines run horizontally in the central forehead, with their lateral ends projecting obliquely inferior over the temple region. Pay particular attention (...) of the cutaneous, or white lip, and the vermilion, or red lip. Key external landmarks include the Cupid’s bow, the philtral columns, the tubercle, the vermilion border, the white roll, and the red line. The white roll is the ridge formed by the insertion of the orbicularis oculi just superior to the vermilion border. The red line of the vermilion is the transition between the wet and dry mucosal lining of the lip. The lip can be further divided into three aesthetic units: the lateral upper lip, the medial

2014 eMedicine.com

103. Lip Reconstruction (Treatment)

, full-thickness lip resections should be repaired in 4 layers. Small-caliber 5-0 or 6-0 sutures placed with reverse-cutting needles are preferred in this delicate area. First, the submucosa is repaired by using a small-caliber, soft, nonirritating suture such as silk or braided polyglactin (Vicryl). The surgeon should take special care to bury the knots to prevent irregular wound contours and suture spitting. Second, the orbicularis oris is repaired by using an absorbable suture such as braided (...) polyglactin (Vicryl), braided polyglycolic acid (Dexon), or polydioxanone (PDS). Careful and meticulous reapproximation of the orbicularis oris is necessary to maintain competence of the oral sphincter. Third, the vermilion-cutaneous border should be realigned with an epidermal vertical mattress suture. Proper and exact restoration of this border is crucial for a good aesthetic outcome. Next, the dermis and subcutaneous tissue of the cutaneous lip is closed with absorbable sutures. Fourth, the surgeon

2014 eMedicine.com

104. Surgical Complications (Treatment)

or ptosis (the orbicularis oculi muscle has a coexisting supply from the zygomatic branch). The zygomatic branch of the facial nerve is less vulnerable as it crosses the zygoma because of its deep plane; it exits the parotid gland prior to its entry into the orbicularis oculi muscle. Injury to this nerve results in ectropion and in the unilateral inability to close the eyelid. Transection of the buccal branch of the facial nerve along its course from the parotid gland to the orbicularis oris muscle (...) , especially in elderly patients with thin skin. Transection of the temporal branch to the frontalis muscle results in unilateral eyebrow ptosis and loss of the normal forehead furrows (see images below). Injury to the temporal branch of the facial nerve causing eyebrow droop and loss of normal forehead furrows. Injury to the temporal branch of the facial nerve causing an inability to raise the eyebrow. Injury to the branches supplying the orbicularis oculi muscle may result in difficulty closing the eye

2014 eMedicine.com

105. Scar Revision (Overview)

in the RSTL direction. Often, these scars cross from an oblique lateral to a more horizontal orientation and require a combination of lateral Z-plasty and running W-plasty over the mentum. Scar revision. W-plasty in scar parallel to orbicularis oris. Forehead The underlying frontalis muscle creates unusually prominent forehead RSTLs. These well-defined lines run horizontally in the central forehead, with their lateral ends projecting obliquely inferior over the temple region. Pay particular attention (...) of the cutaneous, or white lip, and the vermilion, or red lip. Key external landmarks include the Cupid’s bow, the philtral columns, the tubercle, the vermilion border, the white roll, and the red line. The white roll is the ridge formed by the insertion of the orbicularis oculi just superior to the vermilion border. The red line of the vermilion is the transition between the wet and dry mucosal lining of the lip. The lip can be further divided into three aesthetic units: the lateral upper lip, the medial

2014 eMedicine.com

106. Oral Cutaneous Fistulas (Overview)

or orbicularis oris muscle may result in cutaneous spread. Infection from the mandibular molars is usually confined to the lingual aspect of the oral cavity by the mylohyoid muscle and to the buccal aspect by the inferior attachment of the buccinator muscle. If the infection penetrates to the lingual area inferior to the mylohyoid muscle, infections of the submandibular, sublingual, and submental spaces may result. If the infection spreads inferior to the buccinator muscle attachment, cutaneous spread may (...) also may spread to the canine fossa, buccinator space, lateral pterygoid space, and infratemporal space. Spread of infection to the lateral pterygoid and infratemporal spaces is associated with trismus. Infection of maxillary premolars almost always stays confined to the oral cavity and most commonly spreads to the buccal side of the alveolar ridge. Infection from the maxillary anterior teeth is usually contained within the oral cavity. Spread of infection superior to the levator anguli oris muscle

