Functional influences on structure and structural influences on function.

Oculopharyngeal muscular mystrophy (OPMD) is an inherited disorder caused by mutations of the polyadenylate binding protein nuclear 1 (PABPN1) gene. While a pathogenic hypothesis has been formulated that links the genetic and molecular abnormalities to cellular abnormalities, there is no proven explanation for the targeting of the craniofacial muscles. We propose a hypothesis that bridges this gap. It is based on the phenomenon of continuous remodeling of normal adult extraocular muscles (EOMs). Unlike the EOMs, the myonuclei of other skeletal muscles are postmitotic in the adult unless the muscles are injured. Continuous myofiber remodeling most likely requires upregulation of genes involved in cell cycling, and in protein degradation and synthesis. PABPN1 is a nuclear protein that performs the essential function of controlling polyadenylation of mRNA and the fidelity of protein synthesis. In OPMD, the ongoing production of mutant PABPN1 in muscles undergoing continuous remodeling could result in a failure of accurate production of mRNA required for the maintenance of the myocytes. Over many years, this would lead to cumulative myonuclear loss and finally to myofiber loss. This hypothesis offers an explanation for the selective involvement of extraocular muscles affected in OPMD and the onset of symptoms in adulthood.

Facial Muscles↗

PubMed2003

Relationship between tip nasal muscles and the short upper lip.

Since 1993 the authors have been using a new approach to the treatment of the muscles intimately related with the nasal tip and the upper lip, today known as dynamic rhinoplasty. With the idea of improving the dorsum-tip-labial relationship, the dynamic rhinoplasty technique is based on performing an intraoral zetaplasty at the labial frenum, allowing the access to the local musculature, represented by the depressor septi nasi muscle and its three fascicles. Next, we perform a subperiosteal undermining of the medial bundles, releasing them from the lower nasal spine, followed by the treatment of the intermedial bundles (which substitute the former by the special kind of plication at the median line, according to the primary characteristics of the upper lip). Initially, we used the new method only for the treatment of negroid nose or for cases of exuberant droopy nasal tip. Today, with improvements in the surgical technique, it is possible to operate on almost any kind of nasolabial combination, including mouth-breather patients and even cases with long upper lip and upright nose tip. Thus, the authors have established a semiotic classification, discussing both surgical indication and technique, and also showing the importance of combining several surgical stages (septoplasty, dynamic rhinoplasty, rhinosculpture, and turbinectomy) involved in each group.

Facial Muscles↗

PubMed2003

The deep plane facelift.

The goal of any cosmetic facial plastic surgery procedure is to obtain a natural-appearing result that is not overdone or obviously operated upon. This is the case whether the background of the operating surgeon is in facial plastic and reconstructive surgery, general plastic surgery, dermatology, or oculoplastic surgery. To satisfy this goal, the surgeon must apply those techniques that consistently achieve effective but understated results rather than experimenting with every new innovation or fad. More and more surgeons are moving away from some of the so-called advances of the last decade, including the use of lasers for skin resurfacing and the application of endoscopic approaches to the face, in the search for the best results possible. Sometimes this means utilizing older techniques that have proven the test of time, such as the coronal browlift and chemical peels, whereas other times this means embracing those newer techniques that clearly represent major advances in our specialty, such as the transconjunctival approach to lower lid blepharoplasty. The deep plane facelift is one such advance. In contrast to traditional, skin or short-SMAS flap techniques, the deep plane facelift allows the surgeon to consistently obtain a natural-appearing result that not only addresses the key areas of concern in the aging face but also proves to be longer lasting as well. The deep plane technique also results in fewer complications, an improved ability to address the melolabial region and jowls, and increased anatomic appeal for the operating surgeon.

Facial Muscles↗