Facial Anatomy Research Articles

Facial changes related to brachycephaly in Cavalier King Charles Spaniels with Chiari-like malformation associated pain and secondary syringomyelia.

BackgroundRecent studies including an innovative machine learning technique indicated Chiari‐like malformation (CM) is influenced by brachycephalic features.ObjectivesMorphometric analysis of facial anatomy and dysmorphia in CM‐associated pain (CM‐P) and syringomyelia (SM) in the Cavalier King Charles Spaniel (CKCS).AnimalsSixty‐six client‐owned CKCS.MethodsRetrospective study of anonymized T2W sagittal magnetic resonance imaging of 3 clinical groups: (1) 11 without central canal dilation (ccd) or SM (CM‐N), (2) 15 with CM‐P with no SM or <2 mm ccd (CM‐P), and (3) 40 with syrinx width ≥4 mm (SM‐S). Morphometric analysis assessed rostral skull flattening and position of the hard and soft palate relative to the cranial base in each clinical group and compared CKCS with and without SM‐S.ResultsSixteen of 28 measured variables were associated to SM‐S compared to CM‐N and CM‐P. Of these 6 were common to both groups. Predictive variables determined by discriminant analysis were (1) the ratio of cranial height with cranial length (P < .001 between SM‐S and CM‐N) and (2) the distance between the cerebrum and the frontal bone (P < .001 between SM‐S and CM‐P). CM‐P had the lowest mean height of the maxillary area.Conclusions and Clinical ImportanceCKCS with CM‐P and SM‐S have cranial brachycephaly with osseous insufficiency in the skull with rostral flattening and increased proximity of the hard and soft palate to the cranial base. Changes are greatest with CM‐P. These findings have relevance for understanding disease pathogenesis and for selection of head conformation for breeding purposes.

Expanded Transoral Microvascular Mandibular Reconstruction: A Scar-free Approach

BackgroundWe present our experience with transoral segmental mandibulectomy, in conjunction with vascularized osseous mandibular reconstruction, utilizing an intraoral anastomosis and free of extraoral incisions. Virtual surgical planning (VSP) and intra-operative navigation were used to help achieve this minimally invasive and scar-free approach. Additionally, we performed a cadaver dissection to highlight relevant anatomic details of the facial artery and vein. MethodsBetween January 2018 and October 2018, transoral segmental mandibulectomy followed by vascularized osseous reconstruction using an intraoral anastomosis was performed on 9 patients. Pre-operative VSP and intra-operative navigation were used in all cases. The anastomotic recipient vessels were the facial artery and vein. Postoperative panoramic radiographs and CT images were obtained for assessment of the neo-mandible. ResultsSuccessful transoral segmental mandibulectomy was achieved in 9 patients, with an intraoral anastomosis successfully achieved in 8 patients. In one patient, an extraoral anastomosis was required because of challenging facial vein anatomy. Both recipient and donor sites healed uneventfully. In all cases, a well positioned neo-mandible with good occlusion was demonstrated on postoperative imaging and exam. A symmetric facial appearance with no restrictions in mouth opening was also achieved in each case. ConclusionsTransoral segmental mandibulectomy combined with intraoral microvascular mandibular reconstruction is a surgically achievable technique with the benefit of being scar free. In our cadaver dissection, we describe the anatomical course of the facial artery and vein. An average angle of 30 degrees between these vessels is identified.

The masks of Lorenzo Tenchini: their anatomy and surgical/bioengineering clues.

