The author has no financial conflict to disclose. Polo M. Botulinum toxin type A (Botox) for the neuromuscular correction of excessive gingival display on smiling (gummy smile). This is a superficial elevator muscle of the nose and the upper lip utilized in oral-facial expression. Any financial interests relevant to the content must be disclosed. Anatomical variations in the topographic relationships were also described to understand the function of the LLSAN and the transverse part of the nasalis. The posterior end of the wing of the nose. A 24-year-old woman presented with 8.5 mm of anterior gingival display. Your message has been successfully sent to your colleague. Nerve supply :- Buccal branch of facial nerve (VII) supplies the muscle.. Please note the following criteria: Authors will be listed in the order in which they appear in the submission. In this dosage-controlled study, all 30 subjects, regardless of degree of severity, were injected with 2.5U of onabotulinum toxin A at two bilateral sites: (1) the junction/approximation of the muscle fibers of the levator labii superioris alaeque nasi with the levator labii superioris and (2) approximately 1.0cm inferolaterally, the junction/approximation of the levator labii superioris and the zygomaticus minor. The levator labii superioris alaeque nasi arises from the frontal process of the maxilla. 1 and 2). From these data, it might be inferred that the severity of gummy smile in their sample was smaller than that in mine. si --l-kw-n-z. The middle portion of each side of the upper lip. In the midplane, a portion of the fibers intermingle with their respective fellow muscles to form the philtrum of the mouth. It is classified as the buccolabial facial muscle. Scot Glasberg, M.D. 2005;127:214218, 3. Insertion :- It inserts in skin of lateral nostril and upper lip. Articles in Google Scholar by Mario Polo, D.M.D. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Am J Orthod Dentofacial Orthop. David H. Song, M.D., M.B.A., 444 E. Algonquin Rd. Rather than dramatically increasing the dose at the levator labii superioris alaeque nasi sites for severe cases, I opt to keep my dosage at 2.0 to 2.5U and increase the number of sites injected from two to four. It could also be assumed that the dosage needed to correct their less severe condition had to be smaller. He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. Its fibers pass inferiorly to insert on the lateral nasal alar cartilage, the dermis of the upper lip, and the orbicularis oris muscle. These muscles converge inferomedially toward their insertion. Interesting information Levator labii superioris alaeque nasi has the distinction of being the longest name for a muscle in an animal. The levator labii superioris originates along a broad area along the lower orbital rim and inserts in the upper lip complex medial to the corner of the mouth. Her postinjection display was 1.25 mm, with an anterior gingival display reduction of 3.0 mm. Arlington Heights, IL 60005, [emailprotected]. to maintaining your privacy and will not share your personal information without Polo M. Botulinum toxin type A in the treatment of excessive gingival display. To our knowledge, a myocutaneous island flap based on the levator labii superioris alaeque nasi (LLSAN) and nasalis muscles, with vascularity from the lateral nasal and angular arteries, has not been described for reconstruction of the lower lateral nose. Privacy Policy (Updated December 15, 2022), by the American Society of Plastic Surgeons, Textmaximum of 500 words (not including references), Figures/Tablesno more than two figures and/or one table. The levator labii superioris alaeque nasi elevates: The superior end of the nasolabial furrow. Fig. This muscle along with the next one that will be discussed, the levator labii superioris alaeque nasi, is used to snarl indicting aggression which is more effective in animals that have more imposing canines than humans do, but can be used alone to lift the lip and to show off your new veneers. Plastic and Reconstructive Surgery131(6):934e-935e, June 2013. Its medial fibers form the angular head (also known as the levator labii superioris alaeque nasi muscle,) which arises by a pointed extremity from the upper part of the frontal process of the maxilla and passing obliquely downward and lateralward divides into two slips.. One of these is inserted into the greater alar cartilage and skin of the nose; the other is prolonged into the . Plast Reconstr Surg. It is not to be confused with the levator labii superioris alaeque nasalis muscle, which has a very similar name, at least partially covers it, and extends and inserts medial to it. Please enable scripts and reload this page. We strongly encourage authors to submit figures in color. Now we can, applying 5 UI in the depressor septi nasi and 3 UI in each levator labii superioris alaeque nasi, attenuate this muscle's action, diminishing