[Psychotherapy for the elderly. Arriving in paradise with a smile].
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Aged↗
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[An evaluation of the functional lip posture].
The purpose of this study was to evaluate the relationship of the functional lip posture to the anterior teeth and gingiva and at the same time establish an objective esthetic standard in the clinic. The functional lip posture referred here were the smiling lip line and the maximum opening lip line. From an esthetic and clinical point of view, the functional lip posture was described, classified and scored using the relationship of the border of the upper and lower lip to the labial surface of the anterior teeth and gingiva. A device for taking standardized oral photographs with a high degree of reproducibility was used. Tjan, et.al. studied the esthetic factors in a smile. Using their classification the result of this study were as follows: high smile, 32%; average smile, 42%; and low smile, 26%. The difference in the amount of maxillary and mandibular gingival exposure were also determined in this study. The measurement of the maxillary area was used in classifying the smile since the mandibular area showed interproximal gingiva only. In analyzing the maximum opening lip line, it was not possible to apply Tjan's classification since it referred only to the smile line. A scoring system (smile score) was devised, instead, to evaluate the functional lip posture. By this scoring system, the smiling lip line was classified using the maxillary teeth and gingiva only. The classification were as follows: high smile, score was over 4; average smile, from 3-4; and low smile, under 3. Note that the maxilla was used as reference in analyzing the smiling lip line and the mandible for the maximum opening lip line.
Cuspid↗
Esthetics: patients' perceptions of dental attractiveness.
PURPOSE: The importance of dentofacial attractiveness to the psychosocial well-being of an individual has been well established. Very little information is available regarding dental patient perceptions of a pleasing esthetic image. The purpose of this study was to identify factors distinctive to attractive smiles versus unattractive smiles, as perceived by patients. MATERIALS AND METHODS: Standardized format photographs (5 x 7 in, matte finish, at f-32 and 1:2 magnification) of eight male and eight female smiles, framing only lips and teeth, were viewed by 297 subjects. The smiles exhibited differences in symmetry, tooth shade, number of teeth displayed, and height of maxillary lip line, and included both restored and unrestored teeth. Respondents ranked the photographs in order from most to least appealing appearance. Respondents viewed each series of photographs in a similar lighting and time period. A questionnaire identified the respondent's age, sex, race, education, income, and home town. Twenty-five demographic groups were established from the information in the questionnaire. Data were analyzed using stepwise discriminant analysis to determine the combination of smile characteristics that best predicted the ranking. RESULTS: The same female smile was chosen as the most attractive by 24 of the 25 demographic groups. This smile is characterized by natural teeth having light shade, high lip line, a large display of teeth, and radiating symmetry. Two female smiles typified by darker shade and asymmetry were rated by all groups as being least attractive. Two male smiles were judged equal as the most pleasing esthetically. Respondents favored those smiles characterized by light shade, a moderate display of teeth, moderate lip line, and a symmetrical arrangement of teeth. One male smile characterized by darker shade was rated as least attractive. CONCLUSIONS: In all cases, tooth shade was the most important factor, followed in sequence by unrestored natural teeth and number of teeth displayed. No correlation was found to exist between specific demographic groups and smile variables.
Color↗
Stratified mucin-producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia?
BACKGROUND: Squamous (CIN) and glandular (ACIS) intraepithelial lesions often coexist in the same cervical specimen. However, a less common and little studied variant consists of a stratified epithelium resembling CIN in which conspicuous mucin production is present (Stratified Mucin-producing Intraepithelial LEsions (SMILE). This report describes the phenotypic characteristics of the SMILE, its associated lesions, and its immunophenotype. METHODS: Eighteen SMILEs were identified by the presence of conspicuous cytoplasmic clearing or vacuoles in lesions otherwise resembling CIN. The morphologic spectrum of SMILEs was detailed; including associated intraepithelial and invasive cervical neoplasms. In addition, selected cases were stained for mucicarmine, markers of squamous cell/reserve cell differentiation (keratin-14 and p63), and proliferative activity (Mib-1). RESULTS: Stratified neoplastic epithelial cells with a high Mib-1 index and a rounded or lobular contour at the epithelialstromal interface characterized SMILEs. In contrast to CIN, in which mucin droplets are confined to surface cells, mucin was present throughout the epithelium, varying from indistinct cytoplasmic clearing to discrete vacuoles. SMILEs were distinguished from benign metaplasia by nuclear hyperchromasia and a high Mib-1 index. All but three coexisted with either a squamous (CIN) or glandular (ACIS) precursor lesion. Nine of nine coexisting invasive carcinomas contained glandular, adenosquamous differentiation, or both. SMILEs stained negative for keratin-14 and variably for p63. When present, staining with p63 was confined to basal areas of SMILEs and was absent in areas of columnar differentiation. CONCLUSIONS: SMILEs are unusual cervical intraepithelial lesions best classified as variants of endocervical columnar cell neoplasia based on immunophenotype. The distribution and immunophenotype of SMILEs are consistent with a neoplasm arising in reserve cells in the transformation zone. The coexistence of a wide spectrum of intraepithelial and invasive cell phenotypes suggests that SMILEs are a marker for phenotypic instability, emphasizing the importance of identifying SMILEs and ensuring a complete examination of specimens containing this unusual precursor lesion.
