Facial Index Research Articles

Epineurectomy of Facial Nerve Trunk for Refractory Oral-Ocular and Oculo-Oral Synkinesis Following Bell Palsy.

Synkinesis is a common sequelae after incomplete recovery from Bell palsy. Current first-line treatments include botulinum toxin injection and physical therapy. However, patients unresponsive to these treatments may require further surgery. Various surgical treatments have been reported, but no consensus has been reached for the optimal surgery. In a guinea pig model of synkinesis, the facial nerve trunk (FNT) was observed using a scanning electron microscope. Based on the results of scanning electron microscope and clinical ultrasonography, the authors chose FNT as the therapeutic target. The authors performed epineurectomy of FNT for 11 patients with refractory oral-ocular and oculo-oral synkinesis under abnormal muscle response and facial electromyography monitoring. The postoperative assessments at 1 year were conducted using Sunnybrook Facial Grading System and Facial Disability Index scale. Furthermore, the epineurium excised during the operation was collected as the specimen and submitted for histopathological examination; the cadaveric FNT served as the control group. The follow-up results showed significant relief from synkinesis (4.91 ± 0.37 versus 10.18 ± 0.64, P < 0.01), improvement of physical (84.55 ± 1.96 versus 73.18 ± 3.65, P < 0.01) and social functions (77.09 ± 3.24 versus 61.82 ± 6.28, P < 0.01), with no worsening of facial paralysis in the patients. The histopathological examination revealed many nerve fibers in the epineurium, suggesting that FNT was the area of aberrant axon regeneration. Epineurectomy of FNT is a safe and effective surgical remedy. It can be considered as a surgical option for patients with refractory oral-ocular and oculo-oral synkinesis following Bell palsy.

Interpreting Quality-of-Life Questionnaires in Patients with Long-Standing Facial Palsy.

Objective(s): To interpret change in quality-of-life scores in facial palsy patients by calculating the smallest detectable change (SDC) and minimal important change (MIC) for the Facial Disability Index (FDI), Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Materials and Methods: The SDC, for individuals and groups, was calculated using previously collected test-retest data (2-week interval). The MIC (predictive modeling method) was calculated in a second similar facial palsy population using two measurements (1-1.5-year interval) and an anchor question assessing perceived change. Results: SDCindividual of FaCE was 17.6 and SAQ was 28.2. SDCgroup of FaCE was 2.9 and SAQ was 4.6 (n = 62). Baseline FaCE and SAQ scores were 43.3 (interquartile range [IQR]: 35.8;55.0) and 51.1 (IQR: 32.2;60.0), respectively. MIC for important improvement of FDI physical/social function, FaCE total, and SAQ total were 4.4, 0.4, 0.7, and 2.8, respectively (n = 88). MIC for deterioration was 8.2, -1.8, -8.5, and 0.6, respectively. Baseline scores were 70.0 (IQR: 60.0;80.0), 76.0 (68.0;88.0), 55.0 (IQR: 40.0;61.7), and 26.7 (IQR: 22.2;35.6), respectively. Number of participants reporting important change for the different questionnaires ranged from 3 to 23 per subscale. Conclusion: Interpreting change scores of the FDI, FaCE, and SAQ is appropriate for groups, but for individual patients it is limited by a substantial SDC.

Associations Between Clinician-Graded Facial Function and Patient-Reported Quality of Life in Adults With Peripheral Facial Palsy