tip ptosis during smile, leaving the alar insertion in a neutral position . Join the referral service exclusive to board-certified plastic surgeons. Levator labii superioris alaeque nasi is a facial muscle that lifts the upper lip and flares the nostrils. The aim of this study was to determine how the depressor supercilii (DS) connects to the levator labii superioris alaeque nasi (LLSAN) and inferior fibers of the orbicularis oculi (OOc INF) in the human midface. Interestingly, it has the longest name of any muscle in the human body. Blood supply:- Summary origin: maxilla, nasal bone, medial canthus insertion: nasal base The results of my pilot study published in 20052 were referenced in the article by Sucupira and Abramovitz. This muscle has a broad insertion that acts to lift the upper lip baring the upper teeth. Sucupira and Abramovitz report an average preinjection gingival display of 3.62mm, an average injection of 1.95U of onabotulinum toxin A at two sites, and an average postinjection display of 0.58mm, as compared with a 5.2-mm preinjection display, 2.5U at four sites, and a mean 0.4-mm postinjection display in my study. may email you for journal alerts and information, but is committed The mean postinjection gingival display was 5.1mm, and had declined to 0.09mm ( 1.06mm) in 30 patients (t = 26.01, p < 0.00001). . An indication to use the additional injection sites in individuals with severe gummy smiles at the levator labii superioris/zygomaticus minor site, with excellent cosmetic results, seems to be present. In Latin, levator labii superioris alaeque nasi means 'lifter of the upper lip and of the wing of the nose.' This is the longest name given to any muscle in the human body. The authors have no sources of funding to report related to the writing or submission of this discussion. One site (levator labii superioris alaeque nasi/levator labii superioris) was injected with 2.0 U of onabotulinum toxin A per side. . The total dosage was 4.0 U. MASO J. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence. Since subjects with anterior gingival display of 7.0mm or more also have an increase in lateral gingival display in the bicuspid region, injection at the levator labii superioris/zygomaticus minor site, which inserts more laterally, provides excellent aesthetic results (Figs. Background: The nose is a common site for cutaneous malignancy and post-ablative reconstruction. Two sites (levator labii superioris alaeque nasi/levator labii superioris and levator labii superioris/zygomaticus minor) were injected with 2.5 U of onabotulinum toxin A per side. There are 11 of these muscles and their functions include: Elevating and everting the upper lip levator labii superioris, levator labii superioris alaeque nasi, levator anguli oris zygomaticus major zygomaticus minor muscles Depressing and everting the lower lip depressor labii inferioris depressor anguli oris orbicularis oris muscle 1. The levator labii superioris, levator labii superioris alaeque nasi, and zygomaticus minor are the three muscles that insert at the upper lip . Purpose: The aim of this study was to clarify the anatomical relationship of the procerus with the nose, especially focusing on the transverse part of the nasalis, the nasal ala, and the levator labii superioris alaeque nasi (LLSAN). It both elevates the upper lip but in addition widens the nostril and raises the corner of the nose. Head and Neck Anatomy: Part II Musculature. Levator labii superioris alaeque nasalis ( LLSAN) muscle is traditionally thought of as a muscle of the mouth, but is also a crucial muscle of the nose , a subset of the facial muscles 1. . One site (levator labii superioris alaeque nasi/levator labii superioris) was injected with 2.0 U of onabotulinum toxin A per side. The levator labii superioris alaeque nasi muscle originates near the medial corner of the eye on the maxillary process of the maxilla. It only slightly lifts the central part of the upper lip. This muscle facilitates the expression of 'snarling' by causing dilation of the nostrils, as well as elevation of the wings of the nose and upper . The levator labii superioris extends superiorly from its insertion at the upper lip to its origin at the inferior margin of the orbit just cranial to the infraorbital foramen . The levator labii superioris is partially covered by the levator labii superioris alaeque nasi and the zygomaticus minor. Insertion: orbicularis oris at corners of mouthFunction: (1) moves food to the grinding surfaces of molars and (2) constricts oropharynxDeep to the risorious (more inside to the cheek) - also runs transversally. The levator labii superioris lifts the upper lip. If BoNT type A treatment paralyzes the DS, . Her postinjection display was 3.0 mm, with an anterior gingival display reduction of 5.5 mm. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium. My current protocol is shown in Table 1. The levator labbi superioris alaeque nasi muscle arises via the frontal process of maxilla Upper frontal process of maxilla. Its origination point is on the upper portion of the maxilla and then inserts into the alar cartilage and levator labii superiors (LLS). Levator labii superioris by Anatomy Next Origin The average preinjection gingival display was 5.2 1.4mm. After more than a decade injecting hundreds of patients for gummy and asymmetric smiles,4 I have concluded that, just as with any other cosmetic injection, onabotulinum toxin A dosage and injection sites need to be individualized according to the degree of severity presented. Figure 14. Insertion: Nostril and upper lip. Login or Register to receive relevant, timely communication, take CE courses and more. Nasalis, which allows you to flare your nostrils. Some error has occurred while processing your request. The aim of this study was to determine how the depressor supercilii (DS) connects to the levator labii superioris alaeque nasi (LLSAN) and inferior fibers of the orbicularis oculi (OOc INF) in the . Literal meaning The muscle from the wing of the nose that elevates the upper lip. your express consent. Wolters Kluwer Health At this origin, the . It then passes inferiorly and insert both into the upper lip and the alar of the nose. For more information, please refer to our Privacy Policy. Actions : Levator labii superioris alaeque nasi muscle The levator labii superioris alaeque nasi (Latin: musculus levator labii superioris alaeque nasi) is a muscle of facial expression that widens the nostril and elevates the upper lip, thus enabling the facial expression of snarling. In my clinical experience, treating these severe cases with the dose reported by the authors will not provide the required amount of gummy smile reduction. Other articles in this journal by Mario Polo, D.M.D. The total dosage was 10.0 U. Sucupira E, Abramovitz A. The marginal . Use of larger dosages and additional injection sites is discouraged: Other target muscles described in the literature do not give any additional benefit to this application and could easily lead to lip ptosis, inferior lip protrusion, asymmetry, or excessive lengthening of the upper lip.. Results: The procerus originated from the superficial and deep layers in all . Please try after some time. The muscle is attached to the upper frontal process of the maxilla and inserts into the skin of the lateral part of the nostril and upper lip. A 22-year-old woman presented with 4.25 mm of anterior gingival display. Until the discovery of the Botulinum toxin, acting over these muscles was only possible through surgical procedures. The levator labii superioris ( LLS) muscle ( TA synonym: musculus levator labii superioris) is one of the elevators of the upper lip, a subset of the facial muscles. Purpose: The aim of this study was to clarify the morphology and topography of the deep layer of levator labii superioris alaeque nasi muscle (LLSAN) and the transverse part of the nasalis. origin: Nasal bone. The insertion site of the mentalis fibers into the dermis can be observed in the pout expression. Insertion [edit | edit source] The peripheral part travels medially into the labial areas to insert on the dermis of the lips. Ever since 2001, I have been using onabotulinum toxin A injections to treat gummy and asymmetric smiles with excellent results. : a muscle that arises from the nasal process of the maxilla, that passes downward and laterally, that divides into a part inserting into the alar cartilage and one inserting into the upper lip, and that dilates the nostril and raises the upper lip. ORIGIN Upper frontal process of maxilla: INSERTION Skin of lateral nostril and upper lip: ACTION Dilates nostril and elevates upper lip: NERVE Buccal branch of facial nerve (VII) . Levator labii superioris alaeque nasi muscle details: translated from Latin, the "lifter of both the upper lip and of the wing of the nose". This muscle along with the next one that will be discussed, the levator labii superioris alaeque nasi, is used to snarl indicting aggression which . Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). Skin of the alar cartilage of nose and skin of the upper lip.; Action. Levator labii superioris alaeque nasi, which can open your nostrils and lift your upper lip. This muscle has a broad insertion that acts to lift the upper lip baring the upper teeth. He receives author royalties from Elsevier. Levator labii superioris alaeque nasi by Anatomy Next Origin Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. The levator labii superioris alaeque nasi muscle (occasionally shortened alaeque nasi muscle) is, translated from Latin, the "lifter of both the upper lip and of the wing of the nose ". Join Our Crest + Oral-B Professional Community. It is classified as the nasal facial muscle. #levator #nasimuscle #levatorlabiiinh. A second study was then performed and those results were published in 