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Philtrum
Philtrum
from Wikipedia
Philtrum
Philtrum of a healthy, one-month-old baby
Philtrum of a domestic dog (marked in red)
Details
PrecursorMedial nasal prominence[1]
Identifiers
TA98A05.1.01.007
TA2222
FMA59819
Anatomical terminology

The philtrum (Latin: philtrum, from Ancient Greek φίλτρον phíltron, lit. 'love charm'[2]) or medial cleft is a vertical indentation in the middle area of the upper lip, common to therian mammals, extending in humans from the nasal septum to the tubercle of the upper lip. Together with a glandular rhinarium and slit-like nostrils, it is believed to constitute the primitive condition for at least therian mammals. Monotremes lack a philtrum, though this could be due to the specialised, beak-like jaws in living species.[3]

Function

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In most mammals, the philtrum is a narrow groove that may carry dissolved odorants from the rhinarium or nose pad to the vomeronasal organ via ducts inside the mouth.[4]

For humans and most primates, the philtrum survives only as a vestigial medial depression between the nose and upper lip.[5]

The human philtrum, bordered by a pair of ridges known as the philtral columns, is also known as the infranasal depression, but has no apparent function. That may be because most higher primates rely more on vision than on smell.[4] Strepsirrhine primates, such as lemurs, still retain the philtrum and the rhinarium, unlike monkeys and apes.[6]

Development

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In humans, the philtrum is formed where the nasomedial and maxillary processes meet during embryonic development. When these processes fail to fuse fully, a cleft lip may result.

Variation

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Flattened philtrum seen on a 6-month-old baby with fetal alcohol syndrome (FAS)
Adult Tahitian man with a well-pronounced philtrum and upper lip

A flattened or smooth philtrum may be a symptom of fetal alcohol syndrome or Prader–Willi syndrome.[7][8]

A study of boys diagnosed with autism spectrum disorders found that a broader than average philtrum is one of a cluster of physical attributes associated with autism.[9]

Society and culture

[edit]

In Jewish tradition, each embryo has an angel teaching it all of the wisdom in the world while it is in utero. The angel lightly taps the infant's upper lip before birth to prevent the infant from revealing the secrets of the universe; the infant then forgets the Torah it has been taught.[10] Some believers of the story speculate that this is the cause of the philtrum, but it does not have a basis in traditional Jewish texts.[11]

In Key Largo (1948), Frank McCloud (Humphrey Bogart) tells a fairy tale, saying that, before birth, the soul knows all the secrets of heaven, but at birth an angel presses a fingertip just above one's lip, which seals us to silence.[12] This is also cited in Stephen King's short story "Afterlife".

In the movie Mr. Nobody, unborn infants are said to have knowledge of all past and future events. As an unborn infant is about to be sent to its mother, the "Angels of Oblivion" lightly tap its upper lip, whereupon the unborn infant forgets everything it knows. The movie follows the life story of an infant whose lip had not been tapped.[13]

In the book Prince Ombra by Roderick MacLeish, the "cleft on our upper lips" is attributed to being hushed by a "cavern angel" just before we are born.[14]

In Philippine mythology, the enchanted creature diwata (or encantado) has smooth skin, with no wrinkles even at the joints, and no philtrum.[15]

In Les Misérables by Victor Hugo, as translated by Isabel F. Hapgood, Fantine's philtrum is described thus, "in the very characteristic interval which separates the base of the nose from the upper lip, she had that imperceptible and charming fold, a mysterious sign of chastity, which makes Barberousse fall in love with a Diana found in the treasures of Iconia." Book Third—In The Year 1817, Chapter III—Four And Four.[16]

In Icelandic folklore, the huldufólk, or elfin "hidden people", may appear as normal humans but have a physical characteristic making them different: they have a convex rather than concave philtrum.[citation needed]

The Orang bunian, "elves" or "hidden people" from Southeast Asian folklore also have similar physical characteristics where they lack a philtrum.[17]

