PubMed · 4290506
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L Cohen. 1967. Hemifacial spasm.. https://doi.org/10.1016/0030-4220(67)90339-8
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Primary extra-nodal non-Hodgkin's lymphoma (NHL) of the skeletal muscles is a well recognized entity although such occurrences are not very common. Presentation in the muscles of the face has only rarely been described. We present a case of primary extra-nodal NHL in a non-immunocompromised patient involving only the muscles of facial expression and not extending to the oral cavity or sinonasal tract. The patient was subsequently treated with chemotherapy and at the time of writing remained in remission. We suggest that lymphoma should be considered among the causes for malignant infiltration of the muscles of the face.
Assuming that an agonistic function is present to maintain an adequate visual field, we hypothesized that stretching of the mechanoreceptor of Mueller muscle induces involuntary contraction of the occipitofrontalis muscle, as well as the levator muscles. In patients with aponeurotic blepharoptosis, both unilateral instillation of phenylephrine to contact Mueller smooth muscle fibers and unilateral aponeurotic fixation ipsilaterally reduced the eyebrow height during primary and upward gazing. Bilateral aponeurotic fixation bilaterally reduced the eyebrow height, with fewer forehead wrinkles. Stretching of the mechanoreceptor of Mueller muscle induces involuntary contraction of the bilateral levator muscles. Its increased stretching may induce involuntary contraction of the ipsilateral occipitofrontalis muscle via the mesencephalic trigeminal nucleus and the facial subnucleus as another stretch reflex. The involuntary contraction of the occipitofrontalis muscle that causes forehead wrinkles during primary gazing can be corrected by the aponeurotic fixation to reduce the stretching of Mueller muscle.
OBJECTIVE: To determine if the diagram with schematic drawings of the face based on House-Brackmann facial nerve grading scale can be of easier use than the original grading scale for facial palsy patients. STUDY DESIGN: Prospective case study of 32 patients with facial palsy. SETTING: Tertiary referral center-university hospital. PATIENTS: Patients with different degrees of acute peripheral facial palsy from any cause. MAIN OUTCOME MEASURES: The patients were photographed and then classified by degree of facial palsy through analysis of the pictures. At first, three of the authors individually utilised the original classification described by House-Brackmann facial nerve grading and then, after 7 days, they employed the illustration table proposed. After 30 days, the same methods were again used by the same authors for both House-Brackmann facial nerve grading and the illustration table. RESULTS: The analysis of the obtained data reveals that the classification described by House and Brackmann (Otolaryngol. Head Neck Surg. 1985;93:146) presents several items to be evaluated, making it difficult to use and demanding greater time for correct application. On the contrary, the proposed illustration table allows faster evaluation and easier memorisation, not being subject to possible interpretation or translation mistakes, as illustrations are a universal language. Neither method presented absolute reproducibility, however, we found slightly larger concordance indexes among the authors for the proposed illustration table. We noticed average values of reproducibility were approximately 65% in the House-Brackmann classification, and 75% in the evaluation using the diagram of the schematic drawings. CONCLUSIONS: The authors concluded that the illustration table could be utilised in substitution for the original description of House-Brackmann facial nerve grading; they also concluded that the illustration table allows faster evaluation and easier memorisation.