2014 eMedicine.com

107. Lip Reconstruction (Overview)

of cutaneous lip (C), orbicularis oris muscle (D), lamina propria of mucosal lip with salivary glands (E), mucosa of mucosal lip (F), labial artery (G). Anatomy of the lip region. Cosmetic units of the lip. The Cupid's bow is the downward projection of the philtral unit, which gives the lip its characteristic appearance. The white roll is the light linear projection that circumferentially outlines the upper and lower lip at the border of the cutaneous and vermilion lip. Reconstruction of the Cupid's bow (...) and are perpendicular to the fibers of the orbicularis oris muscle. The vermilion portion is the most cosmetically apparent portion of the lip. This portion is a modified mucosal membrane that lacks pilosebaceous units, eccrine glands, and salivary glands. The pink-to-red color of the vermilion lip is due to the extensive superficial vasculature in this area. The wet, or mucosal, lip abuts the teeth and contains minor salivary glands, which empty onto its surface. The red line is where the upper and lower lips meet

2014 eMedicine.com

108. Hemifacial Spasm (Overview)

of the orbicularis oculi and spreads over years to other facial muscles (corrugator, frontalis, orbicularis oris, platysma, zygomaticus). [ , ] Clonic movements progress to sustained tonic contractions of involved musculature. Chronic irritation of the facial nerve or nucleus, the near-universal cause of hemifacial spasm, may arise from numerous underlying conditions. Facial musculature is subject to the same movement disorders as muscles of the limbs or trunk. Myoclonus, dystonia, and other movement disorders

2014 eMedicine.com

109. Lip Reconstruction (Follow-up)

, full-thickness lip resections should be repaired in 4 layers. Small-caliber 5-0 or 6-0 sutures placed with reverse-cutting needles are preferred in this delicate area. First, the submucosa is repaired by using a small-caliber, soft, nonirritating suture such as silk or braided polyglactin (Vicryl). The surgeon should take special care to bury the knots to prevent irregular wound contours and suture spitting. Second, the orbicularis oris is repaired by using an absorbable suture such as braided (...) polyglactin (Vicryl), braided polyglycolic acid (Dexon), or polydioxanone (PDS). Careful and meticulous reapproximation of the orbicularis oris is necessary to maintain competence of the oral sphincter. Third, the vermilion-cutaneous border should be realigned with an epidermal vertical mattress suture. Proper and exact restoration of this border is crucial for a good aesthetic outcome. Next, the dermis and subcutaneous tissue of the cutaneous lip is closed with absorbable sutures. Fourth, the surgeon

2014 eMedicine.com

110. Human Bites (Follow-up)

may be reconstructed with mucosal advancement flaps. Wounds measuring up to a third of the length of the lip may be closed by using a wedge or chevron excision and approximating the 2 cut edges. [ ] Perform muscular reapproximation of the orbicularis oris with interrupted, buried, absorbable sutures to assure continuity of the sphincteric muscular ring. Small (< 1.5 cm 2 ) lip segments have been successfully replanted as composite grafts when a segment of lip has been amputated and is available

2014 eMedicine.com

111. Human Bite Infections (Follow-up)

may be reconstructed with mucosal advancement flaps. Wounds measuring up to a third of the length of the lip may be closed by using a wedge or chevron excision and approximating the 2 cut edges. [ ] Perform muscular reapproximation of the orbicularis oris with interrupted, buried, absorbable sutures to assure continuity of the sphincteric muscular ring. Small (< 1.5 cm 2 ) lip segments have been successfully replanted as composite grafts when a segment of lip has been amputated and is available

