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There is a continuum of smiles from the one of the reserved Mona Lisa to a full dental smile where there is maximal exposure of teeth and full triggering of all the major and minor smile muscles. The ramus mandibularis paralysis is more obviously noted in the full dental smile. The ramus mandibularis paralysis is best corrected through a technique of wedge resection of the lower lip with a segmental sling to the nasolabila groove.
Dual representation of peptide and non-peptide structures in a chemical database as atomic-level molecular graphs and sequence strings permits chemical substructure and similarity searches as well as sequence-based substring and regular expression searches. CHUCKLES interconverts monomer-based sequences with SMILES, which represent atomic-level molecular graphs. Forward-translation maps peptide or other sequences into SMILES. Back-translation extracts monomer sequences from SMILES. This approach permits a generalized representation of monomers allowing user specification of any monomer. CHUCKLES allows mixing of atoms with user-defined monomer names; that is, monomer representation is consistent with SMILES notation. In addition, oligomer branching and cyclization are handled.
Cosmetic dentistry has evolved with the advent of more robust porcelain materials and ever-stronger bonding agents. This series of three articles aims to provide a practical overview of what is now possible both functionally and cosmetically from the preparation of a small number of teeth, through a whole smile, to full mouth rehabilitation. A complete diagnosis is the starting point to planning any cosmetic or functional changes. Guidance is given on the techniques used but adequate training must be considered essential before embarking upon modification in occlusal schemes or even minor adjustments in smile design. Conservative use of porcelain laminate veneers can result in significant aesthetic improvements to a patient's smile and it is not always necessary to prepare all the teeth visible in a smile.
BACKGROUND: Botulinum toxin type A (BTX-A, BOTOX) is an excellent therapeutic option for hyperkinetic facial lines. It improves wrinkles by relaxing the muscles of facial expression, which underlie the rhytids. Periocular wrinkles such as lateral orbital rhytids respond well to treatment. BOTOX can be used in the lower eyelid to improve wrinkles and widen the eye. OBJECTIVE: To determine whether there is additional benefit in using more than 2 U of BTX-A to improve infraorbital wrinkles and widen the eye. METHODS: Nineteen women had BTX-A injected into the orbicularis oculi muscle. Eleven women had 4 U injected into the lower eyelid bilaterally, 3 mm below the ciliary margin, and 12 U of BTX-A injected into one lateral orbital (crow's feet) area. Eight patients had 8 U injected bilaterally into the lower eyelid and 12 U placed unilaterally into the crow's feet. Physicians and patients independently evaluated the degree of improvement (grade 3=dramatic improvement, grade 2=moderate improvement, grade 1=mild improvement, and grade 0=no improvement). Single investigator analysis was used to measure, in actual millimeters, the amount of increase in palpebral aperture. Side effects were noted. RESULTS: Improvement was noted in lower eyelid wrinkles by both physicians and patients at both dose groups. When only the lower lid was injected, patients reported an improvement of 1.18 with 4 U and a grade of 1.63 with 8 U. When both the lower eyelid the lateral orbital area were treated, an improvement of 1.73 was reported with 4 U and a grade of 2.25 reported with 8 U in the lower eyelid. Physician evaluations had grades of 1.85 for 4 U alone and 1.85 with 8 U alone. Grades of 2.35 and 2.25 were obtained for 4 U plus 12 U and 8 U plus 12 U, respectively. An increase in palpebral aperture (IPA) occurred in all subjects. Subjects who received 4 U in the lower eyelid alone had a 1.8-mm IPA at rest and a 2.6-mm increase at full smile. Subjects who received 8 U of BTX-A alone in the lower lid had an IPA of 2.2 mm at rest and 2.9 mm at full smile. Eyes treated with 12 U in the bilateral orbital area plus 4 U in the lower eyelid had an IPA of 2.2 at rest and 4.5 mm at full smile. Those treated with 8 U in the lower lid plus the crow's feet had an IPA of 1.5 at rest and 4.0 at full smile. Side effects increased with dosage, with eight of eight subjects in the 8-U dose groups reporting bothersome side effects such as lower eyelid edema and incomplete sphincter function. CONCLUSION: A dose-response curve is seen with increasing doses of BTX-A used in the lower eyelid. Treatment of the lateral orbital area in combination with the lower lid produces a synergistic response at lower doses, but at higher doses, a plateau effect is suggested. Although increasing doses of BTX-A increases eye widening, unattractive results and side effects are seen at higher doses. The authors recommend that lower 2- or 4-U doses of BTX-A be used in the lower eyelid and specifically discuss techniques.
