The female upper lip is shorter than its male counterpart. We have recently described a precise direct surface measurement technique of the philtral height. In this study we aim to quantify the difference in philtral height using this same measuring technique between two groups of young male and female Lebanese subjects. The mean philtral height obtained in the young male group was 15.7 ± 1.7 mm. By comparing this result to the previously described mean philtral height of 14.3 ± 1.9 mm in the young female group, we obtained a mean difference of 1.3 ± 1.8 mm between the two groups. This result confirms and quantifies by direct surface measurement the gender difference in upper lip height and should be considered when planning a gender-affirming upper lip shortening surgery.

The aim of this study is to evaluate the changes in nasolabial soft tissues following Le Fort I osteotomies, focusing on the impact of maxillary vertical repositioning. This retrospective study included 39 patients with a history of Le Fort 1 osteotomy between 2013 and 2021. Patients were grouped based on their maxillary movement into three categories: pure advancement (group A), advancement with impaction (group B), and advancement with downward repositioning (group C). Preoperative and postoperative CBCT (Cone Beam Computed Tomography) data were analyzed to measure the changes in nasolabial soft tissues. The current study utilized Mimics Suite 20.0 for measuring linear and angular variables. The evaluated variables included intercanthal distance, nasal dorsal length, tip protrusion, mouth width, alar width, upper lip height, nostril dimensions, and angles of nasolabial, alar base, and upper lip. Among them intercanthal distance, nasal dorsal length, or tip protrusion showed no statistical difference (p > 0,05). Mouth width, alar width, alar base angle were increased and upper lip angle was decreased significantly (p < 0.001). Changes in upper lip height and nasolabial angle differed among the groups of the study. While upper lip height increased significantly in groups A and C (p < 0.05), there was a slight decrease in Group B with no significance (p > 0.05). Nasolabial angle decrased significantly on Groups A and B (p < 0.05). The results of this study revealed changes in several soft tissue parameters, some of which occurred regardless of vertical repositioning of the maxilla. Within the limitations of the study, maxillary advancement surgery can affect the aesthetics of the nasolabial region and cause specific changes in related soft tissues. Understanding these changes is essential to establish realistic patient expectations and achieve optimal functional and aesthetic outcomes.

UNASSIGNED: To describe 3 cases of midline congenital upper lip sinus (MCULS) and review current literature to inform risk of intracranial involvement in the context of this rare congenital facial anomaly.
UNASSIGNED: A limited case series with chart review is presented. A literature search was conducted to review proposed theories of the embryology of MCULS and to determine the relative frequency of cephalic extension.
UNASSIGNED: Including the 3 new cases presented herein, there have been 42 cases of MCULS described in the literature over the past 53 years. Thirty-nine cases (93%) underwent surgical excision, with 2 of these cases (4.7%) demonstrating cephalic extension of the fistula tract beyond the maxillary crest with termination at the anterior skull base. However, 95% (37/39) of surgically excised MCULS cases demonstrated a more limited depth of extension, with termination of the tract at or below the anterior nasal spine.
UNASSIGNED: The MCULS anomaly is rare, with fewer than 50 cases reported in the literature. Only 2 cases have been described with extension of the MCULS superior to the anterior nasal spine and into the nasal septum. It is the authors\' opinion that preoperative neuroimaging is not routinely required for MCULS. However, if extension of the sinus tract beyond the anterior nasal spine is noted intraoperatively, the surgeon should consider aborting the case and obtaining appropriate neuroimaging.

BACKGROUND: Salivary gland tumors are relatively rare. Most minor salivary gland tumors are malignant with benign tumors accounting for 18% of the tumors. Pleomorphic adenoma (PA) is the most common salivary gland tumor. Lip PA is uncommon with 9.8% occurring in the upper lip. We are adding on the knowledge of the rare upper lip PA (benign mixed tumor).
METHODS: We report an upper lip PA (benign mixed tumor) in a 28-year-old man. His complaint was a painless swelling on the upper lip. A painless, non-tender, well-circumscribed, slightly mobile, sessile, nodular, and rubbery (in consistency) tumor measuring 5.0 cm x 2.0 cm was noted on the left side of his upper lip. The overlying skin was not fixed and of normal color. There was no ulceration, and palpation did not elicit pain or bleeding. There was no history of trauma. Blunt dissection was used to completely excise the nodular, whitish, and encapsulated tumor. Microscopy showed a well-circumscribed and partly encapsulated biphasic lesion, with large lobules of myxo-chondroid stroma and intervening cellular nodules of basaloid cells, well-formed tubules containing eosinic secretion, and nests of myoepithelial cells. A diagnosis of PA (benign mixed tumor) was confirmed.
CONCLUSIONS: Blunt dissection is indicated to preserve the cosmesis and function of the upper lip.

Congenital midline sinus of the upper lip are rare congenital malformations. We recently identified a case featuring a congenital midline sinus of the upper lip. The punctate opening was positioned at the midline of the philtrum, immediately below the base of the columella. Surgical removal of the sinus tract was conducted through an intraoral approach. Up to now, fewer than 70 cases have been reported. Several postulates, including the fusion theory, merging theory, and invagination theory, have been proposed to explain the formation of the congenital midline sinus of the upper lip. Nevertheless, the etiology of this uncommon abnormality remains unclear. This report details a case of a congenital upper lip sinus presenting as a congenital midline sinus of the upper lip and reviews the current literature on this condition.

Upper lip lifting is a very popular procedure but there is no objective guidelines on how much skin has to be removed to obtain an optimal result. We have measured and compared the philtral height in two groups of young and old female Lebanese subjects. We have found a mean philtral height of 14.3 ± 1.9 mm in the young group and 19.8 ± 2.4 mm In the old group, with a mean philtral lengthening of 5.5 ± 2.9 mm. We suggest using these results to plan the amount of skin that has to be removed during a lip lift procedure.

Introduction  Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective  To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods  In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t -test and linear regression in the IBM SPSS Statistics for Windows software. Results  The length of the upper lip increased by 1 mm ( p  = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm ( p  = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display ( p  = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length ( p  = 0.033). Conclusions  Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help predict the postoperative results. Changing the angulation of the incisors can predict the incisal display. In maxillary impaction, skeletal changes in the vertical dimension can predict the changes in the length of the upper lip.

BACKGROUND: The traditional nasolabial V-Y advancement flap is widely used for midface reconstruction, particularly for the lower third of the nose and upper lip, as its color and texture are similar to these areas. However, it provides insufficient tissue to cover large defects and cannot restore the nasal convexity, nasal ala, and adjacent tissues. The purpose of this study is to investigate the modified nasolabial V-Y advancement flap with extension limbs the along alar crease for the reconstruction of complex midface defects.
METHODS: A retrospective analysis of 18 patients, who underwent reconstruction with the modified nasolabial V-Y advancement flap, was performed between September 2014 and December 2022. An extension limb was added along the alar crease, adjacent to the defect area, and was hinged down as a transposition flap at the end of the advancement flap.
RESULTS: The extension limb along the alar crease successfully covered large and complicated defects, including those of the ala, the alar rim, the alar base, the nostrils, and the upper lip, with minor complications.
CONCLUSIONS: The alar crease is a good donor site for the reconstruction of large and complex nasal and upper lip defects.

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