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Orbicularis Oris

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141. Rhytidectomy, Deep Plane Facelift

, dissection in the mid face to separate the malar fat pad and skin complex from the deeper structures is performed above the SMAS. As a result, the nerves innervating the zygomaticus major and minor muscle complex, which enter these muscles from their deep surface, are not injured. To accomplish this goal, the sub-SMAS dissection is stopped in the lower part of the face at a level approximately 1 cm below the zygomatic arch. Identification of the orbicularis oris muscle and the origin of the zygomaticus (...) major and minor muscles is a key part of the operation. Dissection is facilitated into the mid face in a safe plane just above the orbicularis oris and zygomaticus major and minor muscles to the melolabial fold and into the upper lip, if needed. A thick subcutaneous flap is created that contains the malar fat pad attached to the skin and allows for repositioning of the malar fat pad–skin complex in a more youthful posterior-superior direction. Anatomic details relevant to this technique are further

2014 eMedicine Surgery

142. Dynamic Reanimation for Facial Paralysis

from the skull base (D), transfer of the temporalis muscle in a subcutaneous plane, but superficial to the muscular aponeurotic system (E), and insertion of the temporalis muscle into the orbicularis oris muscle with an overcorrected position (F). Intraoral approach harvests the masseter muscle for transfer. Incision is made along the gingival sulcus (A). One muscle is exposed; curved scissors are used to transect the muscle in the midportion (B). Two slips of muscle are attached to the dermal

2014 eMedicine Surgery

143. Craniofacial, Unilateral Cleft Lip Repair

. The primary muscle of the lip is the orbicularis oris, and it has two well-defined components: the deep (internal) and the superficial (external) components. The deep (internal) fibers run horizontally or circumferentially from commissure (modiolus) to commissure (modiolus) and functions as the primary sphincteric action for oral feeding. The superficial (external) fibers run obliquely, interdigitating with the other muscles of facial expression to terminate in the dermis. They provide subtle shades (...) of expression and precise movements of the lip for speech. The superficial fibers of the orbicularis decussate in the midline and insert into the skin lateral to the opposite philtral groove forming the philtral columns. The resulting philtral dimple centrally is depressed as there are no muscle fibers that directly insert into the dermis in the midline. The tubercle of the lip is shaped by the pars marginalis, the portion of the orbicularis along the vermilion forming the tubercle of the lip with eversion

2014 eMedicine Surgery

144. Craniofacial, Bilateral Cleft Lip Repair

length and vertical height to the lip during reconstruction. Bilateral cleft lip repair. (A) The prolabial width is typically set at 4-5 mm. (B) The prolabial flap is elevated to the base of the columella. The adjacent flaps are turned over to create a labial sulcus. (C) The orbicularis oris muscle, dissected from the overlying skin, is approximated across the midline. (D) The skin is approximated, and the Cupid's bow is created from the lateral vermilion flaps. Previous Next: Epidemiology Frequency (...) that is exposed to air) and the wet mucosa. The primary muscle of the lip is the orbicularis oris. It has 2 well-defined components: the deep (internal) layer and the superficial (external) layer. The deep fibers run circumferentially from commissure (modiolus) to commissure (modiolus) and function as the primary sphincter for oral feeding. The superficial fibers run obliquely, interdigitating with the other muscles of facial expression to terminate in the dermis, and function to provide subtle shades

2014 eMedicine Surgery

145. Craniofacial, Unilateral Cleft Nasal Repair

of the facial muscles, especially in the orbicularis oris, in distorting the anatomy is another important consideration. Abnormal insertions or tractions of disorganized muscle may increase or accentuate the deformity as the face continues to grow. [ ] Nasal tip skin and mucosae are usually normal. The lower lateral cartilage is subluxed on the cleft side and inappropriately lengthens the cleft side of the nose. [ ] However, the quantity of soft tissue present in the nostril on the cleft side is sufficient

2014 eMedicine Surgery

146. Burns, Electrical

occurs for 3-5 months before spontaneous softening takes place. Sites of involvement Electric burns of the oral cavity can involve the lip, tongue, mucous membranes, and underlying bone. [ ] The most frequent site of involvement is the upper and lower lips with the intervening commissure. This injury to the lip may be associated with damage to the orbicularis oris muscle as well as mucous membranes. As muscles heal, may develop, and repair of the injured mucous membranes may result in labial (...) of the oral opening to attain adequate functional and aesthetic appearance of the injured mouth. Position each commissure laterally equidistant to the midline of the lips, and maintain the orbicularis oris muscle at a 2-point fixation. This prosthetic treatment can be accomplished either intraorally or extraorally, depending on the patient's dentition and ability to cooperate. Because these patients are often aged only 1-2 years, parents must participate and cooperate in the treatment plan. Perform

