Frontalis Muscle Research Articles

Effectiveness of Kabat Technique versus Mirror Book Therapy on clinical and electrophysiological parameters in patients with Bell’s palsy: a comparative interventional study

Abstract Background Bell’s palsy significantly impacts facial function, aesthetics, and quality of life. Objective To compare the effects of the Kabat Technique (KT) and Mirror Book Therapy (MBT) on clinical and electrophysiological parameters in patients with Bell’s palsy. Methods This randomized controlled trial included 31 patients divided into two groups: KT (n = 16) and MBT (n = 15). Both groups received their respective interventions (6 days/week for 3 weeks) in addition to conventional physiotherapy. Sunnybrook Facial Grading Score and Nerve Conduction Test (amplitude and latency of frontalis, nasalis, and mentalis muscles) were assessed pre- and post-intervention. Results Statistical analysis (SPSS v20) revealed significant intragroup improvements in all outcome measures (p < 0.05). Intergroup comparison showed MBT had superior improvements in amplitude of frontalis and reduced latency of nasalis. Both groups demonstrated significant improvement in the Sunnybrook grade shift. Conclusion This study suggests that KT and MBT, combined with conventional physiotherapy, positively impact clinical and electrophysiological parameters in Bell's Palsy patients. MBT showed superior results in select Nerve Conduction Test parameters.

Deciphering the Refined Musculature of the Brow Area in Asians by Micro-Computed Tomography.

The brow area is an important aesthetic unit. Accurate anatomical understanding of the brow is important for clinical treatments related to this region. Due to the complexity of the brow area and limitations of methods, there are still some controversies regarding its musculature description. This article aims to reveal the detailed musculature using micro-computed tomography (micro-CT) combined with histological staining. Eight fresh cadaver (16 hemifaces) were obtained. Eight hemifaces were processed with phospho-tungstic acid contrast staining for micro-CT scanning and reconstruction. The other corresponding 8 hemifaces were prepared with Masson staining. The orbicularis oculi muscle (OOM), frontalis muscle (FM), depressor supercilii (DS) and procerus muscle (PM) were situated superficially. The FM terminated and connected with its antagonistic muscles at 2-5 mm above the brow but the fusion line descended in lateral third. The corrugator supercilii muscle (CSM) originated from the periosteum, extending laterally and superficially. During its course, it mainly penetrated the FM. CSM had broad subcutaneous insertion, covering about 77.9% ± 7.5% of the hairy brow. CSM fibers connected to the subcutaneous fiber septa to directly transmit contraction force. The soft tissue on the lateral side of the brow was looser than that on the medial side. Our study deepens the understanding of the precise anatomy of the brow area and helps guide clinical practice.

Relationship between fatigue and quantitative electromyography findings in patients with myasthenia gravis

BackgroundFatigue is a common complaint among patients with myasthenia gravis (MG). In this study, we investigated the alterations in muscle morphology in patients with MG experiencing fatigue using quantitative electromyography (QEMG), and explored the relationship between electrophysiological findings and the severity of both fatigue and disease. MethodsWe performed QEMG of the biceps brachii muscle using the peak ratio method and multi-motor unit potential (MUP) analysis across three groups: 18 MG patients with fatigue, 34 MG patients without fatigue, and 33 healthy subjects. Stimulated single-fiber EMG was performed on the frontalis muscle. The severity of perceived fatigue and disease was subsequently assessed using the quantitative myasthenia gravis (QMG) score, the MG-activities of daily living (MG-ADL) profile, self-reported fatigue questionnaires, and handgrip strength measurements. ResultsThe QEMG study revealed a reduced mean MUP duration and size index (SI), in addition to an increased peak ratio in patients with MG (p < 0.05), which tended to be more pronounced in those experiencing fatigue. Compared to healthy subjects, MG patients with fatigue displayed a myopathic pattern characterised by a high peak ratio, short duration, and small-amplitude MUPs, without any increase in the number of phases or small time intervals. The mean peak ratio was positively correlated with the QMG, MG-ADL, and Fatigue Impact Scale total and physical subscores (p < 0.05). Further, MG patients with fatigue exhibited reduced maximum grip strength, which was positively correlated with the mean MUP duration, amplitude, SI, and thickness, and negatively correlated with the mean peak ratio (p < 0.05). No significant differences were observed in the jitter or block measurements (p > 0.05). ConclusionsThe present study investigated electrophysiological findings that were not considered or theorised in prior studies on patients with MG experiencing fatigue. The results of this study suggest that myopathic changes may be a critical pathophysiological component underlying the fatigue associated with MG.

