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PubMed2006

Sensitivity of 4-year-olds to featural and second-order relational changes in face distinctiveness.

Sensitivity to adult ratings of facial distinctiveness (how much an individual stands out in a crowd) has been demonstrated previously in children age 5 years or older. Experiment 1 extended this result to 4-year-olds using a "choose the more distinctive face" task. Children's patterns of choice across item pairs also correlated well with those of adults. In Experiment 2, original faces were made more distinctive via local feature changes (e.g., bushier eyebrows) or via relational changes (spacing changes, e.g., eyes closer together). Some previous findings suggest that children's sensitivity develops more slowly to relational changes than to featural changes. However, when we matched featural and relational changes for effects on distinctiveness in adult participants, 4-year-olds were equally sensitive to both. Our results suggest that (a) 4-year-olds' face space has important aspects of structure in common with that of adults and that (b) there is no specific developmental delay for a second-order relational component of configural/holistic processing.

Adult↗
PubMed2004

Source of bacterial shedding in laminar flow theatres.

In a previous unpublished observation, unacceptably high bacterial counts, presumably due to shedding episodes, occurred in two of 56 (3.57%) slit-air samples during arthroplasty surgery in a laminar flow operating theatre. The isolates matched those cultured from swab samples taken from the skin of one of the surgeons's foreheads on each of the two occasions. These findings occurred despite scrub staff wearing standard occlusive gowns, hats and masks with visors. In order to localize the potential source of such shedding more accurately, 20 members of theatre staff underwent anonymous microbiological swabbing from the facial areas not covered by theatre clothing, namely their foreheads, eyebrows and ears. These swabs were cultured and the growths were compared statistically. Significantly more colonies were cultured from swabs taken from the theatre staff's ears (P = 0.047, Freidman's test) compared with the other two facial areas studied. These data support the use of exhaust helmets in arthroplasty surgery, or at least mandatory coverage of the ears with theatre hats for scrub staff.

Arthroplasty↗
PubMed2005

Facial soft tissue injuries as an aid to ordering a combination head and facial computed tomography in trauma patients.

PURPOSE: While the trauma computed tomography (CT) head scan is frequently ordered during resuscitation of multiply injured patients, determining when also to order facial CT in these situations can be difficult. Consequently, facial fractures are commonly missed on initial imaging evaluation. In acute trauma situations, facial soft tissue injury markers are often used to aid in this decision. A study was undertaken to identify exactly which facial soft tissue injuries correlate with facial fractures and which did not. The aim of our research was to compare the facial soft tissue injury patterns of patients receiving a combination head and facial CT who had facial fractures versus those who had no facial fractures. PATIENTS AND METHODS: A retrospective trauma registry review was performed for a 5-year period at Legacy Emanuel Hospital, a level 1 trauma center. The trauma team saw a total of 9,871 trauma patients and 49.9% required head CT as part of their initial evaluation. A total of 777 (15.7%) patients had a combination head and facial CT in which 477 (61.4%) had a facial fracture and 300 (38.6%) had no facial fracture. Statistical significance was established using Bonferroni corrected P values less than .05. RESULTS: Lacerations occurring in areas of the lips, nose, and intraorally, as well as wounds leading to periorbital contusion and subconjunctival hemorrhage, were significantly prevalent in the fracture group. Conversely, scalp lacerations and scalp contusions were significantly higher in the nonfracture group. Other injuries such as lacerations of the tongue, chin, forehead, cheek, ear, eyelid, and eyebrow were indistinguishable between both groups. CONCLUSIONS: Our data demonstrate that there are certain facial soft tissue injury zones that correlate with facial fractures in trauma patients who obtain head CT. We would like to propose that the acronym LIPS-N (Lip laceration, Intraoral laceration, Periorbital contusion, Subconjunctival hemorrhage, and Nasal laceration) be used in conjunction with a physical examination when assessing if a trauma patient who is getting head CT should also get facial CT.

Abbreviations as Topic↗
PubMed2005

Ocular manifestations of keratitis-ichthyosis-deafness (KID) syndrome.