Understanding how the quality of life of adults (≥18 years) with peripheral facial palsy can be estimated using clinician measures of facial function and patient-reported variables might aid in counseling patients and in conducting research. To analyze associations between clinician-graded facial function and patient-reported quality of life in adults with peripheral facial palsy, compare associations between facial function and the physical and social functions of quality of life, and examine factors that might influence the associations. A literature search was conducted in PubMed, Embase, CINAHL, Web of Science and PsycInfo on June 4, 2020, with no restrictions on the start date. Twenty-three studies reporting an association between clinician-graded facial function and patient-reported quality of life in adults with peripheral facial palsy were included. Facial function instruments included the House-Brackmann, Sunnybrook Facial Grading System, and electronic clinician-graded facial function assessment. Quality-of-life instruments included the Facial Disability Index and Facial Clinimetric Evaluation Scale. Data extraction and qualitative synthesis were performed according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Record screening, data extraction, and quality assessments were done by 2 researchers independently. Data were pooled using random-effects models. The main outcome was the association between facial function and quality of life, quantified by Pearson r, Spearman ρ, or regression analysis. In total, 23 studies (3746 participants) were included. In the 21 studies that reported on the sex of the cohorts, there were 2073 women (57.3%). Mean or median age ranged from 21 to 64 years and mean or median duration of palsy ranged from newly diagnosed to 12 years. Bell palsy (n = 1397), benign tumor (n = 980), and infection (n = 257) were the most common etiologic factors. Pooled correlation coefficients were 0.424 (95% CI, 0.375-0.471) to 0.533 (95% CI, 0.447-0.610) between facial function and Facial Clinimetric Evaluation Scale total, 0.324 (95% CI, 0.128-0.495) to 0.397 (95% CI, 0.242-0.532) between facial function and Facial Clinimetric Evaluation Scale social function, 0.423 (95% CI, 0.322-0.514) to 0.605 (95% CI, -0.124-0.910) between facial function and Facial Disability Index physical function, and 0.166 (95% CI, 0.044-0.283) to 0.208 (95% CI, 0.031-0.373) between facial function and Facial Disability Index social function. Associations noted in this systematic review and meta-analysis were overall low to moderate, suggesting that only a small part of quality of life is explained by facial function. Associations were higher between facial function and physical function than social function of quality of life.

Morphological and Osteometric Analysis of the Skull in Abaza goats (Capra aegagrus)

This study presents osteological measurements and morphological descriptions of the Abaza goat skull. In total, 18 osteometric parameters of 10 Abaza goat skulls were measured. As a result, the mean skull length was determined as 20.82±1.4 cm, cranial length as 11.67±0.7 cm, facial length as 11.65±1.5 cm, skull index as 51.01±1.8 cm, cranial index as 50.5±7.5 cm, facial index as 71.0±8.1 cm and foramen magnum index as 106.7±13.7 cm respectively. In four skulls major intra-corneal protuberance was found on frontal bone, while in others (six skull) a deep fossa was observed. Prominent facial tuberosity was located dorsal to the 3rd-4th cheek tooth. İnfraorbital foramen in four skulls was single one it her side which was dorsally located to the junction of the first and second upper premolar tooth, in the others had partition. Paracondylar process down wards one it her side and its not same level of the occipital condyle. As a result, morphological and osteometric data were obtained on the skull of Abaza goats. The data obtained were compared with other studies in the literature.

Facial asymmetry assessment in skeletal Class III patients with spatially-dense geometric morphometrics.

Quantification and visualization of the location and magnitude of facial asymmetry is important for diagnosis and treatment planning. The objective of this study was to analyze the asymmetric features of the face for skeletal Class III patients using spatially-dense geometric morphometrics. Three-dimensional facial images were obtained for 86 skeletal Class III patients. About 7160 uniformly sampled quasi-landmarks were automatically identified on each face using template mapping technique. The pointwise surface-to-surface distance between original and mirror face was measured and visualized for the whole face after robust Procrustes superimposition. The degree of overall asymmetry in an individual was scored using a root-mean-squared-error. Automatic partitioning of the face was obtained, and the severity of the asymmetry compared among seven facial regions. Facial asymmetry was mainly located on, but not limited to, the lower two-thirds of the face in skeletal Class III patients. The lower cheek and nose asymmetry were detected to have more extensive and of a greater magnitude of asymmetry than other facial anatomical regions but with various individual variations. The overall facial asymmetry index and the regional facial asymmetry indices were higher in males and patients with chin deviation. Soft tissue asymmetry is predominately presented in the lower-third of the face in skeletal Class III patients and with various variations on other facial anatomical regions. Morphometric techniques and computer intensive analysis have allowed sophisticated quantification and visualization of the pointwise asymmetry on the full face.

