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Anatomy of the Ageing Lip

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Anatomy of the Ageing Lip AESTHETIC FOCUS Anatomy of the ageing lip With lip augmentation an ever popular option for those seeking more youthful looks it is vital that practitioners have a proper understanding of anatomy. In the first of our two-part special focus on lipsDr Foutsizoglou provides a comprehensive guide to function and anatomy. BY SOTIRIOS FOUTSIZOGLOU he lips are pliable, mobile, muscular folds that encircle the opening of the oral cavity. They contain the orbicularis oris and superior and inferior labial vessels and nerves. The lips are covered externally by skin and internally by mucous membrane. A sagittal cut through the lip can reveal the layers of soft tissue that form this relatively simple anatomical structure. That is, from Tsuperficial to deep: skin, superficial fat compartment, orbicularis oris muscle, deep fat compartment and mucosa. The lips are used for grasping food, sucking liquids, clearing food from the oral vestibule, forming speech, osculation, and controlling the size of the oral aperture. Functions of the lips as part of the tactile senses. Lips are very sensitive to touch, warmth and cold. Food intake Lips serve to close the mouth airtight shut, Erogenous zone to hold food and drink inside. Because of their high number of nerve endings, the lips are an erogenous zone. Mastication The lips therefore play a crucial role in Lips help to hold food between upper and osculation and other acts of intimacy. lower teeth during chewing. Facial expressions Figure 1: Anatomical landmarks of the lip. Deglutition The lips form an integral part of facial Lips push food into the oral cavity proper expression e.g. smiling, frowning, etc. (Greek for love-charm), that extends from during the voluntary phase of swallowing the external nasal septum, separating the where it is ingested and prepared for nostrils, to the vermillion border – the digestion in the stomach and small Lip anatomy sharp demarcation between the coloured intestine. The upper lip lies between the nose and edge of the lip and surrounding skin. The the orifice of the oral cavity. Laterally lower lip lies between the mouth and the Articulation the lips are separated from the cheeks labiomental groove, which separates the The lips serve for creating different sounds by the nasolabial grooves that extend lower lip form the chin [1]. The upper and – mainly labial, and labiodental consonant from the nose and pass approximately lower lips are continuous at the angles of sounds. 1 cm lateral to the angles of the mouth. the mouth or oral commissures (Table 1). These grooves or folds are easier to In adults the outer lip skin is thicker and Tactile organ observe when smiling. The upper lip has contains hair, sweat glands, and sebaceous glands. The edges of the lips are covered The lip has many nerve endings and reacts an infranasal depression, the philtrum TABLE 1: LIP TOPOGRAPHY (ALSO SEE FIGURE 1) • Vermillion: the red part of the lips. It is covered with a specialised stratified squamous epithelium, which is in continuity with the oral mucosa of the gingivolabial groove. Confusingly, the vermillion itself is also often referred to as the lips. • Vermillion border: the demarcation line that separates the vermillion lip from the surrounding skin. It is also called the vermillion-cutaneous junction (V-C junction). • Cupid’s bow: the upper central vermillion border at the base of the philtral columns. In a frontal view, this border resembles an archer’s bow, which curves medially and superiorly from the commissures to the paramedian peaks located at the bases of the pillars of the philtrum (crista philtrae) with an inferior convexity lying between those peaks [2]. • Oral commissure: The landmark where the lateral aspects of the vermillion of the upper and lower lips join [3]. • Modiolus: A fibromuscular condensation where the extrinsic and intrinsic muscles of the mouth meet. The modiolus lies about 10-12mm superolateral to the corner of the mouth and is shaped in the form of a hub of a cart wheel. It is contributed to by the orbicularis oris, buccinator, levator anguli oris, depressor anguli oris, zygomaticus major, risorius, platysma, levator labii superioris. The modiolus is very important for the stability and strength of the oral aperture and movement of the mouth. pmfa news | DECEMBER/JANUARY 2017 | VOL 4 NO 2 | www.pmfanews.com AESTHETIC FOCUS with reddish skin, called the vermillion, numerous hair follicles. As a ‘keratinised’ function. The contraction of this portion of and are abundantly provided with or waterproofed component of the skin, the muscle is responsible for accentuation sensitive nerve endings. The vermillion stratified squamous epithelium provides of vertical fine perioral wrinkles or is a transition layer between the outer, substantial protection against friction, ‘smoker’s lines’. hair-bearing tissue and the inner mucous microbial invasion and desiccation. As the Orbicularis