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At least 703 records · Page 39Linked to original sources
PubMed2001

Functional reconstruction of the lateral face after ablative tumor resection: use of free muscle and musculocutaneous flaps.

BACKGROUND: Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either due to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. METHODS: We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects and facial palsy. Defect reconstruction and facial reanimation was accomplished in one stage through functional muscle transplantation. RESULTS: Follow-up of more than 1 year showed good symmetry at rest and reanimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the transplanted muscle, developed significant muscle contracture and binding of the cheek skin. CONCLUSIONS: Every effort should be made to optimize the functional and cosmetic outcomes of neurovascular muscle transfers through precise planning and careful execution of the intricate details of the surgical technique for muscle transplantation.

Adolescent↗
PubMed1987

Dynamic rehabilitation of the paralyzed face: I. Electronic control of reinnervated muscles from intact facial musculature in the rabbit.

An entirely satisfactory solution to dynamic rehabilitation of the paralyzed facial musculature has not yet been found. Recent interest in selective reinnervation of the laryngeal musculature, synchronous with appropriate afferent information, has led us to propose that miniature strain gauges be placed on one or more muscles of facial expression on the intact side to channel electrical signals to the opposite corresponding facial musculature reinnervated via nerve-muscle pedicles. In order to avoid introducing extraneous factors related to facial motion, this principle was first studied on crossover ansa hypoglossi nerve-muscle pedicles in New Zealand white rabbits. Surgery was performed on a total of five animals that were under general anesthesia with xylazine and ketamine, through a midline neck incision. The animals were reexplored after 12 weeks, and after verification that reinnervation had taken place, a vertical incision was made under the external canthus, in order to expose the facial nerve. A miniature strain gauge was then sutured on the facial musculature and connected to a central modulating unit that was, in turn, linked to the nerve-muscle pedicle via a monopolar electrode. Facial wiggle that resulted from direct electrical facial nerve stimulation caused synchronous contraction of all reinnervated strap muscles under study; this was documented on film and through facial and strap muscle activity tracings. Our next step will be to extend this principle to paralyzed facial muscles. If successful, this system could be miniaturized for long-term implantation in human beings.

Animals↗
PubMed1981

Clinically manifesting carriers in Duchenne muscular dystrophy.

Three manifesting carriers of Duchenne muscular dystrophy were examined clinically and histologically. All had muscle weakness in the upper and lower limbs without facial muscle involvement, onset being at the ages of 35, 19 and 25 years, respectively. Pseudohypertrophy of calves was evident in all cases. Biochemical, electrocardiographic and histological observations revealed the presence of myopathy in all cases. Sex chromatin patterns were normal. Compared with the manifesting carriers previously reported by others, at least one case showed more severe histological findings which were typical of the advanced stage of Duchenne muscular dystrophy. The cardiac involvement in three cases was moderate. A possible involvement of other factors besides Lyonization influencing the development of myopathy in the carriers is suggested.

Adult↗
PubMed1991

[Peroperative monitoring of the facial nerve in surgery for acoustic neuroma].

This paper reports our experience about intraoperative facial nerve monitoring carried out in 97 patients operated on by a retrosigmoid approach. Intra-operative facial nerve monitoring was performed using a pneumatic sensor which transforms into acoustic signals contractions of facial muscles elicited by mechanical, electrical or thermal stimulations of facial nerve. Long term results showed that a normal facial function (grade I) was achieved in 90.5% of patients, 4 patients were grade II, 2 patients grade III, a total paralysis (grades V and VI) was persistent in 3 patients. Our experience with facial nerve monitoring suggests a modification of the strategy of dissection based upon a preservation of the arachnoid veil and a medial to lateral direction of dissection.

Electric Stimulation↗
PubMed1989

Rigid fixation and facial asymmetry.

The use of rigid fixation for the correction of facial asymmetry is in principle no different from its use in other forms of craniomaxillofacial deformity. The use of screws and plates demands more precise techniques than the use of wires. Attention to detail in passively fitting the plate to the defect and accurate insertion of the drill holes and screws enables the production of good occlusion and a symmetrical face. The precise osteotomies and bone grafts needed in the correction of all forms of skeletal asymmetry are as described for hemifacial microsomia or temporomandibular ankylosis. In a young child whose secondary dentition has not yet erupted it is not possible to insert screws, neither is the bone in a costochondral graft solid enough to permit screw fixation without the use of intermaxillary fixation. Therefore, rigid fixation can be used for osteotomies and bone grafts in patients whose main permanent dentition has erupted and in whom the cortex of the bone graft is strong enough to retain the screws against the pull of facial muscles.

