Facial emotion recognition in patients with focal and diffuse axonal injury.

PubMed

Yassin, Walid; Callahan, Brandy L; Ubukata, Shiho; Sugihara, Genichi; Murai, Toshiya; Ueda, Keita

2017-01-01

Facial emotion recognition impairment has been well documented in patients with traumatic brain injury. Studies exploring the neural substrates involved in such deficits have implicated specific grey matter structures (e.g. orbitofrontal regions), as well as diffuse white matter damage. Our study aims to clarify whether different types of injuries (i.e. focal vs. diffuse) will lead to different types of impairments on facial emotion recognition tasks, as no study has directly compared these patients. The present study examined performance and response patterns on a facial emotion recognition task in 14 participants with diffuse axonal injury (DAI), 14 with focal injury (FI) and 22 healthy controls. We found that, overall, participants with FI and DAI performed more poorly than controls on the facial emotion recognition task. Further, we observed comparable emotion recognition performance in participants with FI and DAI, despite differences in the nature and distribution of their lesions. However, the rating response pattern between the patient groups was different. This is the first study to show that pure DAI, without gross focal lesions, can independently lead to facial emotion recognition deficits and that rating patterns differ depending on the type and location of trauma.

[Facial nerve injuries cause changes in central nervous system microglial cells].

PubMed

Cerón, Jeimmy; Troncoso, Julieta

2016-12-01

Our research group has described both morphological and electrophysiological changes in motor cortex pyramidal neurons associated with contralateral facial nerve injury in rats. However, little is known about those neural changes, which occur together with changes in surrounding glial cells. To characterize the effect of the unilateral facial nerve injury on microglial proliferation and activation in the primary motor cortex. We performed immunohistochemical experiments in order to detect microglial cells in brain tissue of rats with unilateral facial nerve lesion sacrificed at different times after the injury. We caused two types of lesions: reversible (by crushing, which allows functional recovery), and irreversible (by section, which produces permanent paralysis). We compared the brain tissues of control animals (without surgical intervention) and sham-operated animals with animals with lesions sacrificed at 1, 3, 7, 21 or 35 days after the injury. In primary motor cortex, the microglial cells of irreversibly injured animals showed proliferation and activation between three and seven days post-lesion. The proliferation of microglial cells in reversibly injured animals was significant only three days after the lesion. Facial nerve injury causes changes in microglial cells in the primary motor cortex. These modifications could be involved in the generation of morphological and electrophysiological changes previously described in the pyramidal neurons of primary motor cortex that command facial movements.

Impact of Injury Mechanisms on Patterns and Management of Facial Fractures.

PubMed

Greathouse, S Travis; Adkinson, Joshua M; Garza, Ramon; Gilstrap, Jarom; Miller, Nathan F; Eid, Sherrine M; Murphy, Robert X

2015-07-01

Mechanisms causing facial fractures have evolved over time and may be predictive of the types of injuries sustained. The objective of this study is to examine the impact of mechanisms of injury on the type and management of facial fractures at our Level 1 Trauma Center. The authors performed an Institutional Review Board-approved review of our network's trauma registry from 2006 to 2010, documenting age, sex, mechanism, Injury Severity Score, Glasgow Coma Scale, facial fracture patterns (nasal, maxillary/malar, orbital, mandible), and reconstructions. Mechanism rates were compared using a Pearson χ2 test. The database identified 23,318 patients, including 1686 patients with facial fractures and a subset of 1505 patients sustaining 2094 fractures by motor vehicle collision (MVC), fall, or assault. Nasal fractures were the most common injuries sustained by all mechanisms. MVCs were most likely to cause nasal and malar/maxillary fractures (P < 0.01). Falls were the least likely and assaults the most likely to cause mandible fractures (P < 0.001), the most common injury leading to surgical intervention (P < 0.001). Although not statistically significant, fractures sustained in MVCs were the most likely overall to undergo surgical intervention. Age, number of fractures, and alcohol level were statistically significant variables associated with operative management. Age and number of fractures sustained were associated with operative intervention. Although there is a statistically significant correlation between mechanism of injury and type of facial fracture sustained, none of the mechanisms evaluated herein are statistically associated with surgical intervention. Clinical Question/Level of Evidence: Therapeutic, III.

Effect of rocuronium on the level and mode of pre-synaptic acetylcholine release by facial and somatic nerves, and changes following facial nerve injury in rabbits.

PubMed

Tan, Jinghua; Xu, Jing; Xing, Yian; Chen, Lianhua; Li, Shitong

2015-01-01

Muscles innervated by the facial nerve show differential sensitivities to muscle relaxants than muscles innervated by somatic nerves. The evoked electromyography (EEMG) response is also proportionally reduced after facial nerve injury. This forms the theoretical basis for proper utilization of muscle relaxants to balance EEMG monitoring and immobility under general anesthesia. (1) To observe the relationships between the level and mode of acetylcholine (ACh) release and the duration of facial nerve injury, and the influence of rocuronium in an in vitro rabbit model. (2) To explore the pre-synaptic mechanisms of discrepant responses to a muscle relaxant. Quantal and non-quantal ACh release were measured by using intracellular microelectrode recording in the orbicularis oris 1 to 42 days after graded facial nerve injury and in the gastrocnemius with/without rocuronium. Quantal ACh release was significantly decreased by rocuronium in the orbicularis oris and gastrocnemius, but significantly more so in gastrocnemius. Quantal release was reduced after facial nerve injury, which was significantly correlated with the severity of nerve injury in the absence but not in the presence of rocuronium. Non-quantal ACh release was reduced after facial nerve injury, with many relationships observed depending on the extent of the injury. The extent of inhibition of non-quantal release by rocuronium correlated with the grade of facial nerve injury. These findings may explain why EEMG amplitude might be diminished after acute facial nerve injury but relatively preserved after chronic injury and differential responses in sensitivity to rocuronium.

Effect of rocuronium on the level and mode of pre-synaptic acetylcholine release by facial and somatic nerves, and changes following facial nerve injury in rabbits

PubMed Central

Tan, Jinghua; Xu, Jing; Xing, Yian; Chen, Lianhua; Li, Shitong

2015-01-01

Muscles innervated by the facial nerve show differential sensitivities to muscle relaxants than muscles innervated by somatic nerves. The evoked electromyography (EEMG) response is also proportionally reduced after facial nerve injury. This forms the theoretical basis for proper utilization of muscle relaxants to balance EEMG monitoring and immobility under general anesthesia. (1) To observe the relationships between the level and mode of acetylcholine (ACh) release and the duration of facial nerve injury, and the influence of rocuronium in an in vitro rabbit model. (2) To explore the pre-synaptic mechanisms of discrepant responses to a muscle relaxant. Quantal and non-quantal ACh release were measured by using intracellular microelectrode recording in the orbicularis oris 1 to 42 days after graded facial nerve injury and in the gastrocnemius with/without rocuronium. Quantal ACh release was significantly decreased by rocuronium in the orbicularis oris and gastrocnemius, but significantly more so in gastrocnemius. Quantal release was reduced after facial nerve injury, which was significantly correlated with the severity of nerve injury in the absence but not in the presence of rocuronium. Non-quantal ACh release was reduced after facial nerve injury, with many relationships observed depending on the extent of the injury. The extent of inhibition of non-quantal release by rocuronium correlated with the grade of facial nerve injury. These findings may explain why EEMG amplitude might be diminished after acute facial nerve injury but relatively preserved after chronic injury and differential responses in sensitivity to rocuronium. PMID:25973033

Evoked electromyography to rocuronium in orbicularis oris and gastrocnemius in facial nerve injury in rabbits.

PubMed

Xing, Yian; Chen, Lianhua; Li, Shitong

2013-11-01

Muscles innervated by the facial nerve show different sensitivities to muscle relaxants than muscles innervated by somatic nerves, especially in the presence of facial nerve injury. We compared the evoked electromyography (EEMG) response of orbicularis oris and gastrocnemius in with and without a non-depolarizing muscle relaxant in a rabbit model of graded facial nerve injury. Differences in EEMG response and inhibition by rocuronium were measured in the orbicularis oris and gastrocnemius muscles 7 to 42 d after different levels of facial nerve crush injuries in adult rabbits. Baseline EEMG of orbicularis oris was significantly smaller than those of the gastrocnemius. Gastrocnemius was more sensitive to rocuronium than the facial muscles (P < 0.05). Baseline EEMG and EEMG amplitude of orbicularis oris in the presence of rocuronium was negatively correlated with the magnitude of facial nerve injury but the sensitivity to rocuronium was not. No significant difference was found in the onset time and the recovery time of rocuronium among gastrocnemius and normal or damaged facial muscles. Muscles innervated by somatic nerves are more sensitive to rocuronium than those innervated by the facial nerve, but while facial nerve injury reduced EEMG responses, the sensitivity to rocuronium is not altered. Partial neuromuscular blockade may be a suitable technique for conducting anesthesia and surgery safely when EEMG monitoring is needed to preserve and protect the facial nerve. Additional caution should be used if there is a risk of preexisting facial nerve injury. Copyright © 2013 Elsevier Inc. All rights reserved.

Sound-induced facial synkinesis following facial nerve paralysis.

PubMed

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

2009-08-01

Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed.

How do I manage an acute injury to the facial nerve?

PubMed

Colbert, Serryth; Coombes, Daryl; Godden, Daryl; Cascarini, Luke; Kerawala, Cyrus; Brennan, Peter A

2014-01-01

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Primary repair of facial dog bite injuries in children.