An academic, anatomist, and Lombrosian psychiatrist active at the University of Parma in Italy at the end of the 19th century, Lorenzo Tenchini produced ceroplastic-like masks that are unique in the anatomical Western context. These were prepared from 1885 to 1893 with the aim of 'cataloguing' the behaviour of prison inmates and psychiatric patients based on their facial surface anatomy. Due to the lack of any reference to the procedure used to prepare the masks, studies were undertaken by our group using X-ray scans, infrared spectroscopy, bioptic sampling, and microscopy analysis of the mask constituents. Results showed that the masks were stratified structures including plaster, cotton gauze/human epidermis, and wax, leading to a fabrication procedure reminiscent of 'additive layer manufacturing'. Differences in the depths of these layers were observed in relation to the facial contours, suggesting an attempt to reproduce, at least partially, the three-dimensional features of the facial soft tissues. We conclude the Tenchini masks are the first historical antecedent of the experimental method for face reconstruction used in the early 2000s to test the feasibility of transferring a complete strip of face and scalp from a deceased donor to a living recipient, in preparation for a complete face transplant. In addition, the layering procedure adopted conceptually mimics that developed only in the late 20th century for computer-aided rapid prototyping, and recently applied to bioengineering with biomaterials for a number of human structures including parts of the skull and face. Finally, the masks are a relevant example of mixed ceroplastic-cutaneous preparations in the history of anatomical research for clinical purposes.

Is CT necessary for imaging paediatric congenital sensorineural hearing loss?

Objectives: To determine if MRI alone is adequate for pre-operative assessment of paediatric congenital sensorineural hearing loss (SNHL). While aberrant intratemporal facial nerve anatomy is usually occult on MRI, we postulate that the majority of cases have no adverse bearing on surgical outcomes.Methods: MRI and CT of the temporal bones were analysed in 240 children who underwent both on the same day for SNHL. Only children under the age of 5 years with no reported clinical syndrome or dysmorphic external ear anatomy were included.Results and discussion: 169 patients satisfied the inclusion criteria. MRI detected 32/54 cases of cochleovestibular dysplasia, with the majority of the additional CT findings comprising subtle incomplete partition type 2 (IP2) anomalies. Of the 22 cases not evident on MRI, 13 patients also had large vestibular aqueduct syndromoe (LVAS), which would have prompted evaluation with CT due to the near universal co-existence of these entities. Only one patient exhibited aberrant intratemporal facial nerve anatomy that may have conferred surgical risk and was occult on MRI.Conclusion: In a defined paediatric SNHL cohort, the addition of routine temporal bone CT to MRI offers limited additional yield but confers a significant radiation burden on a young population.

Periocular hyaluronic acid fillers: applications, implications, complications.

The use of dermal filler in the periocular area is increasing - both for functional and aesthetic indications. Hyaluronic acid fillers dominate the market; these treatments offer an alternative to some surgical procedures with the advantage of instant results, minimal healing time and low complication rates. However, success depends on judicious selection of patients, products and procedures to achieve favourable outcomes. This article reviews current understanding of the principal complications in the periocular area and their management. Hyaluronic acid is a ubiquitous, biodegradable, nonspecies-specific molecular substrate with limited potential for immunogenic reactions. However, in the periocular area, such products can migrate and last significantly longer than the expected filler lifespan. Contamination or subsequent immune stimulation can trigger delayed-onset inflammatory reactions. Though minor vascular occlusions are not uncommon, cases of blindness secondary to facial filler injections are thought to be rare. Timely enzymatic degradation with injectable hyaluronidase can be effective in the treatment of some such complications. But recent studies demonstrate lack of penetration through arterial walls and optic nerve sheath, casting doubt on the role of retrobulbar hyaluronidase in the management of vision loss because of embolism with hyaluronic acid filler. Hyaluronic acid fillers represent an emerging and important addition to the armamentarium of the oculofacial plastic surgeon with their use in the aesthetic field also expected continue to rise. The oculoplastic facial surgeon, armed with a thorough knowledge of facial anatomy, safe injection planes and the means of minimizing and treating complications is in the best position to lead clinically in the use of this well tolerated and effective treatment modality.

Reconstructing Denisovan Anatomy Using DNA Methylation Maps.

Denisovans are an extinct group of humans whose morphology remains unknown. Here, we present a method for reconstructing skeletal morphology using DNA methylation patterns. Our method is based on linking unidirectional methylation changes to loss-of-function phenotypes. We tested performance by reconstructing Neanderthal and chimpanzee skeletal morphologies and obtained >85% precision in identifying divergent traits. We then applied this method to the Denisovan and offer a putative morphological profile. We suggest that Denisovans likely shared with Neanderthals traits such as an elongated face and a wide pelvis. We also identify Denisovan-derived changes, such as an increased dental arch and lateral cranial expansion. Our predictions match the only morphologically informative Denisovan bone to date, as well as the Xuchang skull, which was suggested by some to be a Denisovan. We conclude that DNA methylation can be used to reconstruct anatomical features, including some that do not survive in the fossil record.