oris is supplied mainly by membrane. The skin of the vermillion is epithelium approaches the so-called red the superior and inferior labial branches made up of three to five cellular layers area of the lip, the epithelium becomes of the facial artery, the mental and and is very thin compared to the skin non-keratinised stratified squamous infraorbital branches of the maxillary on the rest of the face, which is typically epithelium. This type of epithelium is artery, and the transverse facial branch arranged in 16 cellular layers. The mucous designed for protection and lubrication of the superior temporal artery. Its membrane of the lip is full of capillaries during chewing and swallowing. nerve supply comes from the buccal and that are close to the translucent surface of mandibular branches of the facial nerve. the vermillion, giving it its characteristic Orbicularis oris reddish colour. In newborn infants the Sensory innervation The orbicularis oris muscle, the lip inner surface is much thicker, with muscle, is a broad elliptical muscle sebaceous glands and minute projections around the mouth (Figure 2). When the Upper lip called papillae. These structural orbicularis oris is tonically contracted, the Superior labial nerve from the infraorbital adaptations seem to aid the process of mouth is closed, whereas active (phasic) nerve, one of the major cutaneous sucking [4]. contraction causes the mouth orifice branches of the maxillary nerve (CNV2), The upper lip (labium superioris) is to become narrower as when kissing the intermediate division of the trigeminal superior in name only since it is actually or whistling. Its lateral fibres join the nerve. somewhat smaller than its partner, the modiolus, a chiasma of facial muscles held lower lip (labium inferioris). In an ideal together by fibrous tissue, located lateral Lower lip world, the lower lip vermillion show and slightly superior to each angle of the Mental nerve from the inferior alveolar should be Phi times greater than the mouth. nerve, a major branch of the mandibular upper vermillion. However, that ratio can Orbicularis oris consists of two nerve (CNV3), which arises in the vary dramatically with ethnic background, distinct parts, the pars marginalis and mandibular canal and emerges from and even from individual to individual pars peripheralis, which differ in location the mental foramen normally located within the same ethnic group. and function [5]. Anatomical studies inferiorly to the second premolar tooth The vermillion or ‘dry’ part of the lip have shown that pars peripheralis fibres in the mandible. Those practitioners who is not hairy and does not have sweat or decussate at midline and insert into the use mental blocks for injections into the labial glands. Therefore, it does not have contralateral philtral ridge, whereas pars lower lip should be aware of the anatomical the usual protective layer of sweat and marginalis fibres form a continuous band changes associated with loss of mandibular body oils which keep the skin smooth, from modiolus to modiolus. teeth. Following complete loss or removal inhibit pathogens, and regulate warmth. of mandibular teeth, the alveoli begin to For these reasons, the lips dry out faster Pars marginalis and become chapped more easily. On the fill in with bone and the alveolar process It is developed to a unique extent in other hand, the epithelium of the mucosal begins to resorb. Gradually the mental human lips and is closely associated lip or ‘wet’ part of the lip is moistened by foramen lies near the superior border of with speech. In each quadrant, the labial and other glands associated with the body of the mandible. In extreme cases, pars marginalis consists of a single the oral cavity. the mental foramina disappear, exposing (occasionally) double band of narrow- The muco-cutaneous line or ‘wet-dry the mental nerves to injury. Pressure from diametre muscle fibres lodged within border’, formed where the upper and a dental prosthesis, resting on an exposed the vermillion zone of the lip. At their lower lips meet, marks the transition nerve, may produce pain during eating. Loss medial end, the marginal fibres meet and between the vermillion lip and the of all the teeth also results in a decrease interlace with their contralateral fellows mucosal lip. The skin of the lips is in the vertical facial dimension and and then attach to the dermis of the categorised as stratified squamous mandibular prognathism [1]. vermillion zone a few millimetres beyond epithelium, or flattened tissue cells. the median plane. At their lateral ends, The outer lip skin is keratinised Blood supply the fibres converge and attach to the stratified squamous epithelium with Superior and inferior labial arteries arise deepest part of the modiolar base along from the facial artery. They are located a horizontal strip level with the buccal 1mm posterior to the mucocutaneous angle [6]. border or white roll – the transition between the mucosa and skin of the Pars peripheralis lip.
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