2014 eMedicine.com

112. Scar Revision (Follow-up)

in the RSTL direction. Often, these scars cross from an oblique lateral to a more horizontal orientation and require a combination of lateral Z-plasty and running W-plasty over the mentum. Scar revision. W-plasty in scar parallel to orbicularis oris. Forehead The underlying frontalis muscle creates unusually prominent forehead RSTLs. These well-defined lines run horizontally in the central forehead, with their lateral ends projecting obliquely inferior over the temple region. Pay particular attention (...) of the cutaneous, or white lip, and the vermilion, or red lip. Key external landmarks include the Cupid’s bow, the philtral columns, the tubercle, the vermilion border, the white roll, and the red line. The white roll is the ridge formed by the insertion of the orbicularis oculi just superior to the vermilion border. The red line of the vermilion is the transition between the wet and dry mucosal lining of the lip. The lip can be further divided into three aesthetic units: the lateral upper lip, the medial

2014 eMedicine.com

113. Bell Palsy (Overview)

of the eighth cranial nerve. The facial nerve passes through the stylomastoid foramen in the skull and terminates into the zygomatic, buccal, mandibular, and cervical branches. These nerves serve the muscles of facial expression, which include the frontalis, orbicularis oculi, orbicularis oris, buccinator, and platysma muscles. Other muscles innervated by the facial nerve include the stapedius, stylohyoid, posterior belly of the digastric, occipitalis, and anterior and posterior auricular muscles. All

2014 eMedicine.com

114. Bell Palsy (Overview)

of the eighth cranial nerve. The facial nerve passes through the stylomastoid foramen in the skull and terminates into the zygomatic, buccal, mandibular, and cervical branches. These nerves serve the muscles of facial expression, which include the frontalis, orbicularis oculi, orbicularis oris, buccinator, and platysma muscles. Other muscles innervated by the facial nerve include the stapedius, stylohyoid, posterior belly of the digastric, occipitalis, and anterior and posterior auricular muscles. All

2014 eMedicine.com

115. Anatomy in Cutaneous Surgery (Overview)

tightly. This complex lies superficially in the eyelid skin and is encountered with even a shallow incision. The dominant muscle of the nose is the nasalis muscle, which consists of nasal and alar components. Its function is to compress and dilate the nares. Mouth muscles The has the most extensive network of facial musculature and accounts for much of an individual's capability of facial expression. The orbicularis oris encircles the mouth and is the major component of the lips. The major functions (...) of the orbicularis oris muscle are to pull the lips against the teeth, to draw the lips together, to pull the corners of the mouth together, and to pucker the mouth. This muscle is also extremely important for the phonation of sounds that rely on the lips, such as the pronunciation of the letters M , V , F , and P . A group of 6 muscles, collectively known as the quadratus labii superioris muscle, controls the upper mouth. The 6 muscles are as follows: Zygomaticus major muscle - Starts from the posterolateral

2014 eMedicine.com

116. Prerhytidectomy Facial Analysis

between these bands can result in further loss of the cervicomental angle. Loss of this angle produces the appearance of a “turkey gobbler” neck. The mandible reabsorbs, allowing chin pad ptosis and contributing to the illusion of increased nasal projection. Especially in the edentulous patient, the resorption of the alveolar ridge causes a relative excess of skin. This excess skin, when combined with loss of the subcutaneous tissues, reveals the intrinsic tone in the orbicularis ori muscle, forming (...) lid skin allows pseudoherniation of the orbital fat. This process forms palpebral bags, and an accentuation of tear-trough depression. Loss in subcutaneous fullness overlying the orbicularis oculi brings the muscle into close contact with the overlying thin skin, giving the infraorbital area a darkened, tired appearance. This loss of subcutaneous tissue also accentuates the intrinsic muscle tone and gives rise to the appearance of “crow’s feet.” Over time, the fullness in the glabella, nasion