Adenocarcinoma↗
Affective exchanges between young autistic children and their mothers.
This study examined autistic children's social behavior, affect, and use of gaze during naturalistic interactions with their mothers. Sixteen autistic children, 30 to 70 months of age, and 16 normal children, matched on receptive language, participated. Children and their mothers were videotaped during three situations: a free-play period, a more structured period during which communicative demand was made on the child, and a face-to-face interaction. In all three situations, autistic and normal children did not differ in the frequency or duration of gaze at mother's face. In the one condition (face-to-face interaction) during which affective expressions were coded, autistic and normal children also were not found to differ significantly in the frequency or duration of smiles displayed, and neither group displayed frowns. However, autistic children were much less likely than normal children to combine their smiles with eye contact in a single act that conveyed communicative intent. Autistic and normal children were not found to differ in the percentages of smiles they displayed to social versus nonsocial events. However, when autistic children's responses to mother's smiles specifically were examined, it was found that they were much less likely to smile in response to mother's smiles than were normal children. Finally, it was found that mothers of autistic children displayed fewer smiles and were less likely to smile in response to their children's smiles, when compared with mothers of normal children. These findings suggest that the autistic child's unusual affective behavior may negatively affect the behavior of others.
Affect↗
An ultrasound investigation of the lip levator musculature.
The aims of this study were to determine if there were any differences in the thickness of the lip levator musculature in men and women, and whether the height of the smile line in adults was related to the thickness of the lip levator musculature. Thirty Caucasian (13 males, 17 females), and 24 Asian (11 males, 13 females) undergraduate dental students participated in this study. The subjects were placed in high, medium, and low smile-line groups, according to the height of their upper lip while smiling. The thickness of the levator labii superioris and zygomaticus major muscles was measured on ultrasound scans of the relaxed muscles. Gender, right-left side, and ethnic differences in muscle thickness were determined, and the thicknesses of the lip levator musculature in subjects in the high, medium, and low smile-line groups were compared. There were significantly more women than men with high smile-lines and the zygomaticus major muscle was significantly thicker in the women, as compared with the men. There were, however, no statistically significant differences in muscle thickness in the three smile-line groups. While it appears that women have higher smile-lines and significantly thicker zygomaticus major muscles than men, the height of the smile line is not due to the thickness of either the levator labii superioris or zygomaticus major muscles.
Adolescent↗
Perception of activity in the Zygomaticus major and Corrugator supercilii muscle regions.
This study was designed to assess differences in perception of activity in the zygomaticus major (predominant during smiling) and corrugator supercilii facial muscles (predominant during frowning). Magnitude production psychophysical methods were used to relate subjective intensity to objective electromyographic activity using a psychophysical power function under four conditions: smiling, frowning, smiling concurrent with maintenance of a frown, and frowning concurrent with maintenance of a smile. High correlation coefficients for each power function for both zygomatic and corrugator activity were obtained. Differences in sensitivity evaluated by comparing the exponent for slope of the power functions showed differences across the muscles and as a function of the conditions. The exponent for frowning was greater than for smiling. Although the exponent for zygomatic activity was similar with and without frowning, significantly greater exponents were shown for corrugator activity when concurrently frowning and smiling than when only frowning. Maximal electromyographic activity was greater in the zygomaticus major muscle during smiling than in the corrugator supercilii muscle during frowning. These results provide a methodology for perception of electromyographic activity which could be a useful basis for analysis of the role of perception in regulating affect.
Adolescent↗
Submucosal minimally invasive lingual excision: an effective, novel surgery for pediatric tongue base reduction.