2008.3 The 2008 publication was not included in their references. Cook et al. We reserve the right to edit Viewpoints to meet requirements of space and format. The location and affiliation information should read as follows: Arlington Heights, Ill. From the American Society of Plastic Surgeons/Plastic Surgery Foundation. Botulinum toxin injections into the zygomaticus minor are usually considered to treat a gummy smile or facial asymmetry in patients with excessive upward and lateral displacement of the upper lip [ 31 ]. The levator labii superioris originates along a broad area along the lower orbital rim and inserts in the upper lip complex medial to the corner of the mouth. Levator labii superioris . The frontal process of the maxilla.; Insertion. Polo M. Botox for asymmetric smiles correction. Structure. is the President of the American Society of Plastic Surgeons (ASPS). Nerve: Buccal branch of the facial nerve. Materials and methods: The 53 faces from Korean cadavers were examined anatomically. Levator labii superioris alaeque nasi Origin. The levator labii superioris (Latin: musculus levator labii superioris) is a facial muscle located above the upper lip close to the opening of the oral cavity. Get new journal Tables of Contents sent right to your email inbox, A Simplified Method for Smile Enhancement: Botulinum Toxin Injection for Gummy Smile, First-in-Human Free Flap Tissue Reconstruction Using a Dedicated Microsurgical Robotic Platform, A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits, The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago, The Impacts of Lymph on the Adipogenesis of Adipose-Derived Stem Cells, The Superficial Fascia System: Anatomical Guideline for Zoning in Liposuction-Assisted Back Contouring, Tips and Tricks for Facial Toxin Injections with Illustrated Anatomy, Current Use of Cosmetic Toxins to Improve Facial Aesthetics, Modern Fat Grafting Techniques to the Face and Neck, Lower Nose Arterial Plexus and Implications for Safe Filler Injections. You may be trying to access this site from a secured browser on the server. Follow us on Instagram and create an account on ProShop for easy ordering for yourself or your office. Levator labii superioris alaeque nasi [edit | edit source] Origin [edit | edit source] A . Larger and closer to the teeth Levator Labii Superioris , Instruction for Registration and Activation. Upgrade your Find a Surgeon profile with a Connect subscription and dont miss out on 5x more referrals. 2008;133:195203, 4. The levator labii superioris alaeque nasi (LLSAN) lies in the sulcus between the nose and cheek. The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. The total dosage was 4.0 U. Her lateral gingival display was also considerably improved. He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. A simplified method for smile enhancement: Botulinum toxin injection for gummy smile. Want to learn more about the levator labii superioris alaeque nasi Muscle?Get watching our short and informative video! Mentalis, a pair of muscles toward the center of your chin that helps control your lower lip. Levator labii superioris alaeque nasi (LLSAN) This muscle is the target for treatment in the gummy smile. To remember the long. Her postinjection display was 1.25 mm, with an anterior gingival display reduction of 3.0 mm. (2001) suggested that the origin, insertion, and anatomy of the DS creates a depressing action of the eyebrow, and the DS has a distinct origin and insertion, as observed histologically. Injection Protocol According to Degree of Severity of Gingival Exposure. Department of SurgeryPlastic and Reconstructive CenterSan Jorge Childrens Hospital702 La Torre De Plaza525 F. D. Roosevelt AvenueSan Juan, Puerto Rico 00918[emailprotected], I read the Ideas and Innovations article by Sucupira and Abramovitz that appeared in the September 2012 issue.1 The authors advocate the use of an average amount of onabotulinum toxin A of 1.95U at both right and left levator labii superioris alaeque nasi muscles for the treatment of gummy smiles. By constant motion but only slightly, it can nearly separate the lips through elevating the mid-part . 2: LEVATOR LABII SUPERIORIS ALAEQUE NASI. Viewpoints should be submitted electronically via PRS enkwell, at www.editorialmanager.com/prs/. 2012;130:726728, 2. The goal was set to be 0mm. Levator labii superioris muscle (Musculus levator labii superioris) Levator labii superioris is a short, paired triangular muscle of the face.It belongs to the buccolabial group of muscles of facial expression.This is a broad group of muscles, that besides levator labii superioris also contains levator labii superioris alaeque nasi, zygomaticus major, zygomaticus minor, levator anguli oris . 2011;10. Depressor labii inferioris, a muscle in your chin that helps control movement in your lower lip. Am J Orthod Dentofacial Orthop.
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