2014 eMedicine Surgery

117. Head and Neck Cancer: Reconstruction

covers the reconstruction of specific anatomical entities of the head and neck. Previous Next: Reconstruction of Lip Defects The lower lip is the site of more than 90% of cancers of the lips, as it receives more ultraviolet exposure than the upper lip. Anatomy The lips are formed of 3 layers: skin, muscle (orbicularis oris), and mucosa. The vermilion (“red lip”), which is formed of modified mucosa, is the myocutaneous junction; it includes the “white line” where the skin meets the vermilion (...) lip tissue transfer Restoration of orbicularis oris No commissure violation Cross-lip flap Second surgery Relative microstomia Temporary denervation Trap-door deformity as scar appears thickened Vascular compromise Vermillion notching Lip asymmetry Scarring extension beyond sublabial crease Estlander 1/2-1/3 lip defects involving oral commissure Maintain motor/sensory competence of lip One stage Scar can be hidden in skin crease No mouth closure Requires commissuroplasty Commissure violation

2014 eMedicine Surgery

118. Forehead Anatomy

supercilii 6. Orbicularis oculi 7. Nasalis 8. Levator labii superioris 9. Levator anguli oris 10. Levator labii superioris alaeque nasi 11. Orbicularis oris 12. Mentalis 13. Depressor labii inferioris 14. Depressor anguli oris 15. Platysma 16. Masseter 17. Zygomaticus major 18. Zygomaticus minor 19. Temporalis 20. Lateral pterygoid 21. Medial pterygoid 22. Buccinator Frontalis muscle The paired frontalis muscles are the primary elevators of the brow. The vertically orientated muscle fibers offer no true (...) of the temporal fat pad. Plast Reconstr Surg . 1989 Feb. 83(2):265-71. . Media Gallery Skull. Facial muscles: 1. Galea aponeurotica 2. Frontalis 3. Procerus 4. Depressor supercilii 5. Corrugator supercilii 6. Orbicularis oculi 7. Nasalis 8. Levator labii superioris 9. Levator anguli oris 10. Levator labii superioris alaeque nasi 11. Orbicularis oris 12. Mentalis 13. Depressor labii inferioris 14. Depressor anguli oris 15. Platysma 16. Masseter 17. Zygomaticus major 18. Zygomaticus minor 19. Temporalis 20

2014 eMedicine Surgery

119. Facial Nerve Embryology

, mandibular, and cervical branches are deeper. Multiple facial muscles appear at this time as well, including the zygomaticus major and minor, depressor anguli oris, buccinators, and frontalis. Week 8 (32-49 mm) A sulcus develops around the facial nerve that is the beginning of the fallopian canal. The orbicularis oris, levator anguli oris, and orbicularis oculi muscles appear. Week 9 (50-60 mm) Auricularis anterior, corrugator supercilii, occipital and mandibular platysma, and levator labii superioris

2014 eMedicine Surgery

120. Facial Nerve Paralysis, Static Reconstruction

be aesthetically and functionally problematic. Static suspension of the commissure can reestablish symmetry and enhance oral competence. The sling involves suspension of autologous or alloplastic materials from the orbicularis oris muscle to either the zygomatic arch or the orbital rim. [ ] Sundry surgical approaches and incisions are used in facial suspension. A standard rhytidectomy incision and dissection provide excellent exposure to the entire hemiface. Moreover, exposure of the oral commissure can (...) for normal orbicularis oris and lip from the contralateral unaffected side. The lip resection should be achieved with a full-thickness V or W wedge. As much as one third of both the upper and lower lip can be excised and closed primarily. The goal of this rotation and transfer of normal tissue is to reestablish a dynamic sphincter. Cheiloplasty can improve speech, eating, commissure competence, and appearance. Illustrative case The case illustrated below depicts a patient with facial nerve paralysis

2014 eMedicine Surgery

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