OBJECTIVES: The aim of this study was to develop an effective single intraoral, minimally invasive technique to reduce the enlarged tongue base in children with obstructive macroglossia. METHODS: We present the anatomic dissection of fresh cadavers and a representative case series of children who underwent submucosal minimally invasive lingual excision (SMILE) with a plasma-mediated radiofrequency device (coblation) under intraoral ultrasonic and endoscopic guidance. Multiple anatomic dissections determined the relative location of the hypoglossal nerve and lingual neurovascular bundle in relation to removable tongue base musculature. A pediatric case series demonstrates the straightforward SMILE technique. RESULTS: Laboratory anatomic dissection and clinical lingual ultrasonography revealed the surgical safety borders for SMILE. The surgical safety and efficacy of SMILE is demonstrated by preoperative and postoperative clinical examinations and polysomnograms in children with obstructive macroglossia (such as Beckwith-Wiedemann and Down syndromes and tongue vascular malformation). Coblation submucosally removes excessive tongue base tissue through a small anterior tongue incision. SMILE was performed without excessive pain, bleeding, edema, infection, or tongue dysfunction. CONCLUSIONS: SMILE is an effective novel operation that incorporates coblation with ultrasonography and endoscopic guidance for children who need tongue base reduction. Anatomic dissection and clinical cases demonstrate the potential for aggressive yet relatively safe tissue removal by this minimally invasive technique. SMILE also has significant potential for adults with obstructive sleep apnea due to a large tongue base.
Adolescent↗
Quantitative facial motion analysis after functional free muscle reanimation procedures.
The purpose of this study was to evaluate the success of functional free muscle transfer in patients with chronic facial paralysis using a recently developed quantitative method known as the maximum static response assay of facial motion. A retrospective review of a single surgeon series of six patients with longstanding facial paralysis was performed. The maximum static response assay was performed on all patients preoperatively and serially during the postoperative period. Twenty-seven patients (54 sides) with normal facial function were also evaluated and served as controls. The contralateral normal side in those patients with unilateral facial paralysis (n = 4) also served as a control. Movement of the modiolus during smile was recorded in the x axis and y axis. To determine net smile movement, the vector of movement was calculated by means of the Pythagorean theorem. Vectors were then defined mathematically by calculating direction and magnitude. The average direction of the vector during smile for the normal control population was 58.3 degrees (range 32.5 to 83.1 degrees) from the horizontal through the modioli, and the average magnitude was 10.6 mm (range 4.2 to 20.1 mm). The average preoperative direction for the reanimated sides was 176.8 degrees with a range of 83.3 to 225 degrees. Patients with bilateral paralysis (n = 2) were excluded for calculation of the vectors on the normal contralateral side. The average preoperative direction for the normal contralateral side in patients with facial paralysis was 58.3 degrees with a range of 48.2 to 68.4 degrees. Postoperatively, the average direction of the vector during smile for the reanimated sides improved to a value of 77.6 degrees with a range of 45.7 to 113.8 degrees. The average change in direction of the preoperative reanimated side compared with the postoperative reanimated side was significant (p = 0.01). Postoperatively, the average direction of the vector for the contralateral normal sides was 43 degrees with a range of 11 to 57.2 degrees. The change in direction for the contralateral normal side was not significant (p = 0.18). The average magnitude of the reanimated side improved from a non-anatomic 2.8 mm preoperatively (range 0.8 to 6.8 mm) to an anatomic 4.9 mm postoperatively (p = 0.02). The contralateral normal side magnitude decreased from 9.4 mm (range 7.3 to 11.6 mm) preoperatively to 5.7 mm (range 3.8 to 7.7 mm) postoperatively (p = 0.006). More specifically, the absolute change in movement on the reanimated side during smile for the x axis and y axis was 2.3 mm (p = 0.05) and 4.0 mm (p = 0.002), respectively. This corresponded to an absolute change in the magnitude of the vector of 4.6 mm in an anatomic direction. On the contralateral side the absolute change in magnitude during smile from preoperative to postoperative for the x axis and y axis decreased by 1.5 mm (p = 0.13) and 5.3 mm (p = 0.05), respectively. This reflected an absolute change in the magnitude of the vector of 5.5 mm. Functional free muscle transfer in patients with chronic facial paralysis resulted in anatomic recovery of motion in the majority of patients in this series. The maximum static response assay can be used to objectively assess the results of facial reanimation.
