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PubMed1994

Simultaneous quantitation of facial movements: the maximal static response assay of facial nerve function.

An assay is described that enables the simultaneous measurement of bilateral facial movements within zones relevant to facial nerve function. The assay allows the accurate quantitation of movement of the eyebrows, radix, lower eyelids, philtrum, mentum, and oral commissures relative to these points on the resting face. Global or region-specific facial nerve dysfunction is detectable using this assay, as shown in examples of patients having single branch facial nerve palsy and bilateral facial palsy (Möbius syndrome variant). Because facial movement is tested by region, with the remainder of the face relaxed, synkinesis can be detected when present. The assay has potential to be used as an adjunct to the presently used ordinal scales of facial nerve function, by allowing actual quantitation of region-specific facial movement. This feature may prove helpful in vector planning for reanimation procedures and may allow the tracking of functional responses after such procedures, thereby providing a measurement of their efficacy.

Adult↗
PubMed1996

Repair of "coup de sabre," a linear form of scleroderma.

A case of coup de sabre, a linear form of scleroderma, is presented. Treatment consisted of soft-tissue expansion and autologous bone grafting to the forehead, a composite graft for alar reconstruction, and a scalp graft for eyebrow reconstruction. None of the linear scleroderma cases reported in the literature consisted of bony reconstruction.

Adult↗
PubMed1997

Local injection into mimetic muscles of botulinum toxin A for the treatment of facial lines.

The purpose of this clinical investigation is to confirm the efficacy of eliminating facial wrinkles by injecting botulinum toxin A into mimetic muscles. Fifty-four patients were injected with BOTOX A-14 in the corrugator superciliaris, 19 in the frontalis muscles, and 13 in the orbicularis oculis. Dilution was obtained by adding 4 ml preservative-free saline to 100 IU of BOTOX A. The dose used varied according to the patient. The severity of wrinkles and the intensity of muscle contraction (facial expression) were taken into account. The paralysis obtained in the mimetic muscles was effective for 6 months in 39 patients, 8 months in 10 patients, and 9 months in 1 patient. The results were documented by photographs, videotape, and electromyographies pre- and postinjection. To preserve the results, 21 patients (39%) demanded a second infiltration to achieve satisfactory results. Neither local nor general adverse effects were noted, except transitory eyebrow palsy in 2 patients, and edema and ecchymosis in 4 patients. The improvement obtained in facial mimetic wrinkles was satisfactory to the patient and to us.

Adult↗
PubMed1998

Endoscopic osteosynthesis for frontal bone fracture.

Endoscopic surgery to repair a frontal bone fracture is described. This operation is less invasive than the conventional open technique, which is performed under direct vision through a bicoronal or eyebrow incision. Endoscopic surgery leaves no conspicuous scars in the forehead and is free from complications such as nerve or vascular injuries, and appears to be of significant clinical value.

Adult↗
PubMed2002

Four parallel flaps for correction of a wide forehead defect.

A simple method for closure of a defect in the forehead area by four parallel flaps along the forehead wrinkle lines is illustrated. The main advantage of this method lies in its simple design, which enables the surgeon to close large defects with no elevation of the eyebrow, while preserving the hairline, and most of the suture lines are parallel to the forehead wrinkle lines.

Aged↗
PubMed1995

Percutaneous endoscopic sinus surgery for frontal sinusitis or a cyst.

Using percutaneous endoscopic surgery, we achieved good results in patients with frontal sinus cyst. The surgical procedure is described and discussed. The endoscopic system consisted of a needle-shaped rigid fiberscope (direct-vision and angle-vision types [30 degrees, 90 degrees]) 1.7 mm in diameter with a light source. A small incision was made at the eyebrow, the sinus was cleaned, and an opposite hole was made through the existing wound. This procedure permitted less invasive surgery under direct view of the surgical field compared with conventional percutaneous transnasal frontal sinus procedures. Postoperative patency of the sinus was also satisfactory. This percutaneous endoscopic procedure was designed for surgical maneuvers in the frontal sinus through a small, 3- to 5-mm incision. This technique is considered effective for the treatment of inflammatory disorders of the frontal sinus caused by positional abnormalities after trauma or recurrence after conservative transnasal surgery.