Regression models of teleradiographic indicators of the position of teeth and the profile of face soft tissues in ukrainian young men and young women with different face profiles according to Schwarz A. M.

Annotation. The needs of modern dentistry require constant improvement of research methods of human dental apparatus, parameters of craniofacial structures, determination of congenital and acquired deformities of the dental apparatus and improving the consequences of treatment. Diagnosis of orthodontic pathology is based on the identification of a large number of different indicators, which requires the use of mathematical analysis not only to processing of received parameters, but also to mathematical modelling individual cephalometric, gnatometric indicators, facial soft tissue parameters that affect its profile and aesthetics. The aim of the work is to develop and analyze regression models of teleradiographic indicators of tooth position and facial soft tissue profile indices according to A. M. Schwarz in Ukrainian boys and girls with orthognathic occlusion and with different facial profiles. Lateral teleroentgenograms (TRG) of 49 young men aged 17 to 21 years and 76 young women aged 16 to 20 years with a physiological bite as close as possible to orthognathic were analyzed. In the licensed package “Statistica 6.0” regression models of teeth position and soft tissue profile according to the A. M. Schwarz method are built depending on the basic cephalometric (1st group) and gnatometric (2nd group) indicators separately for young men and young women with different facial profiles according to A. M. Schwarz In young men, 21 of the 24 possible reliable regression models with coefficients of determination greater than 0.6 (R2 = from 0.736 to 0.999) were constructed. For young men with 2 face profile (straight face profile), the following models of all 8 indicators were built, and the coefficients of determination in the models of this group of persons (R2 = from 0.966 to 0.999) were the highest compared to the models of other groups of young men or young women. For young men with 3 face profile (front face profile), models were built for 7 indicators (except for the SnPog'-Pn angle indicator) with R2 from 0.736 to 0.983. For young men with 1 face profile (back face profile), such models were created for 6 indicators (R2 from 0.815 to 0.993) – in addition to the angle II and the angle SnPog'-Pn. A total of 18 models out of 24 possible were built for young women (R2 = from 0.736 to 0.999). In young women with 2 face profile, as well as in young men with this profile, models were constructed for all 8 studied TRG-indicators of tooth position and facial soft tissue indicators according to A.M. Schwarz (R2 = from 0.736 to 0.982), and for young women with 3 face profile – for 7 indicators (except for angle II) with R2 from 0.604 to 0.740. For young women with 1 face profile, the smallest number of models of the studied indicators was constructed in comparison with all groups of young men or young women with different face profiles – only 3 models out of 8 possible: for Sn-Pn distance (R2 = 0.828), Pog'-Por distance (R2 = 0.844) and the angle SnPog'-Pn (R2 = 0.982). Both young men and young women in the created models more often include indicators of 2nd group.

Effect of row-like puncture at sternocleidomastoid on peripheral facial palsy at recovery stage