2014 eMedicine Surgery

147. Anatomy in Cutaneous Surgery (Follow-up)

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

148. Botulinum Toxin (Follow-up)

region are too close to the eyelid. Asymmetry of the face can occur because of differences in injection techniques or doses between the 2 sides of the face. Drooling can occur when injections of the orbicularis oris muscle are too close to the lip. [ ] Systemic complications are possible. Headache has been reported and is usually transient. Hypersensitivity reactions have not been described. Antibody development is described in patients receiving high doses of botulinum toxin (eg, for the treatment (...) injection. With the latter method, which is used primarily in the platysma, the preferred injection site is identified with EMG. The needle is then inserted parallel to the plane of the muscle, and the injection is performed while the needle is carefully withdrawn. Orbicularis muscle/periorbital crow's feet injection. Frontalis muscle injections. Corrugator muscle injections. Procerus muscle injections. Next: Preoperative Details Preoperative details include the following: identifying contraindications

2014 eMedicine.com

149. Surgical Complications (Diagnosis)

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

150. Microstomia

, the philtrum and 2 lateral subunits that extend from the philtral columns to the melolabial folds laterally. The lower lip is one functional subunit that extends to the labiomental fold inferiorly and to the melolabial folds laterally. The orbicularis oris is a circular muscle innervated by branches of the facial nerve. Its function is important in maintaining oral competence, normal speech articulation, and facial expression. The deep fibers of the orbicularis oris are oriented horizontally and act (...) :1977. pp.1575, with permission from Elsevier). Schematic representation of orbicularis oris muscle-lengthening procedure. Schematic representation of orbicularis oris muscle-lengthening procedure. of 8 Tables Contributor Information and Disclosures Author Homere Al Moutran, MD Attending/Staff Physician in Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, New York Head and Neck Institute, Staten Island University Hospital Homere Al Moutran, MD is a member of the following

2014 eMedicine Surgery

151. Lips and Perioral Region Anatomy

corresponds to the depth of the gingivolabial sulcus. Next: Histology From superficial to deep, the layers of the upper and lower lips include the epidermis, subcutaneous tissue, orbicularis oris muscle fibers, and mucosa. In cross-section, the superior and inferior labial arteries can be observed as they course between the orbicularis muscle fibers and the mucosa. The vermilion is composed of nonkeratinized squamous epithelium that covers numerous capillaries, which give the vermilion its characteristic (...) that passes under the mandibular body in an anteromedial direction. The facial artery ascends in a plane deep to the platysma, risorius, and zygomaticus major and minor muscles and superficial to the buccinator and levator anguli oris. This artery branches into an inferior and a superior labial artery, which course beneath the orbicularis oris and anastomose with the contralateral vessel. [ ] The superior labial artery usually branches from the facial artery 1.1 cm lateral (SD 0.43) and 0.9 cm (SD 0.20

2014 eMedicine Surgery

152. Lip Reduction

the inner pars villosa and the outer pars glabra, resulting in glandular hypertrophy along with redundant labial mucosa. The excess tissue forms an accessory lip, which is more apparent during smiling. The underlying orbicularis oris muscle is not involved. Ascher syndrome is identical to double lip deformity, with associated and endocrine disorders. Another example of hypertrophy is , a sarcoidlike condition. [ , ] Traumatic causes result in an inflammatory infiltration leading to fibrosis

2014 eMedicine Surgery

153. Lip Reconstruction

and inferior to the most distal portion of pars peripheralis, and anterior to the bundle of buccinator muscle. [ ] Formally, the orbicularis oris muscle as a whole is composed of 8 segments, each representing a fan with its stem at the modiolus. The region of opposition of marginal and peripheral parts is indicated by the red-white junction ventrally, and the mucosal-red lip junction posteriorly. Accessory muscles of the orbicularis oris complex exist and mainly consist of superior and inferior tractors (...) of labial vessels may be a contraindication to the use of a pedicled labial flap. Therefore, a complete history is essential. Previous References Karapandzic M. Reconstruction of lip defects by local arterial flaps. Br J Plast Surg . 1974 Jan. 27(1):93-7. . Hwang K, Kim DJ, Hwang SH. Musculature of the pars marginalis of the upper orbicularis oris muscle. J Craniofac Surg . 2007 Jan. 18(1):151-4. . Gonzalez A, Etchichury D. Reconstruction of Large Defects of the Lower Lip After Mohs Surgery: The Use

