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PubMed1998

Single hair grafting for the treatment of vitiligo.

BACKGROUND: Vitiligo is a disease of unknown cause, and many medical and surgical therapeutic methods are used to treat it. OBJECTIVE: Our purpose was to evaluate the effectiveness of single hair grafting in patients with vitiligo. METHODS: Single hairs were grafted into vitiliginous areas of 21 patients. The diameter of the spreading pigmentation was evaluated periodically. RESULTS: Perifollicular repigmentation around the grafted hair was observed in 15 patients (71%) within 2 to 8 weeks. The diameter of the spreading pigmentation ranged from 2 to 10 mm during a 12-month follow-up period. In cases of generalized vitiligo, perifollicular pigmentation was seen in one of four patients (25%), whereas it was observed in 14 of 17 patients (82%) with localized/segmental vitiligo. Transformation of depigmented hairs into pigmented ones occurred in five patients. CONCLUSION: Single hair grafting appears to be an effective method for treating localized/segmental vitiligo, especially on hairy parts of the skin, including the eyelids and eyebrows, and for small areas of vitiligo.

Adult↗
PubMed1977

Cryptophthalmos: symptoms and treatment of a rare deformity. A case report.

Since 1872 more than 50 cases of the cryptophthalmos syndrome have been reported. In addition to other deformities, the typical anomalies of this syndrome are the missing palpebral fissure, eyebrow and the rudimentary eyeball. This paper deals with the possibilities of operative correction in a 13-year-old female. We are of the opinion that by means of plastic surgery, social integration into the community of the patient is possible.

Abnormalities, Multiple↗
PubMed1978

Facial duplication -- the unique case of Antonio.

A case of facial duplication with its surgical correction in childhood and the consequences on facial growth is reported. It is a unique case in the duration of observation. The following structures were fully duplicated: the nose, the premaxilla, the cribriform plate, the crista galli. In addition there was an enormous facial cleft including lip, alveolus and palate. Additionally there were two rudimentary eye sockets, eyes, and two supplementary eyebrows. The monstrous hypertelorism with the facial duplication was corrected at the age of ten. The surgical procedure is described and the postoperative complications are discussed. Gross lack of growth of the middle third of the facial skeleton was observed. This was probably the consequence of the initial corrective surgery. Overgrowth of the mandible created a gorilla-like appearance by the end of the growth period. This was corrected in one operation by advancement of the middle third in three sections and repositioning of the mandible as a whole together with the mandibular anterior alveolar segment. Finally all parts of the lower half of the nose had to be enlarged, both soft tissues as well as the cartilaginous framework. A pharyngoplasty in addition to the correction of the intermaxillary abnormalities did much to improve the speech quality of the patient. A large secondary cranial defect was successfully reconstructed with the use of 14 halved ribs. In spite of the removal of four ribs from one side and three ribs from the other, there were no postoperative respiratory problems. Spontaneous rib regeneration was found where ribs had been removed one year earlier.

Adolescent↗
PubMed1981

The use of a single fronto-zygomatic osteosynthesis plate and a sinus balloon in the repair of fractures of the lateral middle third of the face.

In certain orbito-zygomatic fractures, a fronto-zygomatic screwed plate and a sinus balloon permit, at the expense of a single eyebrow incision, the repositioning of the cheekbone and the alignment of the other fracture sites; the other fractures sites consolidate and remodel themselves spontaneously due to the action of the adjacent soft tissues. The plate is malleable so that correct reduction can occur during the course of surgical repair; the plate should align the cheekbone perfectly. Neglect of the stability offered by reduction after exposure of the bone fragments may seem exaggerated, in simple cases; the orbital approach is without risk and limited. This argument - which also depends on the experience of the surgeon - does not apply in the case with a comminution of the orbital rim; closed fracture site reduction and distant osteosynthesis offer an alternative to the classical repair which requires a wide cutaneous incision and significant periosteal stripping with the subsequent risk of eyelid distortion.

Bone Plates↗
PubMed2002

Detecting deception in pain expressions: the structure of genuine and deceptive facial displays.