PubMed

Wu, Peter S; Beres, Alana; Tashjian, David B; Moriarty, Kevin P

2011-09-01

The management of dog bite wounds is controversial, and current data on risk of infection are variable and inconsistent. Furthermore, the use of prophylactic or empiric antibiotics for the treatment of these wounds is debatable. We investigate the rate of wound infections and other complications after primary repair of pediatric facial dog bite injuries. We reviewed 87 consecutive patients aged 18 years or younger who had facial dog bite injuries from January 2003 to December 2008. Variables examined were age, sex, setting of repair, number of sutures used for repair, whether surgical drains were used, and antibiotic administration. End points measured were incidence of wound infection, need for scar revision, and any wound complications. The mean age of patients was 6.8 years, and the majority were women (53%). All facial injuries were primarily repaired at the time of presentation either in the emergency department (ED; 46%), operating room (OR; 51%), or an outpatient setting (3%). All patients received an antibiotic course, none of the patients developed wound infection, and no subsequent scar revisions were performed. Three patients repaired in the OR underwent placement of a total of 4 closed-suction drains. The mean (SD) age of patients repaired in the OR was significantly younger than those repaired in the ED (5.7 [3.9] vs 8.0 [4.5] years, respectively; P < 0.01). The number of sutures used were greater for patients repaired in the OR than in the ED (66.4 [39.6] vs 21.7 [12.5], respectively; P < 0.01). Intuitively, younger patients and patients with greater severity injuries are more likely to undergo repair in the OR, and this was supported by our data. Overall, we found that primary repair of pediatric facial dog bite injuries, including complex soft-tissue injuries, is safe when performed in conjunction with antibiotic administration; however, further cross-specialty studies are needed to fully characterize these end points in a larger population.

[Magnetic resonance imaging in facial injuries and digital fusion CT/MRI].

PubMed

Kozakiewicz, Marcin; Olszycki, Marek; Arkuszewski, Piotr; Stefańczyk, Ludomir

2006-01-01

Magnetic resonance images [MRI] and their digital fusion with computed tomography [CT] data, observed in patients affected with facial injuries, are presented in this study. The MR imaging of 12 posttraumatic patients was performed in the same plains as their previous CT scans. Evaluation focused on quality of the facial soft tissues depicting, which was unsatisfactory in CT. Using the own "Dental Studio" programme the digital fusion of the both modalities was performed. Pathologic dislocations and injures of facial soft tissues are visualized better in MRI than in CT examination. Especially MRI properly reveals disturbances in intraorbital soft structures. MRI-based assessment is valuable in patients affected with facial soft tissues injuries, especially in case of orbita/sinuses hernia. Fusion CT/MRI scans allows to evaluate simultaneously bone structure and soft tissues of the same region.

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

PubMed Central

Saperi, Bin Sulong; Ramli, Roszalina; Ahmed, Zafar; Muhd Nur, Amrizal; Ibrahim, Mohd Ismail; Rashdi, Muhd Fazlynizam; Nordin, Rifqah; Rahman, Normastura Abd; Yusoff, Azizah; Nazimi, Abd Jabar; Abdul Rahman, Roselinda; Abdul Razak, Noorhayati; Mohamed, Norlen

2017-01-01

Objective Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. Materials and methods A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. Results A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. Conclusion Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia. PMID:28223831

Pediatric facial fractures as a result of gunshot injuries: an examination of associated injuries and trends in management.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-03-01

Facial fractures are relatively uncommon in the pediatric population, especially those inflicted as a result of interpersonal violence in the form of gunshot injuries. Few studies have examined the unique management of such high-energy injuries in the pediatric population. Oftentimes the resultant damage to soft tissue and bony structures is so great that it challenges the previously accepted standards in the management of pediatric facial fractures. This study will examine a level 1 trauma center's experience with these unique injuries. A retrospective review of all facial fractures occurring in a pediatric population (those 18 years of age or younger) as a result of gunshot wounds in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Descriptive information was collected regarding each case as well as information regarding concomitant injuries, treatment modalities, and selected outcomes. During this time period, there were 3147 facial fractures treated at our institution, 353 of which were in pediatric patients. Of these, 17 were the results of gunshot wounds. Three patients were excluded due to insufficient data, leaving a total of 14 patients. The average age of patients was 16.5 (range 14-18); all patients were African-American males. The most common fracture was that of the mandible (n = 10), with 2 of those patients exhibiting panfacial fractures. The average Glasgow Coma Scale on admission was 13.5 (range 3-15). Six of the patients were intubated in the emergency department. The most common concomitant injury was a skull fracture (n = 3), followed by cervical spine fractures (n = 2) and intracranial hemorrhages (n = 2). All patients were admitted to the hospital for reasons other than fracture management. Seven patients ultimately went to the operating room for fracture management. The treatment modalities employed were conservative management with closed techniques (n = 11), rigid internal fixation (n = 2), and the

Effects of agmatine sulphate on facial nerve injuries.

PubMed

Surmelioglu, O; Sencar, L; Ozdemir, S; Tarkan, O; Dagkiran, M; Surmelioglu, N; Tuncer, U; Polat, S

2017-03-01

To evaluate the effect of agmatine sulphate on facial nerve regeneration after facial nerve injury using electron and light microscopy. The study was performed on 30 male Wistar albino rats split into: a control group, a sham-treated group, a study control group, an anastomosis group, and an anastomosis plus agmatine sulphate treatment group. The mandibular branch of the facial nerve was dissected, and a piece was removed for histological and electron microscopic examination. Regeneration was better in the anastomosis group than in the study control group. However, the best regeneration findings were seen in the agmatine sulphate treatment group. There was a significant difference between the agmatine group and the others in terms of median axon numbers (p < 0.004) and diameters (p < 0.004). Agmatine sulphate treatment with anastomosis in traumatic facial paralysis may enhance nerve regeneration.

Hypoglossal-facial nerve "side"-to-side neurorrhaphy for facial paralysis resulting from closed temporal bone fractures.

PubMed

Su, Diya; Li, Dezhi; Wang, Shiwei; Qiao, Hui; Li, Ping; Wang, Binbin; Wan, Hong; Schumacher, Michael; Liu, Song

2018-06-06

Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. we modified the classical method by hypoglossal-facial nerve "side"-to-side neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side"-to-side neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electrophysiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. We concluded that the hypoglossal-facial nerve "side"-to-side neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal

A Single-Center Review of Facial Fractures as the Result of High-Speed Projectile Injuries

PubMed Central

Liu, Farrah C.; Halsey, Jordan N.; Hoppe, Ian C.; Ciminello, Frank S.; Lee, Edward S.; Granick, Mark S.

2018-01-01

Purpose: Gunshot injuries to the face that result in fractures of the underlying skeleton present a challenge in management. The goal of this study was to evaluate patterns of facial fractures as a result of gunshot injuries and strategies for management. Methods: A retrospective review of facial fractures resulting from gunshot injuries in a level 1 trauma center was performed for the years 2000 to 2012. Data were collected for patient demographics, fracture distribution, concomitant injuries, and surgical management strategies. Results: A total of 190 patients sustained facial fractures from a gunshot injury. The average age was 29.9 years, and 90% were male. Sixteen injuries were self-inflicted. The most common fractures were of the mandible and the orbit. Uncontrolled hemorrhage was noted on presentation in 68 patients; 100 patients were intubated on arrival. The average Glasgow Coma Scale score on arrival was 11.9. Concomitant injuries included skull fracture, intracranial hemorrhage, and intrathoracic injury. Surgical management was required in 89 patients. Nine patients required soft-tissue coverage. Thirty patients expired. Conclusion: Gunshot injuries to the face resulting in fractures of the underlying skeleton have high instances of morbidity and mortality. Life-threatening concomitant injuries can complicate management of facial fractures in this population. PMID:29713397

Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures.

PubMed

Halsey, Jordan N; Hoppe, Ian C; Marano, Andrew A; Kordahi, Anthony M; Lee, Edward S; Granick, Mark S

2016-01-01

Cervical spine injury may present with pediatric patients having sustained fractures of the craniofacial skeleton. Management considerations of the cervical spine often take priority to the fractures of the facial skeleton. The goal of this study was to examine this subset of patients with a focus on initial presentation and need for intervention. A retrospective review from 2000 to 2012 of all facial fractures in patients ≤ 18 years at a level 1 trauma center was performed. Patient demographics, location of fractures, and the presence of a cervical spine injury were collected. During this time period, 285 patients met inclusion criteria. Ten patients were found to have a cervical spine injury. Fractures of the zygoma and orbit were significantly associated with a cervical spine injury. Patients with a cervical spine injury had a Glasgow Coma Scale of 11.2 compared with 13.8 in those without (P < 0.05). C1 was injured in 4 patients, C2 in 2 patients, and C3 to C7 in 4 patients. A surgical airway was required in 1 patient, and 6 were intubated in the trauma bay. Fractures of the mandible were significantly associated with injury to C2. Le Fort fractures and palate fractures approached significance with injury to C1. Only 1 patient had neurologic impairment at presentation, manifested as upper extremity parasthesias, and underwent decompression and fusion in the operating room. Those patients admitted (90%) were all admitted for reasons other than management of the cervical spine injury. The majority of patients (70%) were treated with collar immobilization. One patient expired. No patients had a neurologic deficit at the time of discharge. In this study only 1 cervical spine injury necessitated intervention, with an eventual full recovery. Cervical spine injuries presenting with fractures of the facial skeleton appear to be relatively benign in this series; however, care must be taken to identify all such injuries to avoid exacerbation during maneuvers commonly

Osteopathic manipulative treatment for facial numbness and pain after whiplash injury.

PubMed

Genese, Josephine Sun

2013-07-01

Whiplash injury is often caused by rear-end motor vehicle collisions. Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. Osteopathic manipulative treatment techniques applied at the level of the cervical spine, suboccipital region, and cranial region alleviated the patient's facial symptoms by treating the right-sided strain of the trigeminal nerve. The strain on the trigeminal nerve likely occurred at the upper cervical spine, at the nerve's cauda, and at the brainstem, the nerve's point of origin. The temporal portion of the cranium played a major role in the strain on the maxillary.

Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery.

PubMed

Lee, Tae Sung; Park, Sanghoon

2017-10-01

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.

[Changes in facial nerve function, morphology and neurotrophic factor III expression following three types of facial nerve injury].