See also

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References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia
from Grokipedia
The philtrum (from : φίλτρον (phíltrōn), lit. 'love charm') is the vertical midline groove of the upper lip, extending from the base of the nose (specifically the ) to the of the lip, and bordered laterally by two symmetrical raised ridges known as philtral columns or pillars. This anatomical feature is a normal component of morphology, with its depth, length, and prominence varying among individuals and determined primarily by genetic factors. Embryologically, the philtrum forms during the early stages of facial development, around the 6th to 7th week of , as a result of the fusion of the two medial nasal prominences derived from the frontonasal prominence. This midline merger creates the characteristic groove, while the surrounding ridges arise from the underlying musculature and of the , which inserts into the philtral columns to support lip movement and expression. The vascular supply to the philtrum is provided by branches of the superior labial , forming a consistent arcade that influences the compartmentalization of superficial fat in the upper lip. Clinically, the philtrum serves as an important landmark in assessing facial dysmorphology, particularly in pediatric and genetic evaluations. A smooth, flattened, or hypoplastic philtrum—lacking defined ridges—is a key diagnostic feature of fetal alcohol spectrum disorders (FASDs), often accompanied by thin upper lip vermilion and short palpebral fissures, resulting from prenatal alcohol exposure disrupting normal facial morphogenesis. Similar alterations can occur in other congenital conditions, such as or certain chromosomal syndromes, where incomplete fusion of facial processes leads to philtral anomalies. In aesthetic and , the philtrum's structure is preserved or restored to maintain natural lip contour and symmetry.

Anatomy

Description

The philtrum is defined as the vertical midline groove or indentation located on the upper lip, extending from the base of the of the (subnasale) to the of the upper lip. This feature is bordered by two raised ridges, known as the philtrum columns, which flank the central depression and contribute to its distinctive appearance. In humans, the philtrum presents a smooth, concave central groove that contrasts with the slightly elevated surrounding tissue, providing both visual and tactile distinction. Typical dimensions of the philtrum in adults vary by sex and population, but generally measure approximately 12-15 mm in length and 5-10 mm in width at the base, with the columns tapering toward the . These proportions create a subtle yet defining contour to the midface, often accentuated in profile views. The philtrum is a common anatomical feature across therian mammals, appearing as a midline indentation on the upper lip or nasal planum. In , including humans and chimpanzees, it is particularly prominent due to the relatively flat facial structure, whereas in other species such as carnivores or ungulates, it may be more subtle or integrated into the nasal . This variation highlights its conserved role in mammalian facial morphology.

Structure and Composition

The philtrum consists of a layered structure typical of the skin but with specialized features in the upper region. The outermost layer is the , a keratinized characteristic of the upper , which has the thickest epidermis in the face, providing a smooth, hairless surface along the midline groove. Beneath this lies the , which is approximately 0.5 mm thick and characterized by a unique collection of dense bundles and elastic fibers that form the prominent philtral ridges flanking the central depression. These collagenous elements contribute to the philtrum's vertical contour and structural integrity. The subcutaneous layer includes sparse organized into distinct compartments, which are compartmentalized by fibrous elements, enhancing the region's definition and subtle mobility. Vascular supply to the philtrum arises primarily from branches of the superior labial artery, a derivative of the , with left and right ascending philtral arteries coursing parallel to the philtral columns. Anatomical dissections have revealed a consistent midline vascular arcade, where these vessels form a predictable limited laterally by the philtral ridges and do not penetrate deeply into the overlying or underlying musculature. This arrangement supports the region's compartmentalization without extensive across the midline. Sensory innervation of the philtrum is provided by the , the terminal branch of the maxillary division (V2) of the , which emerges from the and distributes fine branches to the upper lip midline. These neural elements integrate with the and subcutaneous layers to convey tactile sensations specific to the philtral area. The framework of the philtrum features fibrous septa and membranes that extend from the into the superficial fat layer, dividing it into distinct compartments aligned with the philtral columns. These septa, composed of dense , coincide with the vascular structures and provide structural support, delineating the philtrum from adjacent upper lip regions.