Clinicians tend to assign greater weight to non-verbal expression than to patients' self-report when judging the location and severity of pain. Judgments can misrepresent the actual experience because patients can successfully alter their pain expressions. The present research provides a basis for discriminating genuine and deceptive pain expressions by expanding detailed accounts of facial expressions to include previously unexamined variables, including study of temporal patterns and contiguity of facial actions as well as the occurrence of specific deception cues. Low back patients' facial expressions (n=40) were videotaped at rest and while undergoing a painful straight leg raise with instructions to: (1) genuinely express their pain, or (2) pretend that it did not hurt. As well, they were asked to fake pain without moving. The Facial Action Coding System was used to describe and quantify facial activity. The different types of expression were compared on the frequency, type, intensity, temporal pattern and contiguity of facial actions, as well as on the frequency of specific deception cues. Findings confirmed the difficulty of discriminating the facial expressions, but indicated that faked pain expressions show a greater number of pain-related and non-pain-related actions, have a longer peak intensity and overall duration, and the facial actions observed tend to be less temporally contiguous than are those in genuine pain expressions. The differences between masked pain and neutral expressions were subtle, with a greater frequency of mouth opening and residual eyebrow movement in masked pain expressions. Thus, there is an empirical basis for discriminating genuine and deceptive facial displays.

Adult↗
PubMed2000

Quantification of functional results after facial burns by the faciometer.

In the present study the faciometer(R) is introduced in order to quantify the ranges of mimic movements observed after surgical treatment of facial burns. This instrument which consists of calipers and an electronic display was introduced in 1994 in order to measure the extent of facial palsy during reconstructive procedures. The study group consisted of 23 patients, who had been operated on for facial burns. The distances between standardised stable and moving points in the face were determined after mimic movements such as lifting of the eyebrows, maximum showing of the teeth and pursing of the lips. These distances were expressed as a percentage of the distance at rest. For comparison the scars were classified according to the Vancouver Scar Scale. In all patients the functional results after burn trauma in the face and, in some cases, asymmetries at rest could be objectified. Depending upon the severity of scarring, the distance between tragus and mouth was shortened between 0 and 19% after maximal showing of the teeth. In general the mouth region showed more functional deficits than the forehead. Comparing different manners of treatment, it could be objectively demonstrated that the results after deep burns requiring skin grafts were worse than those observed after more superficial lesions and other methods of coverage. The application of keratinocytes to close the burn showed highly variable results.

Adolescent↗
PubMed2004

Pigeon's recognition of cartoons: effects of fragmentation, scrambling, and deletion of elements.

J. Cerella [Pattern Recognit. 12 (1980) 1] and more recently S. Watanabe [Behav. Proc. 53 (2001) 3] demonstrated that pigeons showed no decrement in recognizing cartoons that were spatially scrambled, indicating that pigeons' discriminative responding is controlled by local features alone. In contrast Kirkpatrick-Steger et al. [J. Exp. Psychol. Anim. Behav. Proc. 24 (1998) 34] used line drawings as stimuli and demonstrated the importance of spatial organization for picture recognition by pigeons, confirming related findings reported in their previous studies. The present study revisited the recognition of cartoons by pigeons. In Experiment 1, pigeons were trained to discriminate cartoon people on a variety of background scenes. Subsequent tests revealed that discriminative performances with both familiar and novel instances decreased as the objects and object-like parts were progressively fragmented, indicating that search for the targeted cartoon people in the stimulus array might have enhanced the pigeons to attend to global aspects of cartoon people. Experiment 2 used line drawings of cartoon faces as stimuli and examined effects of scrambling and deletion of components. A set of components (eyes and eyebrows) exerted strong control over behavior and scrambling only moderately suppressed responding. The results suggest that pigeons use both global and local aspects, with different mixtures of these types of information depending on the particular perceptual context.

Animals↗
PubMed1996

A clinical study of the craniofacial features in Apert syndrome.

A clinical study of the craniofacial features in Apert syndrome is based on our experience with 136 cases. Characteristics included hyperacrobrachycephaly, steep wide forehead, flat occiput, common craniofacial asymmetry, ocular hypertelorism and proptosis, downslanting palpebral fissures, divergent upgaze and esotropic downgaze, a tendency towards large ears, and marked depression of the nasal bridge. The nose is short and wide with a bulbous tip, and the anterior facial height is reduced. Common features during infancy included horizontal grooves above the supraorbital ridges that disappear with age, a break in the continuity of the eyebrows, and a trapezoidal-shaped mouth at rest. Radiographic aspects of Apert syndrome were also assessed. Tables are provided which compare the craniofacial features of Apert and Crouzon syndromes.

Acrocephalosyndactylia↗
PubMed2003

Surgical approaches to suprasellar and parasellar tumors.