Two-step, imaging-device–guided, precise filler-injection technique

Hyaluronic acid injection is one of the most common procedures for facial rejuvenation and volumization. Although it is generally considered safe, complications sometimes occur, such as bruising, cutaneous necrosis, and blindness. Although knowledge of facial anatomy may minimize the risk, the distribution of vessels varies for each patient.

Dual Semi-Supervised Learning for Facial Action Unit Recognition

Current works on facial action unit (AU) recognition typically require fully AU-labeled training samples. To reduce the reliance on time-consuming manual AU annotations, we propose a novel semi-supervised AU recognition method leveraging two kinds of readily available auxiliary information. The method leverages the dependencies between AUs and expressions as well as the dependencies among AUs, which are caused by facial anatomy and therefore embedded in all facial images, independent on their AU annotation status. The other auxiliary information is facial image synthesis given AUs, the dual task of AU recognition from facial images, and therefore has intrinsic probabilistic connections with AU recognition, regardless of AU annotations. Specifically, we propose a dual semi-supervised generative adversarial network for AU recognition from partially AU-labeled and fully expressionlabeled facial images. The proposed network consists of an AU classifier C, an image generator G, and a discriminator D. In addition to minimize the supervised losses of the AU classifier and the face generator for labeled training data, we explore the probabilistic duality between the tasks using adversary learning to force the convergence of the face-AU-expression tuples generated from the AU classifier and the face generator, and the ground-truth distribution in labeled data for all training data. This joint distribution also includes the inherent AU dependencies. Furthermore, we reconstruct the facial image using the output of the AU classifier as the input of the face generator, and create AU labels by feeding the output of the face generator to the AU classifier. We minimize reconstruction losses for all training data, thus exploiting the informative feedback provided by the dual tasks. Within-database and cross-database experiments on three benchmark databases demonstrate the superiority of our method in both AU recognition and face synthesis compared to state-of-the-art works.

Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome

Objectives: To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population. Study Design: Observational, retrospective study. Materials and Methods: Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded. Results: 6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication. Conclusions: Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.

Geometric morphometrics for the study of facial expressions in non-human animals, using the domestic cat as an exemplar

Facial expression is a common channel for the communication of emotion. However, in the case of non-human animals, the analytical methods used to quantify facial expressions can be subjective, relying heavily on extrapolation from human-based systems. Here, we demonstrate how geometric morphometrics can be applied in order to overcome these problems. We used this approach to identify and quantify changes in facial shape associated with pain in a non-human animal species. Our method accommodates individual variability, species-specific facial anatomy, and postural effects. Facial images were captured at four different time points during ovariohysterectomy of domestic short haired cats (n = 29), with time points corresponding to varying intensities of pain. Images were annotated using landmarks specifically chosen for their relationship with underlying musculature, and relevance to cat-specific facial action units. Landmark data were subjected to normalisation before Principal Components (PCs) were extracted to identify key sources of facial shape variation, relative to pain intensity. A significant relationship between PC scores and a well-validated composite measure of post-operative pain in cats (UNESP-Botucatu MCPS tool) was evident, demonstrating good convergent validity between our geometric face model, and other metrics of pain detection. This study lays the foundation for the automatic, objective detection of emotional expressions in a range of non-human animal species.

Treating nasolabial folds with dermal fillers: a holistic approach

There are multiple surgical and non-surgical ways to treat the nasolabial fold. Traditionally, the non-surgical way of treating nasolabial folds was through careful placement of hyaluronic acid fillers directly to the fold. Our understanding of the facial ageing process and facial anatomy has enabled us to evolve our technique so that nasolabial fold treatments are safer for patients and deliver better clinical outcomes. By treating nasolabial folds indirectly, by addressing the changes that occur through aging, the aesthetic practitioner can achieve more natural and effective reduction in the fold. Indirect treatment of the nasolabial fold requires addressing the bony resorption, deep fat and superficial fat volume loss. Through better understanding of the facial aging process, we are entering an era where more practitioners are treating the cause of a particular line than treating it directly. This has the benefit of creating a more balanced and natural result with longer lasting rejuvenation.