OBJECTIVE: Keratitis-ichthyosis-deafness (KID) syndrome is a rare congenital ectodermal dysplasia characterized by the association of hyperkeratotic skin lesions, moderate to profound sensorineural hearing loss and vascularizing keratitis. Mutations in the GJB2 gene coding for connexin 26, a component of gap junctions in epithelial cells, have been observed in several KID patients. Variable ocular manifestations of the disease in 3 patients with molecular genetically confirmed KID syndrome are reported. DESIGN: Retrospective case series. METHODS: Clinical examination and molecular genetic analysis for mutations in the GJB2 gene were performed in 3 patients with KID syndrome ages 5, 13, and 41 years. RESULTS: Visual acuity ranged from normal to severe visual loss. The ocular signs included loss of eyebrows and lashes, thickened and keratinized lids, trichiasis, recurrent corneal epithelial defects, superficial and deep corneal stromal vascularization with scarring, keratoconjunctivitis sicca, and, in one patient, presumed limbal insufficiency. Whereas ocular surface integrity could be maintained with artificial tears in one patient, and an epithelial defect healed under conservative treatment in the second patient, multiple surgical procedures including superficial keratectomies, limbal allograft transplantation with systemic immunosuppression, amniotic membrane transplantation, lateral tarsorrhaphies, and lamellar keratoplasty could not preserve useful vision in the third patient. CONCLUSIONS: KID syndrome may affect the ocular adnexae and surface with variable severity independent of the age of the patient. Lid abnormalities, corneal surface instability, limbal stem cell deficiency with resulting corneal complications, and dry eye are the main ocular manifestations.

Adolescent↗
PubMed2006

Methimazole embryopathy: a contribution to defining the phenotype.

It has been suggested that children prenatally exposed to methimazole may present some features in common but the phenotype remains to be defined. The reported facial features include upward slanted palpebral fissures, arched flared eyebrows and small nose with a broad bridge. Choanal atresia and other anomalies like esophageal atresia and aplasia cutis were also described with this embryopathy. Additionally, developmental delay was reported in some patients along with one of these major malformation. We present a patient with the mentioned facial features, developmental delay and radio-ulnar synostosis whose mother has been exposed to methimazole during pregnancy and any other ethiological cause could be recognize.

Abnormalities, Drug-Induced↗
PubMed2005

Contesting stigma and contested emotions: personal experience and public perception of specific phobias.

This paper draws on interviews with members of the United Kingdom National Phobics Society to explore the implications of the contested nature of specific phobias for their experience and perception. In common with other chronic and contested conditions such as Chronic Fatigue Syndrome, phobias are stigmatised and subjected to widespread judgmental attitudes in both medical and lay populations. In contrast, however, phobic experience is rarely characterised by difficulty in describing symptoms and obtaining a diagnosis: core fearful reaction to and avoidance of particular objects is usually obvious and uncontested. The crucial difference is that phobias are constituted by emotions and behaviours considered irrational and inconsequential, and it is their (perceived absence of) significance that raises questions and eyebrows. In other words, what does it matter and who cares if you happen to be scared of snakes? Using phobics' own words as far as possible, the paper explores the processes through which phobic emotions are constructed as contested, and examines phobic means of managing experience and perception of these emotions. It reveals that many respondents are resourceful and resistant, continually renegotiating their positioning as irrational, incapable and emotionally weak.

Adaptation, Psychological↗
PubMed2006

The endoscopic supraorbital approach to tumors of the middle cranial base.

BACKGROUND: Access to tumors of the middle cranial base has traditionally required wide surgical exposures via open craniotomies. These open techniques often require the use of potentially disfiguring skin incisions and are often associated with a significant degree of brain retraction and potential morbidity. We report our experience with the use of a minimally invasive supraorbital endoscopic approach through the eyebrow for excision of middle cranial base tumors in 2 cases. METHODS: We describe 2 patients with large-sized middle cranial fossa tumors (a medial sphenoid wing meningioma measuring 6 x 4 cm and a recurrent right cavernous sinus meningioma measuring 4 x 3.5 cm) that were entirely removed via a fully endoscopic supraorbital approach using a 1.5-cm keyhole craniotomy. CONCLUSION: These cases demonstrate how the application of endoscopic techniques to surgery of the middle cranial base can eliminate the need for traditional open techniques without compromising surgical success.

Adult↗
PubMedDate not supplied

Dysmorphology and the orbital region: a practical clinical approach.

Dysmorphology is the field of medicine focusing on congenital developmental abnormalities due to exogenous teratogens, chromosomal anomalies, or to a defect in a single gene. Numerous syndromes have been reported and a growing number of genes or chromosomal anomalies are identified. The clinical observation of the face remains an essential part of the clinical evaluation of the patients. The orbital region, as other regions of the face, should be systematically evaluated. Orbital malformations can be isolated or part of a syndrome. In the diagnostic process, the orbital anomaly can be classified as a major feature (essential for the diagnosis), a moderate feature (important but not essential for the diagnosis), or a minor feature (contributing weakly to the diagnosis). The diagnoses of the main orbital anomalies in dysmorphology are reviewed and illustrated with relevant examples of syndromes that are presented as well as the usual landmarks used in clinical practice. Abnormal position of the eyes in syndromes such as hypertelorism, hypotelorism, primary or secondary telecanthus, asymmetry, and proptosis are discussed. Eyelid anomalies, such as cryptophthalmos, ablepharon, blepharophimosis, euryblepharon, or anomalies at the level of the eyelashes and eyebrows are described.