To observe the effect of conventional acupuncture combined with row-like puncture at sternocleidomastoid on peripheral facial palsy at recovery stage. A total of 60 patients with peripheral facial palsy at recovery stage were randomized into an observation group and a control group, 30 cases in each one. Acupuncture was applied at affected Cuanzhu (BL 2), Yangbai (GB 14), Sibai (ST 2), Quanliao (SI 18), Jiache (ST 6), Dicang (ST 4), Hegu (LI 4), Taichong (LR 3) and Zusanli (ST 36) in the control group. On the basis of the treatment in the control group, row-like puncture was applied at sternocleidomastoid (1 needle was punctured at muscle origin and insertion respectively, 3 to 4 needles were row-like punctured at the connection line of muscle origin and insertion). The treatment was given once a day, 5 times were as one course, with 2-day interval, totally 4 courses were required in the both groups. The house-brackmann (H-B) facial nerve function grade, facial nerve function rating system-dynamic view rating scale score and facial disability index (FDI) scale score [including scores of FDI physical function (FDIp) and FDI social life function (FDIs)] before and after treatment were observed, and the clinical efficacy was evaluated in the two groups. After treatment, the H-B facial nerve function grades were improved compared before treatment in the both groups (P<0.05), and that in the observation group was superior to the control group (P<0.05). After treatment, the scores of dynamic view rating scale and FDIp were increased (P<0.05), FDIs scores were decreased compared before treatment in the both groups (P<0.05); compared with the control group, the scores of dynamic view rating scale and FDIp were increased (P<0.05), FDIs score was decreased in the observation group (P<0.05). The total effective rate was 93.3% (28/30) in the observation group, which was superior to 73.3% (22/30) in the control group (P<0.05). Compared with conventional acupuncture, combination therapy with row-like puncture at sternocleidomastoid can improve the therapeutic effect of peripheral facial palsy at recovery stage.

Targeted chemodenervation of the posterior belly of the digastric muscle for the management of jaw discomfort in facial synkinesis

Botulinum toxin (BT-A) chemodenervation has been proved to significantly improve the physical and psychological well-being of patients suffering from facial synkinesis. Despite this, a cohort of patients has persistent tightness and discomfort around the angle of the jaw, which may be caused by synkinesis within the posterior belly of digastric (PBD) muscle. This study was designed to evaluate the benefits of ultrasound-guided BT-A injections into the PBD. Thirty-three patients with recalcitrant tightness and discomfort around the angle of the jaw, despite maximal facial therapy and platysmal chemodenervation were selected for inclusion. Patients underwent ultrasound-guided BT-A injection into the ipsilateral PBD muscle (skin puncture site 1 cm inferior and posterior to the angle of mandible). Outcomes consisted of the Facial Disability Index (FDI), Synkinesis Assessment Questionnaire (SAQ), and a visual analogue scale (VAS) designed to assess tightness and pain around the PBD when moving the jaw, swallowing, and masticating. Questionnaires were completed two weeks before and postinjection. Statistical analysis was performed using a paired t-test. Nineteen patients completed the post-treatment outcome questionnaire. A statistically significant improvement was noted in the physical and social function aspects of the FDI and all aspects of the patient-reported VAS scores apart from tightness and pain on jaw retrusion and swallowing. There was no significant difference in the SAQ. This study has demonstrated the patient-perceived benefit of ultrasound-targeted BT-A chemodenervation of PBD. This represents a low-risk treatment option that can be easily added to the repertoire of treatments offered to patients with post paralysis facial synkinesis.

A cross-sectional study of facial index in Western Uttar Pradesh population between 18-25 years of age

Background: Facial anthropometry is the scientific study of measurements and proportions of the human face. There is huge paucity in the metric measurements of face in Indian population. This study is involved in collecting facial anthropometric data of Western Uttar Pradesh population of age group between 18-25 years.&#x0D; Aims and Objectives: This study aims at evaluating predominant facial phenotype, using facial height and facial width of Western Uttar Pradesh population as study subjects.&#x0D; Materials and Methods: The study was conducted on 200 medical and paramedical students of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bareilly, Uttar Pradesh. The study subjects were of 18-25 year’s age, belonging to Western Uttar Pradesh region. Digital Vernier Caliper was used to measure the facial parameters. The data was analyzed using statistical tool SPSS 16.0 version.&#x0D; Results: In the present study it is found that facial height and width are more in males compared to females. This difference is statistically significant. On analyzing facial index, hyperleptoprosopic face is the predominant phenotype in males as well as in females, followed by leptoprosopic type in males and mesoprosopic type in females. However, gender differences in facial index are not statistically significant at p&lt;0.05. &#x0D; Conclusion: The current study reveals that facial parameters can be used to determine the gender of an individual on the basis of height and width.