Enhancing the Cupid's bow with hyaluronic acid dermal fillers

A common request in aesthetic practice is for a well-defined Cupid's bow. This article will discuss the increasing popularity of this treatment, and the steps that the healthcare professional should take in delivering it. This should always start with an in-depth assessment of the patient, as well as of their expectations of treatment. Patients should always be made aware of the limitations of treatment, and their expectations should be managed accordingly. Treatment technique, product selection and volume calculation are also discussed. This can be a safe and effective enhancement for some patients; however, the healthcare professional requires an in-depth knowledge of the facial anatomy in order to deliver this treatment safely and effectively.

Apraclonidine in the unlicensed treatment of eyelid ptosis

Eyelid ptosis is a complication that may occur following injection of botulinum toxin type A. It generally presents within 3–7 days of treatment. A drooping or lowering of the eyelid may be severe to the point that it leads to restriction of vision, or it may be subtle, with just the feeling of a heavy lid or, more typically, difficulty in being able to apply eye make-up. There is currently no licensed treatment for eyelid ptosis. Apraclonidine hydrochloride, commonly known as Iopidine is an alpha-adrenergic receptor agonist and causes the contraction of the Muller's muscle, which may result in an eyelid lift of 1–3 mm. There are factors that may lead to an increased risk of this complication, and there are also ways in which to help prevent it from occurring. Thorough consultations should always be given and practitioners should always ensure that they have in-depth knowledge of facial anatomy and musculature and use good injection technique.

Evolution of facial muscle anatomy in dogs

Domestication shaped wolves into dogs and transformed both their behavior and their anatomy. Here we show that, in only 33,000 y, domestication transformed the facial muscle anatomy of dogs specifically for facial communication with humans. Based on dissections of dog and wolf heads, we show that the levator anguli oculi medialis, a muscle responsible for raising the inner eyebrow intensely, is uniformly present in dogs but not in wolves. Behavioral data, collected from dogs and wolves, show that dogs produce the eyebrow movement significantly more often and with higher intensity than wolves do, with highest-intensity movements produced exclusively by dogs. Interestingly, this movement increases paedomorphism and resembles an expression that humans produce when sad, so its production in dogs may trigger a nurturing response in humans. We hypothesize that dogs with expressive eyebrows had a selection advantage and that "puppy dog eyes" are the result of selection based on humans' preferences.

Getting Better Results in Facelifting.

The facelift has significantly evolved over the past several decades. What was once considered a skin only operation is now a sophisticated, elegant procedure that requires meticulous preoperative analysis, understanding of underlying anatomically based aging changes, and extreme attention to detail. According to the American Society of Plastic Surgeons, 125,697 facelifts were performed in 2017. It is not surprising that given these advances that facial rejuvenation surgery is still a very common procedure with a high degree of patient satisfaction despite the increase in nonsurgical facial aging treatments. With an improved understanding of facial anatomy including the facial retaining ligaments and intervening superficial and deep fat compartments, the modern facelift requires an anatomically targeted approach. Furthermore, the modern facelift surgeon must achieve consistently excellent results with reasonably little downtime while being aware of methods to improve the safety of this popular elective procedure. Hematoma is the most common complication after rhytidectomy with an incidence between 0.9% and 9%, with a higher incidence in males. Other potential complications include seroma, nerve injury, skin flap necrosis, siaolocele as a consequence of submandibular gland debulking, and skin flap rhytid and hairline distortion. This review aims to discuss safe, consistent, and reproducible methods to achieve success with facelift.

Treatment of Nasal Aging and Possible Long-term Nasal Enhancement with Fat Using Injectable Tissue Replacement.