PubMed

Zhang, Lili; Wang, Haibo; Fan, Zhaomin; Han, Yuechen; Xu, Lei; Zhang, Haiyan

2011-01-01

To study the changes in facial nerve function, morphology and neurotrophic factor III (NT-3) expression following three types of facial nerve injury. Changes in facial nerve function (in terms of blink reflex (BF), vibrissae movement (VM) and position of nasal tip) were assessed in 45 rats in response to three types of facial nerve injury: partial section of the extratemporal segment (group one), partial section of the facial canal segment (group two) and complete transection of the facial canal segment lesion (group three). All facial nerves specimen were then cut into two parts at the site of the lesion after being taken from the lesion site on 1st, 7th, 21st post-surgery-days (PSD). Changes of morphology and NT-3 expression were evaluated using the improved trichrome stain and immunohistochemistry techniques ,respectively. Changes in facial nerve function: In group 1, all animals had no blink reflex (BF) and weak vibrissae movement (VM) at the 1st PSD; The blink reflex in 80% of the rats recovered partly and the vibrissae movement in 40% of the rats returned to normal at the 7th PSD; The facial nerve function in 600 of the rats was almost normal at the 21st PSD. In group 2, all left facial nerve paralyzed at the 1st PSD; The blink reflex partly recovered in 40% of the rats and the vibrissae movement was weak in 80% of the rats at the 7th PSD; 8000 of the rats'BF were almost normal and 40% of the rats' VM completely recovered at the 21st PSD. In group 3, The recovery couldn't happen at anytime. Changes in morphology: In group 1, the size of nerve fiber differed in facial canal segment and some of myelin sheath and axons degenerated at the 7th PSD; The fibres' degeneration turned into regeneration at the 21st PSD; In group 2, the morphologic changes in this group were familiar with the group 1 while the degenerated fibers were more and dispersed in transection at the 7th PSD; Regeneration of nerve fibers happened at the 21st PSD. In group 3, most of the fibers

Management of missiles injuries of the facial skeleton: primary, intermediate, and secondary phases.

PubMed

Kummoona, Raja

2010-07-01

This study included 235 patients with missile injuries of the facial skeleton, who were treated in the Maxillofacial Unit of the Hospital of Specialized Surgery in Medical City, Baghdad, Iraq, during a period of 4 years of war, since Iraq became the international battlefield for terrorism. There were 195 men and 40 women, with ages ranging from 1 to 70 years (mean, 39.5 years); all patients had severe facial injuries and posttraumatic missile deformities, including 27 patients with orbital injuries. This study also evaluates the management of the immediate, intermediate, and secondary phases.Deformities of the facial skeleton as a complication of missile injuries were classified into the following cases: 95 patients (40.43%) had bone loss, 72 patients (30.64%) had soft-tissue loss, 33 patients (14.05%) had orbital injuries, and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation.The bony defects of the mandible were reconstructed by both bone chips carried by osteomesh tray harvested from the iliac crest in 24 patients and by block of corticocancellous bone graft from the iliac crest in 38 patients for reconstruction of the mandible, 4 cases for maxillary reconstruction, and 4 cases of orbital floor defect. K-wire was used in 23 cases for holding missing segments of the mandible. Soft-tissue reconstruction of the face was done in 72 cases, local flaps were used in 30 cases, regional flaps including lateral cervical flap in 10 cases, and cervicofacial flaps in 11 cases. The orbit was reconstructed by bone graft, lyophilized dura, and silastic implant. Low-velocity bullet injury to the frontal part of the head was treated by coronal flap, as an access in 6 cases required craniotomy and dura was reconstructed by galea or temporalis muscle. Scar contracture was treated by scar revision, and sinus tract was excised at the same time of scar revision. Primary phase required an urgent airway management, controlling an active

Facial Fractures.

PubMed

Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

2018-06-01

The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

The effect of motorcycle helmet type, components and fixation status on facial injury in Klang Valley, Malaysia: a case control study

PubMed Central

2014-01-01

Background The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists. Method 755 injured motorcyclists were recruited over a 12-month period in 2010–2011 in southern Klang Valley, Malaysia in this case control study. Of the 755 injured motorcyclists, 391participants (51.8%) sustained facial injuries (cases) while 364 (48.2%) participants were without facial injury (control). The outcomes of interest were facial injury and location of facial injury (i.e. upper, middle and lower face injuries). A binary logistic regression was conducted to examine the association between helmet characteristics and the outcomes, taking into account potential confounders such as age, riding position, alcohol and illicit substance use, type of colliding vehicle and type of collision. Helmet fixation was defined as the position of the helmet during the crash whether it was still secured on the head or had been dislodged. Results Helmet fixation was shown to have a greater effect on facial injury outcome than helmet type. Increased odds of adverse outcome was observed for the non-fixed helmet compared to the fixed helmet with adjusted odds ratio (AOR) = 2.10 (95% CI 1.41- 3.13) for facial injury; AOR = 6.64 (95% CI 3.71-11.91) for upper face injury; AOR = 5.36 (95% CI 3.05-9.44) for middle face injury; and AOR = 2.00 (95% CI 1.22-3.26) for lower face injury. Motorcyclists with visor damage were shown with AOR = 5.48 (95% CI 1.46-20.57) to have facial injuries compared to those with an undamaged visor. Conclusions A helmet of any type that is properly worn and remains fixed on the head throughout a crash will provide some form of

Under pressure: progressively enlarging facial mass following high-pressure paint injection injury.

PubMed

Mushtaq, Jameel; Walker, Abigail; Hunter, Ben

2016-01-19

High-pressure paint injection injuries are relatively rare industrial accidents and almost exclusively occur on the non-dominant hand. A rarely documented complication of these injuries is the formation of a foreign body granuloma. We report a case of a 33-year-old man presenting with extensive facial scarring and progressive right paranasal swelling 7 years after a high-pressure paint injury. After imaging investigations, an excision of the mass and revision of scarring was performed. Access to the mass was gained indirectly through existing scarring over the nose to ensure an aesthetic result. Histological analysis revealed a florid granulomatous foreign body reaction to retained paint. To the best of our knowledge, this is the first reported case of a facial high-pressure paint injury with consequent formation of a foreign body granuloma. 2016 BMJ Publishing Group Ltd.

Examination of life-threatening injuries in 431 pediatric facial fractures at a level 1 trauma center.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-09-01

Pediatric facial fractures represent a challenge in management due to the unique nature of the growing facial skeleton. Oftentimes, more conservative measures are favored to avoid rigid internal fixation and disruption of blood supply to the bone and soft tissues. In addition, the great force required to fracture bones of the facial skeleton often produces concomitant injuries that present a management priority. The purpose of this study was to examine a level 1 trauma center's experience with pediatric facial trauma resulting in fractures of the underlying skeleton with regards to epidemiology and concomitant injuries. A retrospective review of all facial fractures at a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patients aged 18 years or younger were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. A significance value of 5% was used. During this period, there were 3147 facial fractures treated at our institution, 353 of which were pediatric patients. Upon further review, 68 patients were excluded because of insufficient data for analysis, leaving 285 patients for review. The mean age of patients was 14.2 years with a male predominance (77.9%). The mechanism of injury was assault in 108 (37.9%), motor vehicle accident in 68 (23.9%), pedestrian struck in 41 (14.4%), fall in 26 (9.1%), sporting accident in 20 (7.0%), and gunshot injury in 16 (5.6%). The mean Glasgow Coma Scale (GCS) on arrival to the emergency department was 13.7. The most common fractures were those of the mandible (29.0%), orbit (26.5%), nasal bone (14.4%), zygoma (7.7%), and frontal bone/frontal sinus (7.5%). Intracranial hemorrhage was present in 70 patients (24.6%). A skull fracture was present in 50 patients (17.5%). A long bone fracture was present in 36 patients (12.6%). A pelvic or thoracic fracture was present in 30 patients (10.5%). A cervical spine

Pediatric Facial Fractures: Interpersonal Violence as a Mechanism of Injury.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Lee, Edward S; Granick, Mark S

2015-07-01

Interpersonal violence is a relatively infrequent cause of injury to the craniofacial skeleton in the pediatric population. The presentation of fractures as a result of different causes varies dramatically and can have a direct impact on management. The current study compares facial fractures in a pediatric population as a result of interpersonal violence with other mechanisms of injury. A retrospective review of all of the facial fractures at a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patients ≤18 years were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, services consulted, and surgical management strategies. Patients were placed into 2 groups, those sustaining an injury as a result of interpersonal violence and all others. A significance value of 5% was used. During this period, there were 3147 facial fractures treated at our institution, 353 of which were in pediatric patients. Upon further review, 68 patients were excluded because of insufficient data for analysis, leaving 285 patients for review. There were 124 (43.5%) patients identified as sustaining a fracture as a result of interpersonal violence. Those sustaining a fracture as a result of interpersonal violence were statistically (P < 0.05) more likely to be boys and to have sustained a fracture of the mandible. The most common services consulted for this group of patients was plastic surgery and oral and maxillofacial surgery. This group of patients was statistically (P < 0.05) more likely to be admitted specifically for management of a facial fracture and statistically (P < 0.05) more likely to be treated operatively with rigid internal fixation. Those sustaining a fracture as a result of interpersonal violence were significantly less likely to have other systemic injuries such as spinal fractures, intracranial fractures, long bone fractures, and pelvic/thoracic fractures. This group was

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

PubMed Central

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

2014-01-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

PubMed

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

2014-08-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Facial injuries following hyena attack in rural eastern Ethiopia.