Protocol for Pilot Study Testing the Effect of Avocado Consumption on Skin Aging

ObjectivesAvocados are an excellent source of bioactive compounds such as monounsaturated fatty acids, sterols, polyhydroxylated fatty alcohols and carotenoids. A common cause of photoaging is exposure to UV light, as the radiation generates oxidative stress, which leads to inflammation and erythema of the skin. Studies have demonstrated that topical application of bioactive compounds from avocado reduce UVB-induced photoaging. Ultraviolet-B (UVB) protection by oral avocado consumption has not been clinically investigated in humans. Therefore, it is the objective of this pilot study to determine if the consumption of one avocado daily for 16 weeks can increase resistance to UVB radiation and reduce skin aging in healthy women. MethodsThis study is a randomized, two arm, parallel group comparison of daily avocado consumption vs. habitual diet. Eligible participants are females, at least 25 years of age, Fitzpatrick Skin type II-IV, in good health with an increased waist circumference of 35 cm. Participants will be excluded if they are habitually eating 2 avocados per month, allergic to avocado and any unstable medical conditions. At screening, informed consent and HIPAA authorization will be reviewed and signed. In addition, Fitzpatrick Skin type and response to UVB will be assessed. Subjects will consume 1 avocado a day (Hass Avocado) or maintain habitual diet (up to 2 avocados/month) daily for 16 weeks. Skin will be assessed at weeks 0, 8 and 16. Minimal erythema dose (MED) will be determined by exposing the inner arm covered by a sleeve with 6 cut out windows with an increasing dose of UVB using the Dermalight 90. Facial melanin index, hydration and sebum will be determined using the mexameter MA18, corneometer CM825 and sebumeter SM815 probes attached to the Cutometer dual MPA 580 (Courage&Khazaka electronic GmbH, Koeln, Germany). 22 participants will be enrolled in each group considering a 10%dropout rate. ResultsPrimary outcome will be the effect of daily avocado consumption on MED assessed by UVB exposure compared to habitual diet. Secondary outcomes will be the effect of daily avocado consumption on facial skin elasticity, sebum, melanin and hydration status as assessed by cutometer compared to habitual diet. ConclusionsThis study is currently recruiting participants. Funding SourcesHass Avocado Board.

Almond Consumption Increased UVB Resistance in Healthy Asian Women

Abstract Objectives Almonds are a rich source of phenolic and polyphenolic compounds, which have antioxidant activity. In vitro and in vivo studies have demonstrated that topical application of almond oil and almond skin extract reduces UVB-induced photoaging. Ultraviolet-B (UVB) protection by oral almond consumption has not been previously studied in humans. It was the objective to investigate whether oral almond consumption can increase resistance to UVB radiation and reduce skin aging in healthy Asian women. Methods Thirty-nine female participants (18–45 years) with Fitzpatrick skin type II-IV were randomly assigned to consume either 1.5 oz of almonds or 1.8 oz of pretzels daily for 12 weeks. Minimal erythema dose (MED) was determined using a standardized protocol, which determined the minimal radiation inducing erythema on the inner arm 24 hours following UVB exposure. Facial skin texture was evaluated by two dermatologists using the Clinician's Erythema Assessment scale and Allergan Roughness scale. Facial melanin index, hydration, sebum, and erythema were determined using a cutometer. Results Women who consumed almonds, experienced a significant increase in MED from 415 ± 64 to 487 ± 59 (18.7 ± 19.2%, P = 0.006) from baseline to week 12 compared to women in the pretzel group from 415 ± 67 to 421 ± 67 (1.8 ± 11.1%). The exposure time to reach minimal erythema was also increased significantly in the almond group from 160 ± 23 to 187 ± 25 (17.5 ± 22.2%) compared to the pretzel group from 165 ± 27 to 166 ± 25 (1.7 ± 14%) (p=0.026). There were no differences noted between the groups consuming almonds versus pretzels in Allergan roughness, melanin, hydration, or sebum on facial skin. Conclusions Our findings suggest that daily oral almond consumption may lead to enhanced protection from UVB photodamage by increasing the MED. Protection from other UV radiation was not tested and therefore almond consumption will not replace other methods of sun protection such as application of sunscreen or wearing protective closing. Funding Sources Almond Board of California.