Uncommonly, pituitary tumors require a complex intracranial approach. In such instances of extensive para- and suprasellar involvement, an approach that incorporates basic techniques enhanced by developments in contemporary cranial base surgery is effective. Tumors with extensive invasion of the cavernous sinus unilaterally are generally best approached by a frontotemporal transcavernous strategy. Those with bilateral cavernous sinus involvement are better suited for a bifrontal transbasal type of approach. Supra-sellar tumors are best exposed by a strategy that affords the surgeon an adequate inferior-to-superior viewing angle, which is generally accomplished by removal of all or part of the orbital rim. These approaches yield benefits in decreased frontal lobe retraction, which may be particularly important in cases requiring a bilateral approach. Finally, some tumors with more modest extensions outside the bounds of the sella are now treated with a more minimalistic type of approach via a small incision in the eyebrow. This marks a move toward a "minimally invasive" type of strategy. Sound judgment based on adequate experience with these approaches must be exercised to ensure appropriate application of this strategy.

Craniotomy↗
PubMed2003

The use of Botox to treat glabellar rhytids.

Many areas of the face benefit from Botox. The deep vertical and horizontal creases between the eyebrows or glabellar area are the best known to cosmetically improve with Botox injections. As with almost any cosmetic procedure, adequate evaluation and pre-operative assessment can lead to a good outcome and a satisfied patient.

Botulinum Toxins, Type A↗
PubMed1999

Clinical findings in the medico-legal investigation of arsonists.

Criminal and pathological arson is often committed with the help of fire accelerants. The formation of an explosive gas/air mixture may lead to an explosion whose extent and fierceness is often underestimated by the offenders. This explosion causes typical heat changes on exposed persons: * Singeing of eyelashes, eyebrows and hair growing near the frontal hairline * Singeing of the beard * Singeing of body hair in regions not covered by clothing (e.g. back of the hand) * In severe cases, skin burns of varying degree (back of hand, face). Such heat-related changes can sometimes be detected weeks after the offence.

Journal Article↗
PubMed2003

Tics and developmental stuttering.

BACKGROUND: Developmental stuttering affects 1% of the population but its cause remains unclear. Recent PET studies of metabolism in the central nervous system suggest that it may be related to dysfunction in the basal ganglia or its connections with regions of the cortex associated with speech and motor control. OBJECTIVE: To determine the presence and characteristics of involuntary movements (IMs) in people who stutter and to investigate the hypothesis that these movements may be of a very similar nature to the IMs seen in patients with movement disorders due to basal ganglia dysfunction. METHODS: Sixteen adults with developmental stuttering and 16 controls matched for sex and age were audio-videotaped while freely speaking 300 words in conversation and reading aloud 300 words. The audio data was inspected for dysfluencies and the video data was scrutinised for the presence and characteristics of IMs. RESULTS: Subjects who stuttered produced more IMs than controls during free speech (354 vs 187, p<0.05) and reading (297 vs 47, p<0.001). Most of the IMs in both groups were tics, with a greater number of both simple and complex motor tics (CMTs) in subjects who stuttered. CMTs were more frequent than simple motor tics in those who stuttered, but not in controls. The combination of repetitive eye blink followed by prolonged eye closure was found exclusively in the stuttering group, as were simple tics consisting of eyebrow raise or jaw movement. Dystonia in the form of blepharospasm was identified in a small number of subjects who stuttered. Choreic movements were not associated with stuttering. CONCLUSIONS: Developmental stuttering is associated with the presence of IMs that are predominantly simple and CMTs. This association suggests that tics and stuttering may share a common pathophysiology and supports the view that, in common with tics, stuttering may reflect dysfunction in the basal ganglia or its immediate connections.

Adolescent↗
PubMed2000

Making features relevant: learning faces and event-related potentials recording using an analytic procedure.

We present a procedure designed for the learning of faces (represented by realistic drawings) and a task for the subsequent recording of Event-Related Potentials (ERPs), with the aim of investigating the psychobiological mechanisms involved in the recognition of familiar (or known) faces. The learning procedure consisted in a series of six sessions in which subjects familiarized themselves with the faces through a forced-choice features task: after the study of a set of 40 faces, each of these was presented at random in an incomplete way (without the eyes/eyebrows fragment), together with two sets of eyes and eyebrows for the subject to decide which of them corresponded to each face. This procedure is thought to facilitate for subjects the acquisition of the information related to the structural description of the faces (that is, without associated verbal/semantic information) using preferentially analytic processing strategies. The parameter d' of the Theory of Signal Detection allowed us to evaluate in the course of the learning sessions the degree of familiarization achieved with the studied faces. Subsequently, an ERPs' recording session was carried out, during which subjects executed a face-feature matching task. In this task, similar in structure to that carried out in the learning sessions, the subject had to decide whether the automatic completion of the faces that was made was correct or incorrect. ERPs' effects related to mismatching features were obtained, which indicate the existence of specific cerebral mechanisms involved in the recognition of faces.

