Corner Of Mouth Research Articles

Anatomical Characterization and Three-Dimensional Modeling of the Muscles at the Corner of the Mouth: An Iodine Staining Technique Based on Micro-Computed Tomography.

The anatomy of the modiolus and surrounding muscles is complicated and contributes to the morphology of the mouth corner. The authors used iodine staining and micro-computed tomography to observe the anatomy of the modiolus and surrounding muscles. Based on the micro-computed tomographic images and the three-dimensional model construction, the authors found that the muscle fibers in the modiolus were oriented continuously in the running direction of the muscle itself and that there were no chaotic clumps in the region of muscle fiber convergence. The pars marginalis of the orbicularis oris muscle connects with the deep buccinator muscle, which may account for how the pars marginalis fibers act to press the upper lip against the maxillary teeth or invert it closer to the oral cavity. These findings may be helpful for plastic surgeons who perform commissuroplasty.

Clinical efficacy of tape feedback therapy on oculo-oral synkinesis following severe peripheral facial nerve palsy

Mirror feedback rehabilitation is effective in preventing the development of oro-ocular synkinesis following severe facial palsy. However, we do not have effective maneuvers to prevent the deterioration of oculo-oral synkinesis. We developed a new method of biofeedback rehabilitation using tape for the prevention of oculo-oral synkinesis. The aim of the present study was to investigate the efficacy of taping feedback rehabilitation. Twelve consecutive patients with peripheral facial nerve palsy who developed synkinesis were divided into 2 groups. Six patients were treated with the new training method, and the remaining 6 patients were treated with conventional therapy as controls. In the experiment group, tape was placed around the mouth, and the patient was instructed to close the eyes so that no movements of the mouth would be perceived from sensations of the taped skin. After 4 weeks of training, facial movements were recorded and movie images were graded for mouth synkinesis using the revised Sunnybrook facial grading system by examiners blinded to patient grouping. Mouth corner contraction during eye closure was significantly weaker in the experimental group than in the control group. Our new feedback method could help prevent the deterioration of oculo-oral synkinesis.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report

BackgroundThe surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome.Case presentationIn this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence.ConclusionsIt is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.

Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management.

To examine technical aspects of pediatric tracheal intubation using video recording and to determine the association between tracheal intubation technique and procedural outcomes. Prospective observational study. Emergency department resuscitation bay in single tertiary pediatric center. Children undergoing emergent tracheal intubation under videorecorded conditions. None. A published scoring tool for characterizing patient positioning, intubator kinematics, and adjunctive maneuvers during tracheal intubation was applied to videorecorded pediatric resuscitations when tracheal intubation was performed. Procedural outcomes were measured from video review. Seventy-one children underwent 109 tracheal intubation attempts with an overall first attempt success rate of 69% and a median laryngoscopy duration of 34 seconds (interquartile range, 24-47 s). A significant subset of tracheal intubation attempts were made with the patient's bed at a height below the level of intubator's umbilicus (61%), the patient in a supine position without head elevation (55%), the intubator bent at the waist to greater than 45° (66%), less than 1 cm of mouth opening by the intubator's right hand prior to laryngoscopy (46%), and with the intubator's face less than 12 inches away from the patient's mouth (65%). Adjunctive maneuvers were used in a minority of attempts (cricoid pressure 48%, external laryngeal manipulation 11%, retraction of the right corner of the patient's mouth 26%). On multivariate analysis, including controlling for patient age category and intubator background, retraction of the right corner of the patient's mouth by an assistant showed an independent association with successful tracheal intubation. No other technical aspects were associated with tracheal intubation success. Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.