The Relationship Between Glabellar Contraction Patterns and Glabellar Muscle Anatomy: A Magnetic Resonance Imaging-based Study.

Glabellar contraction patterns were introduced to the scientific literature to help guide glabellar neuromodulator injection algorithms. However, the relationship between the underlying musculature and its influence on these glabellar contraction patterns is unclear. The aim of this study was to identify via Magnetic Resonance Imaging (MRI) glabellar muscle parameters that display an influence on the distribution of individual glabellar contraction patterns. Thirty-four healthy young individuals of Caucasian Polish descent were investigated (17 women, 17 men) with a mean age of 23.6 years and a mean BMI of 22.8 kg/m2. MRI-based measurements of length, thickness, width and surface area of procerus, corrugator supercilii, orbicularis oculi and frontalis muscles were conducted. Unadjusted models revealed that there was no statistically significant difference between the five glabellar contraction types and the investigated muscle parameters indicating that independent of the skin rhytid pattern, the underlying musculature was not different between the investigated groups in this sample with all p ≥ 0.102. Adjusted models revealed that sex was the most influential factor due to males displayed in general higher values for the investigated parameters when compared to females. The results of this study reveal that based on the MRI parameters investigated and based on the investigated cohort, there does not appear to be a strong relationship between glabellar contraction patterns and underlying glabella muscle anatomy. Utilizing glabellar contraction patterns to design neuromodulator treatment algorithms may be of variable clinical merit.

Compositions of Four Different Arms in the Anatomy of the Frontalis Muscle Revisited.

Compositions of Four Different Arms in the Anatomy of the Frontalis Muscle Revisited.

Comprehensive Mapping and Dynamic Monitoring of the Temporal Branch of the Facial Nerve in Complex Cranial Reconstruction Surgery and Revision Cranioplasty.

Facial nerve (FN) injury is a significant risk during complex cranial reconstruction surgeries, especially in revision cases where normal anatomy is distorted. The authors introduce a technique to mitigate FN injury, including preoperative FN mapping, intraoperative FN mapping, and continuous FN monitoring. Preoperative mapping uses a handheld ball-tip stimulator to elicit compound muscle action potentials (CMAP) in the frontalis muscle. Needle electrodes are placed above the orbital margin to record responses, starting at the stylomastoid foramen and extending until the entire temporal branch is mapped. Intraoperatively, continuous mapping is achieved using an electrified insulated suction device, allowing dynamic mapping during soft tissue dissection. Continuous monitoring involves placing stimulation electrodes near the stylomastoid foramen and recording CMAP responses from the frontalis and orbicularis oculi/orbicularis oris muscles. The authors tested this technique in 5 patients. The authors successfully mapped the temporal branch of the FN with isolated frontalis CMAP recordings in all patients. Intraoperative FN mapping and continuous monitoring were successfully performed in all cases. Two patients experienced complete cessation of FN CMAPs, which resumed upon loosening the tension on the myocutaneous flap held by fishhooks. One patient showed a 39% decrement in frontalis CMAP that did not recover. Despite these issues, all patients had intact FN function postoperatively and at follow-up. Our technique shows promise in mitigating FN injury during complex cranial reconstruction and cranioplasty revision surgery. Further research with a larger cohort is needed to confirm efficacy and statistical significance.

Journey of frontalis muscle advancement in severe blepharoptosis: Review of the techniques, modifications, and outcomes.

We aimed to review the degree of standardization of frontalis muscle (FM)-orbicularis muscle advancement techniques in the management of severe congenital blepharoptosis and also study the evidence which supports the procedure correcting blepharoptosis. The undisputed rationale of all types of brow suspension in the management of severe blepharoptosis is based on the concept that slings are the conventional way to simultaneously suspend a ptotic eyelid and transmit the contractile action of the FM to the tarsal plate. Traditionally, frontalis suspension using sling has been used to treat patients with severe congenital blepharoptosis with poor levator function; however, postoperative lagophthalmos, forehead scarring, and recurrence remain major concerns. Since the early 80s, a significant number of consecutive articles have suggested that the eyelid can be effectively suspended by directly suturing FM to the tarsal plate. This review article intends to evaluate the level of standardization of FM advancement techniques in the management of severe blepharoptosis. 'In addition, to determine if the procedure should be performed in a standard manner, and is there enough evidence available to recommend FM advancement as a useful surgical technique.