2014 eMedicine Surgery

154. Lip Reconstruction

, which can be further divided into 3 components: cutaneous, vermilion, and mucosal (see image below).The cross-sectional anatomy of the lips consists of the epidermal, dermal, subcutaneous, muscular (orbicularis oris), submucosal, and mucosal layers. Neurovascular, lymphatic, and glandular structures mainly run between the muscular and submucosal layers. At the vermilion, a rich neural and vascular plexus lies beneath a layer of specialized squamous epithelium, making the vermilion highly sensate (...) of mouth medially Zygomaticus major Zygomatic arch Modiolus at angle of the mouth Buccal branch of facial nerve (VII) Elevates and draws laterally the angle of the mouth Zygomaticus minor Lateral infraorbital margin Lateral skin and muscle of upper lip Buccal branch of facial nerve (VII) Elevates and everts upper lip Depressors Depressor labii inferioris Mandible below mental foramen along oblique line Orbicularis oris and skin of lower lip Mandibular branch of facial nerve (VII) Depresses

2014 eMedicine Surgery

155. Anatomy in Cutaneous Surgery (Diagnosis)

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

156. Botulinum Toxin (Diagnosis)

- Crow's feet Mark the lateral canthal line 1 cm lateral to the canthus. Then, the patient should be asked to squint, and the squint lines above and below the lateral canthal line are marked. The injections are symmetrically placed into the muscle on both sides of the face. To avoid problems with eyelid closure, do not inject too close to the eyelids. Orbicularis oris and mentalis muscles - Excessive lip pursing The injection site is the point halfway between the vermilion border of the lower lip (...) canthal lines associated with orbicularis oculi activity in adults. It is also indicated for the temporary improvement in the appearance of moderate-to-severe forehead lines associated with frontalis muscle activity in adults. Dysport® ( ) is indicated for the treatment of adults with cervical dystonia, lower limb spasticity, and spasticity. The cosmetic indication is for the temporary improvement in the appearance of moderate-to-severe glabellar lines associated with procerus and corrugator muscle

2014 eMedicine.com

157. Bell Palsy (Diagnosis)

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

158. Bell Palsy (Diagnosis)

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

159. Cleft Lip and Palate (Overview)

. Novel evidence of association with nonsyndromic cleft lip with or without cleft palate was shown for single nucleotide polymorphisms in FOXF2 gene in an Asian population. Birth Defects Res A Clin Mol Teratol . 2015 Oct. 103 (10):857-62. . Marazita ML. Subclinical features in non-syndromic cleft lip with or without cleft palate (CL/P): review of the evidence that subepithelial orbicularis oris muscle defects are part of an expanded phenotype for CL/P. Orthod Craniofac Res . 2007 May. 10(2):82-7 (...) . . Rogers CR, Weinberg SM, Smith TD, Deleyiannis FW, Mooney MP, Marazita ML. Anatomical basis for apparent subepithelial cleft lip: a histological and ultrasonographic survey of the orbicularis oris muscle. Cleft Palate Craniofac J . 2008 Sep. 45(5):518-24. . Suzuki S, Marazita ML, Cooper ME, et al. Mutations in BMP4 are associated with subepithelial, microform, and overt cleft lip. Am J Hum Genet . 2009 Mar. 84(3):406-11. . Croen LA, Shaw GM, Wasserman CR, Tolarová MM. Racial and ethnic variations

2014 eMedicine Pediatrics

160. Birth Trauma (Treatment)

of the facial muscles, unilateral absence of the orbicularis oris muscle, and intracranial hemorrhage. Management and recovery Most infants begin to recover in the first week, but full resolution may take several months. Palsy that is due to trauma usually resolves or improves, whereas palsy that persists is often due to absence of the nerve. Management consists of protecting the open eye with patches and synthetic tears (methylcellulose drops) every 4 hours. Consultation with a neurologist and a surgeon

2014 eMedicine Pediatrics

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