OBJECTIVE: The purpose was to determine whether preschool children aged 3 years 0 months through 3 years 6 months could be tested with the Random Dot E, Stereo Smile, and Randot Preschool stereoacuity tests, which are random dot stereotests marketed for use with preschoolers. METHODS: A total of 118 children from five Vision In Preschoolers Study Clinical Centers participated. Strabismic children, as determined by the cover test at distance and near, were excluded from this study. Stereopsis was tested on each child using each of the three tests in a variable, balanced order. A child's testability for each test was determined by the ability to complete the nonstereo task (pretest) and the gross stereo task for each stereotest. Proportions of children able to perform each test were compared using statistical methods accommodating multiple measurements per child. RESULTS: Testability of children on the pretest was greater for the Stereo Smile test (91%) than for the Random Dot E test (81%; p = 0.007) or the Randot Preschool test (71%; p < 0.0001) and greater for the Random Dot E test than for the Randot Preschool test (p = 0.02). For all children, testability on the gross stereo task was greater for the Stereo Smile (77%; p < 0.0001) and Random Dot E (74%; p = 0.005) tests than for the Randot Preschool test (56%) but did not differ significantly between the Stereo Smile and Random Dot E tests (p = 0.19). There were no significant differences among the proportion of children able to complete the gross stereo task among those who were testable on the pretest (p > 0.12, all comparisons). CONCLUSIONS: Among preschoolers aged 3 years 0 months through 3 years 6 months, testability differs significantly across the three commercially available random dot stereotests evaluated. The results suggest that two-choice procedures increase testability of young preschoolers.
Despite the wide spectrum of hemifacial microsomia manifestations, treatment mainly focuses on mandible and ear abnormalities, rather than on facial paralysis. In fact, the surgical treatment of facial paralysis associated with hemifacial microsomia is quite underdeveloped, because the degree of paralysis is frequently incomplete or partial. Timing and type of surgery are also difficult to determine. Neurovascular free-muscle transfer is now a standard procedure for the dynamic smile reconstruction of longstanding facial paralysis. This type of strategy has considerable potential in the treatment of facial paralysis in patients with hemifacial microsomia. We present here our experience with neurovascular free-muscle transfer for smile reconstruction in eight patients with facial paralysis associated with hemifacial microsomia. The age of the patients at the time of surgery ranged from 7 to 28 years old, (average, 13.9 years). Six were male patients and two were female patients. The two-stage method combining gracilis muscle transfer with cross-face nerve grafting was performed in three patients, whereas the one-stage transfer of the latissimus dorsi muscle was performed in five. To construct a natural or near-natural smile, the muscles were transferred into the paralyzed cheek in all except one patient, in whom the latissimus dorsi muscle was transferred into the sublabial area to reconstruct a paralyzed lower lip. A dermal flap segment vascularized with perforating vessels from the latissimus dorsi muscle was simultaneously inserted into the underdeveloped cheek for soft-tissue augmentation in this patient. Muscle contraction was evident in all patients between 4 and 8 months after muscle transfer. Our present series revealed that neurovascular free-muscle transfer is a good option not only for smile reconstruction but also for restoration of the facial contours of patients with hemifacial microsomia. Compared with the two-stage method combining gracilis muscle transfer with cross-face nerve grafting, the one-stage method using the latissimus dorsi muscle has some advantages, including a one-stage operation, a shorter recovery period, and the absence of sequelae that occur after harvesting a sural nerve.