Adult↗
PubMed1996

The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern?

In April 1992, the American Academy of Pediatrics recommended back or side sleeping for healthy newborns to reduce the risk of sudden infant death syndrome. Subsequently, the US Public Health Service organized a health care coalition to promote a "Back to Sleep Campaign" to advocate back or side sleeping for infants. Since 1992, our craniofacial anomalies center has witnessed a marked increase in the incidence of infants with defomational changes of the cranium and face. The purpose of this project was to study the etiologies of deformational plagiocephaly and possible correlation with infant head position. We reviewed 52 consecutive patients presenting with deformational plagiocephaly from January 1992 to December 1994. A diagnosis of deformational plagiocephaly was determined by (1) history (date when head shape change was first noted), (2) clinical examination (occipital flattening, contralateral forehead flattening, lowering of the eyebrow, and ear shearing), and (3) skull radiographs (patent cranial sutures). All infants had medical photography to document baseline craniofacial morphology and any follow-up changes after nonsurgical therapy. Cranial asymmetry was first noted after birth at a mean time of 3.6 months. All infants were initially positioned on their back/side. In 52 patients, 61% had right-sided flattening of the occiput (vs 39% left-sided). All infants had flattening of the occiput, contralateral brow lowering or inferior displacement of the brow, contralateral forehead flattening, and posterioinferior displacement of the ear. All skull radiographs demonstrated patent sutures. Follow-up of patients ranged from 3 to 22 months with a mean of 10.5 months. Follow-up clinical examination and photography demonstrated significant improvement of cranial form in all patients with recommended frequent head turning (73%), helmet molding (23%), and surgery (4%). Our unit has seen an increase in the number of infants with deformational plagiocephaly over the last three years. All of the affected infants in this study had been managed according to the officially recommended protocol of back/side positioning. These findings suggest a possible relationship between this type of infant positioning and the development of a deformational plagiocephaly. However, cranial asymmetry in this group of patients decreased significantly with nonsurgical therapy. We have not recommended cranial vault remodeling surgery for the mild and moderate types of this deformity. However, if there is evidence of increasing asymmetry of deformational plagiocephalic infants during follow-up and evidence of severe variants of these deformities, surgical correction of the cranial vault is recommended.

Cranial Sutures↗
PubMed1997

Paranasal sinus mucocele: diagnosis and treatment.

Several controversies still exist regarding the etiopathogenesis, diagnosis, and type of surgical treatment used in response to paranasal sinus mucocele. We wish to contribute to the standardization of therapeutic treatment for paranasal sinus mucocele by reporting our clinical experience in "open surgery." This analysis considers 53 patients--23 males and 30 females (age range: 11-80 years)--affected by frontoethmoidal or sphenoidal sinus mucocele whom we have surgically treated. Patients were classified according to age, sex, previous surgical treatment in the nasal area, symptoms, and acute visual difficulties; 15 patients showed disease in the frontal area, 28 in frontoethmoidal area, and 10 in the posterior ethmoidal or sphenoidal area (or both); in 18 patients the disease had reached the intracranial region. Transfacial approaches were used in all patients who did not show evidence of disease in the intracranial region. Of all the incisions performed 18 were coronal, 16 were paralateral, and 4 were through upper eyebrow approaches; a transnasal endoscopic approach was used in only 1 patient in whom the intracranial region was affected by disease. All patients showed satisfying functional and aesthetic results during and after recuperation.

Adolescent↗
PubMed1999

Bilateral Tessier No. 9 cleft.

The authors describe a patient with bilateral Tessier no. 9 cleft. This is the rarest of the rare craniofacial clefts. It is an upper lateral orbital cleft with a soft-tissue deformity that extends from the lateral third of the upper eyelid, through the lateral end of the eyebrow to the temporal scalp. The bony disruption extends from the superolateral orbital rim across the greater wing of the sphenoid to the upper squamous temporal area. The clinical and radiological examinations are reported. No surgical correction was necessary.

