Lateral Orbital Region Research Articles

Can exostoses of the external occipital protuberance and superior nuchal lines cause headache? A report of two cases

Compression of the occipital nerves can cause occipital headache. Several potential compression points have been identified along their course. One of these points is the hitherto undescribed instance of exostoses of anatomic structures of the occipital bone. A 34-year-old man with a prominent external occipital tuberance and superior nuchal lines complained of headache in the area of distribution of the greater occipital nerve with tenderness near the bony protrusion on palpation. A 44-year old woman experienced stabbing pain in the lateral orbital region with pressure on the ossified insertion of the ipsilateral trapezius muscle near the external occipital protuberance. Local nerve block achieved temporary relief of pain. Exostosis of the external occipital protuberance and superior nuchal lines may impinge on the greater and third occipital nerves. The characteristics of the pain in our cases differ in some aspects from those of occipital neuralgia.

Evaluation of Orbitomalar Region Projection in Patients With Operated Cleft Lip and Palate (Cephalometric Study).

The aim of this study was to compare the orbitomalar region projection in patients with cleft lip and palate (CLP) with skeletal class 1 cases. Retrospective. Single center. Cephalometric data of 52 cases with unilateral CLP, 25 cases with bilateral CLP, and 60 healthy participants in skeletal class 1 without CLP were included. A total of 5 parameters, 3 in the orbital and 2 in the suborbital region, that determine the projection of the orbitomalar region on lateral cephalograms, and 13 parameters of the craniofacial region were evaluated. Lateral, inferior, and anterior orbital parameters were similar between groups, while suborbital parameters were in a retrusive position in the CLP groups compared to the control group (P < .05). No significant difference was found between the CLP groups in terms of suborbital parameters. A moderate positive correlation was found between orbitomalar parameters and the anteroposterior positions of the maxilla and mandible. The lateral orbital region had a moderate negative correlation with anterior maxillary height, and the suborbital region had a negative moderate correlation with maxillary inclination. Suborbital projection was more retrusive in CLP compared to the control group, but no difference was found between the CLP groups. On the other hand, the correlation between orbitomalar projection and maxillary and mandibular development was significant. The results show that there is a need for alternative treatment modalities for the suborbital region in patients with CLP.

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis

A dermoid cyst with a draining sinus in the lateral orbital region

Abstract A 7-year-old girl presented with a small fistula in the right lateral orbital region since birth. Bacteremia developed from a local infection of the region at the age of 6 years and 10 months. The blind end of the fistula was a cyst located slightly cranial to the right frontozygomatic suture, and the region was accompanied by osseous concavity. Based on the present case and our literature search of reported cases, when this defect is suspected, it is important to identify its location and morphology using imaging techniques and perform early excision of the cyst.

Maxillary “All-On-Four” treatment using zygomatic implants. A mechanical analysis

Zygomatic implants may be used for dental rehabilitation in atrophic maxillae. The aim of this study was to establish experimentally the areas of stress distribution using 2 kinds of "All-On-Four" maxillary procedures. The best position to insert the implants was selected using polyurethane craniomaxillary models and surgical guides were made. Group 1 was designed with two posterior zygomatic implants and two conventional anterior implants, and group 2 with two posterior zygomatic implants and two anterior zygomatic implants. A titanium bar was built to link the 4 implants in both groups. Photoelastic replicas of these models were made and the implants were inserted using the surgical guides. An Instrom 4411 testing machine was used to perform a unilateral compressive loading at the level of the right first molar until 2mm of displacement was obtained. Group 1 showed a high strain concentration in the right lateral orbital region at the level of the apex of the zygomatic implant. Less strain was noticed at the apical levels of the conventional implants in the anterior sector and of the contralateral zygomatic implant. Group 2 showed high strains in the lateral inferior orbital area. The load was low in the alveolar bone sector. Zygomatic bone and paranasal structures are loaded at high levels when zygomatic implants are used to stabilize a full maxillary prosthodontic rehabilitation on 4 implants. The use of 4 zygomatic implants loads the alveolar bone to a lower extent and seems better suited from a mechanical point of view than the use of 2 zygomatic implants.