We describe a 4-month-old Japanese infant with West syndrome with gelastic seizures in clusters. Smile developed around 3 months and gradually increased in frequency and intensity. Positron emission tomography showed hypoperfusion in bilateral hypothalamus. Interictal electroencephalogram (EEG) showed hypsarrythmia. Simultaneous video/EEG monitoring was performed. At first, a smile-like episode developed every several seconds, gradually increased to an abrupt flexion of the neck and extremities, and gradually decreased to a smile-like episode at the end. Ictal EEG revealed desynchronization. ACTH was effective. Smiles are common emotional responses in infancy. However, EEG and neuroimaging should be considered in a case of perinatal asphyxia and delayed development.
Four handicapped children were taught four positive social-emotional behaviors: smiling, sharing, positive physical contacting, and verbal complimenting, using instructions, modelling, and praise. Rates of these behaviors were shown to increase in four trained subjects using a within-subject multiple-baseline experimental design. The generality of the behavior change was investigated by integrating three untrained subjects with the trained subjects in a setting free of adult-imposed contingencies and through a series of follow-up observations. Three trained subjects evidenced collateral increases in the generalization setting on at least one other behavior when training in smiling was conducted. One trained subject showed generalization session increases for each behavior when training was conducted to increase that behavior. All three untrained subjects demonstrated increased rates of smiling and sharing when interventions were conducted to increase those behaviors with the trained subjects. There was no appreciable generalization of verbal complimenting by either the trained or the untrained subjects. Both trained and untrained subjects generally maintained their increased rates of smiling, sharing, and positive physical contacting across four weeks of follow-up observations.
Hajime Hoshi was the founder of Hoshi Pharmaceutical Company and Hoshi University. He made one of the biggest pharmaceutical companies in Japan in the early 20th century, and furthermore was a journalist, member of the Diet, educator, and also a writer. With such a checkered career, he had an attractive and invincible philosophy. As well as his most import philosophy "kindness first" described in the previous paper, "cooperation first" also had weight in his thought. In the Creed of the Hoshi Pharmaceutical Company, he said "self-reliance should go hand-in-hand with cooperation. Cooperation is an essential requisite in all successful enterprises." "Cooperation is an order of the god, and leads directly to progress." "Cooperation is construction, but noncooperation is destruction." Besides the thought "cooperation first," a part of his profound aphorism is described below. "Patience produces everything and conquers everything." "Success is proportioned to the degree of patience." "Success or failure is determined not at the end, but at the start of an enterprise. A well-conceived plan is the mother of success." "Train your mind. Man's brains become the more fertile and keen, the more they are used." "The is no limit to improvement and invention. We should never relax our endeavor to improve and invent." "Smile! Smile! Do your work with a smile on your face. Conquer difficulty and discontent with smiles." "Yesterday's impossibility is today's possibility. Today's impossibility is tomorrow's possibility."
Visual evoked potentials (VEP) were recorded in the right and left parietal and occipital regions of 40 right-handed controls in a facial recognition task. VEP were studied first according to the renown of the faces, then according to their emotional expression. Asymmetry was noted between the hemispheres: P100 was of greater amplitude and longer latency in the left occipital region. Later components (P400 and P600) were of greater amplitude and longer latency in the right parietal region in all situations. P100 latency on the left side was shorter for renowned faces than for non-renowned faces (P = 0.05). P600 latency was shorter on the right (P < 0.03) and left (P < 0.05) sides for smiling than for non-smiling faces. When the subjects were asked to look for emotional expression of the face (smiling or non-smiling) P400 was very ample and P600 of little amplitude. When the subjects were asked to recognize the face (renowned or not renowned) P600 was very ample and P400 of little amplitude. Thus, there seems to be a differential treatment of information: automatic and rapid to detect emotion (P400), controlled, tardy (P600) and involving memory in the search for renown.