Topographic anatomy of facial artery and medial canthus artery

Objective To explore the layers of the facial and angular arteries between the orbital notch and the antegonial notch. Methods Anatomical studies were performed on 5 cases of adult cadavers (10 sides). Parallel lines were drawn on each cadaver through the position of the orbital incise, inner canthus, above of wing nose, nasal wing point, mouth angle, anterior incise. When the region of the arterial level changes, the parallel lines could be temporarily divided. The levels of the arteries that appeared on every horizontal line were recorded. Results The surface artery between the orbital notch (including the supraorbital notch) and the inner canthus (including the inner cantholes) was mainly in the orbicularis muscle layer. In the middle of the inner canthus and the highest point of the nasal wing, 1/3 of the arteries were mainly walking in the orbicularis orbicularis muscular layer, and the next 1/3 were mainly located in the superficial layer or subcutaneous fat layer of the orbicularis oculi muscle. The highest point of the nose wing was found in the middle of the subcutaneous fat. The main line between the top of the nose and the lower part of the nose was deep in the subcutaneous fat. At the bottom of the nose, the main line was located in the fat layer of the zygomaticus, the zygomaticus maximus. In the middle and upper part of the nose and the middle of the mouth, a third of the main lines were walking in the lower fat layer (from shallow to deep) under the zygomaticus, and the next 1/3 segment was found in the subcutaneous fat deep. On the outside of the corner of the mouth, the main line was walking the subcutaneous fat layer or the lower fat layer of the platysma. Conclusions This study preliminarily clarifies the walking level of the facial artery from the upper orbital notch and the anterior notch of the angle. Bearing in mind the depth and the location of the vasculature within each zone, clinical practitioners can tailor their injection techniques to prevent vessel injury and avoid cannulation. Key words: Facial artery; Angular artery; Layer; Anatomy; Injection

Comparison of mouth morphology and prey size selection among three esocid taxa

Aquatic organisms, especially fishes, exhibit exceptional diversity in mouth morphology and this variation has been shown to influence foraging patterns. We compared mouth morphology among muskellunge Esox masquinongy, northern pike Esox lucius and their hybrid, tiger muskellunge E. masquinongy x E. lucius. Head and mouth size among the three taxa were similar for juveniles (<400 mm total length), but diverged with increasing length, being greater for northern pike than muskellunge. Tiger muskellunge had a head and mouth size intermediate to the two, but more similar to northern pike than muskellunge. Morphological differences among taxa were related to data examining prey size selection in laboratory and field experiments. In the laboratory, northern pike selected prey that were smaller than their maximum mouth width (widest point between outside corners of mouth), tiger muskellunge selected larger prey, and muskellunge size-selection was intermediate between the other two taxa. Among the three esocids, muskellunge had the smallest increase in handling time with increasing prey body depth relative to predator mouth width. In a common garden field experiment in three lakes containing mainly deep-bodied prey, results generally followed morphological patterns, with northern pike selecting larger prey compared to muskellunge. Although morphology predicted most of the variation in greatest body depth of prey consumed, the best predictor of prey size was a model that included predator mouth width, taxon, and interaction. Information comparing prey size selection among esocid taxa is useful for understanding how to manage esocid populations based on system-specific prey characteristics and also for understanding how variations in morphological characteristics of apex predators can influence prey vulnerability and ecosystem structure.

SUPPORT VECTOR MACHINE IN GENDER RECOGNITION

In the paper, Support Vector Machine (SVM) methods are discussed. The SVM algorithm is a very strong classification tool. Its capability in gender recognition in comparison with the other methods is presented here. Different sets of face features derived from the frontal facial image such as eye corners, nostrils, mouth corners etc. are taken into account. The efficiency of different sets of facial features in gender recognition using SVM method is examined.

MPIIGaze: Real-World Dataset and Deep Appearance-Based Gaze Estimation.

Learning-based methods are believed to work well for unconstrained gaze estimation, i.e. gaze estimation from a monocular RGB camera without assumptions regarding user, environment, or camera. However, current gaze datasets were collected under laboratory conditions and methods were not evaluated across multiple datasets. Our work makes three contributions towards addressing these limitations. First, we present the MPIIGaze dataset, which contains 213,659 full face images and corresponding ground-truth gaze positions collected from 15 users during everyday laptop use over several months. An experience sampling approach ensured continuous gaze and head poses and realistic variation in eye appearance and illumination. To facilitate cross-dataset evaluations, 37,667 images were manually annotated with eye corners, mouth corners, and pupil centres. Second, we present an extensive evaluation of state-of-the-art gaze estimation methods on three current datasets, including MPIIGaze. We study key challenges including target gaze range, illumination conditions, and facial appearance variation. We show that image resolution and the use of both eyes affect gaze estimation performance, while head pose and pupil centre information are less informative. Finally, we propose GazeNet, the first deep appearance-based gaze estimation method. GazeNet improves on the state of the art by 22 percent (from a mean error of 13.9 degrees to 10.8 degrees) for the most challenging cross-dataset evaluation.