Development

Embryonic Formation

The embryonic formation of the philtrum occurs during weeks 4 to 7 of , as part of the broader development of the facial structures from neural crest-derived mesenchyme. Initially, the frontonasal prominence appears in the fourth week, giving rise to paired medial and lateral nasal prominences surrounding the nasal placodes, while the maxillary prominences emerge from the first . By the fifth week, the nasal placodes invaginate to form nasal pits, elevating the surrounding prominences and initiating the topographic arrangement necessary for midline fusion. The core fusion mechanism involves the paired medial nasal prominences growing toward and merging in the midline, while the maxillary prominences expand medially to contact the inferior aspects of the medial nasal prominences. This process, completing around the sixth to seventh week, results in the intermaxillary segment, where the philtrum emerges as a visible midline groove or "scar" along the line of epithelial and mesenchymal union between the merging processes. The groove arises from the programmed and remodeling of the epithelial seam at the fusion site, ensuring seamless integration without complete obliteration of the junction. The primary palatal shelf, derived from the fused medial nasal prominences within the intermaxillary segment, forms the anterior and defines the inferior boundary of the philtrum by establishing the premaxillary region. Concurrently, the secondary palatal shelves outgrowths from the maxillary prominences elevate horizontally around week 8 and fuse with the primary by week 9, further delineating the philtrum's lower limit through the separation of oral and nasal cavities. Key developmental milestones include the initial of nasal placodes at week 5, marking the onset of prominence elevation and positioning for fusion; ridge formation along the philtrum by week 8, as mesenchymal proliferation accentuates the midline groove; and post-fusion maturation through weeks 8 to 12, involving epithelial differentiation and remodeling to refine the philtral columns and depth. Genetic factors, such as those regulating epithelial-mesenchymal signaling, can modulate this sequence but are detailed separately.

Genetic and Environmental Factors

The development of the philtrum is regulated by key genetic determinants that orchestrate midline fusion of the medial nasal processes during early embryogenesis. The IRF6 gene, encoding a critical for epithelial differentiation, is essential for proper fusion; variants in IRF6 contribute to approximately 12% of the genetic risk for orofacial clefts, which impair philtral ridge formation and depth. Inheritance patterns of philtrum characteristics exhibit familial clustering, particularly in depth and width, consistent with a polygenic model. Genetic risk variants for nonsyndromic cleft lip and palate, such as those near IRF6, exert additive effects on philtrum width in the general , supporting moderate to high for these metrics beyond syndromic cases. Environmental teratogens during , including maternal alcohol consumption and , can subtly disrupt philtrum fusion and lead to morphological changes like reduced depth without resulting in full clefts. Alcohol intake greater than 6 units per week is significantly associated with altered philtrum shape, while independently affects upper contour; their combined exposure amplifies these effects on philtral ridges. Low-level prenatal alcohol exposure has also been linked to broader facial dysmorphology, including smoother philtral grooves, as observed in population cohorts. Epigenetic influences, such as gestational hormonal variations, modulate tissue growth rates in the developing philtrum by altering without changing DNA sequences. Prenatal testosterone exposure, proxied by lower digit ratios, correlates with a narrower and longer philtrum, reflecting hormone-driven epigenetic modifications in facial during weeks 6-10 of gestation. Maternal smoking may further impose epigenetic changes, such as shifts, impacting philtral contour and upper lip development. Population-based twin studies underscore the strong genetic basis of philtrum metrics, estimating at 60-80% for depth and shape variations in the upper lip region. These analyses, using 3D imaging of monozygotic and dizygotic pairs, attribute the majority of phenotypic variance to , with minimal shared environmental influence.

Function

Evolutionary and Biomechanical Roles

The philtrum is a conserved feature across therian mammals, representing a primitive condition in mammalian morphology formed as part of the fusion of facial prominences during early development. In non-primate mammals, the philtrum often appears as a narrow groove associated with the , facilitating the transfer of moisture and dissolved odorants to the for chemosensory detection. This structure reflects the evolutionary adaptation of the mammalian muzzle as a configuration that overrode reptilian developmental constraints, enabling enhanced sensory and feeding capabilities in early mammals. In , the philtrum becomes more pronounced and deeper, correlating with the of advanced musculature that supports complex expressions and vocalizations. The of upper fibers in the midline contributes to this deepened groove, allowing for greater upper lip mobility and differentiation from the more uniform lip structures in other mammals. This likely enhanced social communication through subtle movements, distinguishing faces from the sensory-focused snouts of carnivorous ancestors. Biomechanically, the philtrum serves as a natural divider in the upper lip, composed of dense and elastic tissue that provides additional recruitable for stretching during oral activities. This enhances lip flexibility and , particularly in , where it supports precise movements for speech, mastication, and expressions without excessive tension on surrounding tissues. In comparative terms, while more prominent in carnivores to aid sensory functions like maintaining nasal for olfaction, the human philtrum is largely vestigial for such roles but plays a role in triggering the suckling reflex through its tactile sensitivity during infant latching.