Adult↗
PubMed1978

Delineation of syndromes due to partial 6q imbalances. Trisomy 6q21 leads to qter and monosomy 6q221 leads to qter in two unrelated patients.

Two unrelated patients carrying imbalances involving the long arm of chromosome 6 are described. In the first trisomy 6q21 leads to qter had segregated from a maternal translocation t(6;16)(q15;q24). The clinical data of the proposita are compared with those of three other published cases. A partial 6q trisomy syndrome is postulated characterized by: growth deficiency of prenatal onset, psychomotor retardation, craniofacial abnormalities (microcephalia, hypertelorism, downward slanting palpebral fissures, flattened nasal bridge, long philtrum, hypoplastic perioral features, large jaw resulting in a round appearance of the face, receding chin, malformed ears) and dysmorphic extremities (contractures of limbs due to short flexor tendons, hypoplastic fingers, toes and nails). In the second case, monosomy 6q221 leads to qter resulted from a de novo rearrangement and was responsible for mental retardation and facial dysmorphism (reduced biparietal diameter, hypotelorism, absent eyebrows, prominent nose, ptosis, receding chin, dysmorphic ears). Studies of HLA and PGM3 segregation showed normal inheritance patterns and ruled out the location of these genes in bands 6q221 leads to qter.

Abnormalities, Multiple↗
PubMedDate not supplied

Endoscopic and minimally invasive microsurgical approaches for treating brain tumor patients.

Recent developments in neuroendoscopy and minimally invasive procedures have greatly impacted the diagnosis and treatment of brain tumors. In this paper, we will review these innovations and discuss how they have influenced our approach to the treatment of intraventricular and pituitary tumors. Finally, the concept of keyhole neurosurgery is illustrated by discussing 'eyebrow orbitotomy' approach as an example. As noninvasive therapeutic alternative become available, future neurosurgeons will be challenged to develop effective and less invasive surgical approaches for the diagnosis and treatment of patients will brain tumors.

Brain Neoplasms↗
PubMed2000

Aneurysms of the distal branches of the external carotid artery.

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten days after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear, which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter. Surgeons' familiarity with this entity is important for diagnosis and treatment.

Adult↗
PubMed2003

Five new subjects with ring chromosome 22.

Ring chromosome 22, a rare cytogenetic finding, was first described by Weleber et al. in 1968. Since then approximately 50 patients have been reported in the medical literature. We describe five previously unreported subjects with ring chromosome 22 syndrome, summarize the clinical findings of reported patients from the literature and discuss the involvement of the ring chromosome and clinical outcome. Our subjects demonstrated the prominent features of this syndrome including mental retardation, hypotonia, motor delay, lack of speech, full eyebrows, and large ears. In addition, two of our subjects had central nervous system malformations and regression. The lack of consistent physical abnormalities in our subjects further supports no consistent phenotype manifestations in this cytogenetic syndrome. The variable clinical manifestations seen in ring chromosome 22 subjects may be associated with loss of chromosome 22 sequences near the telomere or attributed to the genetic background of each subject. Similarly, recessive alleles unmasked by the deletion could also contribute to the phenotype.

Abnormalities, Multiple↗
PubMed2002

Acceleromyography of the orbicularis oculi muscle I: significance of the electrode position.

BACKGROUND: This study aimed to establish the best position of the stimulating electrodes for facial nerve stimulation during acceleromyographic monitoring from the orbital part of the orbicularis oculi muscle. METHODS: In 59 anaesthetised patients, an acceleration transducer was positioned over the middle of the eyebrow. In 47 patients, supramaximal train-of-four (TOF) stimulation was established for four electrode pairs with different positions along the facial nerve and behind the ear. The electrode pair with the lowest, the intermediate, and the highest supramaximal stimulating current based on first response (T1) in TOF was found in each patient. A possible response from direct muscle stimulation was evaluated during complete vecuronium block. In 12 patients, supramaximal stimulation was established using a stimulation sequence different from the one used in the first part of the study. RESULTS: The best positions for the stimulating electrodes were either with both electrodes just lateral to the eye, or with one electrode lateral to the eye and one in front of the ear. In most patients, supramaximal stimulation was obtained at these positions at 20-60 mA. However, in 10-21% of the patients, supramaximal stimulation could not be obtained. During complete block, 1-4 responses with a twitch height of 3-11% were recorded in 80% of the patients. CONCLUSION: The best placements of the stimulation electrodes are either just lateral to the eye or along the zygomatic arch. However, supramaximal stimulation may often not be obtainable, and activation of other facial muscles may be a confounding factor that may impede correct evaluation of the degree of neuromuscular block.

Adult↗