Trigger Features for Conveying Facial Expressions: The Role of Segmentation.

Primates are especially good at recognizing facial expression using two contrasting strategies—an individual diagnostic feature (e.g., raise eyebrows or lower mouth corner) versus a relationship between features. We report several novel experiments that demonstrate a profound role of grouping and segmentation—including stereo—on recognition of facial expressions.

Comparative Study of Harris and Active Contour using Viola-Jones Algorithm for Facial Landmarks Detection

In this paper, we present a comparative study of two methods: Harris corners detector (H) and Active Contour detector (A.C) using Viola-Jones algorithm (V.J) for facial landmarks (eyes, nose, mouth) corners detection. These methods were implemented on two face databases; ECVP and FEI databases with combination of two methods (V.J + H) and (V.J + A.C). Experimental results showed that (V.J +A.C) gives a higher rate of detection than (V.J + H) method.

Immediate reconstruction of facial nerve defect using cable grafting of the greater auricualr nerve after parotid cancer resection

Objective:To evaluate the feasibility of immediate reconstruction of facial nerve defect by using cable grafting of the greater auricular nerve after parotid cancer resection.Method:Clinical data of 11 patients suffering from parotid cancer was reviewed.9 cases were diagnosed as mucoepidermoid carcinoma and 2 cases were adenoid cystic carcinoma. Total parotidectomy and elective neck dissection were performed before cable grafting of the greater auricular nerve was interposed between stumps of facial nerve trunk and its branches. The facial nerve electromyogram and symmetry of mimetic musculature were evaluated. The House Brackmann (HB) grading system was used to assess the functional outcome of facial nerve rehabilitation. 8 patients received 50-65 Gy postoperative radiotherapy. The follow-up time ranged from 8 months to 36 months with the mean time of 12 months.Result:At all function oriented facial nerve reconstructed region, satisfactory orbicularis oculi muscle function in 7 patients was achieved (7/7); 5 patients obtained seeable and almost symmetric frowning (5/7); 9 patients obtained obvious nasolabial groove and satisfactory rest symmetry of the mouth corners (9/9); 4 patients got better facial nerve function restoration when it was 3 months after radiotherapy. Nine patients got HB grade Ⅱ, and 2 patients got HB grade Ⅲ facial nerve function restoration. Facial nerve electromyogram revealed weaker amplitude nerve conduction in 9 patients of HB grade Ⅱ than the conduction at its corresponding normal side.Conclusion:Cable grafting of the greater auricular nerve is a feasible candidate for the immediate reconstruction of facial nerve defect. Free nerve transplantation is probably not a contraindication for postoperative radiotherapy in the parotid region.

P2-46. Effect of muscle strengthening on facial asymmetry following peripheral facial nerve paralysis – Comparison by Linear Measurement

The aim of the present study was to compare facial asymmetry in severe cases of Bell’s palsy and Ramsay Hunt syndrome after I year of treatment by muscle-strengthening (MS) or non-muscle-strengthening (N-MS) physical therapy. This prospective study included 34 patients showing facial nerve palsy with an initial electroneurography value of 20% or less. The patients were divided into two groups using a cluster randomized design in five randomly assigned hospitals. The Linear Measurement method was used to evaluate facial asymmetry at VI months and 12 months after the onset of facial palsy. At VI months after onset, ptosis at rest and the pull of the mouth corners were significantly increased in the N-MS group. At 12 months, however, there were no significant differences in the measurement results between the MS group and N-MS group. According to the results of this study, increased muscular strength did not affect the facial asymmetry at I year after the onset of facial nerve palsy.