Sensory and Physiological Aspects

The philtrum, as part of the upper lip, receives sensory innervation primarily from the , a branch of the maxillary division (V2) of the (cranial nerve V), which provides tactile, thermal, and nociceptive sensations to the midface region including the philtral columns. This innervation supports fine tactile discrimination in the perioral area, where the skin exhibits a relatively high density of mechanoreceptors such as Merkel cells and Meissner corpuscles, contributing to precise sensory feedback during oral-motor activities like speech articulation and food manipulation. Thermoreceptors, including free nerve endings responsive to temperature changes, are also present in the philtral skin, enhancing detection of thermal stimuli in proximity to the nasal and oral cavities. Physiologically, the philtrum's dense vascular network, supplied by superior labial branches of the , lies in close proximity to the skin surface and may contribute to heat exchange in the perioral region. In clinical contexts, surgical interventions such as lip lifts or philtrum shortening can lead to temporary alterations in philtral sensitivity, including numbness, heightened tactile perception, or due to disruption of branches, which typically resolve within weeks to months but may impact patient recovery and oral function. These changes underscore the philtrum's role in perioral sensory integrity post-procedure. Sensory signals from the philtrum travel via the to the , then ascend through the maxillary division to the principal sensory nucleus and in the , where they integrate with broader oral and facial sensory maps for processing of touch, temperature, and proprioceptive inputs. This pathway ensures coordinated sensory representation in the somatosensory cortex, essential for reflexive oral behaviors.

Variations and Abnormalities

Normal Human Variations

The philtrum exhibits normal variations in appearance and dimensions across human populations, influenced by ethnicity, age, sex, and established measurement protocols in . These differences fall within the healthy spectrum and reflect natural diversity in morphology. Ethnic variations in the philtrum are evident in its depth and overall prominence, with deeper philtra commonly observed in African and Asian populations compared to shallower ones in Caucasian populations. These differences are linked to broader features, such as fuller upper lips in African and Asian individuals, which accentuate the philtral groove, whereas thinner lips in Caucasians result in a less pronounced structure. Separate lip-philtrum assessment guides exist for Caucasian and African ethnicities to account for these normative differences in groove smoothness and lip thickness. Age-related changes affect philtrum prominence, which typically peaks during as facial growth stabilizes, before gradually flattening with advancing age due to and reduced skin elasticity. These alterations are part of general perioral aging, where the philtrum lengthens while its vertical ridges become less sharp. Sex differences manifest in philtrum length, with males exhibiting slightly longer philtra (average 13-15 mm) than females (average 11-13 mm), a disparity attributed to hormonal influences on facial development during . Males also tend to have a flatter and less pronounced ridges, enhancing a more angular appearance. In anthropometric studies, the philtrum is standardized using metrics like the length-to-width ratio to evaluate facial harmony and normality. Length is measured from the base of the to the , while width spans the base of the groove; this ratio aids in cross-population comparisons and aesthetic assessments.

Associated Medical Conditions

The philtrum is notably affected in cleft lip and palate, a common congenital anomaly resulting from the failure of fusion between the medial nasal and maxillary prominences during embryonic development, leading to an absent, disrupted, or bifurcated philtrum. This condition occurs in approximately 1 in 700 live births worldwide, with genetic factors such as mutations in the IRF6 gene implicated in both syndromic and nonsyndromic forms. Surgical repair is the primary treatment, typically performed in infancy to reconstruct the philtrum and restore , with nearly all cases undergoing intervention to address functional and aesthetic concerns. In fetal alcohol spectrum disorders (FASD), prenatal alcohol exposure disrupts facial morphogenesis, often resulting in a smooth, flattened philtrum that serves as a key diagnostic marker alongside short palpebral fissures and thin upper . This feature is particularly prominent in fetal alcohol syndrome, the most severe end of the spectrum, where it contributes to the characteristic dysmorphic facies used in clinical diagnosis. The smoothness reflects altered midline facial development and correlates strongly with the degree of exposure, aiding in identification even in partial expressions of FASD. Several genetic syndromes feature philtral abnormalities as part of their dysmorphic profiles. In , a long and smooth philtrum accompanies other facial traits like a short and thin upper , arising from mutations in genes such as NIPBL that affect cohesin-mediated development. , caused by mutations in RAS pathway genes like , is associated with a deep, prominent philtrum that deepens the groove between the and mouth, often alongside and . Emerging research also links philtral variations, such as increased width or altered depth, to autism spectrum disorder through facial dysmorphology assessments, suggesting shared prenatal influences on neurofacial development, though these are not diagnostic on their own. Diagnosis of philtral abnormalities relies on standardized dysmorphology evaluations, including the 1-5 Lip-Philtrum Guide scale, where rank 1-2 indicates normal ridging and depth, while 3-5 denotes progressive smoothness and flatness indicative of disorders like FASD or syndromic conditions. These tools facilitate early detection in clinical exams, guiding referrals for or multidisciplinary management.