This study was performed to elucidate quantitatively upper lip-tooth-jaw relativity in the vertical dimension. Values for five linear dentolabial measurements were generated from male (n = 42) and female (n = 46) reference samples. In addition, three vertical skeletofacial dimensions and two vertical dental dimensions were recorded. A significant sexual dimorphism was found in the vertical lip-tooth-jaw relationship: the upper lip of the female subjects was positioned on average 1.5 mm more superiorly at maximum smile than the upper lip of the male subjects (p less than 0.01). High smile lines appeared to be a female lineament, and low smile lines appeared to be a male lineament. There was a significant sex difference in upper lip length: the male subjects exhibited a longer upper lip than the female subjects (p less than 0.001). The mean difference was 2.2 mm. A similarly significant male-female difference was seen in the skeletal maxillary height measurement: the male sample showed a 2.2 mm mean vertical maxillary increase over the female sample (p less than 0.001). Furthermore, a significant difference was found between the clinical crown height of the maxillary central incisors in the male and female subjects of comparable ages: the male group had longer central incisor crowns (p less than 0.01).
BACKGROUND: The aim of the study was to investigate various factors that might affect facial attractiveness from ages 11 to 31 years. METHODS: Sixty subjects were selected from a sample participating in the longitudinal Cardiff Survey. Three-quarter-view facial photographs were taken of the subjects smiling and not smiling. Photos were taken in 1981, when the subjects were aged 11 years, and in 2001, when they were aged 31. Twelve judges used a 9-point Likert scale to evaluate overall facial attractiveness and the attractiveness of various facial features. The judges were also asked to estimate the adults' ages. Univariate and multivariate statistical tests and the generalizability theory were used. RESULTS AND CONCLUSIONS: Overall facial attractiveness does not depend on any single feature; smiling and youthful facial appearance make women look more attractive; facial attractiveness tends to decrease over time from ages 11 to 31; people tend to retain their relative levels of attractiveness throughout their life spans; orthodontic treatment improves dental appearance, but it does not necessarily make a person more attractive in the long term. Nevertheless, the positive effect of orthodontic treatment could still be observed, especially in men with lower levels of facial attractiveness in childhood.
The facial expressions of adults with Down's syndrome (DS; n = 15) as they watched happy, sad, and neutral videotapes were compared with those of a healthy age-matched control group (n = 20). Facial movements were analyzed with the Facial Action Coding System (P. E. Ekman & W. V. Friesen, 1978). While watching happy stimuli, the 10 DS adults who were able to appropriately rate their reactions smiled with a cheek raise as frequently as control adults, suggesting that the expression of positive affect in these individuals is normal. Contrary to predictions, however, the DS group exhibited fewer smiles without cheek raises than did control adults and were more likely not to smile. Neither group showed prototypic sad facial expressions in response to sad stimuli. Independent of emotion, DS participants made more facial movements, including more tongue shows, than did control participants. Differences in facial expression in DS adults may confuse others' interpretations of their emotional responses and may be important for understanding the development of abnormal emotional processes.
There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.
A new measuring system to judge facial aesthetics in young Caucasians is presented. The system uses sets of three photographs (one frontal, one three-quarter smiling, and one lateral) as a stimulus. Scores are performed on a visual analogue scale (VAS) with separate sets of reference photographs for girls and boys. The choice of the reference photographs was based on a panel evaluation of facial aesthetics of 40 boys and 40 girls from the archive of the orthodontic department. Reproducibility of the new measuring system was tested on a series of photographic sets (one frontal, one three-quarter smiling, and one lateral view) of 64 patients, using a panel of 78 adult laymen and 89 professionals. The panel members assessed these sets of photographs on a VAS, in relation to the reference sets. The system was shown to be reproducible. Although the intra-observer reproducibility was low, the reliability coefficient was excellent (Cronbach's alpha > or = 0.98). Validity was tested by comparing the scores on the new scales with those of the three-quarter smiling photographic views on an earlier published scale. The correlation between the ratings on the new measuring system and the earlier published scale was 0.82 for laymen and 0.77 for professionals. The new system is simple and flexible in its use, and reproducible and valid for assessing facial aesthetics in young Caucasians. The system can be used in further investigations on the evaluation of facial aesthetics.