Living in a harsh habitat: epidemiology of the whale louse, Syncyamus aequus (Cyamidae), infecting striped dolphins in the Western Mediterranean

Whale lice (Cyamidae) are ectoparasitic amphipods exclusive to cetaceans. Data on their epidemiology usually come from species infecting baleen whales, which are large, slow-moving hosts. In this study, we provide data on infection parameters, population structure and microhabitat selection in a whale louse exclusive to delphinids, Syncyamus aequus, with the aim of comparing them with those from cyamid species from large whales. A total of 176 striped dolphins Stenella coeruleoalba stranded along the Mediterranean coast of Spain during 1980–2016 were examined. The prevalence of S. aequus was 27.3% (95% CI: 20.9–34.3), and populations were sparse, with a mean number of whale lice per infected host of just 4.5 (3.4–6.7). The parasites were found on the head, with a clearly nested pattern, with the blowhole being the most frequently occupied site, followed by the mouth corner and eyes. Single-male or single-female populations were found on as much as 39.6% of infected dolphins. The sex ratio did not significantly depart from 1:1. Females were significantly larger than males and exhibited low fecundity (<10 eggs). The sex or the age class of the dolphins did not significantly affect the abundance or population structure of S. aequus. The patterns here obtained are in sharp contrast with those reported for whale lice infecting large whales. The small, streamlined body of dolphins creates strong current flows that would restrict the amount of suitable microhabitats and the body size of their associated cyamids. This would limit population growth, which in turn would lower the chances of host-to-host transmission upon body contacts, as well as male competition for the access to females.

Salient-points-guided face alignment

Regression-based face alignment approach is fast and accurate but is always limited by the initial face. Aim at limitation of initialization in regression methods, this paper presents a novel two-stage framework named salient-points-guided face alignment. In first stage, we use cascade regression framework to train a salient points (eye centers, nose, mouth corners) localization model. Then the salient points information is used as a guidance for searching the similar faces from training set. In second stage, leveraging the similar faces to generate the initial face for all points regression. In order to give more comprehensive comparison, a new evaluation metric is proposed. Considering the global distance between estimated face and ground-truth, the new evaluation metric is defined as sum of the global distance and the widely used average point-to-point distance. The results show that our approach can achieve state-of-the-art performance (12% higher than the human performance on COFW) and the new evaluation metric is more reasonable.

Síndrome de Smith-Lemli-Opitz. Anomalía en la síntesis de colesterol

Smith-Lemli-Opitz (SLO) es un síndrome debido a la deficiencia de la 7- dehidrocolesterol reductasa (DHCR7). DHCR7 cataliza principalmente la reducción del 7-dehidrocolesterol (7DHC) en colesterol. En SLO, esto se traduce en la disminución del colesterol y el aumento de los niveles de 7DHC, tanto durante el desarrollo embrionario y después del nacimiento. Las malformaciones que se encuentran en SLO puede ser consecuencia de la disminución del colesterol, aumento de 7DHC o una combinación de estos dos factores. Objetivo: Describir los aspectos clínicos y diagnósticos de un paciente con SLO y hacer una revisión actualizada del tema. Caso clínico: El reporte de caso se basa en datos recopilados en la historia clínica del paciente. Destacándose la presencia de bajo peso y talla. Microcefalia con dismorfias faciales como frente estrecha, hipotelorismo, epicanto bilateral, filtrum largo, comisuras bucales hacia abajo, paladar ojival y micrognatia. También micropene, hipospadia y criptorquidia bilateral, clinodactilia de 5to dedo bilateral, braquidactilia con pulgares de implantación proximal en manos y sindactilia parcial bilateral entre 2do y 3er dedo de los pies. Hipotonía generalizada y retraso del desarrollo psicomotor. Conclusión: Ante la presencia de un paciente con rasgos fenotípicos característicos de este síndrome y con niveles bajos del colesterol sérico, se debe sospechar en la posibilidad de SLO como diagnóstico.

Genome-wide association studies and meta-analysis reveal novel quantitative trait loci and pleiotropic loci for swine head-related traits.