Adult↗
Selective marginal mandibular neurectomy for treatment of the marginal mandibular lip deformity in patients with chronic unilateral facial palsies.
BACKGROUND: For unilateral facial palsies, reanimation techniques such as cross-facial nerve grafting with free muscle transfer have been very successful at improving symmetrical lip elevation when smiling. However, these procedures do not address the residual asymmetry with respect to lip depression resulting from an uncorrected marginal mandibular nerve palsy. Techniques that do address this residual lip asymmetry have had variable results. Selective neurectomy of the unaffected marginal mandibular nerve has largely been abandoned as a treatment since it has been reported to result in severe oral functional and cosmetic deficiencies. The authors argue that selective marginal mandibular neurectomy is a reliable technique for treatment of the marginal mandibular lip deformity that does not compromise oral functionality. METHODS: Thirteen patients with unilateral facial palsies underwent selective marginal mandibular neurectomy of the unaffected side; the procedure was performed by the principal investigator. These patients were then evaluated on the basis of symmetry with smiling and oral functionality. Twelve of the patients were contacted and questioned with a standardized questionnaire. Twelve of the patients were evaluated independently for symmetry with smiling using randomized preoperative and postoperative photographs. RESULTS: Eleven of the 12 patients reported either improvement or no change in oral competence. Ten of the 12 patients reported either improvement or great improvement in symmetry with smiling. Improvement in symmetry with smiling was independently observed 77.2 percent of the time. CONCLUSION: These results support selective marginal mandibular neurectomy of the unaffected side in patients with unilateral facial palsies as a means of improving symmetry with smiling without compromising functionality.
Adolescent↗
Reproducibility of two four-point clinical severity scores for lateral canthal lines (crow's feet).
BACKGROUND: Several clinical scoring systems have been used to evaluate the efficacy of botulinum toxin A in the treatment of hyperkinetic wrinkles. So far very few have been investigated for their reproducibility. OBJECTIVE: The aim of this study was to investigate the reproducibility of two clinical four-point scales for lateral canthal lines (crow's feet), at rest and at maximum smile. MATERIAL AND METHODS: Based on standardized photographs, a consensus atlas depicting the different severity grades [from 0 (none) to 3 (severe)] was developed. After training based on the atlas, 49 photographs at rest and 48 at maximum smile were graded by the same group of investigators on 2 consecutive days (n=9 on Day 1; n=8 on Day 2). The scores were compared for reproducibility using kappa statistics. RESULTS: Overall, reproducibility was good for both scales. Interobserver reproducibility showed an agreement of 0.6 at rest and 0.58 at maximum smile (unweighted kappa). Intraobserver reproducibility showed an agreement between 0.47 and 0.86 at rest and between 0.62 and 0.81 at maximum smile (unweighted kappa). Using weighted kappa analysis, the agreement ranged between 0.63 and 0.91 at rest and between 0.71 and 0.85 at maximum smile. CONCLUSION: The clinical scales using scores of 0 to 3 for crow's feet, both at rest and at maximum smile, show a good inter- and intraobserver reproducibility. The use of these scores in clinical trials can be recommended.
Cosmetic Techniques↗
Permuting input for more effective sampling of 3D conformer space.
SMILES strings and other classic 2D structural formats offer a convenient way to represent molecules as a simplistic connection table, with the inherent advantages of ease of handling and storage. In the context of virtual screening, chemical databases to be screened are often initially represented by canonicalised SMILES strings that can be filtered and pre-processed in a number of ways, resulting in molecules that occupy similar regions of chemical space to active compounds of a therapeutic target. A wide variety of software exists to convert molecules into SMILES format, namely, Mol2smi (Daylight Inc.), MOE (Chemical Computing Group) and Babel (Openeye Scientific Software). Depending on the algorithm employed, the atoms of a SMILES string defining a molecule can be ordered differently. Upon conversion to 3D coordinates they result in the production of ostensibly the same molecule. In this work we show how different permutations of a SMILES string can affect conformer generation, affecting reliability and repeatability of the results. Furthermore, we propose a novel procedure for the generation of conformers, taking advantage of the permutation of the input strings--both SMILES and other 2D formats, leading to more effective sampling of conformation space in output, and also implementing fingerprint and principal component analyses step to post process and visualise the results.
Algorithms↗
An intrusive impact of anchors in children's faces pain scales.