Cultural Significance

Aesthetic Perceptions

The philtrum significantly influences perceptions of facial attractiveness, particularly through its depth and definition, which are associated with youthfulness across cultures. In Western aesthetics, a deeper, more defined philtrum with prominent columns is viewed as enhancing and signaling , as the feature tends to flatten and elongate with aging. A study involving diverse respondents found that 84% rated young faces with philtral contours as more attractive, while 68% preferred them in aged faces, underscoring a strong preference for this trait. Similarly, in East Asian cultures, such as in Korean and Chinese beauty ideals, a shorter and well-defined philtrum contributes to a harmonious, youthful appearance, with preferences for configurations showing approximately 1 mm of exposure in smiles. Cosmetic practices increasingly target the philtrum to align with these ideals, using fillers to accentuate column depth or bullhorn surgery to reduce length and enhance definition. These interventions aim to restore or amplify perioral proportions for a more balanced, attractive profile. The American Society of Plastic Surgeons reports that procedures, encompassing philtrum enhancements, reached 1,449,565 in 2024, marking steady annual growth of about 5% since 2020 and reflecting rising demand amid evolving beauty standards. Aesthetic emphasis on the philtrum varies by , with greater focus on its refinement in women to evoke lip fullness and ; ideal female philtrum length is typically 12-15 mm, contrasting with longer averages in men (around 15-16 mm) that support masculine contours. This distinction influences perceptions of allure, as shorter philtra in women are linked to upper lip projection and overall facial harmony. Historically, in Europe depicted prominent philtra in noble portraits to convey refinement and status, as seen in Botticelli's idealized representations of figures like , where precise upper lip proportions symbolized aristocratic beauty.

Symbolism in Art and Society

The term philtrum originates from the word philtron, meaning " charm" or "," reflecting its historical association with allure and affection in classical culture. In Western folklore, the philtrum is associated with themes of and enchantment due to its etymological roots. In Jewish mythology, the philtrum is believed to be the imprint left by an angel, such as Lailah, who touches the infant's upper lip just before birth to cause the child to forget the knowledge of the universe acquired in the womb. In certain Asian traditions, particularly Chinese face reading (mian xiang), the philtrum holds significant symbolic value related to and . A deep and well-defined philtrum is regarded as an auspicious sign, indicating good fortune, , and the potential for many healthy descendants, along with , respect, and . Conversely, a flat or shallow philtrum may suggest diminished or reproductive energy, drawing from ancient physiognomic texts that interpret facial features as harbingers of life's blessings. Artistic representations of the philtrum have emphasized its role in conveying human emotion and identity across eras. In Renaissance portraits, such as Giovanni Bellini's Portrait of a Young Man (ca. 1505), artists meticulously depicted the philtrum to achieve realistic facial depth and expressiveness, highlighting individual character amid the era's focus on naturalistic . This attention to the philtrum contributed to the symbolic portrayal of inner virtues or sensuality, as seen in the exaggerated features of Quentin Massys's An Old Woman (The Ugly Duchess, ca. 1513), where a prominent philtrum amplifies themes of aging and on beauty ideals. In contemporary media, the philtrum features prominently in digital enhancements and character creation. Social media filters on platforms like and often shorten or define the philtrum to promote a youthful, balanced aesthetic, fueling trends in virtual modifications that influence user perceptions of desirability. In and , designers incorporate the philtrum to enhance expressiveness, ensuring realistic mouth dynamics during speech and emotion; its depth affects lip synchronization and in 3D models. This deliberate inclusion allows for nuanced , where subtle philtral variations signal personality or heritage in character designs.

References

  1. https://www.[mdpi](/page/MDPI).com/2673-527X/5/2/5
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