Craniofacial Abnormalities↗
PubMed2006

Treatment of 'en coup de sabre' deformity with porous polyethylene implant.

Linear scleroderma "en coup de saber" (LSCS) deformity is a subgroup of scleroderma characterized by unilateral atrophy and depression above the level of the eyebrow. In rare cases where it involves the whole unilateral face it can be mistaken with Parry-Romberg syndrome. Involvement of the trunk and extremities together with facial lesions has been extremely rare in the literature. We report an unusual case of linear scleroderma "en coup de sabre" where there is concomitant involvement of the ipsilateral side of the trunk and lower extremity. The patient's facial deformity is reconstructed with a polyethylene implant.

Adipose Tissue↗
PubMed1987

Management of ptosis in chronic progressive external ophthalmoplegia.

Patients with chronic progressive external ophthalmoplegia (CPEO) are often disabled by ptosis; however, conventional ptosis surgery may induce lagophthalmos and exposure keratitis. Ten patients with CPEO underwent ptosis correction via bilateral frontalis suspensions, using monofilament synthetic material. Three of these patients were also treated with lower eyelid horizontal tightening. The frontalis sling was adjusted to provide a firm linkage between the eyebrow and eyelid, but was loose enough to allow eyelid closure when the frontalis muscle is relaxed. All patients experienced lessening of ptosis and relief from visual obstruction. One patient required reoperation of one eyelid for undercorrection. No lagophthalmos or corneal complications occurred. The rationale for treatment, preoperative evaluation, and operative procedure in CPEO is discussed herein.

Adult↗
PubMed1989

Ptosis correction in the context of the treatment of external congenital ophthalmoplegia.

The results are reported of our operative experience with 22 cases of external congenital ophthalmoplegia. The familiality, the muscular enzymes and isoenzymes, and often the skeletal electromyography have been studied, with the latter three being significantly altered in most cases. The main indication for surgery is the need to improve the anomalous position of the hyperextended neck. In the presence of inherent ptosis, this is achieved by suspending the upper eyelid from the frontalis muscle by using an autogenous fascia lata. A review of the previously published reports on eyebrow suspension leads one to conclude that autogenous fascia lata is the best material for this purpose.

Adolescent↗
PubMed1991

Anatomy of the orbital septum and associated eyelid connective tissues. Implications for ptosis surgery.

The anatomy of the orbital septum and associated eyelid connective tissues was examined using cadaver dissection, histologic sections, surgical observations, and special radiologic imaging. The embryologic development of the eyelid connective tissues was also reviewed. Examination revealed a distinct layer of fibroadipose tissue in the eyelid and eyebrow posterior to the orbicularis and frontalis muscles, and anterior to the orbital septum. Fibrous septa within the submuscular fibroadipose tissue become contiguous with more compact lamellae of the orbital septum posteriorly imparting a multilayered quality to the orbital septum. Fat within the fibroadipose layer anterior to the orbital septum may be mistaken for the preaponeurotic fat pad by the unwary surgeon and may lead to surgical error. The orbital septum and the levator aponeurosis were found to join 2 to 5 mm above the superior tarsal border (average, 3.4 mm). Recommendations for ptosis surgery based on these anatomic principles are given.

Adipose Tissue↗
PubMed1993

The staged management of ophthalmic complications of facial nerve palsy.

A six-stage approach to the management of the ophthalmic complications of facial palsy was developed to aid the physician in logically organizing therapy and to provide patients with reassuring goals. This stepwise approach was applied prospectively in 120 consecutive facial palsy patients from 1986 to 1990. The six stages included (a) supportive care (with and without tarsorrhaphy), (b) planning facial reanimation, (c) lower eyelid and lateral canthal resuspension, (d) passive upper eyelid reanimation, (e) dynamic eyelid animation (palpebral springs), and (f) soft tissue repositioning including eyebrow lift and blepharoplasty. Each stage was considered in order, although action in each stage was not appropriate for all patients. All 120 patients received supportive care, which was all that was necessary to accomplish the therapeutic goals for 63 (52.5%). Eight patients received temporary tarsorrhaphies (7%) and 14 (12%) permanent. One hundred ten were considered for stage 2. Thirty-five underwent stage 3 procedures, 30 received gold weights in stage 4, 5 had palpebral springs placed in stage 5, and 6 underwent stage 6 procedures. This staged approach was effective in achieving corneal compensation, maintaining vision, and improving the quality of life in all patients.