The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories; those with a neutral face as the 'no pain' anchor, and those with a smiling face as the 'no pain' anchor. This study examined the potentially biasing impact of these anchor types on children's self-reports of pain in response to a series of vignettes. Participants were 100 children stratified by age (5-6 years, 7-8 years, 9-12 years) and randomly assigned to one of three groups: (1) neutral scale/sensory instructions; (2) smiling scale/sensory instructions; (3) smiling scale/affective instructions. Children completed a faces scale, a VAS, and emotions ratings in response to four scenarios depicting: (1) no pain/negative emotions; (2) pain/negative emotions; (3) no pain/positive emotions: (4) pain/positive emotions. Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale. Instructions varying in focus on sensory or affective qualities of pain had no effect on children's pain ratings. Group differences in children's ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a child's concept of pain. Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children. These findings suggest that children's pain ratings vary depending on the types of faces scale used, and that faces scales with smiling anchors may confound affective states with pain ratings.
Aging↗
LINGO, an efficient holographic text based method to calculate biophysical properties and intermolecular similarities.
SMILES strings are the most compact text based molecular representations. Implicitly they contain the information needed to compute all kinds of molecular structures and, thus, molecular properties derived from these structures. We show that this implicit information can be accessed directly at SMILES string level without the need to apply explicit time-consuming conversion of the SMILES strings into molecular graphs or 3D structures with subsequent 2D or 3D QSPR calculations. Our method is based on the fragmentation of SMILES strings into overlapping substrings of a defined size that we call LINGOs. The integral set of LINGOs derived from a given SMILES string, the LINGO profile, is a hologram of the SMILES representation of the molecule described. LINGO profiles provide input for QSPR models and the calculation of intermolecular similarities at very low computational cost. The octanol/water partition coefficient (LlogP) QSPR model achieved a correlation coefficient R2=0.93, a root-mean-square error RRMS=0.49 log units, a goodness of prediction correlation coefficient Q2=0.89 and a QRMS=0.61 log units. The intrinsic aqueous solubility (LlogS) QSPR model achieved correlation coefficient values of R2=0.91, Q2=0.82, and RRMS=0.60 and QRMS=0.89 log units. Integral Tanimoto coefficients computed from LINGO profiles provided sharp discrimination between random and bioisoster pairs extracted from Accelrys Bioster Database. Average similarities (LINGOsim) were 0.07 for the random pairs and 0.36 for the bioisosteric pairs.
Biophysical Phenomena↗
Faces scales for the measurement of postoperative pain intensity in children following minor surgery.
OBJECTIVES: Faces scales are commonly used to obtain self-reports of pain intensity from children. Previous research using hypothetical vignettes and pain following venepuncture has found differences in children's pain ratings as a function of the type of faces scale used. The purpose of the present study was to determine whether scales beginning with a smiling rather than neutral "no pain" face would produce higher ratings in the assessment of postoperative pain intensity in children and to compare ratings using different faces scales to those reported with an additional independent measure of pain intensity. METHODS: Participants were 78 children between the ages of 5 and 13 years undergoing surgery, one of their parents, and their postoperative care nurse. Following surgery, children were asked to provide a rating of their current pain intensity using a set of 5 successively administered faces scales and the Colored Analog Scale (CAS). Parents and nurses provided independent ratings using the same measures. RESULTS: Results showed that parents and nurses rated significantly more pain when using scales with a smiling rather than a neutral "no pain" face. This pattern was not as clear for the children's ratings, although their highest ratings were provided when using a smiling "no pain" faces scale. Children's and nurses' ratings on the CAS were generally more similar to their ratings using scales with neutral "no pain" faces, whereas parents' CAS ratings tended to fall in between ratings provided on the smiling and neutral "no pain" faces scales. Scale preference, age and sex differences in pain ratings, and child-parent-nurse agreement in pain ratings are also examined. DISCUSSION: Children's and parents' ratings of postoperative pain intensity are influenced by the presence of a smiling "no pain" face at the beginning of faces scales, with such scales producing significantly higher ratings than scales with neutral "no pain" faces. Ratings on the independent CAS measure were more comparable to those provided on faces scales with neutral "no pain" faces. Nurses are also susceptible to the influencing effect of a smiling face at the beginning of a faces scale.
Adolescent↗
Measuring fatigue related to facial muscle function.