Bone Transplantation↗
PubMedDate not supplied

[Clinical symptoms and the results of Doppler ultrasonography in stenosis and occlusion of the internal carotid artery].

In 28 patients with stenosis or occlusion of the external carotid artery confirmed by angiography the clinical manifestations were analysed, and the usefulness of Doppler ultrasonography of the arteries for diagnosis was assessed. The clinical manifestations of stenosis or occlusion of the external carotid artery include trophic and vascular signs. The most frequent trophic signs were: premature rapid loss of teeth and atrophy of facial muscles. The vascular clinical signs included weak pulsation of facial arteries. In 26 cases (96%) abnormal USG findings were obtained. The USG investigations showed that despite complete occlusion of the external carotid artery the blood flow in its branches was frequently maintained owing to collateral circulation.

Adult↗
PubMed1975

An evoked electromyographic test for peripheral facial palsy.

The purpose of the present study was to determine the degree of nerve degeneration in patients with facial palsy from the number of spikes in M-wave which were induced from the facial muscle by means of a bipolar concentric needle electrode when the facial nerve was stimulated. Ten normal cases between 14 and 72 years of age and 46 cases with facial palsy between 12 and 73 years of age were examined. Histopathological findings of ten denervated nerves were studied to determine to what extent this method may reflect the state of nerve degeneration.

Adolescent↗
PubMed2006

Sensitivity of repetitive facial-nerve stimulation in patients with myasthenia gravis.

Repetitive stimulation of the facial nerve is commonly performed in cases of suspected myasthenia gravis (MG) because bulbar weakness is often present, but the most sensitive facial muscle is unknown. We compared the sensitivity of repetitive nerve stimulation (RNS) to the frontalis and nasalis muscles in 244 patients with suspected MG. We found no difference in sensitivity of RNS when recording from these muscles in both ocular and generalized MG. In addition, we confirmed the low sensitivity of RNS for ocular (18%) or generalized (47%) MG. The specificity of facial RNS for both muscles was 100% and, in certain circumstances, may obviate the need for further diagnostic testing.

Aged↗
PubMed1984

Retrograde axonal transport of antibodies to synaptic membrane components.

It is well known that several exogenous substances, including, for example, lectins, nerve growth factor and several toxins, are retrogradely transported in axons after selectively binding to molecules on the surface of the synaptic membrane. In the present study, we sought to determine if antibodies to components of the synaptic membrane are also retrogradely transported. Retrograde axonal transport of antibodies to the Con A-positive fraction of synaptic membranes was studied in the rat hypoglossal and facial nerves. After injection of antibodies into the tongue and facial muscles, labeled cells were present in the hypoglossal nucleus and facial nucleus, respectively. Injections of normal serum produced no labeling in either system.

Animals↗
PubMed2001

Unusual causes of hemifacial spasm.

Hemifacial spasm (HFS) has been defined as consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. HFS, perhaps the most common of the abnormal involuntary facial movements, has been classically ascribed to vascular loop compression at the root exit zone of the facial nerve. Causes other than such vascular loops are rare in the medical literature. Here we present three case studies in which the phenomenology of the HFS was atypical in onset and evolution. Using these three patients as introduction to the topic, we reviewed the literature of all cases of HFS with causes other than the vascular loop. In these three cases, HFS was caused by (1) a parotid gland tumor, (2) a cerebellopontine angle meningioma, and (3) an acoustic schwannoma. We also discuss the radiological findings as well as possible differences in the genesis of HFS and phenomenology in such cases and present recommendations on how to evaluate these patients.

Adenocarcinoma↗
PubMed2005

The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry.