A Novel Method to Estimate Height of an Individual with Facial Index

Objective: Face is the most important part of the body. Cranial anthropometry is well known determinant ofgood and important aspects of treatment in the field of medicine, dentistry, plastic surgery, aesthetics. Thereare studies on the facial index determination and classification of faces. There are very few studies on theestimation of height of an individual from facial index as a parameter. Here in this study, we have aimed toestimate height of an individual from facial index derived from his/her 2D photograph. Therefore, here inthis study we have attempt to estimate height from the facial index of an individual.Materials and Methods: Study population were randomly selected 105 samples to measure the facialparameters using digital vernier calipers manually, and also height with the help of stadiometer. Then thefacial index was determined from the postcard size photograph of an individual, then classified based onBannister classification and formula was derived to estimate the height of an individual from it.Result and Conclusion: We observe a correlation existing between the facial index and the height of anindividual. This study will be of great utility for the forensic application for estimation of height from the2D photograph of an individual.

Updating Standards of Facial Growth in Romanian Children and Adolescents Using the Anthropometric Method-A Pilot Study.

The anthropometric method is an important tri-dimensional and non-invasive assessment instrument for accurate diagnosis in paedodontics, orthodontics, and other medical fields. Our aim was to propose a technique that is accessible for clinicians and to determine the reference values for Romanian children and adolescents for the facial parameters selected. We proposed three basic instruments: a plastic compass, a ruler, and a digital caliper. Eighty-five children and adolescents (62% girls and 38% boys), aged between 3.5 and 14.5 years, were included in the study. We selected eight transversal, 12 vertical, and three sagittal measurements. Facial indices, according to Farkas L.G., were directly determined. The correlations between facial and general growth parameters, using Pearson correlation coefficient, for the entire sample were significant, direct, and strong for the following: Zy-Zy, Go-Go, N-Gn, N-Sn, Sto-Gn, Tr-Gn, Tr-Sn, Tr-Tr (r = 0.526–0.925, p < 0.001), and insignificant for Sn-Sto (r = 0.099–0.124, p > 0.354). The highest correlation coefficient is exhibited by Tr-Gn (r = 0.893 with height and r = 0.925 with weight). When performing a gender related comparison, we noticed that the vertical and transversal linear parameters and some facial indices are increased in boys (p < 0.05), depending on the age group. The simplified anthropometric technique represents an accessible method to every clinician, bringing important information related to dentofacial growth, diagnosis, and treatment planning in dentistry.

One-splint versus two-splint technique in orthognathic surgery for class III asymmetry: comparison of patient-centred outcomes

ObjectivesTwo-jaw orthognathic surgery (OGS) is done using either the one-splint technique with free-hand positioning of the maxillomandibular complex or the two-splint technique with intermediate splints to position the maxilla. It is uncertain which technique achieves better outcomes. This study compares frontal soft tissue symmetry and subjective patient QoL between one-splint and two-splint techniques in skeletal Class III asymmetry patients undergoing OGS with three-dimensional surgical planning.Materials and methodsThis retrospective case-control study comprised 34 one-splint and 46 two-splint OGS patients. Frontal photographs and Orthognathic Quality of Life Questionnaire (OQLQ) were done pre- and post-treatment. Frontal soft tissue symmetry was analysed with the anthropometric Facial Symmetry Index. Measurements were compared with t-tests and chi-squared tests with p-value set at 0.05.ResultsThe groups differed in pre-treatment ANB and OQLQ scores. The two-splint group showed significant improvement in all symmetry measures. The one-splint group showed significant improvement in all symmetry measures except midface deviation, upper contour deviation and the Facial Contour Symmetry Index. Both groups showed significant improvement in OQLQ scores. There were no significant differences in post-treatment symmetry measurements and OQLQ scores between groups.ConclusionsAlthough two-splint technique may better improve contour symmetry, there were no significant differences in frontal soft tissue symmetry and QoL after OGS in skeletal Class III asymmetry with either one-splint or two-splint technique, with both techniques resulting in significant improvement.Clinical relevanceOne-splint and two-splint surgical techniques produce similar patient-centred outcomes in Class III asymmetry patients.