OBJECTIVE: The purpose of this study was to explore the expression of facial muscle fatigue in individuals without impaired muscle function using surface electromyography (EMG). DESIGN: Descriptive study of the expression of facial muscle fatigue in individuals without impaired muscle function. PARTICIPANTS: Convenience sample. Twenty individuals, 5 men and 15 women, between 20 and 50 years of age who volunteered to participate. OUTCOME MEASURES: Two tests of fatigue, a 10-second sustained contraction test, and a 25 repeated 3-second contractions test, were conducted on three facial expressions: brow raise, smile, and pucker. Surface EMG quantification of the muscle activity of the voluntary maximal facial muscle contractions was recorded during the fatigue tests. RESULTS: For the sustained fatigue test, all three expressions had a significant decline in activity (brow raise 34.51%, smile 22.96%, and pucker 29.05%); confirmed by a one-way ANOVA with repeated measures (brow raise df = 2, 38; f = 53.28; p = 0.00; smile df = 2, 38; f = 39.913; p = 0.00; pucker df = 2, 38; f = 76.002; p = 0.00). For the repeated fatigue test, percent fatigue was significant for smile (11.62%; df = 1, 19; f = 13.823; p = 0.001) but not for brow raise (7.27%; df = 1, 19; f = 1.945; p = 0.179) or pucker (4.22%; df = 1, 19; f = 2.508; p = 1.30). CONCLUSIONS: The muscle activity of sustained maximal voluntary muscle contractions of facial muscles fatigues significantly with time for brow raise, smile, and pucker expressions. The same facial muscles are more resistant to fatigue of muscle activity with repeated, brief contractions. Knowing the amount of facial muscle fatigue of individuals without impairment can be beneficial in developing outcome measures and goals for rehabilitation of individuals with facial neuromuscular dysfunction. Changes in fatigue tests of an individual with facial neuromuscular dysfunction with rehabilitation is reviewed for comparison.
Adult↗
Selected aspects of the art and science of facial esthetics.
The historical aspects of facial esthetics and its role in orthodontic teachings and practice are traced to their origins in classical art. Related discussions include the failure of "divine proportions," the ascent of the Class II facies, and the influence of 19th century pseudoscience. Today, the treatment of facial form for a diverse society requires a tolerant sense of esthetic pluralism. Moreover, advances in neuroscience and psychology have extended understanding of the biological basis of variation in facial expression and judgment. The nature of oral esthetics was examined through quantitative studies of the smile line. Significant sexual dimorphism was found, ie, the gingival smile line (GSL) appears to be a female lineament and the low smile line seems to be a male lineament. Further results indicated that the GSL is associated with several facial characteristics, including anterior vertical maxillary excess, and the muscular capacity to raise the upper lip significantly higher than average on smiling. Other variables associated with GSL are statistically significant increases in overjet, interlabial gap at rest, and overbite. The gingival smile line is not necessarily objectionable esthetically and it will normally diminish with age. However, the treatment of choice for the GSL patient with an uncoached complaint is orthognathic surgery and orthodontics.
Adolescent↗
Comparative objective and subjective analysis of temporalis tendon and microneurovascular transfer for facial reanimation.
The aim of this study was to compare objectively and subjectively the results after temporalis tendon and microneurovascular transfer for reanimation of the paralysed face. For the objective analysis, measurements of the distances between static and dynamic points in three-dimensional space were performed at rest and during smiling. The patients were assessed subjectively by non-professionals scoring videotapes. The range of motion of the oral commissure on smiling was 1.7 mm (0.8, mean and SE) after tendon and 5.5 mm (1.6) after microneurovascular transfer (P < 0.05) without showing teeth, and 0.6 mm (1.3) vs 3.6 mm (2.4, ns) with showing teeth. Compared with the healthy side, the excursions reached 6% (16) after tendon and 71% (26, P < 0.05) after microneurovascular transfer for smiling without, and -4% (14) vs 19% (14, ns) for smiling with showing teeth, respectively. Virtually no difference was found in the measurements at rest as well as in the subjective evaluation. Swelling of the cheek (28%) and tethering of the skin (24%) were shown to be the most disturbing symptoms after microneurovascular transfer. Better excursion and symmetry of the oral commissure were achieved by microneurovascular reconstruction for voluntary smile. However, the aesthetic outcome after microneurovascular transfer is markedly impaired by chronic complications including swelling of the cheek and tethering of the skin, which were not detected by the three-dimensional measurement technique used. We conclude that the aesthetic appearance should be considered equally important as the range of motion in the reanimated face.
Adult↗