title: Myotomy of the levator labii superioris muscle and lip repositioning: a combined approach for the correction of gummy smile.
abstract: BACKGROUND
  Treatment of excessive gingival display usually involves procedures such as Le Fort impaction or maxillary gingivectomies. The authors propose an alternative technique that reduces the muscular function of the elevator of the upper lip muscle and repositioning of the upper lip.
  
  
  METHODS
  Fourteen female patients with excessive gingival exposure were operated on between February of 2008 and March of 2009. They were filmed before and at least 6 months after the procedure. They were asked to perform their fullest smile, and the maximum gingival exposures were measured and analyzed using ImageJ software. Patients were operated on under local anesthesia. Their gingival mucosa was freed from the maxilla using a periosteum elevator. Skin and subcutaneous tissue were dissected bluntly from the underlying musculature of the upper lip. A frenuloplasty was performed to lengthen the upper lip. Both levator labii superioris muscles were dissected and divided.
  
  
  RESULTS
  The postoperative course was uneventful in all of the patients. The mean gingival exposure before surgery was 5.22 +/- 1.48 mm; 6 months after surgery, it was 1.91 +/- 1.50 mm. The mean gingival exposure reduction was 3.31 +/- 1.05 mm (p < 0.001), ranging from 1.59 to 4.83 mm.
  
  
  CONCLUSIONS
  This study shows that the proposed technique was efficient in reducing the amount of exposed gum during smile in all patients in this series.
authors.affiliation: São Paulo, Brazil From the Division of Plastic Surgery, University of São Paulo.
authors.forename: Luis H
authors.initials: LH
authors.lastname: Ishida
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Ishida
authors.forename: Jorge
authors.initials: J
authors.lastname: Ishida
authors.forename: Julio
authors.initials: J
authors.lastname: Grynglas
authors.forename: Nivaldo
authors.initials: N
authors.lastname: Alonso
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008046:Lip / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult
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