Anatomical Trajectory of the Corrugator Supercilii Muscle in Koreans: Implications for Aesthetic and Clinical Practices.

Understanding the attachment patterns of the corrugator supercilii muscle (CS) is vital for treatments designed to improve facial symmetry and functionality. The aim of this research was to elucidate the anatomical trajectory and intricate relationships of the CS within the upper face and midface, specifically focusing on its connections with the frontalis (FT) and orbicularis oculi (OOc) muscles. The CS was examined in 41 specimens of embalmed adult Korean cadavers using microdissection, histological analyses, and microcomputed tomography, an in-depth exploration of its anatomical positioning and intricate interactions with adjacent muscles. Some lower fibers of the CS extended to the upper orbital part of the OOc in 59.5% of cases, while the CS interdigitated or blended exclusively with the FT in 40.5% of cases. The fibers of the CS demonstrated diverse extensions towards the upper face and midface, exhibiting varied trajectories and lengths. Additionally, lower fibers of the CS extended to significant anatomical landmarks such as the OOc, malaris muscle, and the superficial musculoaponeurotic system (SMAS). This study demonstrates that precise understanding of the CS and its relationship with the FT and OOc is crucial for optimizing invasive or non-invasive treatment like botulinum toxin injection, SMAS lifting and browplasty surgery. The extension of lower fibers of the CS to significant anatomical landmarks indicates complex interactions with adjacent facial structures, highlighting the necessity of detailed anatomical knowledge for clinical applications.

Clinical Effect of Combined Fascia Sheath Suspension With Shortening Levator Muscle on Severe Blepharoptosis.

To study the clinical effect of conjoint fascial sheath (CFS) suspension and levator palpebrae superioris muscle shortening in the treatment of severe blepharoptosis. Forty-five patients with severe blepharoptosis (75 eyes) from May 2020 to February 2022 in the authors' hospital were divided into 2 groups: group A (n = 33, 43 eyes) and group B (n = 24, 32 eyes). Group A was operated on by CFS + levator muscle shortening, and group B was operated on by frontal muscle flap suspension + levator muscle shortening. Both groups were followed up for 12 months (until February 2023). The clinical effect was counted in 6 months after operation, the early complications were counted in 1 month after operation, and the late complications were counted in 1 month to 12 months after operation. Margin to corneal reflex distance 1 (MRD1) and palpebral fissure height (PFH) were recorded before, 1 week, 3 months, and 12 months postoperatively, and the amount of eyelid retrogression was counted again. The good correction rate was 90.70% in group A, higher than in group B (71.88%), and the difference was statistically significant (P< 0.05); the early postoperative complication rate was 9.30%, lower than in group B (24.38%), and the difference was statistically significant (P< 0.05); the late postoperative complication rate was 2.33%, lower than group B (18.75%), and the difference was statistically significant (P< 0.05). The MRD1 and PFH of group A were higher than those of group B (P< 0.05) at 3 months postoperatively and 12 months postoperatively; the MRD1 and PFH of group A were lower than those of group B (P< 0.05) at 3 months postoperatively and 12 months postoperatively. Repeated measurement analysis of variance showed that there were significant differences in the main effects of MRD1, PFH, eyelid retrogression, and time in group A and group B (P< 0.05), and there was interaction between intervention and time (P< 0.05). Conjoint fascial sheath suspension combined with levator palpebrae superioris muscle shortening can effectively improve MRD1 and PFH, and the amount of upper eyelid retraction is controllable 1 year after operation.

Anatomie de la région frontale

The forehead is an anatomic region located between the frontal hairline cranially, the eyebrow and the glabella caudally, and the anterior border of the temporal fossa laterally on both sides. Its vertical situation, due to the telencephalon growth, is specific of the human species. From surface to deep planes, the skin and sub-cutaneous fat pads are described first. The muscular plane is constituted of the frontal muscles elevators of the forehead and the eyebrow, and the depressors which are the procerus and orbicularis oculi muscles superficially, the depressor supercilii muscle, and the corrugator supercilii in a deep plane. The galea aponeurotica, located deep to the frontal muscles, is a fibrous lamina on which the muscles of the skull insert. There is a sexual dimorphism of the frontal bone. The male forehead has extensive supraorbital bossing, and above this there is often a flat area, in teh femalethe supraorbital bossing is often nonexistent and above, there is a continous mild curvature. Blood supply to the forehead is given by an anterior pedicle constituted by the supraorbital and supratrochlear vessels and a lateral pedicle made of the anterior branches from the superficial temporal vessels. The sensory innervation of the forehead is given by the ophtalmic nerve which divides in frontal, nasociliar and lacrymal nerves. The motor innervation is given by the temporal ramus of the facial nerve which passes laterally to the zygomatic arch, and gives the innervation of the frontal, corrugator supercilii and procerus muscles.