French Canadian Translation, Cultural Adaptation, and Validation of Facial Clinimetric Evaluation Scale and Facial Disability Index Questionnaires for Patients with Peripheral Facial Paralysis.

French Canadian Translation, Cultural Adaptation, and Validation of Facial Clinimetric Evaluation Scale and Facial Disability Index Questionnaires for Patients with Peripheral Facial Paralysis.

Multistage Management of Complex Maxillofacial Defects Due to Gunshot Injury

Background and Aim: The injuries due to gunshot can form extensive defects. The management of these defects is required in multistage procedures, and the treatment achievement should be evaluated in many aspects. In this study, a methodology was tried to be developed to reveal the path to be followed in the management of maxillofacial defects caused by high-energy close-range gunshot injury. In addition, similar cases were analyzed retrospectively, and the functional and social successes of the treatment were evaluated. Subjects and Methods: Five patients with high-energy gunshot injuries were retrospectively analyzed. The tissue requirements of the patients were identified. The technical and quantitative details of the treatment were recorded. The facial disability index was used to evaluate the patient's social and motor functions in the 1st year after the operations were completed. Results: The patients' mean age was 31 (17–45), and all of them were male. The mean follow-up time was 25 months (14–26), and the mean operation amount was 7.6 (3–11). Four mandibular, one maxillary, and five soft-tissue defects were detected. It was detected that these defects were managed in basic four steps. Satisfactory, functional, and social results were obtained in four patients in the postoperative 1 year. Conclusions: The management of this group of patients comprises complicated procedures. First, the patient should be stabilized vitally. Definitive reconstruction should be carried out after the wound is stabilized. To increase treatment success, the patient's mental status should be stabilized during the treatment period. Providing social function is important along with physical function.

Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis.

To evaluate the role of body dysmorphic disorder (BDD) in patients with postparalytic facial nerve syndrome with synkinesis (PFS). A single-center retrospective cohort study. A total of 221 adults (74% women; median age: 44 years; median duration since onset of facial palsy: 1.6 years) were included. To diagnose BDD, the BDD Munich Module was used. Associations with House-Brackmann grading, Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, Facial Disability Index (FDI), general quality of life (SF-36), Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) was analyzed. A total of 59 patients (27%) were classified as patients with BDD. Significant associations were found between the diagnosis of BDD and female gender and lower FDI, FaCE, and SF-36 scores and higher BDI and LSAS scores. Multivariate analysis revealed BDI, FaCE total score, and FaCE social function subscore as independent factors associated with BDD. BDD was a relevant diagnosis in patients with PFS. A higher BDD level was associated with general and facial-specific quality of life and more psychosocial disabilities. Optimal treatment of PFS has to include these nonmotor dysfunctions. 3 Laryngoscope, 131:E2518-E2524, 2021.

The craniofacial indicators of aggression: a cross-sectional multiparametric anthropometry study.