PubMed

Fell, M J; Ayalew, Y; McClenaghan, F C; McGurk, M

2014-12-01

Hyenas are effective hunters and will consider humans as potential prey if the need and opportunity arise. This study describes the circumstances of hyena attacks, the patterns of injuries sustained, and reconstruction in a resource-poor setting. As part of a charitable surgical mission to Ethiopia in 2012, 45 patients with facial deformities were reviewed, of whom four were victims of hyena attacks. A semi-structured interview was performed to ascertain the circumstances of the attack and the subsequent consequences. The age of the victims at the time of attack varied from 5 to 50 years. The attacks occurred when the victims were alone and vulnerable and took place in outdoor open spaces, during the evening or at night. The initial lunge was made to the facial area; if the jaws closed on the facial bones they were crushed, but in all cases the soft tissues were grasped and torn from the underlying bone. Reconstruction was dictated by the extent of soft tissue loss but could normally be obtained by use of local or regional flaps. Hyenas have been shown to attack humans in a predictable way and cause injuries that typically involve the soft tissues of the face. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report.

PubMed

Casal, Diogo; Pelliccia, Giovanni; Pais, Diogo; Carrola-Gomes, Diogo; Angélica-Almeida, Maria; Videira-Castro, José; Goyri-O'Neill, João

2017-07-29

Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in

Trigeminal Inflammatory Compression (TIC) Injury Induces Chronic Facial Pain and Susceptibility to Anxiety-Related Behaviors

PubMed Central

Lyons, Danielle N.; Kniffin, Tracey C.; Zhang, Liping; Danaher, Robert J.; Miller, Craig S.; Bocanegra, Jose L.; Carlson, Charles R.; Westlund, Karin N.

2015-01-01

Our laboratory previously developed a novel neuropathic and inflammatory facial pain model for mice referred to as the Trigeminal Inflammatory Compression (TIC) model. Rather than inducing whole nerve ischemia and neuronal loss, this injury induces only slight peripheral nerve demyelination triggering long-term mechanical allodynia and cold hypersensitivity on the ipsilateral whisker pad. The aim of the present study is to further characterize the phenotype of the TIC injury model using specific behavioral assays (i.e. light-dark box, open field exploratory activity, and elevated plus maze) to explore pain- and anxiety-like behaviors associated with this model. Our findings determined that the TIC injury produces hypersensitivity 100% of the time after surgery that persists at least 21 weeks post injury (until the animals are euthanized). Three receptive field sensitivity pattern variations in mice with TIC injury are specified. Animals with TIC injury begin displaying anxiety-like behavior in the light-dark box preference and open field exploratory tests at week 8 post injury as compared to sham and naïve animals. Panic anxiety-like behavior was shown in the elevated plus maze in mice with TIC injury if the test was preceded with acoustic startle. Thus, in addition to mechanical and cold hypersensitivity, the present study identified significant anxiety-like behaviors in mice with TIC injury which resembling the clinical symptomatology and psychosocial impairments of patients with chronic facial pain. Overall, the TIC injury model’s chronicity, reproducibility, and reliability in producing pain- and anxiety-like behaviors demonstrate its usefulness as a chronic neuropathic facial pain model. PMID:25818051

Comparison of trophic factors' expression between paralyzed and recovering muscles after facial nerve injury. A quantitative analysis in time course.

PubMed

Grosheva, Maria; Nohroudi, Klaus; Schwarz, Alisa; Rink, Svenja; Bendella, Habib; Sarikcioglu, Levent; Klimaschewski, Lars; Gordon, Tessa; Angelov, Doychin N

2016-05-01

After peripheral nerve injury, recovery of motor performance negatively correlates with the poly-innervation of neuromuscular junctions (NMJ) due to excessive sprouting of the terminal Schwann cells. Denervated muscles produce short-range diffusible sprouting stimuli, of which some are neurotrophic factors. Based on recent data that vibrissal whisking is restored perfectly during facial nerve regeneration in blind rats from the Sprague Dawley (SD)/RCS strain, we compared the expression of brain derived neurotrophic factor (BDNF), fibroblast growth factor-2 (FGF2), insulin growth factors 1 and 2 (IGF1, IGF2) and nerve growth factor (NGF) between SD/RCS and SD-rats with normal vision but poor recovery of whisking function after facial nerve injury. To establish which trophic factors might be responsible for proper NMJ-reinnervation, the transected facial nerve was surgically repaired (facial-facial anastomosis, FFA) for subsequent analysis of mRNA and proteins expressed in the levator labii superioris muscle. A complicated time course of expression included (1) a late rise in BDNF protein that followed earlier elevated gene expression, (2) an early increase in FGF2 and IGF2 protein after 2 days with sustained gene expression, (3) reduced IGF1 protein at 28 days coincident with decline of raised mRNA levels to baseline, and (4) reduced NGF protein between 2 and 14 days with maintained gene expression found in blind rats but not the rats with normal vision. These findings suggest that recovery of motor function after peripheral nerve injury is due, at least in part, to a complex regulation of lesion-associated neurotrophic factors and cytokines in denervated muscles. The increase of FGF-2 protein and concomittant decrease of NGF (with no significant changes in BDNF or IGF levels) during the first week following FFA in SD/RCS blind rats possibly prevents the distal branching of regenerating axons resulting in reduced poly-innervation of motor endplates. Copyright �

Electrical response grading versus House-Brackmann scale for evaluation of facial nerve injury after Bell's palsy: a comparative study.

PubMed

Huang, Bin; Zhou, Zhang-ling; Wang, Li-li; Zuo, Cong; Lu, Yan; Chen, Yong

2014-07-01

There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell's palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell's palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell's palsy. The facial nerve function of 68 patients with Bell's palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. Checking consistency between electrical response grading and House-Brackmann scale: Kappa value 0.028 (P = 0.578). Correlation analysis: the two methods were correlated with the prognosis, and electrical response grading (rER = 0.789) was better than the House-Brackmann scale (rHB = 0.423). Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.

Bilateral traumatic facial paralysis. Case report.

PubMed

Undabeitia, Jose; Liu, Brian; Pendleton, Courtney; Nogues, Pere; Noboa, Roberto; Undabeitia, Jose Ignacio

2013-01-01

Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. We report the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high resolution CT scan and electromyographic studies can be helpful for correct diagnosis. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Trigeminal Inflammatory Compression (TIC) injury induces chronic facial pain and susceptibility to anxiety-related behaviors.

PubMed

Lyons, D N; Kniffin, T C; Zhang, L P; Danaher, R J; Miller, C S; Bocanegra, J L; Carlson, C R; Westlund, K N

2015-06-04

Our laboratory previously developed a novel neuropathic and inflammatory facial pain model for mice referred to as the Trigeminal Inflammatory Compression (TIC) model. Rather than inducing whole nerve ischemia and neuronal loss, this injury induces only slight peripheral nerve demyelination triggering long-term mechanical allodynia and cold hypersensitivity on the ipsilateral whisker pad. The aim of the present study is to further characterize the phenotype of the TIC injury model using specific behavioral assays (i.e. light-dark box, open field exploratory activity, and elevated plus maze) to explore pain- and anxiety-like behaviors associated with this model. Our findings determined that the TIC injury produces hypersensitivity 100% of the time after surgery that persists at least 21 weeks post injury (until the animals are euthanized). Three receptive field sensitivity pattern variations in mice with TIC injury are specified. Animals with TIC injury begin displaying anxiety-like behavior in the light-dark box preference and open field exploratory tests at week eight post injury as compared to sham and naïve animals. Panic anxiety-like behavior was shown in the elevated plus maze in mice with TIC injury if the test was preceded with acoustic startle. Thus, in addition to mechanical and cold hypersensitivity, the present study identified significant anxiety-like behaviors in mice with TIC injury resembling the clinical symptomatology and psychosocial impairments of patients with chronic facial pain. Overall, the TIC injury model's chronicity, reproducibility, and reliability in producing pain- and anxiety-like behaviors demonstrate its usefulness as a chronic neuropathic facial pain model. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

Nerve growth factor reduces apoptotic cell death in rat facial motor neurons after facial nerve injury.

PubMed

Hui, Lian; Yuan, Jing; Ren, Zhong; Jiang, Xuejun

2015-01-01

To assess the effects of nerve growth factor (NGF) on motor neurons after induction of a facial nerve lesion, and to compare the effects of different routes of NGF injection on motor neuron survival. This study was carried out in the Department of Otolaryngology Head & Neck Surgery, China Medical University, Liaoning, China from October 2012 to March 2013. Male Wistar rats (n = 65) were randomly assigned into 4 groups: A) healthy controls; B) facial nerve lesion model + normal saline injection; C) facial nerve lesion model + NGF injection through the stylomastoid foramen; D) facial nerve lesion model + intraperitoneal injection of NGF. Apoptotic cell death was detected using the terminal deoxynucleotidyl transferase dUTP nick end-labeling assay. Expression of caspase-3 and p53 up-regulated modulator of apoptosis (PUMA) was determined by immunohistochemistry. Injection of NGF significantly reduced cell apoptosis, and also greatly decreased caspase-3 and PUMA expression in injured motor neurons. Group C exhibited better efficacy for preventing cellular apoptosis and decreasing caspase-3 and PUMA expression compared with group D (p<0.05). Our findings suggest that injections of NGF may prevent apoptosis of motor neurons by decreasing caspase-3 and PUMA expression after facial nerve injury in rats. The NGF injected through the stylomastoid foramen demonstrated better protective efficacy than when injected intraperitoneally.

Maxillofacial injuries due to work-related accidents in the North West of Italy.

PubMed

Roccia, Fabio; Boffano, Paolo; Bianchi, Francesca Antonella; Gerbino, Giovanni

2013-09-01

The aim of this study was to assess the incidence and patterns of work-related maxillofacial injuries, identifying worker categories with a high risk of injury. From a systematic computer-assisted database that has continuously recorded patients hospitalized with maxillofacial fractures, only patients with work-related injuries were considered. Occupation, mechanism of injury, and demographic and clinical data were analyzed. Work-related facial injuries represented the fifth most common cause of injury, with a percentage of 6.3 %. Maxillofacial fractures were most often seen in construction workers (37.9 %). The middle third was involved in 67 % of the cases; the mandible was the most frequently injured site. Work-related maxillofacial trauma is rare, but it is often complex and challenging as Facial Injury Severity Scale values show. In agreement with the few published reports, construction workers, together with farm and forestry workers, are at the highest risk of injuries, mainly because of struck by a thrown, projected, or falling object.

Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention

PubMed Central

Kim, Jin; Jung, Gu-Hyun; Park, See-Young

2012-01-01

Purpose Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. Materials and Methods A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. Results Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. Conclusion COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM. PMID:22477011

What is expected from a facial trauma caused by violence?

PubMed

Goulart, Douglas Rangel; Colombo, Lucas do Amaral; de Moraes, Márcio; Asprino, Luciana

2014-01-01

The aim of this retrospective study was to compare the peculiarities of maxillofacial injuries caused by interpersonal violence with other etiologic factors. Medical records of 3,724 patients with maxillofacial injuries in São Paulo state (Brazil) were retrospectively analyzed. The data were submitted to statistical analysis (simple descriptive statistics and Chi-squared test) using SPSS 18.0 software. Data of 612 patients with facial injuries caused by violence were analyzed. The majority of the patients were male (81%; n = 496), with a mean age of 31.28 years (standard deviation of 13.33 years). These patients were more affected by mandibular and nose fractures, when compared with all other patients (P < 0.01), although fewer injuries were recorded in other body parts (χ(2) = 17.54; P < 0.01); Victims of interpersonal violence exhibited more injuries when the neurocranium was analyzed in isolation (χ(2) = 6.85; P < 0.01). Facial trauma due to interpersonal violence seem to be related to a higher rate of facial fractures and lacerations when compared to all patients with facial injuries. Prominent areas of the face and neurocranium were more affected by injuries.

A voxel-based lesion study on facial emotion recognition after penetrating brain injury

PubMed Central

Dal Monte, Olga; Solomon, Jeffrey M.; Schintu, Selene; Knutson, Kristine M.; Strenziok, Maren; Pardini, Matteo; Leopold, Anne; Raymont, Vanessa; Grafman, Jordan

2013-01-01

The ability to read emotions in the face of another person is an important social skill that can be impaired in subjects with traumatic brain injury (TBI). To determine the brain regions that modulate facial emotion recognition, we conducted a whole-brain analysis using a well-validated facial emotion recognition task and voxel-based lesion symptom mapping (VLSM) in a large sample of patients with focal penetrating TBIs (pTBIs). Our results revealed that individuals with pTBI performed significantly worse than normal controls in recognizing unpleasant emotions. VLSM mapping results showed that impairment in facial emotion recognition was due to damage in a bilateral fronto-temporo-limbic network, including medial prefrontal cortex (PFC), anterior cingulate cortex, left insula and temporal areas. Beside those common areas, damage to the bilateral and anterior regions of PFC led to impairment in recognizing unpleasant emotions, whereas bilateral posterior PFC and left temporal areas led to impairment in recognizing pleasant emotions. Our findings add empirical evidence that the ability to read pleasant and unpleasant emotions in other people's faces is a complex process involving not only a common network that includes bilateral fronto-temporo-limbic lobes, but also other regions depending on emotional valence. PMID:22496440

Facial Soft Tissue Trauma

PubMed Central

Kretlow, James D.; McKnight, Aisha J.; Izaddoost, Shayan A.

2010-01-01

Traumatic facial soft tissue injuries are commonly encountered in the emergency department by plastic surgeons and other providers. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patient's facial function and aesthetics. This article provides a review of the relevant literature related to this topic and describes the authors' approach to the evaluation and management of the patient with facial soft tissue injuries. PMID:22550459

[Peripheral facial nerve lesion induced long-term dendritic retraction in pyramidal cortico-facial neurons].

PubMed

Urrego, Diana; Múnera, Alejandro; Troncoso, Julieta

2011-01-01

Little evidence is available concerning the morphological modifications of motor cortex neurons associated with peripheral nerve injuries, and the consequences of those injuries on post lesion functional recovery. Dendritic branching of cortico-facial neurons was characterized with respect to the effects of irreversible facial nerve injury. Twenty-four adult male rats were distributed into four groups: sham (no lesion surgery), and dendritic assessment at 1, 3 and 5 weeks post surgery. Eighteen lesion animals underwent surgical transection of the mandibular and buccal branches of the facial nerve. Dendritic branching was examined by contralateral primary motor cortex slices stained with the Golgi-Cox technique. Layer V pyramidal (cortico-facial) neurons from sham and injured animals were reconstructed and their dendritic branching was compared using Sholl analysis. Animals with facial nerve lesions displayed persistent vibrissal paralysis throughout the five week observation period. Compared with control animal neurons, cortico-facial pyramidal neurons of surgically injured animals displayed shrinkage of their dendritic branches at statistically significant levels. This shrinkage persisted for at least five weeks after facial nerve injury. Irreversible facial motoneuron axonal damage induced persistent dendritic arborization shrinkage in contralateral cortico-facial neurons. This morphological reorganization may be the physiological basis of functional sequelae observed in peripheral facial palsy patients.

Facial fractures in football: incidence, site, and mechanism of injury.

PubMed

Kim, S Y; Chan, C L; Hyam, D M

2016-10-01

Football injuries are responsible for many of the maxillofacial injuries sustained during sporting activities. In the Australian Capital Territory (ACT), the four major types of Australian football are played in large numbers and up to a high standard. Our objective was to analyse maxillofacial fractures that were sustained during rugby league, rugby union, Australian rules, and soccer matches. We retrospectively studied 134 patients with maxillofacial fractures during the five-year period 2010-14. All patients were assessed and treated at Canberra Hospital, the major trauma centre in the ACT. Data collected from patients' records included type of football, age, sex, mechanism of injury, site of injury, and treatment. The number of people registered to play was obtained from each football governing body to find out the incidence of fractures. League had the highest incidence of facial fractures, followed by union, Australian rules, and soccer. High speed and high collision football (league and union) had a higher rate of mandibular fractures than high speed and low contact football (Australian rules and soccer) (n=43, 45% compared with n=7, 21%). Australian rules and soccer had a higher incidence of midface fractures than league and union (n=26, 79%, compared with n=52, 55%). Clash of heads was the leading cause of fractures. Collisions against other players' shoulders and forearms were more likely to cause mandible fractures. Ninety-four patients (70%) required surgical intervention. Football-related maxillofacial fractures occur regularly, and different types of football have predictable patterns of injury. Padding of the heads and elbows of players may reduce the number and seriousness of facial fractures. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Emergency department visits with facial fractures among children and adolescents: an analysis of profile and predictors of causes of injuries.

PubMed

Allareddy, Veerasathpurush; Itty, Abraham; Maiorini, Elyse; Lee, Min Kyeong; Rampa, Sankeerth; Allareddy, Veerajalandhar; Nalliah, Romesh P

2014-09-01

The objectives of this study were to provide nationally representative estimates of hospital-based emergency department (ED) visits for facial fractures in children and adolescents, examine the burden associated with such visits, identify common types of facial fracture, and examine the role of patient-related demographic factors on the causes of facial fractures. The Nationwide Emergency Department Sample for 2008 to 2010 was used. All ED visits with a diagnosis of facial fractures in those no older than 21 years were selected. Demographic characteristics, types of facial fracture, causes of injuries, and hospital charges were examined. During the study period, 336,124 ED visits were for facial fractures in those no older than 21 years. Late adolescents (18 to 21 yr old) and middle adolescents (15 to 17 yr old) comprised 45.6% and 26.6% of all ED visits, respectively. Male patients comprised 74.7% of ED visits. The most common facial fractures were those of the nasal bones and mandible. Younger children were more likely to have falls, pedal cycle accidents, pedestrian accidents, and transport accidents, whereas older groups were more likely to have firearm injuries, motor vehicle traffic accidents, and assaults (P < .05). Female patients were more likely to have falls, motor vehicle traffic accidents, and transport accidents, whereas male patients were more likely to have firearm injuries, pedal cycle accidents, and assaults (P < .05). Those residing at low annual income household levels were at a high risk for having firearm injuries, motor vehicle traffic accidents, and transport accidents (P < .05). Late adolescents, middle adolescents, and male patients comprise a significant proportion of these ED visits. Age, gender, and household income levels are significantly associated with the causes of facial fracture injuries. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The surgical management of facial trauma in British soldiers during combat operations in Afghanistan.

PubMed

Wordsworth, Matthew; Thomas, Rachael; Breeze, John; Evriviades, Demetrius; Baden, James; Hettiaratchy, Shehan

2017-01-01

The recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan. Hospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013. 566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK. The presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury. Copyright © 2016. Published by Elsevier Ltd.

Blast injury face: An exemplified review of management

PubMed Central

Kumar, Vijay; Singh, Arun Kumar; Kumar, Parmod; Shenoy, Yogesh Ramdas; Verma, Anoop K.; Borole, Ateesh Jayram; Prasad, Veerendra

2013-01-01

Facial injuries are extremely common due to increased incidence of vehicular and industrial trauma and warfare injuries. But isolated injury to the face due to low voltage cells exploding is rare. In blast injury, the force can cause massive soft tissue injury, along with injury to facial fractures and damage to adnexa. Facial injury is not life threatening unless associated with other injuries of the skull and airway. The major risks to airway in facial trauma are due to anatomic alteration of patient's airway through bony and soft tissue disruption and increased chances of aspiration. The past several decades have seen a rapid growth in the range of procedures available for reconstructive purposes. However, the essential preliminary management is a must and needs to be structured. The patient, a 10-year-old boy, was joining three pencil batteries in series and twisting the wire with his teeth when one battery exploded causing severe injuries to midface and mandibular region. After stabilization, the patient was taken up for surgery. A cap splint with zygomatic suspension was done for the maxilla, and wiring of residual mandibular segments with lining and skin cover provided by a deltopectoral flap was done. Reconstructive surgeries for reconstruction of the upper lip and maintenance of oral continence were planned for the future. The present case stresses the importance of educating the masses about unsafe handling of low voltage devices, management of airway, massive soft tissue injury, along with facial fractures and damage to adnexa. PMID:24163550

Useful Method for Intraoperative Monitoring of Facial Nerve in a Scarred Bed.