A microcomputer-based approach to the quantification of facial expression was used to measure and compare the smiling behavior of a group of Parkinson's disease sufferers, a group of patients with major depression, and a control group of comparable age. Subjects were asked to view a series of amusing slides and their expressions were recorded. The most animated smile for each subject was chosen for analysis and scores on 12 computer-generated measures were obtained using the Facial Expression Measurement program. These measures are end-lip measure, mouth width measure, mouth-opening measure, mid-top measure, mid-lower lip measure, top lip-thickness measure, lower lip-thickness measure, eye-opening measure, top eyelid/iris intersect measure, lower eyelid/iris intersect measure, inner eyebrow measure, and mid-eyebrow measure. The depressed group differed significantly from the other groups, with higher scores on end-lip measure, mid-top lip measure, and mid-eyebrow measure. All subjects completed the Levine-Pilowsky Depression Questionnaire. The depressed patients obtained higher depression scores than the parkinsonian group, who in turn had significantly higher depression scores than the control group. The depression score was correlated with end-lip measure, mouth width measure, mid-top lip measure, eye-opening measure, and mid-eyebrow measure in the population as a whole. A significant negative correlation emerged between the depression score and mid-eyebrow measure in the depressed group. Both the depressed group and the parkinsonian group were found to smile significantly less often during the slide session when compared with the control group. These results are discussed in the light of earlier findings.
An anatomic study was performed on living subjects using magnetic resonance imaging (MRI) to distinguish the relative contribution of skin, subcutaneous tissue, and muscle to dynamic changes in the nasolabial fold during facial animation and aging. MRI scans with the face in repose and then holding a full smile were performed in both young and old adult subjects. Anatomic landmarks were identified, and measurements characterizing their position were made on the MRI console. MRI resulted in excellent image resolution of facial tissue planes. Comparison between young and old subjects with the face in repose demonstrated that progressive thickening of the dependent portion of the check fat pad and overlying skin, with no appreciable change in the muscle plane comprising the levators of the upper lip, resulted in a deeper and more acute nasolabial fold in older subjects. In both age groups there was significant shortening of the mimetic muscles with smiling, with the lateral mimetic muscles drawn closer to the underlying facial bones. This was accompanied by redistribution of the cheek fat pad, thereby maintaining projection of surface landmarks within the cheek mass in young subjects with smiling. These findings indicate that in order to diminish the nasolabial fold, surgery for facial rejuvenation should be directed to the skin and subcutaneous tissue planes superficial to the mimetic muscles to the upper lip. In order to recreate a natural nasolabial fold during surgery for facial reanimation, contraction of the levator muscles to the upper lip should result in redistribution of the cheek fat pad without change in surface projection of the cheek mass or upper lip; this can only be accomplished if the reconstructed levator muscle is positioned deep to the cheek fat pad, with its insertion toward the deep (mucosal) surface of the upper lip.
As patients with facial paralysis regain facial nerve function, they must endure and adapt to complications associated with recovery, such as synkinesis. Synkinesis is the presence of unintentional movement in one area of the face when intentionally performing movement in another area of the face. We used the Maximal Static Response Assay of facial motion to better define the differences between eye closure-associated perioral motion in normal individuals, motion of the affected side in patients with synkinesis, and motion of the unaffected side in patients with synkinesis, thereby characterizing the syndrome of ocular to oral synkinesis. The study population consisted of 78 patients with clinically defined ocular to oral synkinesis of the left or right hemiface and 27 individuals without facial impairment (control subjects). We used the Maximal Static Response Assay to quantify facial motion on the affected and unaffected sides during the motions of eye closure and smile in both groups. Patients with ocular to oral synkinesis had decreased supraorbital and infraorbital motion of the orbicularis oculi during eye closure on both the affected and unaffected sides relative to control subjects. They also had increased modiolar motion during eye closure on both sides relative to control subjects. On the affected side, the modiolus tended to move laterally; on the unaffected side, the modiolus tended to move medially (i.e., toward the side affected by the synkinesis). Modiolar motion present during eye closure in patients with ocular to oral synkinesis was not statistically different from modiolar motion present during smile on the affected side (eye closure, 0.39 cm +/- 0.25; smile, 0.47 cm +/- 0.30, p > 0.05). Using the Maximal Static Response Assay, we have quantitatively defined synkinesis of the affected hemiface and have shown that movement of the unaffected hemiface is influenced by the synkinetic movements of the affected hemiface. These data may provide the basis for a rational system of facial neuromuscular rehabilitation in this patient group.