BACKGROUND: Bell's palsy is an idiopathic neuropathy of cranial nerve VII, and the incidence ranges from 15 to 40 per 100,000. The majority of patients recover, but up to 16 percent of patients have significant sequelae. The phenomenon of the "late recovered" Bell's palsy has the following specific features and has not formerly been described: (1) tightening of the facial muscles, with a deepening nasolabial fold and reduced palpebral fissure; (2) blepharospasm; and (3) incomplete recovery of peripheral VIIth nerve branches, with ipsilateral forehead paralysis, reduced depressor anguli oris function, and poor excursion of the angle of the mouth on smiling. METHODS: Nonsurgical treatment involved four monthly botulinum toxin injections. Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness. The effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. RESULTS: Twenty-three patients were followed up for a mean period of 37 months. The difference in brow height and teeth exposure after injection was less than preinjection measurements, but this did not reach statistical significance. Patient self-assessments showed improvements in their appreciation of the facial symmetry, ability to go out in public, and feelings of self-worth (visual analogue scale). Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty. CONCLUSIONS: The true benefit of botulinum toxin injections was more apparent during facial animation and not when the face was static. The patients greatly appreciated the improvement in facial symmetry. Various treatment options are available to improve the quality of life for patients with late recovered Bell's palsy.

Adult↗
PubMed1989

Mona Lisa syndrome: solving the enigma of the Gioconda smile.

The Mona Lisa smile is presented as a possible example of facial muscle contracture that develops after Bell's palsy when the facial nerve has undergone partial wallerian degeneration and has regenerated. The accompanying synkinesis would explain many of the known facts surrounding the painting and is a classic example of Leonardo da Vinci as the compulsive anatomist who combined art and science.

Facial Expression↗
PubMed1988

Blepharospasm-oromandibular dystonia syndrome (Meige's syndrome): clinical aspects.

Meige's syndrome is a form of cranial dystonia characterized by the presence of bilateral dystonic spasms of the facial muscles and frequently of other cranial muscles as well. Its most common and disabling manifestation is blepharospasm which can render the patient functionally blind. Several types of orbicularis oculi spasms occur in Meige's syndrome: brief clonic spasms, prolonged dystonic spasms, constant tonic contraction, and "apraxia" of lid opening. In the completed form of the syndrome, blepharospasm is typically associated with lower facial or oromandibular dystonia. Spasms of the neck and limb muscles, generally mild, and action tremor not uncommonly accompany the cranial dystonia. In most patients the cause of the spasms is unknown. This so-called idiopathic or primary form of Meige's syndrome is considered an adult form of adult onset dystonia. Secondary Meige's syndrome can be encountered in the context of several neurodegenerative disorders, chronic administration of neuroleptics, levodopa, or other drugs, and in patients with focal brain lesions. These secondary cases of Meige's syndrome suggest that a dysfunction of the basal ganglia or of the mesencephalic/diencephalic region plays an important role in the pathophysiology of this dystonic syndrome. Recent neurophysiologic studies and postmortem findings in some patients also support the notion that disease of the brain stem contributes to the pathophysiology of orofacial dystonia.

Basal Ganglia Diseases↗
PubMed1979

Retraction of the lower eyelid.

Retraction of the lower eyelid is a useful sign of disease. It is an early manifestation of weakness of the facial muscles, occurring with myopathies, myasthenia, and upper and lower motor neuron facial paresis. Rarely, lower and upper lid retraction occur without proptosis in patients with Graves disease. Lower lid retraction occurs in proptosis and varies directly with the degree of proptosis. It is also seen with senile entropion or ectropion, after eye muscle or orbital surgery, and with contraction of lid tissues. Apparent retraction results when the contralateral lower lid is pathologically elevated, as in Horner syndrome, in enophthalmos, or with vertical deviations of the eye.

Exophthalmos↗
PubMed1990

Persistent mutism and dysphagia of acute onset due to bilateral internal capsule infarction.

Acute mutism with paralysis of the bulbar and facial muscles following discrete bilateral internal capsular infarction is a rare stroke syndrome. We describe a 62 year-old male who suddenly became unable to speak or swallow. The paucity of facial expression and inability to voluntarily move the facial, lingual and pharyngeal muscles were persistent and contrasted with a relatively mild limb paresis which recovered. High resolution CT scan revealed infarcts in the posterior limbs of both internal capsules. It is important to recognise this stroke syndrome because of the permanence of dysarthria and dysphagia associated with it.

Bulbar Palsy, Progressive↗
PubMed1996

Differences in capillary supply between human oro-facial, masticatory and limb muscles.