The pig is an important domestic animal that provides a larger amount of meat and serves as a biomedical animal model for human. Head and facial features are closely linked to identity recognition in mammal communication. To uncover the genetic architecture of swine head and facial features, we constructed 5 experimental pig populations and accurately measured 10 traits related to head and facial features, for which genome-wide association studies and meta-analysis were later carried out. As a result, we identified a total of 24 loci harboring 437 SNP on 8 swine chromosomes (SSC) that surpassed suggestively significant levels, of which 17 loci on 6 chromosomes exceeded the 5% genome-wide significance thresholds. To our knowledge, this is the first report of QTL for the distance from the low corner of the eye to the snout end (DES) and to the mouth corner (DEM), the size of extra mouth cleft (EMC), lip thickness, head length, and tongue weight and length in pigs. Notably, 3 pleiotropic loci were detected, including the loci at 298.1 Mb on SSC1 for head length and DES, at about 80.0 Mb on SSC4 for head weight, tongue weight and length, and at 34.8 Mb on SSC7 for head weight, EMC, and lip thickness. Several positional candidate genes at the identified loci might play roles in craniofacial development or have been implicated in syndromes affecting human head and facial features, including glutamate metabotropic receptor 4 (), high mobility group AT-hook 1 (), high mobility group AT-hook 2 (), serum/glucocorticoid regulated kinase family member 3 (), pleiomorphic adenoma gene 1 (), proto-oncogene serine/threonine-protein kinase mos () and DENN (differentially expressed in normal and neoplastic cells) domain containing 1A (). These findings will contribute to further detection of the causal mutations underlying these QTL for head and facial features in pigs and provide insights into the genetic basis of head and facial characteristics in human or other mammals.

안면 마스크식 전신마취 후 발생한 안면신경마비 1예

A 44-year-old woman underwent operation of removal of external fixator and k-wires under general anesthesia using sevoflurane with jaw thrust maneuver. After the operation, the patient complained of left lower lip weakness and left partial facial palsy developed with drooping of left corner of mouth. Compression of marginal mandibular branch of left facial nerve during the jaw thrust maneuver is estimated to be the cause of facial nerve palsy. Patient’s symptoms improved with steroid therapy and physical therapy. A month later, the patient is doing well without discomfort. (J Clinical Otolaryngol 2017;28:86-89)

Emotional Expression in Simple Line Drawings of a Robot's Face Leads to Higher Offers in the Ultimatum Game.

In the present study, we investigated whether expressing emotional states using a simple line drawing to represent a robot's face can serve to elicit altruistic behavior from humans. An experimental investigation was conducted in which human participants interacted with a humanoid robot whose facial expression was shown on an LCD monitor that was mounted as its head (Study 1). Participants were asked to play the ultimatum game, which is usually used to measure human altruistic behavior. All participants were assigned to be the proposer and were instructed to decide their offer within 1 min by controlling a slider bar. The corners of the robot's mouth, as indicated by the line drawing, simply moved upward, or downward depending on the position of the slider bar. The results suggest that the change in the facial expression depicted by a simple line drawing of a face significantly affected the participant's final offer in the ultimatum game. The offers were increased by 13% when subjects were shown contingent changes of facial expression. The results were compared with an experiment in a teleoperation setting in which participants interacted with another person through a computer display showing the same line drawings used in Study 1 (Study 2). The results showed that offers were 15% higher if participants were shown a contingent facial expression change. Together, Studies 1 and 2 indicate that emotional expression in simple line drawings of a robot's face elicits the same higher offer from humans as a human telepresence does.

When seizures are non-epileptic

IntroductionNon-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.Objectives/methodsWe present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.DiscussionA diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.ConclusionsApproximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Perioral soft tissue change after isolated mandibular surgery for asymmetry patients

IntroductionThis study was intended to determine whether isolated mandibular surgery for the correction of asymmetry could also change perioral soft tissue asymmetry. Patients and methodsSkeletal class III patients who had undergone mandibular set-back surgery were included. The subjects were composed of two groups with (n = 20) or without (n = 30) menton (Me) deviation over 4 mm. The perioral lip landmarks were analyzed on three-dimensional image from cone-beam computed tomography taken before and 6 months after the operation. The bilateral and inter-group differences and pre- and post-operative changes were statistically analyzed. ResultsThe corner of mouth on the deviated side was 1.9 mm shorter vertically than that on the contralateral side in patients with asymmetry. After mandibular surgery, the deviated Me moved 5.5 mm to the contralateral side and the lip canting was corrected by 2.4° in the asymmetry group. The degree of Me deviation was significantly correlated with the degree of midline asymmetry in perioral soft tissue landmarks including subnasale, upper and lower lip midline. The predictor variable that affected the changes in lip cant was the surgical correction of Me deviation. DiscussionThe correction of chin deviation by isolated mandibular surgery could significantly improve the subnasal and lip asymmetry.