Craniofacial Abnormalities↗
PubMed1997

Unilateral enophthalmos secondary to acquired hemilipodystrophy.

PURPOSE: To report a case of acquired hemilipodystrophy with ipsilateral enophthalmos. METHODS: Case report. We examined a 25-year-old woman who developed progressive unilateral enophthalmos secondary to fat atrophy on the corresponding left side of her body. RESULTS: Computed tomography confirmed that atrophy in the left orbit, loss of fat in the preorbital area, and partial loss of eyebrow cilia on the same side were present. A biopsy specimen from the left arm was consistent with lipodystrophy. The systemic examination and laboratory values were within normal limits. CONCLUSION: Although it is a rare condition, lipodystrophy may be a cause of unilateral enophthalmos.

Adult↗
PubMed1988

The effect of omitting botulinum toxin from the lower eyelid in blepharospasm treatment.

We randomly selected 26 patients with essential blepharospasm to receive either botulinum toxin or saline injection in their lower eyelids to evaluate the necessity of lower eyelid injection to relieve blepharospasm. As diplopia may occur from botulinum toxin injections for blepharospasm, most commonly from injection of the lower eyelid, and surgical relief of blepharospasm is often achieved by excision of only the upper eyelid protractors, omission of toxin from the lower eyelid seemed both desirable and possible. All patients received botulinum toxin in the upper eyelids, above the eyebrows, across the glabella, and near the lateral canthus. Thirteen of 15 patients who received saline in their lower eyelids had relief of spasm, with the same spasm-free interval as those who received toxin. We recommend avoiding injection of toxin in the medial two thirds of the lower eyelid in order to diminish the likelihood of diplopia from inferior oblique muscle paresis.

Blepharitis↗
PubMed1985

The use of botulinum toxin in blepharospasm.

Twenty-two patients, 17 with benign essential blepharospasm and five with hemifacial spasm, received botulinum toxin by subcutaneous injections in the eyelids and eyebrows. All 22 patients received a standard treatment of 12.5 units of botulinum toxin per side at each injection session. The orbicularis oculi muscle showed pronounced weakness after injection and the spasms decreased. Spasms often recurred despite persistent orbicularis oculi muscle weakness. Side effects were minimal. All patients received some relief, which generally lasted six to 12 weeks.

Blepharospasm↗
PubMed1978

A modified silicone frontalis sling for the correction of blepharoptosis.

We devised a frontalis sling by using two No. 40 silicone bands. Each free end was sutured to the tarsus and joined in the central brow area. We used pulley sutures in the medial and lateral brow incisions to prevent migration of the bands. With this method, adjustment of the eyelid level can be made anytime postoperatively through the central eyebrow incision because of the ease in finding the overlapped ends of the silicone bands. This is particularly useful for patients with chronic progressive ophthalmoplegia where poor closure and exposure keratopathy are potential postoperative problems.

Aged↗
PubMed1999

Transcranial electrical stimulation (Limoge's currents) potentiates the inhibition of righting reflex induced by droperidol in rats.

The effects of transcranial electrical stimulation (TCES) on droperidol-treated rats were evaluated using the righting reflex latency (RRL) test. TCES (high frequency (HF)-166 kHz, intermittent-100 Hz current) delivered through three electrodes (a negative electrode placed between the eyebrows and positive electrodes located in the retro-mastoid region) was shown to potentiate the inhibition of righting reflex induced by droperidol. This potentiation was found to depend on the dose of the drug, the characteristics of the current delivered and the duration of stimulation. We also observed that TCES-induced potentiation of inhibition of righting reflex produced by droperidol injection was not reversed: (i) after naltrexone administration, (ii) when measures were performed on p-chlorophenylalanine (pCPA)-treated animals. These results suggest that, under the experimental conditions: (i) TCES does not interact with opioid endogenous to potentiate droperidol effects, (ii) the effect of TCES on dopaminergic system prevails against TCES action on serotonergic system. Though these findings enlarge the comprehension of TCES effects on the central nervous system, further investigations are necessary to elucidate TCES mechanisms.

Animals↗
PubMed1982

Craniopagus parasiticus: a case report of a parasitic head protruding from the right side of the face.

An extremely rare case of parasitic head protruding from the right side of the face is presented. It differs from all the other cases previously reported in the literature. The patient had a parasitic head with an abnormal brain, two eyebrows, two underdeveloped eyes, nose, mouth, 12 teeth, a tongue and plenty of hair. The parasitic head was excised. The nature of the embryological abnormalities is discussed and the literature of polygnathism reviewed.