PubMed

Aysal, Bilge Kagan; Yapici, Abdulkerim; Bayram, Yalcin; Zor, Fatih

2016-10-01

Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries. Thus, using a nerve stimulator at the operational site may lead to false-positive muscle movements in case of injuries. Using the nerve stimulator to stimulate the main trunk at the tragal point may help to distinguish the presence of possible injuries. A reliable method for intraoperative facial nerve monitoring in a scarred operational site was introduced in this letter.

Neurobiological mechanisms associated with facial affect recognition deficits after traumatic brain injury.

PubMed

Neumann, Dawn; McDonald, Brenna C; West, John; Keiski, Michelle A; Wang, Yang

2016-06-01

The neurobiological mechanisms that underlie facial affect recognition deficits after traumatic brain injury (TBI) have not yet been identified. Using functional magnetic resonance imaging (fMRI), study aims were to 1) determine if there are differences in brain activation during facial affect processing in people with TBI who have facial affect recognition impairments (TBI-I) relative to people with TBI and healthy controls who do not have facial affect recognition impairments (TBI-N and HC, respectively); and 2) identify relationships between neural activity and facial affect recognition performance. A facial affect recognition screening task performed outside the scanner was used to determine group classification; TBI patients who performed greater than one standard deviation below normal performance scores were classified as TBI-I, while TBI patients with normal scores were classified as TBI-N. An fMRI facial recognition paradigm was then performed within the 3T environment. Results from 35 participants are reported (TBI-I = 11, TBI-N = 12, and HC = 12). For the fMRI task, TBI-I and TBI-N groups scored significantly lower than the HC group. Blood oxygenation level-dependent (BOLD) signals for facial affect recognition compared to a baseline condition of viewing a scrambled face, revealed lower neural activation in the right fusiform gyrus (FG) in the TBI-I group than the HC group. Right fusiform gyrus activity correlated with accuracy on the facial affect recognition tasks (both within and outside the scanner). Decreased FG activity suggests facial affect recognition deficits after TBI may be the result of impaired holistic face processing. Future directions and clinical implications are discussed.

Emotional recognition from dynamic facial, vocal and musical expressions following traumatic brain injury.

PubMed

Drapeau, Joanie; Gosselin, Nathalie; Peretz, Isabelle; McKerral, Michelle

2017-01-01

To assess emotion recognition from dynamic facial, vocal and musical expressions in sub-groups of adults with traumatic brain injuries (TBI) of different severities and identify possible common underlying mechanisms across domains. Forty-one adults participated in this study: 10 with moderate-severe TBI, nine with complicated mild TBI, 11 with uncomplicated mild TBI and 11 healthy controls, who were administered experimental (emotional recognition, valence-arousal) and control tasks (emotional and structural discrimination) for each domain. Recognition of fearful faces was significantly impaired in moderate-severe and in complicated mild TBI sub-groups, as compared to those with uncomplicated mild TBI and controls. Effect sizes were medium-large. Participants with lower GCS scores performed more poorly when recognizing fearful dynamic facial expressions. Emotion recognition from auditory domains was preserved following TBI, irrespective of severity. All groups performed equally on control tasks, indicating no perceptual disorders. Although emotional recognition from vocal and musical expressions was preserved, no correlation was found across auditory domains. This preliminary study may contribute to improving comprehension of emotional recognition following TBI. Future studies of larger samples could usefully include measures of functional impacts of recognition deficits for fearful facial expressions. These could help refine interventions for emotional recognition following a brain injury.

Soccer-Related Facial Trauma: A Nationwide Perspective.

PubMed

Bobian, Michael R; Hanba, Curtis J; Svider, Peter F; Hojjat, Houmehr; Folbe, Adam J; Eloy, Jean Anderson; Shkoukani, Mahdi A

2016-12-01

Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury. The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code "soccer" were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms. In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures. The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention. © The Author(s) 2016.

Facial paralysis due to an occult parotid abscess.

PubMed

Orhan, Kadir Serkan; Demirel, Tayfun; Kocasoy-Orhan, Elif; Yenigül, Kubilay

2008-01-01

Facial paralysis associated with benign diseases of the parotid gland is very rare. It has been reported in approximately 16 cases of acute suppurative parotitis or parotid abscess. We presented a 45-year-old woman who developed facial paralysis secondary to an occult parotid abscess. Initially, there was no facial paralysis and the signs and symptoms were suggestive of acute parotitis, for which medical treatment was initiated. Three days later, left-sided facial palsy of HB (House-Brackmann) grade 5 developed. Ultrasonography revealed a pretragal, hypoechoic mass, 10x8 mm in size, causing inflammation in the surrounding tissue. Fine needle aspiration biopsy obtained from the mass revealed polymorphonuclear leukocytes and lymphocytes. No malignant cells were observed. The lesion was diagnosed as an occult parotid abscess. After a week, the mass disappeared and facial paralysis improved to HB grade 4. At the end of the first month, facial paralysis improved to HB grade 1. At three months, facial nerve function was nearly normal.

Pediatric facial fractures: evolving patterns of treatment.

PubMed

Posnick, J C; Wells, M; Pron, G E

1993-08-01

This study reviews the treatment of facial trauma between October 1986 and December 1990 at a major pediatric referral center. The mechanism of injury, location and pattern of facial fractures, pattern of facial injury, soft tissue injuries, and any associated injuries to other organ systems were recorded, and fracture management and perioperative complications reviewed. The study population consisted of 137 patients who sustained 318 facial fractures. Eighty-one patients (171 fractures) were seen in the acute stage, and 56 patients (147 fractures) were seen for reconstruction of a secondary deformity. Injuries in boys were more prevalent than in girls (63% versus 37%), and the 6- to 12-year cohort made up the largest group (42%). Most fractures resulted from traffic-related accidents (50%), falls (23%), or sports-related injuries (15%). Mandibular (34%) and orbital fractures (23%) predominated; fewer midfacial fractures (7%) were sustained than would be expected in a similar adult population. Three quarters of the patients with acute fractures required operative intervention. Closed reduction techniques with maxillomandibular fixation were frequently chosen for mandibular condyle fractures and open reduction techniques (35%) for other regions of the facial skeleton. When open reduction was indicated, plate-and-screw fixation was the preferred method of stabilization (65%). The long-term effects of the injuries and the treatment given on facial growth remain undetermined. Perioperative complication rates directly related to the surgery were low.

"Beaned": A 5-Year Analysis of Baseball-Related Injuries of the Face.

PubMed

Carniol, Eric T; Shaigany, Kevin; Svider, Peter F; Folbe, Adam J; Zuliani, Giancarlo F; Baredes, Soly; Eloy, Jean Anderson

2015-12-01

Baseball remains one of the most popular and safest games played by children and adults in America and worldwide. Rules and equipment changes have continued to make the game safer. For youth leagues, pitching restrictions, safety balls, helmets, and face mask equipment continue to make the game safer. With increased utilization of safety equipment, the objective was to analyze recent trends in baseball-related facial injuries. Cross-sectional analysis of a national database. The National Electronic Injury Surveillance System was searched for baseball-related facial injuries with analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations. From 2009 to 2013, there were 5270 cases entries, or 187,533 estimated emergency department (ED) visits, due to baseball-related facial injuries. During this time, there was a significant decline in the incidence of ED visits (P = .014). Inclusion criteria were met by 3208 visits. The majority of injuries occurred in patients ≤18 years old (81.5%). The most common injury was laceration (33.2%), followed by contusion (29.7%) and fracture (26.9%), while the most common injury site on the face was the nose (24.9%). The injuries were most commonly due to impact from a baseball (70%) or a bat (12.5%). The overall incidence of ED visits due to baseball-related facial injuries has decreased over the past 5 years, concurrent with increased societal use of protective equipment. Nonetheless, these injuries remain a common source for ED visits, and a continued effort to utilize safety measures should be made, particularly in youth leagues. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

[Severe Eyeball and Facial Skeletal Injuries Caused by Firefighting Sport].

PubMed

Rusňák, Š; Maranová, Z; Kasl, Z; Hecová, L; Voigt, E; Raiskup, F

2017-07-01

The aim of this work is to draw attention to possible injuries of the eye and the facial skeleton caused by firefighting sport. There was a group of 9 patients presented who were treated from 2006 to 2015 in the Department of Ophthalmology at the University Hospital in Pilsen and diagnosed with severe eyeball contusion after being hit by a jet of water and/or a water pipe. Three cases are presented in detail. Georg Thieme Verlag KG Stuttgart · New York.

Useful surgical techniques for facial nerve preservation in tumorous intra-temporal lesions.

PubMed

Kim, Jin; Moon, In Seok; Lee, Jong Dae; Shim, Dae Bo; Lee, Won-Sang

2010-02-01

The management of the facial nerve in tumorous temporal lesions is particularly challenging due to its complex anatomic location and potential postoperative complications, including permanent facial paralysis. The most important concern regarding surgical treatment of a tumorous temporal lesion is the inevitable facial paralysis caused by nerve injury during the tumor removal, especially in patients with minimal to no preoperative facial nerve dysfunction. We describe successful four cases in which various surgical techniques were developed for the preservation of the facial nerve in treatment of intratemporal tumorous lesions. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Combat-related facial burns: analysis of strategic pitfalls.