Eyelid Diseases↗
PubMed1996

Relations of the superficial musculoaponeurotic system to the orbit and characterization of the orbitomalar ligament.

The orbital and eyelid relationships of the superficial musculoaponeurotic system (SMAS) were studied in human cadavers. Using gross and microscopic techniques, the SMAS was found to be intimately related to the eyelids and orbicularis oculi muscle, and to have distinct orbital bony attachments. Sub-SMAS fat in the malar region was found to be continuous with the submuscular fat in the eyebrow region. The malar sub-SMAS fat continued superiorly into the lower eyelid above the inferior orbital rim, as a postorbicularis layer. A bony attachment emanating from the inferior orbital rim, the orbitomalar ligament, traveled through the orbicularis oculi muscle in a lamellar fashion prior to inserting into the dermis. The cutaneous insertion of this attachment corresponds to the malar and nasojugal skin folds. With aging, relaxation of the orbitomalar ligament allows inferior migration of orbital fat, in addition to the anterior migration that occurs through an attenuated orbital septum. These findings have implications not only in cosmetic surgery but also in the understanding of facial soft tissue changes that occur with aging.

Adult↗
PubMed1983

Pathophysiology of schizophrenia.

There is still another type of convulsive movement, involving the muscles of the eye and speech, which is both characteristic and of frequent occurrence in dementia praecox. Some of these movements correspond exactly to the movements of expression; wrinkling of the eyebrow, distortion of the mouth, rolling the eyes, and those other facial movements which are characterized as grimacing. These movements remind one of choreic movements and are quite independent of the ideas and feelings. They may be associated with the smacking of the lips, clucking the tongue, sudden grunting, sniffing, and coughing. Furthermore, in the lips we observe very rapid rhythmical movements. More often there exists a peculiar choreiform movement of the mouth which may be described as an athetoid ataxia.

Antibodies, Viral↗
PubMed1992

Behavioral treatment of children and adolescents with trichotillomania.

Trichotillomania is a behavior disorder with onset generally in childhood, characterized by repetitive, compulsive pulling out of hair from the scalp, eyebrows, or other parts of the body, often leading to disfigurement. Trichotillomania tends to be persistent and is often resistant to counselling and standard psychiatric care. A systematic behavioral treatment program for children and adolescents and pilot findings with three patients are described. Methodological issues in relation to compliance and assessment are discussed. The relative safety and potential effectiveness of behavioral techniques suggest a useful role for this approach, perhaps in conjunction with pharmacological, family, and other treatment modalities.

Adolescent↗
PubMed1995

Scalp distribution of electrical fields related to blink reflex.

In 20 subjects the supraorbital nerve was stimulated and R1 recorded from electrodes placed over the ipsilateral orbicularis oculi muscle and from locations Fz, F8, F7, Cz, C6, C5, Pz, T4, and T3 on the scalp. The latter were referred either to an extracranial electrode or to Fz. In five subjects an artificial dipole was set at three different positions on the eyebrow and records were taken from the same derivations on the scalp to study the distribution of fields of known intensity originating from known locations. It was found that R1 could be easily detected from all scalp locations. According to its scalp distribution, three patterns were identified, which matched those of the artificial dipole. Conversely from what had been believed by previous authors, the amplitude of R1 could be larger on the contralateral scalp, according to the reference used or to the location of its origin. Therefore, it is remarked that larger amplitude contralateral to the stimulus cannot anymore be considered an exclusive feature of responses arising from the cortex. The evidence we have provided recommends a highly cautious approach in interpreting results describing trigeminal scalp responses in the latency range of R1.

Adult↗