Abnormalities, Severe Teratoid↗
PubMed1975

The Williams elfin facies syndrome. A new perspective.

Evaluation of 19 patients with the Williams elfin facies syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that "infantile hypercalcemia, peculiar facies, supravalvular aortic stenosis" designation which was heretofore used is inappropriate. Only 32% of the patients have evidence of supravalvular aortic stenosis and not one of them has had documented hypercalcemia, including eight patients who had a serum calcium determination in the first year of life. Rather, the most consistent features are growth deficiency which is predominantly of postnatal onset, mild microcephaly with mental deficiency, and an altered pattern of facial development which includes short palpebral fissures, a stellate pattern in the iris, medial eyebrow flare, a depressed nasal bridge with anteverted nares, and thick lips. The disorder is a sporadic occurrence of unknown etiology.

Adolescent↗
PubMed1981

Kabuki make-up syndrome: a syndrome of mental retardation, unusual facies, large and protruding ears, and postnatal growth deficiency.

A previously unrecognized mental retardation malformation syndrome was observed in five unrelated Japanese children. Consistent clinical features included moderate-to-severe mental retardation, progressive dwarfism of postnatal onset, a peculiar facies characterized by long palpebral fissures, with eversion of the lateral third of the lower eyelids, arched eyebrows, broad and depressed nasal tip, large prominent earlobes, short fifth fingers, abnormal dermatoglyphics including absence of digital triradius c or d, and frequent otitis media in infancy. Inconsistent abnormalities included epicanthal folds, cleft or high-arched palate, widely spaced teeth, low occipital hair line, scoliosis, and dislocation of the hip joint. Neither familial occurrence nor parental consanguinity was noted. The etiology of the malformation syndrome remains unknown.

Abnormalities, Multiple↗
PubMed1981

A new malformation syndrome of long palpebral fissures, large ears, depressed nasal tip, and skeletal anomalies associated with postnatal dwarfism and mental retardation.

Five unrelated patients with a previously unrecognized mental retardation malformation syndrome are presented. Clinical features common to them include moderate mental retardation, postnatal dwarfism, susceptibility to infection in infancy, and peculiar craniofacial dysmorphia characterized by long palpebral fissures, high-arched and abnormal eyebrows, heavy and long eyelashes, large ears, short nasal septum and/or depressed nasal tip, and cleft palate. Other anomalies are stubby fingers, deformed vertebra and other bone and joint anomalies, and abnormal dermatoglyphics. The absence of familial occurrence and of consanguinity suggests some environmental causation, but the possibility of an autosomal dominant or X-linked mode of inheritance remains. Based upon our five patients and other five of Niikawa et al, we propose this syndrome as a new disease entity.

Abnormalities, Multiple↗
PubMed1998

Body site specific incidence of basal and squamous cell carcinoma in an exposed population, Townsville, Australia.

Most data on body site distribution of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) do not take into account the surface proportion occupied by body sites experiencing differing amounts of ultraviolet radiation. The recording of BCC and SCC is heterogenous and body sites are not standardized. This study was undertaken to assess the magnitude of the incidence rates of skin cancers at different body sites in a population which experiences high ultraviolet exposure and involved all primary care services in Townsville over 6 weeks in June 1993. The annual site-specific age-standardized (World Population) incidence rates of histologically diagnosed lesions, determined from data where lesions were recorded on a body map, were adjusted for surface area and expressed per 100,000 body units (BU). Relative site densities of lesions were also calculated. Annual incidence rates for BCC per 100,000 BU on the most exposed face (ears, nose and cheeks) were 25,893 (95% confidence interval (c.i.) 18,837-32,950), 13,222 (95% c.i., 8273-18,171) on the less exposed face (forehead,eyebrow, chin and jaw) and 27,837 (95% c.i., 12,560-43,115) on the least exposed face (area within the orbit and nasolabial fold). Incidence rates for SCC rates were highest on the less exposed face, 5843 (95% c.i., 2627-9058) most exposed face, 4200 (95% c.i., 1274-7126) and the exposed upper limb, 3786 (95% c.i., 2783-4789). The relative site density of histologically confirmed BCC was 14 on the most exposed face in males compared with 5 in females and 11 around the eyes (least exposed) in males and 9 in females compared with the body as a whole. Adjustment for body surface proportion demonstrates that highly exposed body sites are at very high risk. The magnitude of the incidence rates on these sites is attributed to the combination of a susceptible population and high ambient ultraviolet radiation (UVR).

Australia↗