PubMed

Johnson, Benjamin W; Madson, Andrew Q; Bong-Thakur, Sarah; Tucker, David; Hale, Robert G; Chan, Rodney K

2015-01-01

Burns constitute approximately 10% of all combat-related injuries to the head and neck region. We postulated that the combat environment presents unique challenges not commonly encountered among civilian injuries. The purpose of the present study was to determine the features commonly seen among combat facial burns that will result in therapeutic challenges and might contribute to undesired outcomes. The present study was a retrospective study performed using a query of the Burn Registry at the US Army Institute of Surgical Research Burn Center for all active duty facial burn admissions from October 2001 to February 2011. The demographic data, total body surface area of the burn, facial region body surface area involvement, and dates of injury, first operation, and first facial operation were tabulated and compared. A subset analysis of severe facial burns, defined by a greater than 7% facial region body surface area, was performed with a thorough medical record review to determine the presence of associated injuries. Of all the military burn injuries, 67.1% (n = 558) involved the face. Of these, 81.3% (n = 454) were combat related. The combat facial burns had a mean total body surface area of 21.4% and a mean facial region body surface area of 3.2%. The interval from the date of the injury to the first operative encounter was 6.6 ± 0.8 days and was 19.8 ± 2.0 days to the first facial operation. A subset analysis of the severe facial burns revealed that the first facial operation and the definitive coverage operation was performed at 13.45 ± 2.6 days and 31.9 ± 4.1 days after the injury, respectively. The mortality rate for this subset of patients was 32% (n = 10), with a high rate of associated inhalational injuries (61%, n = 19), limb amputations (29%, n = 9), and facial allograft usage (48%, n = 15) and a mean facial autograft thickness of 10.5/1,000th in. Combat-related facial burns present multiple challenges, which can contribute to suboptimal long

Facial lacerations in children.

PubMed

Hwang, Kun; Huan, Fan; Hwang, Pil Joong; Sohn, In Ah

2013-03-01

The aim of this study was to evaluate the demographics and treatment of facial lacerations in pediatric patients. A retrospective record-based analysis was administered on 3783 patients (<15 years of age) presenting with facial lacerations from March 2002 to February 2011. Males were injured more frequently across all age groups (65.3%) and especially in the 13- to 15-year-old group (81.3%) (P = 0.012, Pearson χ). Overall, 48.9% of injuries occurred outdoors and 45.1% in homes. Only 6.0% occurred in schools or kindergartens. Injuries that occurred in schools or kindergarten increased with the age groups (from 2.3% for 0- to 3-year-olds to 19.1% for 13- to 15-year-olds). In the age groups younger than 12 years, injury occurred more frequently on the weekend. In the 13-to 15-year-old group, however, injury occurred more frequently on weekdays (odds ratio, 2.46). Injury occurred most frequently at the times of 7 to 9 PM and least frequently from midnight to 6 AM. The most frequent cause of injury in children was by being struck or by bumping something (32.5%), followed by slip-down (31.5%). Accidents involving furniture and stairs accounted for 9% each. Accidents caused by stairs decreased with age (from 10.2% for 0-3 years of age to 5.5% for 13-15 years of age, P = 0.000, Pearson χ). In a little less than half (47.2%) of the cases, parents accompanied their children at the time of injury. In the 13- to 15-year age group, only 17.9% of the children were accompanied by their parents. Foreheads (26.4%) took the brunt of most frequent injuries, followed by the eyelids (20.6%), eyebrows including the glabella (19.7%), and chin injuries (15.7%). Only 58 cases had associated injuries. Among 3783 cases of facial lacerations, 3745 patients did not have facial bone fractures or associated injuries and were managed under local anesthesia or through dressings only. A sound knowledge about the epidemiology of lacerations might be beneficial for the prevention of pediatric

Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures.

PubMed

Shi, Dan; Patil, Pavan Manohar; Gupta, Ritika

2015-04-01

To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries. A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed. Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05). The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Differences in the Management of Pediatric Facial Trauma

PubMed Central

Braun, Tara L.; Xue, Amy S.; Maricevich, Renata S.

2017-01-01

Craniofacial trauma is common in the pediatric population, with most cases limited to soft tissue and dentoalveolar injury. Although facial fractures are relatively rare in children compared with adults, they are often associated with severe injury and cause significant morbidity and disability. Initial evaluation of a child with facial trauma generally involves stabilizing the patient and identifying any severe concomitant injuries before diagnosing and managing facial injuries. The management of pediatric facial fractures is relatively more conservative than that of adults, and nonsurgical management is preferred when possible to prevent the disruption of future growth and development. Outcomes depend on the site of the injury, management plan, and subsequent growth, so children must be followed longitudinally for monitoring and the identification of any complications. PMID:28496392

[Pediatric facial fractures. Characteristics of Portuguese population].

PubMed

Ferreira, Pedro; Silva, Natividade; Silva, Alvaro; Cardoso, Augusta; Rodrigues, Jorge; Reis, Jorge; Amarante, José

2004-01-01

Fractures of the facial skeleton are relatively uncommon in children and adolescents, and there are only few reports that review a significative number of patients. We performed a retrospective study to analyse the different characteristics of such fractures in the pediatric population in the north of Portugal. We reviewed the clinical and the surgical records of a series of 247 patients younger than 19 years, that were submitted to operation due to facial fractures by the Plastic, Reconstructive and Aesthetic Service of São João Hospital, Oporto (Portugal) between 1993 and 2002. The following parameters were evaluated: age, sex, cause of the accident, time and month of hospital admission, location and type of fractures, presence and location of associated injuries, treatment methods, length of in-hospital stay, and complications. Surgical treatment of 325 fractures was performed. The ratio of boys to girls was 3.3:1. The majority of injuries occurred in patients with 16 to 18 years old. Motor-vehicle accident (MVA) was the most common cause of injuries (57.1%). Mandibular fractures were the most common (62.5%). Associated injuries occurred in 63.2% of patients. Pediatric facial fractures are usually associated with severe trauma. Although MVA was the most frequent cause of fractures, this has decreased. The incidence of these type of fractures is high in Portugal.

Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area.

PubMed

Gurunluoglu, Raffi; Glasgow, Mark; Arton, Jamie; Bronsert, Michael

2014-05-01

Facial dog bite injuries pose a significant public health problem. Seventy-five consecutive patients (45 males, 30 females) treated solely by plastic surgery service for facial dog bite injuries at a Level I trauma center in the Denver Metro area between 2006 and 2012 were retrospectively reviewed. The following information were recorded: breed, relationship of patient to dog, location and number of wounds, the duration between injury and surgical repair and dog bite incident, type of repair, and antibiotic prophylaxis. Primary end points measured were wound infection, the need for revision surgery, and patient satisfaction. Ninety-eight wounds in the head and neck region were repaired (46 children; mean age, 6.8 years) and (29 adults; mean age, 47.3 years). Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries. The duration between injury and repair ranged from 4 hours to 72 hours (mean [SD], 13.7 [10.9] hours). The majority of bite wounds (76 of 98) involved the cheek, lip, nose, and chin region. Direct repair was the most common surgical approach (60 of 98 wounds) (p < 0.05). There was no statistically significant association between wounds needing reconstruction versus direct repair according to dog breed (p = 0.25). Ten wounds required grafting. Twenty-five wounds were managed by one-stage or two-stage flaps. Only three patients (3.06 %) underwent replantation/revascularization of amputated partial lip (n = 2) and of cheek (n = 1). There was one postoperative infection. Data from five-point Likert scale were available for fifty-two patients. Forty patients were satisfied (5) with the outcome, while five patients were somewhat satisfied (4), and seven were neutral. Availability of the plastic surgery service at a Level I trauma center is vital for the optimal treatment of facial dog bite injuries. Direct repair and reconstruction of facial dog bite injuries at the earliest

Soft Tissue Management in Facial Trauma

PubMed Central

Braun, Tara L.; Maricevich, Renata S.

2017-01-01

The management of soft tissue injury after facial trauma poses unique challenges to the plastic surgeon, given the specialized nature of facial tissue and the aesthetic importance of the face. The general principles of trauma management and wound care are applied in all cases. The management of severe injuries to the face is discussed in relation to the location and the mechanism of injury. Facial transplants have arisen in the past decade for the management of catastrophic soft tissue defects, although high morbidity and mortality after these non-life-saving operations must be considered in patient selection. PMID:28496386

The role of multislice spiral computed tomography in the diagnosis and management of acute facial trauma in patients with multiple injuries.

PubMed

Nemsadze, G; Urushadze, O

2011-11-01

Using of mutislice spiral CT as first line examination for the diagnosis of Acute Facial trauma in the setting of Polytrauma reduces both: valuable time and cost of patient treatment. After a brief clinical examination, MDCT was performed depending on the area of injury, using a slice thickness of 0.65 mm. The obtained data were analyzed using 3D, MIP and Standard axial with Bone reconstruction protocols. 64 polytrauma patients were evaluated with both Anterior and Lateral craniography (plain skull X ray: AP and Lateral) and Multi Slice CT. Craniography detected only 18 cases of traumatic injuries of facial bones, but exact range of dislocation and accurate management plan could not be established. In the same 64 cases, Multislice CT revealed localization of all existed fractures, range of fragment dislocation, soft tissue damage and status of Paranasal sinus in 62 cases (96.8%). In two cases MS CT missed the facial fracture, in one case the examination was complicated because of bone thinness and numerous fracture fragments, in another multiple foreign body artifacts complicated the investigation. The study results show that, CT investigation based on our MDCT polytrauma protocol, detects all more or less serious facial bone injuries.

Coadjuvant treatment with surgery and pirfenidone in severe facial trauma due to dog bite.

PubMed

Cantú-Cantú, María Zulema; Lyra-González, Iván; Armendáriz-Borunda, Juan

2013-03-01

This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.

Pediatric craniofacial fractures due to violence: comparing violent and nonviolent mechanisms of injury.