The craniofacial features of a person are unique and critical in the evaluation of age, gender, and ethnicity. The relationships between craniofacial properties and behavioural patterns have been one of the most common research topics. There are studies on the association of facial width-to- -height ratio (fWHR) and aggressive behaviour in men; however, no consensus has been reached as there are inconsistent study results. Most of the studies focus on measuring the pre-determined fWHR in searching for a link to aggression. As the literature lacks data on the associations of multiple craniofacial ratios and aggression, we aimed to study the correlation of aggressive behaviour and multiparametric anthropometric measurements of the craniofacial region in a study group consisting of university students aging 18-38 years. The aggression questionnaire results showed that male students had statistically higher scores than females in all subdomains, except physical aggression. Anthropometric studies revealed that males had higher mean values of craniofacial dimensions and indices than females, except the frontal height, the total lip height, frontal index, and cranial length-head circumference index. The statistical analyses for correlations showed that frontal, upper facial, and total facial height-facial width indices correlated with general and verbal aggression, frontal and upper facial indices correlated with physical aggression, and upper facial and total facial height-facial width indices correlated with indirect aggression only in males. We conclude that our study represents the first example of an extensive craniofacial anthropometric research that correlates several craniofacial measurements and ratios with various aggression subdomains.

Effect of comorbid migraine on propranolol efficacy for painful TMD in a randomized controlled trial.

IntroductionThe migraine-preventive drug propranolol is efficacious in reducing pain from temporomandibular disorder, suggesting potential modifying or mediating effects of comorbid migraine.MethodsIn this randomized controlled trial, myofascial temporomandibular disorder patients were treated with propranolol or placebo for 9 weeks. The primary endpoint was change in a facial pain index derived from daily symptom diaries. Linear and logistic regression models tested for a migraine × treatment-group interaction in reducing facial pain index. Counterfactual models explored changes in headache impact and heart rate as mediators of propranolol's efficacy.ResultsPropranolol's efficacy in reducing facial pain index was greater among the 104 migraineurs than the 95 non-migraineurs: For example, for the binary ≥ 30% reduction in facial pain index, odds ratios were 3.3 (95% confidence limits: 1.4, 8.1) versus 1.3 (0.5, 3.2), respectively, although the interaction was statistically non-significant (p = 0.139). Cumulative response curves confirmed greater efficacy for migraineurs than non-migraineurs (differences in area under the curve 26% and 6%, respectively; p = 0.081). While 9% of the treatment effect was mediated by reduced headache impact, 46% was mediated by reduced heart rate.ConclusionsPropranolol was more efficacious in reducing temporomandibular disorder pain among migraineurs than non-migraineurs, with more of the effect mediated by reduced heart rate than by reduced headache impact.Study identification and registrationSOPPRANO; NCT02437383; https://clinicaltrials.gov/ct2/show/NCT02437383

Development of the facial glycation imaging system for in situ human face skin glycation index measurement.

BackgroundThe accumulation of advanced glycation end products has been proposed as a causative agent of skin aging, but there are no conventional devices for quantifying advanced glycation end‐product accumulation in facial skin.AimsThis study aimed to develop a convenient and accurate in situ advanced glycation end‐product measurement system for the human face.MethodsWe developed a facial glycation imaging system, which consisted of illumination (white light‐emitting diode, ultraviolet light‐emitting diode) and image acquisition modules to capture face images. Advanced glycation end product–related autofluorescence and total skin reflectance were calculated to obtain the skin glycation index using an image analysis algorithm. Correlations between the skin glycation index and facial skin elasticity and age were examined in 36 healthy Korean women.ResultsThe facial glycation imaging system was validated against a volar forearm skin autofluorescence measurement device, that is, the AGE Reader mu, with forearm skin glycation index (R = 0.64, P < .01). Cheek elasticity was negatively correlated with cheek skin glycation index (R = −0.56, R = −0.57, and R = −0.61, P < .01 for R2, R5, and R7, respectively). Age was significantly correlated with forearm skin glycation index (R = 0.44, P < .01) and cheek skin glycation index (R = 0.48, P < .01).ConclusionWe successfully developed a novel in situ facial skin glycation index measurement device. Our convenient and accurate system enables in situ skin glycation index monitoring for skin aging studies such as those on anti‐glycation cosmetics.