Modified Lateral Orbitotomy Approach

Lateral orbitotomy is a well-known approach in the surgical management of lesions in the lateral orbital regions. It is still appropriate for laterally situated tumors, although contemporary cranial base approaches were defined and developed within the last decades. The extent of lateral orbitotomy should depend on the size, consistency, and nature of the lesion for easy surgical removal and reconstruction thereafter. In this regard, contrast-enhanced computed tomographic scans provide useful information for operative strategy. Although there is a wide range of histopathologic diagnosis for orbital tumors, lateral orbitotomy is a safe approach, particularly if the lesions are extraconal. We present a case of pleomorphic adenoma of lacrimal gland managed by a modified lateral orbitotomy approach with pleasing results.

Full-Thickness Eyelid Reconstruction Using Orbicularis Oculi Musculocutaneous Flap Raised From Lateral Orbital Region

Among many methods to reconstruct a full-thickness eyelid defect, we have applied a new design of orbicularis oculi musculocutaneous flap for the anterior wall reconstruction in 7 cases. In all cases, flap survived without any complications. In the design proposed in the article, the flap was raised from the lateral orbital region and the pivot point was placed around the lateral canthus. The method was considered to be safe, easy, and reliable, and at the same time, effective in minimizing the donor site morbidity.

Neural substrates of spontaneous musical improvisation.

To investigate the neural substrates that underlie spontaneous musical performance, functional MRI was used to study improvisation in professional jazz pianists. The purpose of the study was to identify the neural substrates that give rise to spontaneous musical creativity, defined as the immediate, on‐line improvisation of novel melodic, harmonic, and rhythmic musical elements within a relevant musical context. It was hypothesized that spontaneous musical improvisation would be associated with discrete changes in prefrontal activity that provide a biological substrate for actions that are characterized by creative self‐expression in the absence of conscious self‐monitoring. By employing two paradigms that differed widely in musical complexity, it was found that improvisation (compared to production of over‐learned musical sequences) was consistently characterized by a dissociated pattern of activity in the prefrontal cortex: extensive deactivation of dorsolateral prefrontal and lateral orbital regions wi...

Full-thickness reconstruction of the eyelid with rotation flap based on orbicularis oculi muscle and palatal mucosal graft: Long-term results in 12 cases

Numerous techniques have been proposed for full-thickness eyelid reconstruction. Previously, we reported full-thickness eyelid reconstruction with a rotation flap based on the orbicularis oculi muscle and palatal mucosal graft. Here, we report long-term results in 12 cases. After confirmation of defect size, the mucosal defect was covered with a split-thickness palatal mucosal graft. The rotation flap was elevated at the lateral orbital region and the skin defect was covered. Seven cases were reconstructions after tumour excision and five cases were for lagophthalmos after trauma. In cases of tumour excision, five cases had full defects of the lower eyelid and two cases had defect of the lower eyelid lateral to the punctum. In the cases of lagophthalmos, four cases had upper eyelid contracture and one had lower eyelid contracture. Postoperatively, one case showed severe venous congestion of the flap, which led to scleral show. In the other 11 cases, there were no complications, and cosmetic results were excellent. With our method, cosmetically good results can be obtained in either upper or lower eyelids. In the rotation flap based on the orbicularis oculi muscle, the undermined area is small, invasion is minimal, and the effects of scar contracture can be minimised. Minimal shrinkage of palatal mucosal grafts prevents the reconstructed eyelid from sagging. In only one case, poor design of the flap led to flap congestion. However, this complication can be avoided with the proper design.

Neural Substrates of Spontaneous Musical Performance: An fMRI Study of Jazz Improvisation

To investigate the neural substrates that underlie spontaneous musical performance, we examined improvisation in professional jazz pianists using functional MRI. By employing two paradigms that differed widely in musical complexity, we found that improvisation (compared to production of over-learned musical sequences) was consistently characterized by a dissociated pattern of activity in the prefrontal cortex: extensive deactivation of dorsolateral prefrontal and lateral orbital regions with focal activation of the medial prefrontal (frontal polar) cortex. Such a pattern may reflect a combination of psychological processes required for spontaneous improvisation, in which internally motivated, stimulus-independent behaviors unfold in the absence of central processes that typically mediate self-monitoring and conscious volitional control of ongoing performance. Changes in prefrontal activity during improvisation were accompanied by widespread activation of neocortical sensorimotor areas (that mediate the organization and execution of musical performance) as well as deactivation of limbic structures (that regulate motivation and emotional tone). This distributed neural pattern may provide a cognitive context that enables the emergence of spontaneous creative activity.

Myobloc for facial wrinkles

During the past decade, the injection of neuromuscular blocking agents produced by the anaerobic spore-forming bacterium Clostridium botulinum exotoxin has become one of the most popular therapeutic options for reducing or eliminating facial wrinkles, especially those in the glabellar area, forehead, and lateral orbital regions (crow’s feet). In December of 2000, the Food and Drug Administration approved the use of Botulinum toxin type B (BoNT-B; Myobloc) in the United States for the treatment of cervical dystonia. Off-label use of BoNT-B also has occurred subsequent to Food and Drug Administration approval, with facial wrinkles as the typical indication. There is a dearth of research in the literature assessing the efficacy and safety of BoNT-B for this purpose but, like Botulinum toxin type A (BoNT-A; Botox), local intradermal injection of BoNT-B appears to enhance dynamic facial wrinkles by inducing chemical dernervation of striated muscle, leading to temporary flaccid paralysis. This article reviews a pilot study involving the use of Botulinum type B for the treatment of facial wrinkles. The efficacy, safety, and duration of Myobloc is discussed.

Regional Frontal Cortical Volumes Decrease Differentially in Aging: An MRI Study to Compare Volumetric Approaches and Voxel-Based Morphometry

Recent neuroimaging studies suggest that the frontal lobes are the part of the brain most profoundly affected by the aging process. The present study investigated whether subregions within the frontal cortex show different patterns of brain aging. Magnetic resonance images of 57 healthy participants between 21 and 81 years old were used to measure regional frontal gray matter volumes in three ways: a manual tracing method, a semiautomatic “Talairach boxes” volumetric method, and voxel-based morphometry. Seven regions within each hemisphere were manually traced: precentral gyrus, inferior frontal gyrus, dorsolateral frontal cortex, ventral medial region, lateral orbital region, anterior cingulate, and frontal pole. With the semiautomatic approach, four regions were measured: lateral, orbital, and medial frontal regions and frontal pole. Advancing age was strongly associated with decreases in the volume of the whole frontal cortex. Differential age effects on the volumes of frontal subregions were dependent on the method applied. According to the manual approach, age-related volume decreases were strongest in the lateral and orbital frontal gray matter. The semiautomatic and voxel-based analyses found that age effects were most prominent within the lateral frontal and cingulate regions. Overall, it was concluded that although semiautomated and voxel-based methods can provide a reasonable estimate of regional brain volume, they cannot serve as a substitute for manual volumetry.

Regional Frontal Cortical Volumes Decrease Differentially in Aging: An MRI Study to Compare Volumetric Approaches and Voxel-Based Morphometry

Recent neuroimaging studies suggest that the frontal lobes are the part of the brain most profoundly affected by the aging process. The present study investigated whether subregions within the frontal cortex show different patterns of brain aging. Magnetic resonance images of 57 healthy participants between 21 and 81 years old were used to measure regional frontal gray matter volumes in three ways: a manual tracing method, a semiautomatic “Talairach boxes” volumetric method, and voxel-based morphometry. Seven regions within each hemisphere were manually traced: precentral gyrus, inferior frontal gyrus, dorsolateral frontal cortex, ventral medial region, lateral orbital region, anterior cingulate, and frontal pole. With the semiautomatic approach, four regions were measured: lateral, orbital, and medial frontal regions and frontal pole. Advancing age was strongly associated with decreases in the volume of the whole frontal cortex. Differential age effects on the volumes of frontal subregions were dependent on the method applied. According to the manual approach, age-related volume decreases were strongest in the lateral and orbital frontal gray matter. The semiautomatic and voxel-based analyses found that age effects were most prominent within the lateral frontal and cingulate regions. Overall, it was concluded that although semiautomated and voxel-based methods can provide a reasonable estimate of regional brain volume, they cannot serve as a substitute for manual volumetry.

Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus.

Description of the surgical anatomy of the superficial fascia of the face must include its deep attachments. These attachments have been mapped out for the forehead, temple, and cheek as retaining ligaments. The deep attachments of the orbicularis oculi of the lower lid and lateral canthus have long been recognized in canthopexy surgery but have yet to be properly defined. Six fresh cadavers were dissected with histologic support, and the results were correlated with surgical observations. The fascia of the deep aspect of the orbicularis is attached to the periosteum of the orbital rim by an orbicularis retaining ligament. This attachment is weakest centrally and tightest over the inferolateral orbital rim. The retaining ligament fuses with an expanded fibrous attachment beyond the lateral canthus, the lateral orbital thickening, which extends over the lateral orbital rim onto the adjacent deep temporal fascia. Aging changes are associated with attenuation of the ligamentous support provided by the orbital thickening and the orbicularis retaining ligament, which then allows inferior displacement of the lower boundary of the lid and contributes to the typical effects of age in this region. The superficial fascia of the lateral orbital region has a continuous connective tissue structure linking the temporoparietal fascia and orbicularis fascia to the lateral canthal tendon by means of the tarsal plate connection. Release of the deep ligamentous attachments (lateral orbital thickening and orbicularis retaining ligament) of the orbicularis fascia is important in some canthopexy and in rejuvenation procedures. The release allows effective redraping and upward mobilization of the orbicularis of the lower lid and the premalar soft tissues.

The periosteal hinge flap in the subperiosteal cheek-lift

The ability to effectively correct the aging of the midface has been substantially improved with the use of a subperiosteal approach. The pioneering work in this area has focused on elevation of the midface while minimizing possible complications related to lower eyelid malposition. Because the face ages in a vertical direction, attempts to correct the clinical findings in the aging face have focused on procedures that created vertical lift to reposition the midface soft tissues at a more youthful level. It was this concept that stimulated the periosteal hinge flap as a method of reliably suspending the midface vertically. Combined with procedures to minimize lower lid retraction, this technique has produced substantial midface rejuvenation while minimizing possible sequelae and complications related to the lower eyelid and lateral orbital region. Fixation of the inferior retinaculum of the lateral canthal tendon in the form of a canthopexy, or a canthoplasty, has provided a reliable means of stabilizing the lower lid while minimizing the variables encountered in a more complicated canthoplasty.

Sensitivity of a method for the analysis of facial mobility. II. Interlandmark separation.

This study demonstrates a method of quantifying facial movements based on distortions of the skin surface. Landmarks were identified on the faces of five healthy human subjects (2 men and 3 women; mean age, 27.6 years; range, 26 to 29 years), and the distortions were characterized by changes in the separation between 20 pairs of landmark distances during specific maximal facial animations: smile, lip purse, cheek puff, grimace, eye closure, and eye opening. Data were recorded with a video-based tracking system for a period of 3 seconds at a sampling rate of 60 Hz or frames per second. For each subject, we analyzed the change in the separation of 20 pairs of landmarks, of which the majority were bilaterally symmetrical and functionally active. Characteristic patterns of movement emerged for each animation. We found that smiling involved movements of the lateral orbital, circumoral, and chin regions; grimacing involved the inner orbital, lateral orbital, lateral nasal, and upper-lip regions; eye closure involved the inner orbital, lateral orbital, and, to a lesser degree, lateral nasal regions; eye opening involved the inner and lateral orbital regions; cheek puffing involved the cheek and lower-lip regions; and the lip purse animation involved the nasolabial, cheek, commissure, and lip regions. This measurement of distortion provided a quantitative estimate of facial movement, and this approach is especially applicable to patients with unilateral problems in which the patient can serve as his or her own control.

Reciprocal functional connections of the olfactory bulbs and other olfactory related areas with the prefrontal cortex

Reciprocal putative connections of the prefrontal cortex (PFC) (agranular insular, ventral and lateral orbital region) with the ipsi and contralateral main olfactory bulb (IOB; COB), the mediodorsal thalamic nucleus (MD), the basolateral amygdaloid nucleus (BLA) and the piriform cortex (PC) were investigated with electrophysiological techniques. Evoked field responses and orthodromic unit driving, generated in PFC following electrical stimulation of the above mentioned structures, were abolished following topical application of KCl, except for COB evoked mass potentials. Thus, locally generated activity was elicited in agranular insular cortex following IOB activation, the same region where recently, the taste cortex in the rat was localized. Since gustatory-visceral afferent information reaches insular cortex via 2–3 synaptic relays, autonomie, olfactory and gustatory inputs may interact at this level, and, as suggested previously for the mouse, play a key integrative role in flavor perception. Antidromically invaded neurons, 47% of which were identified by the collision-extinction technique, were also found in PFC areas which overlapped to a considerable extent with those from which orthodromic unit responses were obtained. In particular, closely spaced neurons in ventrolateral orbital (VLO) and lateral orbital (LO) regions were antidromically invaded following IOB and PC shocks: some neurons antidromically discharged by IOB were also transsynaptically activated following PC stimulation. These findings are in agreement with recent neuroanatomical studies which demonstrate axonal projections from PFC neurons to the IOB and COB in the rat and South American armadillo. In addition, stimulation of PFC regions dorsal to the rhinal fissure mostly inhibited spontaneous unit discharges recorded at the mitral cell layer of the IOB, suggesting that this effect may be partially mediated by excitatory inputs of prefrontal axons onto granule cells. The conduction properties, antidromic thresholds and activity-dependent variations in conduction velocity (CV) of bulbopetal neurons in prefrontal cortex were found to be similar to those exhibited by cells projecting to the IOB from olfactory peduncle regions, but not to those present in bulbopetal neurons of the horizontal limb of diagonal band, indicating that the OB may be subjected to centrifugal control by at least two cell groups differing in both histochemical and electrophysiological properties.

Insula of the old world monkey. II: Afferent cortical input and comments on the claustrum.

The afferent connections of the insula in the rhesus monkey were studied with axonal transport methods. Injections of horseradish peroxidase (HRP) in the insula revealed labeled neurons in the prefrontal cortex, the lateral orbital region, the frontoparietal operculum, the cingulate gyrus and adjacent medial cortex, the prepiriform olfactory cortex, the temporal pole, the cortex of the superior temporal sulcus, the rhinal cortex, the supratemporal plane, and the posterior parietal lobe. Tritiated amino acid (TAA) injections in some of the cortical regions which contained retrogradely labeled neurons confirmed projections to the insula from prefrontal granular cortex, orbital frontal cortex, prepiriform cortex, temporal pole, rhinal cortex, cingulate gyrus, frontal operculum, and parietal cortex. In these studies, cortical areas that projected to the insula also projected to the claustrum. However, the topographic and quantitative relationships between the projections into the insula and those into the claustrum were inconsistent. Moreover, the claustrum has additional connections which it does not share with the insula. A selected review of the literature suggests that the claustrum and insula differ widely also with respect to ontogenesis and functional specialization.