Approach to eyelid ptosis in a federal hospital in Rio de Janeiro in 2023

Introduction: The upper eyelid has complex anatomy, which is essential for an aesthetic appearance and proper function. Its normopositioning contributes to pleasant lines and is related to the eyebrow. The levator palpebrae and muller muscles maintain their height and excursion, along with the frontalis muscle. Ptosis can be congenital (myogenic or neurogenic) or acquired (myogenic, neurogenic, traumatic, mechanical, aponeurotic). The aesthetic evaluation considers the symmetry, shape and height of the eyelid. Ptosis is diagnosed when the upper eyelid margin to the reflex margin distance from the cornea is abnormally low. Eyelid fold asymmetry is associated with blepharoptosis and may require surgical correction. Methods: A total of 13 cases operated at the HFA from January to December 2023 were analyzed. All patients were approached anteriorly, with shortening of the aponeurosis of the eyelid levator muscle, after the aponeurotic defect was identified. Results: Of the cases approached (13), there were 7 men and 6 women. 11 bilateral cases and 2 unilateral cases. 1 case already operated on another service. 8 cases were elderly over 60 years old, of which 3 had a history of cataract correction (37.5%). Conclusion: The identification of ptosis in the preoperative evaluation with its consequent correction presented a better overall result, not only aesthetically, but mainly functionally. The MEPS aponeurosis shortening technique demonstrated a low complication rate, which was effective, meeting the needs of the patients and satisfying the surgeon.

Neuromodulators in Men.

Botulinum toxin treatment is gaining popularity among men for cosmetic purposes driven by workplace competition and a desire for confidence and youthfulness. Because of the unique features of male facial anatomy, careful consideration is necessary during assessment and treatment execution. The peer-reviewed literature on male facial anatomy in relation to neuromodulator treatment was analyzed with a particular emphasis on studies involving male subjects and the use of botulinum toxin type A. Anatomic differences in muscle mass and contraction patterns between men and women help guide treatment. Men appear to require higher doses for effective treatment of facial wrinkles and, in the case of glabellar lines, often require double the standard dose for women. Treatment of the frontalis muscle in men, responsible for forehead creases, requires precise dosage and placement to avoid brow ptosis. The lateral canthal wrinkles are often the first area that men seek consultation for. Although FDA approval for lower face regions is lacking, off-label use can still be considered. Successful botulinum toxin treatment in men necessitates understanding facial anatomy, customized treatment plans, and appropriate dosing. Further research is warranted to refine protocols and enhance outcomes for male patients.

Different Muscles, Lower Cutoff Values: Does it Truly Improve the Diagnostic Sensitivity of Repetitive Nerve Stimulation in Myasthenia Gravis?

ABSTRACT Context: This study evaluated the diagnostic accuracy of repetitive nerve stimulation (RNS) compared with single-fiber electromyography (SF-EMG) in generalized myasthenia gravis (MG). Aims: The aim of the study was to determine the diagnostic sensitivity of RNS in various muscles and assess the effect of varying decrement cutoff values on diagnostic efficacy. Setting and Design: This was a prospective study of 34 confirmed generalized MG patients. Subjects and Methods: RNS was performed on five muscles. Clinical features, autoantibody presence, and SF-EMG jitter rates recorded from the frontalis muscle were analyzed. Patients were classified according to the MG Foundation of America classification. Statistical Analysis: SPSS version 23 was used for descriptive statistics, comparisons of categorical and quantitative data, and correlation analysis, with the significance level set at P &lt; 0.05. Results: Among the patients (58.8% males and mean age = 59.47 ± 13.37 years), SF-EMG detected increased jitter in 91.2%, whereas RNS identified a significant decrease of 50% across at least one muscle. The decremental response was &gt;10% in the abductor digiti minimi (ADM), trapezius, nasalis, abductor pollicis brevis, and extensor indicis proprius muscles in 5.9%, 26.5%, 29.4%, 11.8%, and 29.4% of patients, respectively. A sensitivity improvement at lower decrement values was observed only in the ADM muscle. A significant correlation was found between decreases in the trapezius muscle and seropositivity. Conclusions: Optimal muscle selection improves RNS diagnostic accuracy in MGs. The study recommends incorporating the spinal accessory and radial nerves in RNS due to their high sensitivity, although modifying the decrement cutoff value has a limited overall effect.