Summary:This article addresses nasal aging using a minimally invasive procedure with an algorithm that includes the diagnosis of a patient’s nose within the context of the individual’s facial anatomy. Pyriform augmentation for the elevation of tip projection and columellar strutting with injectable fat are, to our knowledge, applied for the first time as important steps in minimally invasive rhinoplasties. This procedure offers patients with more subtle nasal changes with aging or other causes to be treated with potentially long-lasting improvements, which can be easily retreated. New techniques using injectable liquid cartilage grafts are being explored.

Facial Nerve Trauma: Clinical Evaluation and Management Strategies.

The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.

Face Dissection as the Plastic Surgery Approach: Effective Method in Residency Training.

The global trend of resident work-hour restrictions requires a more time efficient way of resident training. Among many training programs for learning the facial anatomy, the cadaver is the most similar to live patients. A cadaver should be used as efficiently as possible due to human dignity as well as the consideration of cost. The authors designed an effective cadaver dissection method in learning facial anatomy using the plastic surgery approach. A 51-year-old male cadaver was used for dissection. The program was proceeded 6 times over 6 weeks, and 4 to 8 hours each day. We used standard surgical instruments with magnifying loupes. The results were analyzed through a numerical scale survey. We planned to dissect the face from medial to lateral, cephalic to caudal, and superficial to deep portion. The overall knowledge and confidence level of the face were increased in all 7 participants. The mean knowledge level before and after the seminar was 3.00 and 4.03, respectively. Confidence level also increased through the seminar from 1.86 to 2.86. The authors believe this cadaver dissection program could optimize learning anatomical knowledge and improve resident's surgical confidence through a wide range of procedures.

Reconstructing the Nasal Tip After a Human Bite: A Challenge for the Reconstructive Surgeon.

Human facial bites are uncommon and usually cause a wound that presents major challenges for the reconstructive surgeon. The purpose of this study is to present the advantages and disadvantages of using a superiorly based interpolated nasolabial flap for reconstruction of a nasal tip defect. We present a case of serious injury of the nasal tip as a result of a human bite. Early maxillofacial surgical intervention resulted in restoration of the facial anatomy and function of the structures involved. We present a serious mutilating injury of the tip of the nose in a young patient as a result of a human bite. These injuries can be rather destructive and cause a facial defect which may have a significant adverse psychological impact on the patient. Because of the proximity and the skin colour match of the melolabial fold to the nose, nasolabial flaps are a very attractive and reliable reconstructive choice for nasal tip defects. The relative advantages over other reconstructive options and the limitations of an interpolated superiorly based nasolabial flap are discussed. The elaborated use of a nasolabial peninsular pedicled skin flap may deliver a very satisfactory outcome from a functional and cosmetic point of view.

Percutaneous Threshold of Facial Nerve Stimulation Predicts Facial Canal Dehiscence

ABSTRACTIatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accidental injury. High-resolution computed tomography (HRCT) of the temporal bone is used preoperatively to assess middle ear and mastoid anatomy; however, it is unreliable for detecting facial canal dehiscence. In this study, our aim was to determine if preoperative percutaneous FN stimulation could predict middle ear facial canal dehiscence. Between January 2015 and February 2017, we performed preoperative HRCT and percutaneous FN stimulation on adult patients who underwent otologic surgery at our institution. Stimulation was performed with a monopolar probe placed on the skin over the stylomastoid foramen. Electrical stimuli ranged from 0 to 40 milliamperes (mA). Recordings were made from ipsilateral facial muscles. Dependent variables included threshold to compound muscle action potential (CMAP), threshold to maximum amplitude of CMAP, and maximum amplitude of CMAP for each muscle. A retrospective chart review was performed. Seventy patients met inclusion criteria. Of the 24 with an intraoperatively confirmed dehiscence, 10 were identified preoperatively by the attending surgeon on HRCT. Averages of the lowest recorded threshold to CMAP (5.1mA v. 9.1mA), and an average of the threshold to CMAP (8.9 mA. 11.8 mA) of dehiscent versus non-dehiscent nerves were significantly different (p < .05). In conclusion, percutaneous FN stimulation is a simple and cost-effective tool that can give the surgeon important preoperative information about FN anatomy.