In this report we show that immunostaining of the capillary basement membrane with an antibody directed against laminin is a useful alternative in detecting the capillaries in human muscle. Using this method, the capillary supply of three embryologically, morphologically and functionally different muscle groups, oro-facial, masticatory and limb muscles, were analysed. Significant differences in capillarization between muscles and muscle groups were found. The oro-facial and masseter muscles showed significantly higher density of capillaries than the limb muscles, taken in consideration the muscle cross-sectional area, with the masseter having the highest capillary density ever reported for human sedentary skeletal muscles. Judged from the number of capillaries per muscle fibre, the limb muscles showed the best capillarization. However, since the three muscle groups investigated differed with respect to fibre diameter, our evaluation of number of capillaries per muscle fibre was related also to fibre diameter. Thus, capillary constants were created which take fibre diameter into account. Based on these new parameters, the oro-facial and masseter muscles were found to be relatively better supplied by capillaries than the limb muscles. These results suggest differences in tasks and functional activity between muscles, and reflect a relatively higher need and demand for blood supply in the masticatory and oro-facial muscles than in limb muscles.

Adolescent↗
PubMed1985

Dynamic control of the perioral system during speech: kinematic analyses of autogenic and nonautogenic sensorimotor processes.

Afferent contributions to the motor control of speech were evaluated by applying unanticipated loads to the lower lip during the combined upper lip-lower lip gesture associated with the oral closing movements for a "b" sound. Loads were introduced randomly in approximately 15% of the trials to minimize subject anticipation or adaptation. A total of 490 load trials (in five naive subjects) were distributed within a restricted interval (100 ms) centered on the initiation of agonist muscle contraction associated with the lip-closing movements. Kinematic adjustments of the upper and lower lips to these perturbations were examined in detail. In all subjects, load-induced changes in upper and lower lip displacement, movement time, and closing velocity were statistically significant and observed the first time a perturbation was introduced. Load timing variations within the target interval resulted in systematic changes in the site of the compensatory adjustments (upper versus lower lip) and in the magnitude of the kinematic responses. These kinematic changes appeared to reflect the dynamic nature of underlying control processes and clearly contrasted the different response characteristics of autogenic (lower lip) and nonautogenic (upper lip) compensatory actions. Although both upper and lower lip adjustments contributed to perturbation compensations, autogenic responses were found to predominate when loads occurred 20-55 ms before muscle activation. For these early loads, autogenic responses provided approximately 75% of the total compensation. For later loads, when the evolving speech motor action was more time constrained, nonautogenic (open-loop) compensations predominated, providing approximately 65% of the total compensation. The variations in upper and lower lip compensatory response magnitude did not parallel the time course of facial muscle activation. Lower lip kinematic adjustments were reduced 10-15 ms prior to the onset of agonist muscle activation, whereas upper lip adjustments increased in magnitude 10-20 ms after agonist onset. Apparently the dynamic modulation of these responses is controlled independently from facial motoneuron excitation, possibly involving sensorimotor processing via supranuclear centers. Overall the compensatory movement displacements were highly related to the magnitude of the perturbation displacement, especially for loads introduced prior to agonist muscle onset, reflecting a well-calibrated readjustment.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗
PubMed1980

Central representation and somatotopic organization of the jaw muscles within the facial and trigeminal nuclei of the pigeon (Columba livia).

The location of facial and trigeminal brainstem motoneurons innervating the jaw muscles of the pigeon has been determined, using the technique of retrograde transport of horseradish peroxidase. Trigeminal motoneurons innervating the jaw closing muscles are located within the classically defined main trigeminal motor nucleus, and their organization exhibits approximately a mediolateral somatotopy. Trigeminal neurons innervating the opener muscle of the upper jaw are also located in the main trigeminal motor nucleus, but comprise a dorsomedial subnucleus which is continuous caudally with the dorsal facial nucleus whose neurons innervate the opener muscle of the lower jaw. The Vth and VIIth motor nuclei are thus linked in the rostrocaudal plane. The representations of other head muscles are arranged in a dorsoventral manner within the V-VII motor complex, with the lower eyelid muscle represented most dorsally and the hyoid and superficial neck muscles most ventrally. Jaw closing muscles were well represented in both the Gasserian ganglion and trigeminal mesencephalic nucleus. No such representation was found for either of the jaw opening muscles. The HRP data indicate that the V-VII motor complex in birds is far more extensive than has previously been suggested.

Animals↗