A long-term histological research on human frontalis muscle flap specimens from recurrent blepharoptosis patients.

A long-term histological research on human frontalis muscle flap specimens from recurrent blepharoptosis patients.

Behavior of jittering potential before and after impulse blockings: a preliminary study in myasthenia gravis

Neuromuscular junction disorders lead to secession of bioelectrical activity transmission between motor nerve endings and muscle fibers. In diseases that are severe enough, impulse blockings are observed. This study aims to reveal the behavior of neuromuscular junction before and after impulse blockings. Fourteen recordings harboring impulse blockings from nine myasthenia gravis (MG) patients were included. Recordings were made from frontalis muscle by using concentric needle electrode during voluntary contraction. One hundred traces were acquired in each session. In addition to well-known jitter parameters, new parameters were calculated such as number of consecutive impulse blocking groups, number of impulse blockings in each group, ratio of maximum number of consecutive impulse blockings to all number of blockings. Graphics were composed to show location change behavior of jittering potential in all traces. For jittering potential, before or after a single impulse blocking the amount of getting further away from trigger peak was greater than getting closer to trigger peak. However, after consecutive impulse blockings the amount of getting closer to trigger peak was greater than the amount of getting further away. The behavior of neuromuscular junction before and after impulse blockings was demonstrated in MG patients. Moreover, new features were extracted for jitter studies. Building models for different diseases according to their impulse blockings may be possible with the developed algorithm.Graphical abstract

A Myxofibroma of the Soft Tissue of Face: A Rare Case Report

Myxoma is a locally invasive neoplasm usually involving the jaw bones, typically occurs between the second and fourth decades. This tumor may comprise 3%-6% of odontogenic tumors. Myxomas of the soft tissue of the face are very rare. We present an unusual case of myxofibroma occurring in a 13-year-old man involving the soft tissue of the face. It congenitally occurred and was a 1 cm sized, ovoid in shape, swelling located on the glabella without any symptoms. An excisional biopsy was performed. A well encapsulated ovoid mass was attached to the corrugator supercilli muscle below the frontalis muscle. It was measured 1.1 x 1 x 0.8 cm and completely excised. Histological examination revealed myxofibroma showing stellate and spinde-shaped cells throughout myxoid ground substance. The unusual features of this case are the site of the tumor, which was localized to the non-tooth bearing area of the mandible and its congenital occurrence history.

Cause Analysis and Surgical Treatment of Aponeurotic Ptosis With Upper Eyelid Depression.

Ptosis and upper eyelid depression were previously diagnosed as 2 separate diseases. The authors found that in patients with aponeurotic ptosis accompanied by upper eyelid depression, the main cause of upper eyelid depression was impaired dynamic transmission of the levator aponeurosis. To analyze the causes of upper eyelid depression in patients with aponeurotic ptosis accompanied by upper eyelid depression and to introduce the best treatment methods. The authors enrolled 15 eyes (11 patients) with aponeurotic ptosis accompanied by upper eyelid depression from October 2021 to August 2022. The authors analyzed the causes of upper eyelid depression in those patients and performed aponeurotic ptosis correction surgery and orbital septum fat release surgery. After 6 to 12 months of follow-up, the authors reviewed the patient's medical records and photographs to evaluate the treatment outcomes. After surgery, ptosis was corrected and upper eyelid depression significantly improved in all the patients. One patient had poor eyelid morphology and upper eyelid depression due to habitual brow lifting, which was relieved after an injection of botulinum toxin into the frontalis muscle. One patient had overcorrection of the upper eyelid depression on the affected side and no other complications. The main cause of upper eyelid depression in patients with aponeurotic ptosis is impaired dynamic transmission of the levator aponeurosis. Aponeurotic ptosis repair surgery and orbital septum fat release surgery are simple surgical procedures that restore the normal anatomy and physiology of the upper eyelid and maintain the normal structure of the eyelid, with good post-operative outcomes.

Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial

Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1week (T1), 1month (T2), and 3months (T3). The secondary outcomes studied were operating time and any other complications recorded. Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata etal.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P<.05. The study sample was composed of 22 patients with a mean age of 32.82±11.21years in TMAP and 27.82±8.54years in the TP group respectively (P=.26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P=.53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P=.31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03±9.7 vs 89.56±10; 95% confidence interval -24.28 to -6.65 with P value=.002). TP approach was faster with a mean exposure time of 9.9minutes. The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.

Increasing precision during neuromodulator injections for frontal rhytids-Using ultrasound imaging to identify the line of convergence.

Recent research introduced the concept of the "line of convergence" as a guide for injectors to enhance precision and avoid complications when treating the frontalis muscle with toxins. However, currently, no pre-injection ultrasound scanning is employed to increase precision and reduce adverse events when searching for the line of convergence. To explore the feasibility and practicality of implementing pre-injection ultrasound scanning into aesthetic neuromodulator treatments of the forehead. The sample of this study consisted of n = 55 volunteers (42 females and 13 males), with a mean age of 42.24 (10.3) years and a mean BMI of 25.07 (4.0) kg/m2. High-frequency ultrasound imaging was utilized to measure the thickness, length, and contractility of the frontal soft tissue and to determine the precise location of the line of convergence during maximal frontalis muscle contraction. The results revealed that the line of convergence was located at 58.43% (8.7) of the total forehead height above the superior border of the eyebrow cilia without a statistically significant difference between sex, age, or BMI. With frontalis muscle contraction, the forehead shortens in males by 25.90% (6.5), whereas in females it shortens only by 21.74% (5.1), with p < 0.001 for sex differences. This study demonstrated the feasibility and practicality of pre-injection ultrasound scanning for facial aesthetic neuromodulator treatments. Knowing the location of the line of convergence, injectors can determine precisely and on an individual basis where to administer the neuromodulator deep or superficial or when the injection location is at risk to cause eyebrow ptosis.

Repetitive transcranial acupuncture stimulation combined with electroacupuncture in treatment of acute facial palsy with retroauricular pain: a randomized controlled trial

To observe the clinical effect of repetitive transcranial acupuncture stimulation (rTAS) combined with electroacupuncture (EA) in treatment of acute facial palsy with retroauricular pain. Sixty-eight patients of acute facial palsy with retroauricular pain were randomly divided into an observation group (34 cases, 3 cases dropped out) and a control group (34 cases, 3 cases dropped out). On the basis of conventional therapy, in the control group, Yangbai (GB 14), Cuanzhu (BL 2), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Yifeng (TE 17), Qianzheng (Extra point) and Taiyang (EX-HN 5) on the affected side, and bilateral Hegu (LI 4) were selected. EA was attached to Yangbai (GB 14) and Cuanzhu (BL 2), and Sibai (ST 2) and Dicang (ST 4), respectively, using intermittent wave. In the observation group, on the basis of the regimen as the control group, rTAS was delivered at Baihui (GV 20) and the 1/5 of the lower motor area on the bilateral sides; EA of dense wave was given at the sites of the mastoidⅠand Ⅱ. The intervention of each group was delivered once a day, 6 times a week as one course for 4 courses and taking a day off every course. Before treatment and at the moment after the first treatment completion, the score of visual analogue scale (VAS) was observed in the two groups and the days of retroauricular pain were recorded. Before and after treatment, the score of Sunnybrook facial grading system (SFGS), the grade of House-Brackmann facial nerve function evaluation system (H-B), the latency and amplitude of the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve, were observed in the patients of two groups and the clinical effect was compared between the two groups after treatment. After treatment, SFGS score was increased (P<0.05), H-B grade was improved (P<0.05), the latency was shortened in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude elevated (P<0.05) when compared with those before treatment in the two groups. In the observation group, SFGS score was higher (P<0.05), H-B grade was superior (P<0.05), the latency was shorter in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude was higher (P<0.05) when compared with those of the control group after treatment. After the completion of the first treatment, VAS score of either group was reduced in comparison with that before treatment (P<0.05), and the score in the observation group was lower than that of the control group (P<0.05). The duration of retroauricular pain was shortened in the observation group when compared with that of the control group (P<0.05). The total effective rate was 87.1% (27/31) in the observation group, which was higher than 77.4% (24/31) of the control group (P<0.05). The rTAS combined with EA is effective for reducing neurologic impairment of acute facial palsy and alleviating retroauricular pain in the patients.