Relationship between Changes of Nasal Length and Upper Lip Height during Smile

Depressor septi nasi is an important muscle in the nose and upper lip dynamics.1-4 Hypertrophy of this muscle leads to a deformity during smiling presented by depression of nasal tip, shortening of upper lip, and a horizontal crease in upper lip.4 Rhino-gingivolabial syndrome was defined as depression of nasal tip, shortening of upper lip, and gingival show. This syndrome was attributed to the hypertrophy of the depressor septi nasi muscle.5 In cases with depressor septi nasi hypertrophy, varied combinations of smiling deformity components are encountered. This raises the question about coincidence of hyperactivity of different parts of this muscle.5 Some cases have isolated nasal lengthening, some have isolated upper labial shortening, and some cases presented the combination. If there is a relationship between nasal lengthening and upper lip shortening, resection of depressor septi nasi (DSN) in patients with DSN hypertrophy during rhinoplasty may affect upper lip changes during smile. In this study, nasal length and upper lip changes during smile are studied.5 The results of this study can help predict changes of the upper lip during smile following manipulation of DSN. Fifty cases were enrolled. Exclusion criteria were age less than 18 years, history of operation in the nasal or lip area, and cleft lip. Photographies were done with digital camera with maximum zoom from a distance that the forehead hairline to the chin was visible. Standard photography was done with forward gaze and neutral neck position in standing, in lateral position, in the repose and maximum posed smile. Nasal length was measured from nasion to tip of the nose. Upper lip height was determined from subnasale (the point of the columella to lip attachment) to labrale superior (the midline point of the lip skin attachment to the projecting point of the nasal tip). To obviate possible errors due to changes of photograph size, the height of the middle third of the face from glabella to subnasale was measured for standardization of measurements (Figure 1). Statistical Analysis was performed by the SPSS software 11.5. In this study, 46 cases (92%) were female and 4 cases (8%) were male. the mean age was 26±5.45 (min=18, max=37 years). The mean change in nasal length during smile was 1.31±727 mm increase of length. In 29 cases (58%), nasal length was increased during smile; 4 cases (8%) demonstrated decrease of nasal length during smile and 17 cases (34%) had no change in nasal length 1. Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 2. Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Iran; 3. Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran