Facial Muscles Research Articles

Blink reflex excitability in patients with Hemifacial spasm exhibiting different abnormal discharge patterns: from early isolated discharges to later grouped bursts or tonic spasms.

We studied blink reflex (BR) and BR excitability recovery (BRER) in patients with hemifacial spasm (HFS) exhibiting different abnormal discharge patterns. We hypothesized that patients with groups of clonic or tonic burst activities appear later in the disease course and may have more excitability of the BR circuit at the brainstem compared to patients with isolated twitchings, which occur earlier. We included 124 patients with botulinum toxin-naive HFS (mean age 50.6 ± 13.3years) and 40 healthy subjects. We performed surface polymyography on facial muscles in patients and classified them according to the abnormal discharge pattern: isolated discharges, grouped bursts forming random sequences, tonic spasms, and a combination of these activities. Then, we recorded BR and BRER at 200, 600, and 1000ms interstimulus intervals. We compared disease duration, R1 and R2 latencies, R2 area-under-the-curve (AUC), and BRER% (i) between healthy subjects and patients and (ii) among groups of patients with different abnormal discharge patterns. There were isolated discharges in 28 patients, grouped bursts forming random sequences in 42, and continuous muscle activity with tonic spasms in one. The remaining patients had combinations. Mean R1 and R2 latencies were significantly longer, and mean R2 AUC was significantly higher on the symptomatic side of patients compared to healthy subjects. The mean BRER was enhanced on both sides in patients than in healthy subjects (p < 0.001). However, it was similar among patient groups with different abnormal discharge patterns (p > 0.05). The mean disease duration in patients with isolated discharges was shorter (3.3 ± 2.0years) than those with grouped bursts or tonic spasms (p = 0.002; Kruskal-Wallis test). Our study observed that excitability at the brainstem was similar in HFS patients with different abnormal discharge patterns, suggesting that the difference in discharge patterns in HFS may be due to a reason other than the difference in BR excitability.

Heightened facial muscle reactivity in preadolescent girls with pathological anxiety

AbstractObjectivesAnticipatory anxiety and heightened responses to uncertainty are central features of anxiety disorders (ADs) that contribute to clinical impairment. Anxiety symptoms typically emerge during childhood, and even subthreshold‐AD symptoms are associated with distress and risk for future psychopathology. This study compared facial emotional response to threat and uncertainty between preadolescent girls with ADs, girls with subthreshold‐AD symptoms, and controls.MethodsFacial emotional responding was characterized in preadolescent girls (age 8–11) with a range of anxiety symptoms: no/low anxiety (controls, n = 41), subthreshold‐AD (n = 73), and DSM‐5 diagnoses of separation, social, and/or generalized ADs (n = 45). A threat anticipation paradigm examined how image valence (negative/neutral) and image anticipation (uncertain/certain timing) impacted activity of the corrugator supercilii, a forehead muscle implicated in the “frown” response that is modulated by emotional stimuli (negative &gt; neutral). Corrugator magnitude and corrugator timecourse were compared between groups.ResultsFindings demonstrate greater corrugator activity during anticipation and viewing of negative stimuli, as well as increased corrugator reactivity in subthreshold‐AD and AD girls. Timecourse analyses of negative versus neutral stimuli revealed that AD and subthreshold‐AD girls had greater uncertainty‐related increases in corrugator activity compared to controls.ConclusionResults extend the physiological characterization of childhood pathological anxiety, highlighting the impact of subthreshold‐AD symptoms.

The effect of progressive muscle relaxation education on the quality of sleep in elderly people with hypertension at the South Cilacap Community Health Center

Background: The elderly experience a decreased sleep phase as a result of poor sleep, meaning that they tend to be restless and easily awakened, which can interfere with sleep quality. It can result in physical tension, which affects the increase in blood pressure. Progressive muscle relaxation therapy can improve sleep quality and control tension and anxiety by training patients to consciously relax their body muscles. Purpose: To analyze the effect of progressive muscle relaxation education on the quality of sleep in elderly people with hypertension at the South Cilacap Community Health Center. Methods: This research was conducted on elderly people with hypertension at the South Cilacap Community Health Center using a quasi-experimental research design with a non-equivalent control group design. Simple random sampling was used with a total of 46 respondents. The data were analyzed using a T-test. Results: The results of the study found an increase in the average score on the sleep quality scale, and after progressive muscle relaxation education, the intervention group found a mean pre-test score of 15.57 and in the post-test section a mean score of 5.57. In the control group, the pre-test had a mean value of 14.52, and in the post-test section, the mean value was 12.70. and the results of further analysis of the independent t-test between the intervention group and the control group showed p = 0.000. Conclusion: There was an effect of progressive muscle relaxation therapy on the sleep quality of elderly people in the intervention group among elderly people with hypertension at the South Cilacap Community Health Center. There was a significant difference in the average PSQI score in the post-test measurements of both the intervention and control groups. Progressive muscle relaxation is an alternative therapy designed to reduce muscle tension, which can then relax muscles ranging from facial muscles to leg muscles

Facial Surface Electromyography: A Novel Approach to Facial Nerve Functional Evaluation after Vestibular Schwannoma Surgery.

Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.

Deep learning strategies with CReToNeXt-YOLOv5 for advanced pig face emotion detection.

This study underscores the paramount importance of facial expressions in pigs, serving as a sophisticated mode of communication to gauge their emotions, physical well-being, and intentions. Given the inherent challenges in deciphering such expressions due to pigs' rudimentary facial muscle structure, we introduced an avant-garde pig facial expression recognition model named CReToNeXt-YOLOv5. The proposed model encompasses several refinements tailored for heightened accuracy and adeptness in detection. Primarily, the transition from the CIOU to the EIOU loss function optimized the training dynamics, leading to precision-driven regression outcomes. Furthermore, the incorporation of the Coordinate Attention mechanism accentuated the model's sensitivity to intricate expression features. A significant innovation was the integration of the CReToNeXt module, fortifying the model's prowess in discerning nuanced expressions. Efficacy trials revealed that CReToNeXt-YOLOv5 clinched a mean average precision (mAP) of 89.4%, marking a substantial enhancement by 6.7% relative to the foundational YOLOv5. Crucially, this advancement holds profound implications for animal welfare monitoring and research, as our findings underscore the model's capacity to revolutionize the accuracy of pig facial expression recognition, paving the way for more humane and informed livestock management practices.

First Evidence of Cutaneous Remodelling Induced by Synchronized Radiofrequency Aided by High-Intensity Facial Muscle Stimulation: Porcine Animal Model.

The quality of one's facial appearance diminishes with aging as skin and underlying soft tissues deteriorate. Connective tissue and musculofascial degeneration leads to skin laxity and wrinkles developing. To evaluate the effects of synchronized radiofrequency with high intensity facial stimulation technology on dermal collagen and elastin fibers in a porcine model. Eight sows were divided into Active (N = 6) and Control (N = 2) groups. Synchronized radiofrequency and high intensity facial stimulation were delivered to the ventrolateral abdomen. The Active group received four 20-minute treatments, once a week. Control group was untreated. Skin biopsy sample were histologically analyzed for connective tissue changes pre- and post-treatment. Data were analyzed statistically (α = 0.05). In the Active group: the collagen-occupied area at baseline was 1.12 ± 0.09 × 106 μm 2 and increased by +19.6% ( p < .001) at 1-month and by +26.3% ( p < .001) 2 months post-treatment; elastin-occupied area at baseline was 0.11 ± 0.03 × 106 μm 2 and increased by +75.9% ( p < .001) at 1-month and +110.8% ( p < .001) at 2-months follow-up. No significant changes ( p > .05) found in the Control samples. Collagen and elastin fiber content increased significantly after treatments. Connective tissue in the treatment area was denser up to 2-months post-treatment.

Characteristics of Neurological Deficits in Intracranial Tumors: A Literature Review

Intracranial tumors or brain tumors are abnormal masses in the cranium that can originate from central nervous system cells or from other histopathological types. Brain tumors account for 85% to 90% of all primary central nervous system (CNS) tumors. Intracranial tumors have an incidence of 10-17 cases per 100,000 people. Clinical symptoms vary from one patient to another. The most common symptom is headache, followed by seizures, decreased consciousness, and motor and sensory neurological deficits. Other symptoms that may be found are neurological deficits (smell disturbances, visual disturbances, double vision, numbness or pain in the face, facial muscle weakness, hearing, swallowing, etc.) which are progressive and depend on the location of the tumor, seizures, cognitive decline, balance disorders and personality disorders. These signs and symptoms can be used to determine the location of the tumor before radiological investigations are carried out, according to the disturbed anatomical structure. Keywords: intracranial tumors, neurological deficits, supratentorial, infratentorial, suprainfratentorial

Objective Assessment of the Repeated Botox Treatment to the Synkinesis of Facial Paralysis by the Integrated Electromyography.

The widely used botox type A (BTX-A) is effective against synkinesis in facial palsy sequelae. Repeated injections are necessary and permanent improvements have been reported. We objectively evaluated the changes in synkinesis at >6 months after BTX-A injection, including changes over time with the number of administrations. In 48 patients who received multiple BTX-A injections, evaluation by the Sunnybrook Facial Grading System (FGS) and integrated electromyography (iEMG) was performed before treatment and at least 6 months after the first, second, and third BTX-A injection. The iEMG ratio on the affected and healthy sides was calculated for each mimetic muscle and mimic motion. There was no significant difference in the FGS synkinesis score before treatment and after the third injection, although an improvement was observed. The iEMG ratio was significantly improved in the orbicularis oculi with open-mouth smile and lip pucker after the third dose compared to before treatment. The orbicularis oris showed a significant improvement when the eyelids were closed, while the platysma showed a significant improvement when the eyelids were closed and when the lip was pursed. Multiple regression analysis revealed that the orbicularis oculi and platysma had a greater effect on the iEMG ratio for the number of treatments than other factors. Repeated BTX-A injections showed improvements in synkinesis for the orbicularis oculi, orbicularis oris, and platysma, even after >6 months, compared to before treatment.

A Fusion Algorithm Based on a Constant Velocity Model for Improving the Measurement of Saccade Parameters with Electrooculography.

Electrooculography (EOG) serves as a widely employed technique for tracking saccadic eye movements in a diverse array of applications. These encompass the identification of various medical conditions and the development of interfaces facilitating human-computer interaction. Nonetheless, EOG signals are often met with skepticism due to the presence of multiple sources of noise interference. These sources include electroencephalography, electromyography linked to facial and extraocular muscle activity, electrical noise, signal artifacts, skin-electrode drifts, impedance fluctuations over time, and a host of associated challenges. Traditional methods of addressing these issues, such as bandpass filtering, have been frequently utilized to overcome these challenges but have the associated drawback of altering the inherent characteristics of EOG signals, encompassing their shape, magnitude, peak velocity, and duration, all of which are pivotal parameters in research studies. In prior work, several model-based adaptive denoising strategies have been introduced, incorporating mechanical and electrical model-based state estimators. However, these approaches are really complex and rely on brain and neural control models that have difficulty processing EOG signals in real time. In this present investigation, we introduce a real-time denoising method grounded in a constant velocity model, adopting a physics-based model-oriented approach. This approach is underpinned by the assumption that there exists a consistent rate of change in the cornea-retinal potential during saccadic movements. Empirical findings reveal that this approach remarkably preserves EOG saccade signals, resulting in a substantial enhancement of up to 29% in signal preservation during the denoising process when compared to alternative techniques, such as bandpass filters, constant acceleration models, and model-based fusion methods.

Penatalaksanaan Fisioterapi Pada Kasus Bell’s Palsy Sinistra et Causa Diabetes Melitus Dengan Kombinasi Modalitas Electrical Stimulation Facialis dan Mirror Exercise

Bell's palsy is a problem with the cranial nerve in the face idiopathically without being accompanied by other neurological diseases, this has an impact on one-sided facial paralysis. Of the 126 patients who experienced bell's palsy 39% of them had diabetes mellitus. Diabetes mellitus correlates with the presence of microangiopathy due to failure of vasa nervosum microcirculation which has the potential to worsen the condition of bell's palsy patients. The combination of electrical stimulation facialis and mirror exercise treatment is performed on bell's palsy sinistra patients to accelerate recovery. The method of obtaining information related to the patient's condition through observation, interviews, medical records and then providing appropriate treatment. The purpose of this study was to determine the effectiveness of electrical stimulation facialis and mirror exercise treatment in bell's palsy patients. The results obtained increased facial muscle strength T1, T2, T3 in bell's palsy patients. Evaluation of functional effectiveness also increased T1: 66, T2: 81, T3 : 88. This treatment is considered capable of accelerating recovery in patients with bell's palsy.

A tradeoff evolution between acoustic fat bodies and skull muscles in toothed whales

Toothed whales have developed specialized echolocation abilities that are crucial for underwater activities. Acoustic fat bodies, including the melon, extramandibular fat body, and intramandibular fat body, are vital for echolocation. This study explores the transcriptome of acoustic fat bodies in toothed whales, revealing some insight into their evolutionary origins and ecological significance. Comparative transcriptome analysis of acoustic fat bodies and related tissues in a harbor porpoise and a Pacific white-sided dolphin reveals that acoustic fat bodies possess characteristics of both muscle and adipose tissue, occupying an intermediate position. The melon and extramandibular fat body exhibit specific muscle-related functions, implying an evolutionary connection between acoustic fat bodies and muscle tissue. Furthermore, we suggested that the melon and extramandibular fat body originate from intramuscular adipose tissue, a component of white adipose tissue. The extramandibular fat body has been identified as an evolutionary homolog of the masseter muscle, supported by the specific expression of MYH16, a pivotal protein in masticatory muscles. The intramandibular fat body, located within the mandibular foramen, shows possibilities of the presence of several immune-related functions, likely due to its proximity to bone marrow. Furthermore, this study sheds light on leucine modification in the catabolic pathway, which leads to the accumulation of isovaleric acid in acoustic fat bodies. Swallowing without chewing, a major toothed whale feeding ecology adaptation, makes the masticatory muscle redundant and leads to the formation of the extramandibular fat body. We propose that the intramuscular fat enlargement in facial muscles, which influences acoustic fat body development, is potentially related to the substantial reorganization of head morphology in toothed whales during aquatic adaptation.

Bell’s palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis

BackgroundMucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell’s palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve.Case presentationA 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient’s vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell’s palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa.ConclusionFungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell’s palsy.

Schwartz-Jampel Syndrome Type-1: Compound Heterozygosity of Two Novel Variants.

Schwartz-Jampel Syndrome (SJS) type-1 (OMIM; #255800), a rare cause of skeletal dysplasia, is characterized by myotonic myopathy, chondrodystrophy, short stature, facial and eye abnormalities. SJS Type-1 develops due to variations in the HSPG2 gene which produces the "perlecan" molecule, one of the main proteoglycans of the basement membrane. A 6-year-old girl presented with short stature, a mask face, shrunken lips, narrow palpebral opening due to blepharospasm, stiffness of facial muscles, micrognathia, overlapping teeth, a short neck, and a bell-shaped thorax due to myotonic myopathy. She was diagnosed with SJS type-1 due to compound heterozygosity of two novel variations in the HSPG2 gene. In patients with short stature and an accompanying myotonic myopathy SJS should be considered. Compound heterozygosity may cause typical clinical findings of SJS. In case of suspicion creatinine kinase levels can be measured, and the determination of myotonia may require evaluation with electromyography. Once the diagnosis is made, patients should be carefully monitored in terms of growth, neuromuscular disorders, joints problems and bone health.

Enhancing image-based facial expression recognition through muscle activation-based facial feature extraction

This article introduces a non-intrusive method to estimate facial muscle activity from images, diverging from conventional electrode-based approaches. Our methodology capitalizes on an inclusive set of features encompassing a diverse range of facial muscles, often overlooked in research, thus significantly expanding the scope of analyzing muscle activity within facial expressions. Our method is based on the standard 68-point face landmark and extends it by identifying the interactions of these muscles when a person performs a specific facial expression. These interactions are recorded in a feature vector, which is used by three classifiers, Linear Discriminant (LD), Support Vector Machine (SVM) and Multi-layer Perceptron (MLP) to classify six facial expressions (anger, disgust, fear, happiness, neutrality, and sadness). The method’s validation is conducted with three databases: FACES, KDEF, and JAFFE. These databases present different challenges; the first contains faces of individuals from three age ranges and both genders displaying facial expressions. On one hand, the KDEF database contains images of both genders but only within the range of young adults, whereas JAFFE comprises solely female faces. Additionally, JAFFE presents another drawback, representing only 10% of the images contained in FACES. In all these cases, our method yields excellent results, occasionally achieving 100% classification, especially in the young category. It is also noteworthy that the best results were obtained in the classification of facial expressions in female faces, suggesting that women tend to be more expressive. The method was thoroughly evaluated, and the results demonstrate the robustness of the approach, showcasing its good performance across three different databases and also for faces of individuals across various age groups. Numerical metrics, including accuracy, precision, recall, and F1 score, are presented along with confusion matrices.

REFLEXOTHERAPY IN THE COMPLEX REHABILITATION OF FACIAL NEUROPATHY

Abstract. The article is devoted to one of the urgent problems of neurology – neuropathy of the facial nerve. Combined treatment of neuropathy of the facial nerve with reflexotherapy methods has been used for a long time, mainly when there is a delay in the recovery of its functions, primarily, the motor functions of facial muscles. The article also outlines the main theoretical principles of the “balancing hexagrams” technique and its practical implementation. A clinical case is also presented: neuropathy of the facial nerve with a delayed course. The methods of acupuncture diagnostics are described, the description of acupuncture correction is given, and the features of the “favorable” hexagram are considered. Purpose. To consider the peculiarities of the use of reflexology by the method of “balancing hexagrams” in the complex rehabilitation of neuropathy of the facial nerve with a delayed course. Scientific novelty. For the first time in our country, the method of compiling acupuncture prescriptions and acupuncture using the method of “balancing hexagrams” was used in the complex rehabilitation of neuropathy of the facial nerve with a slow course. Methods. We consider one clinical case of the use of reflexotherapy using the method of “balancing hexagrams” in complex rehabilitation of neuropathy of the facial nerve with a slow course. Methods of clinical objective neurological examination, syndromic diagnosis method of traditional Chinese medicine, pulse diagnosis method, and tongue diagnosis method were used. Results. As a result of the treatment using the “balancing hexagrams” method, the patient's condition improved: there was an 80% recovery of facial muscle function on the left side (clinically, which is confirmed by electroneuromyography data). Conclusions: 1. Neuropathy of the facial nerve with a protracted course occurs in the practice of a neurologist and a reflexologist. 2. In the combined treatment measures for neuropathy of the facial nerve with a protracted course, the use of the reflexotherapy method “balancing hexagrams” can be effective.

Pattern of Clinical Profile and Outcome of Gillian Barre Syndrome in Sudanese Patients

Introduction: Guillian Barre'-Syndrome (GBS) is an acute, autoimmune disease affecting spinal roots and peripheral nerves, characterized by a rapidly progressive, ascending weakness of the extremity, trunk and even respiratory and facial muscles and with minor sensory and autonomic dysfunction. As in Sudan there is no enough data regarding the pattern of presentation and outcome of GBS, our research aimed to study clinical profile, electrophysiological variant, and outcome of Sudanese patients diagnosed with (GBS). Methods: A multi centers cross-sectional hospital-based study conducted in Khartoum from March to September 2020, 62 patients enrolled in the study, structured questionnaire consists of personal data, clinical history, examination findings, electrophysiological study result, management and outcome is used to assess the clinical profile and outcome of the disease. Results: The study revealed that males and females are equally represented, 70% patients are between 18 years and 50 years. The onset of the weakness was less than or equal 3 days in 33.9% of patients, from 4 to 7 days in 41.9%, from 8 to 14 days in 11.3% and above 14 days in 12.9%.40.3% patients had Evidence of autonomic dysfunction. The majority of patients presented with weakness that started in the lower limbs (93.5%), in (4.8%) the weakness started in the upper limbs and then descend. In (1.6%) the weakness started in the pharyngeal and respiratory muscles from the start. Sensory complains were observed in 54 patients (87.1%), 3 patients (4.8%) developed urinary bladder incontinence and 36 patients (58.1%) had back pain at the onset of the disease. On clinical examination; (98.4%) of patients had absent reflexes, (35.5%) had bilateral facial nerve palsy and (4.8%) had unilateral facial nerve pals. Based on the electrophysiological studies, (37.09 %) were recorded as acute motor axonal neuropathy (AMAN), (29.03%) as acute inflammatory demyelinating poly neuropathy (AIDP) and (29.03%) as acute motor-sensory axonal neuropathy (AMSAN). Regarding the outcome, 30 patients (48.4%) fully recovered, 25 patients (40.3%) recovered with motor deficit, and 7 patients (11.3%) unfortunately died. Conclusion: This study concluded that Guillian Barre'-Syndrome (GBS) in Sudanese population mainly affects age group from 18 to 50 years with variable maximum onset of weakness, presentation and outcome. Lower limb weakness and absent reflexes were the most presenting features. NCS showed axonal type of GBS found to be in nearly 66% of patients and 40% showed clinical evidence of dysautonomia.

Oral health and healthy ageing: a scoping review

BackgroundGood oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.MethodsA systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O’Malley’s scoping review framework.ResultsThe findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.ConclusionThere is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Advanced Injection of Botulinum Toxin in the Nasal Muscles: A Novel Dynamic Change in Facial Expression.

Among the nasal muscles, the levator labii superior alaeque nasi (LLSAN) acts as a transitional muscle that conjugates with other nasal and perinasal muscles. Thus, when treating the nasal region with Botulinum toxin (BTX), it is important to understand local nasal muscular dynamics and how they can influence the muscular dynamics of the entire face. This is a retrospective analysis of cases treated by an injection pattern encompassing the face, including nasal muscles. Photographs were taken at rest and during motion (frontal and oblique views), before and after treatment. A total of 227 patients have been treated in the last 18months with the following results: eyebrow tail lifting, softness of crow's feet, improvement of the drooping of the tip of the nose, and shortening of the lip philtrum when smiling. We present cases illustrating the use of this approach. Treating the facial muscles globally (including the frontal, corrugators, procerus, orbicularis oculi, platysma, DAO, and nasal muscles) can improve the smile and facial expressions. This is believed to occur because the elevated portion of the upper lip muscle becomes stronger as the nasal part of the LLSAN is paralyzed. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Facial Paralysis Treatment Using Selective Neurectomy: A Comprehensive Review.

Facial paralysis can affect patients undergoing full mouth rehabilitation, regardless of what caused their paralysis. A procedure known as modified selective neurectomy of the facial nerve can enhance the movement of facial muscles in individuals with facial synkinesis safely and effectively. This approach is proposed as an alternative to more invasive surgical options when used independently as a treatment for incomplete facial palsy. Selective neurectomy offers a promising surgical option for managing nonflaccid facial paralysis and synkinesis, enhancing patients' quality of life. However, treatment plans should be individually tailored considering the complexity of facial paralysis and the unique needs of each patient, taking into account the timing and type of treatment. The objective of this review is to explore the use of selective neurectomy as a treatment for facial paralysis based on previously published papers.

Ultrasonographic findings of facial muscles in patients with severe facial palsy who showed no improvement for more than 3months on acute stage.

The study aimed to visualize the changes in the facial muscles of patients with severe facial palsy who showed no improvement for more than 3months on acute stage. The 102 patients with severe facial palsy over House-Brackmann grade IV or an 80% degenerative ratio on ENoG at the initial examination, who showed no improvement for more than 3months on acute stage were indicated to undergo ultrasonography of the face to evaluate the facial muscles. Muscular degeneration was observed in 537/918 muscles (58.5%). Muscle volume shrinkage was observed in 209/918 muscles (22.8%). Fascial adhesions were observed in 209/918 muscles (22.7%). Among all the muscles assessed for degenerative changes, zygomaticus major/minor was the most affected by degenerative changes (91.2%). Degenerative changes were observed in the levator labii superioris muscle in 84.3% patients. The shrinkage was most frequently observed in the zygomaticus major muscle (61/102 patients [59.8%]), followed by the zygomaticus minor muscle (43.1%). Shrinkage of the levator labii suprioris was observed in 24.5% patients. The zygomaticus major/minor muscle had the highest proportion of fascial adhesions in 61.8% and 66.7% patients respectively. The levator labii suprioris muscle showed the lowest proportion of fascial adhesions, with only 7.8% patients being affected. This study confirmed that the zygomaticus major, zygomaticus minor, and levator labii suprioris muscles, which raise the corner of the mouth, are the first to degenerate in patients with severe facial paralysis. This study demonstrated that ultrasonography is a simple and non-invasive examination for facial paralysis.