PubMed

Mericli, Alexander F; DeCesare, Gary E; Zuckerbraun, Noel S; Kurland, Kristen S; Grunwaldt, Lorelei; Vecchione, Lisa; Losee, Joseph E

2011-07-01

This study examines the epidemiologic data of pediatric craniofacial fractures secondary to violence, comparing these data to craniofacial fractures sustained from all other causes. A retrospective review was completed on all patients who presented to the emergency department of a major urban children's hospital from 2000 to 2005 with a craniofacial fracture. Data were compared between patients with fractures due to violent and nonviolent mechanisms. Socioeconomic analysis was performed using Geographic Information System mapping and 2000 US Census data by postal code. One thousand five hundred twenty-eight patients were diagnosed with skull and/or facial fractures. Isolated skull fractures were excluded, leaving 793 patients in the study. Ninety-eight children were injured due to violence, and 695 were injured from a nonviolent cause. Patients with violence-related fractures were more likely to be older, male, and nonwhite and live in a socioeconomically depressed area. A greater number of patients with violence-related injuries sustained nasal and mandible angle fractures, whereas more patients with non-violence-related injuries sustained skull and orbital fractures. Those with violence-related craniofacial fractures had a lower percentage of associated multiorgan system injuries and a lower rate of hospital admissions and intensive care unit admissions. The rate of open reduction and internal fixation for craniofacial fractures was similar in both groups. Patients with violence-related fractures had fewer associated serious injuries and lower morbidity and lived in a more socioeconomically depressed area. The information gained from this descriptive study improves our ability to characterize this population of pediatric patients and to identify the associated constellation of injuries in such fractures.

Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser.

PubMed

Ebrahimi, Ali; Kazemi, Hossein Mohammad; Nejadsarvari, Nasrin

2014-08-01

Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation. The aim of this study was to present our experience in management of facial soft tissue injuries from different causes. We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively. In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases. Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.

Valproic Acid Promotes Survival of Facial Motor Neurons in Adult Rats After Facial Nerve Transection: a Pilot Study.

PubMed

Zhang, Lili; Fan, Zhaomin; Han, Yuechen; Xu, Lei; Liu, Wenwen; Bai, Xiaohui; Zhou, Meijuan; Li, Jianfeng; Wang, Haibo

2018-04-01

Valproic acid (VPA), a medication primarily used to treat epilepsy and bipolar disorder, has been applied to the repair of central and peripheral nervous system injury. The present study investigated the effect of VPA on functional recovery, survival of facial motor neurons (FMNs), and expression of proteins in rats after facial nerve trunk transection by functional measurement, Nissl staining, TUNEL, immunofluorescence, and Western blot. Following facial nerve injury, all rats in group VPA showed a better functional recovery, which was significant at the given time, compared with group NS. The Nissl staining results demonstrated that the number of FMNs survival in group VPA was higher than that in group normal saline (NS). TUNEL staining showed that axonal injury of facial nerve could lead to neuronal apoptosis of FMNs. But treatment of VPA significantly reduced cell apoptosis by decreasing the expression of Bax protein and increased neuronal survival by upregulating the level of brain-derived neurotrophic factor (BDNF) and growth associated protein-43 (GAP-43) expression in injured FMNs compared with group NS. Overall, our findings suggest that VPA may advance functional recovery, reduce lesion-induced apoptosis, and promote neuron survival after facial nerve transection in rats. This study provides an experimental evidence for better understanding the mechanism of injury and repair of peripheral facial paralysis.

Combat-Related Facial Burns: Analysis of Strategic Pitfalls

DTIC Science & Technology

2015-01-01

10), with a high rate of associated inhalational injuries (61%, n = 19), limb amputations (29%, n = 9), and facial allograft usage (48%, n = 15...Combat injuries result in greater burn depths, a greater incidence of inhalation injuries, a greater incidence of concomitant nonburn injuries, and a...associated inhalational injury, of which, 7 were mild, 6 were moderate, and 6 were severe. Of the 31 patients, 6 (19%) had concomitant facial fractures

Functional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model.

PubMed

Brown, Brandon L; Asante, Tony; Welch, Haley R; Sandelski, Morgan M; Drejet, Sarah M; Shah, Kishan; Runge, Elizabeth M; Shipchandler, Taha Z; Jones, Kathryn J; Walker, Chandler L

2018-05-17

Functional and anatomical outcomes after surgical repair of facial nerve injury may be improved with the addition of polyethylene glycol (PEG) to direct suture neurorrhaphy. The application of PEG has shown promise in treating spinal nerve injuries, but its efficacy has not been evaluated in treatment of cranial nerve injuries. To determine whether PEG in addition to neurorrhaphy can improve functional outcomes and synkinesis after facial nerve injury. In this animal experiment, 36 rats underwent right facial nerve transection and neurorrhaphy with addition of PEG. Weekly behavioral scoring was done for 10 rats for 6 weeks and 14 rats for 16 weeks after the operations. In the 16-week study, the buccal branches were labeled and tissue analysis was performed. In the 6-week study, the mandibular and buccal branches were labeled and tissue analysis was performed. Histologic analysis was performed for 10 rats in a 1-week study to assess the association of PEG with axonal continuity and Wallerian degeneration. Six rats served as the uninjured control group. Data were collected from February 8, 2016, through July 10, 2017. Polyethylene glycol applied to the facial nerve after neurorrhaphy. Functional recovery was assessed weekly for the 16- and 6-week studies, as well as motoneuron survival, amount of regrowth, specificity of regrowth, and aberrant branching. Short-term effects of PEG were assessed in the 1-week study. Among the 40 male rats included in the study, PEG addition to neurorrhaphy showed no functional benefit in eye blink reflex (mean [SEM], 3.57 [0.88] weeks; 95% CI, -2.8 to 1.9 weeks; P = .70) or whisking function (mean [SEM], 4.00 [0.72] weeks; 95% CI, -3.6 to 2.4 weeks; P = .69) compared with suturing alone at 16 weeks. Motoneuron survival was not changed by PEG in the 16-week (mean, 132.1 motoneurons per tissue section; 95% CI, -21.0 to 8.4; P = .13) or 6-week (mean, 131.1 motoneurons per tissue section; 95% CI, -11.0 to 10.0; P = .06

Injuries and absenteeism among motorcycle taxi drivers who are victims of traffic accidents.

PubMed

Barbosa, Kevan G N; Lucas-Neto, Alfredo; Gama, Bruno D; Lima-Neto, Jose C; Lucas, Rilva Suely C C; d'Ávila, Sérgio

2014-08-01

Facial injuries frequently occur in traffic accidents involving motorcycles. The purpose of this study was to determine the prevalence of facial injuries among motorcycle drivers who perform motorcycle taxi service. The study design was cross-sectional. A total of 210 participants who served as motorcycle taxi drivers in a city in northeastern Brazil completed a survey concerning their experience of accidents involving facial injuries and consequent hospitalization and absenteeism from work. The motorcycle drivers included in the study were randomly selected from a list provided by the city. Out of the respondents, 165 (78.6%) who were involved in traffic accidents in the last 12 months, 15 (9.1%) reported facial injuries. The types of facial injury most frequently reported involved soft tissues (n = 8; 53.3%), followed by simple fracture (n = 4; 26.7%) and dentoalveolar fracture (n = 3; 20%). We found an association between facial injuries and absenteeism, as well as an association between the presence of facial injury and the need for hospitalization for a period of 2 days or more. Respondents reported that they had accidents, but due to the use of full face motorcycle helmet the number of facial injuries was low. For most of them, absenteeism was observed for a period of one month or more. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Experience With Esthetic Reconstruction of Complex Facial Soft Tissue Trauma: Application of the Pulsed Dye Laser

PubMed Central

Ebrahimi, Ali; Kazemi, Hossein Mohammad; Nejadsarvari, Nasrin

2014-01-01

Background: Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation. Objectives: The aim of this study was to present our experience in management of facial soft tissue injuries from different causes. Patients and Methods: We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively. Results: In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases. Conclusions: Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results. PMID:25337516

Influence of injury severity on the rate and magnitude of the T lymphocyte and neuronal response to facial nerve axotomy.

PubMed

Ha, Grace K; Parikh, Shivani; Huang, Zhi; Petitto, John M

2008-08-13

The temporal relationship between severity of peripheral axonal injury and T lymphocyte trafficking to the neuronal cell bodies of origin in the brain has been unclear. We sought to test the hypothesis that greater neuronal death induced by disparate forms of peripheral nerve injury would result in differential patterns of T cell infiltration and duration at the cell bodies of origin in the brain and that these measures would correlate with the magnitude of neuronal death over time and cumulative neuronal loss. To test this hypothesis, we compared the time course of CD3(+) T cell infiltration and neuronal death (assessed by CD11b(+) perineuronal microglial phagocytic clusters) following axonal crush versus axonal resection injuries, two extreme variations of facial nerve axotomy that result in mild versus severe neuronal loss, respectively, in the facial motor nucleus. We also quantified the number of facial motor neurons present at 49 days post-injury to determine whether differences in the levels of neuronal death between nerve crush and resection correlated with differences in cumulative neuronal loss. Between 1 and 7 days post-injury when levels of neuronal death were minimal, we found that the rate of accumulation and magnitude of the T cell response was similar following nerve crush and resection. Differences in the T cell response were apparent by 14 days post-injury when the level of neuronal death following resection was substantially greater than that seen in crush injury. For nerve resection, the peak of neuronal death at 14 days post-resection was followed by a maximal T cell response one week later at 21 days. Differences in the level of neuronal death between the two injuries across the time course tested reflected differences in cumulative neuronal loss at 49 days post-injury. Altogether, these data suggest that the trafficking of T cells to the injured FMN is dependent upon the severity of peripheral nerve injury and associated neuronal death.

Iatrogenic facial palsy: the cost.

PubMed

Pulec, J L

1996-11-01

The cost of iatrogenic facial paralysis can be high. Ways to avoid facial nerve injury during surgery and, should it occur, ways to minimize the disability and cost are discussed. These include adequate preparation and training by the surgeon, the exercise of sound judgment, the presence of high morals by the surgeon, adequate preoperative diagnosis and surgical instrumentation and thorough preoperative oral and written informed consent. Should facial nerve injury occur, immediate consultation and reparative decompression, anastomosis or grafting should be performed to obtain the best ultimate result. The value of prompt, competent, sympathetic and continuing concern offered by the surgeon to the patient cannot be over emphasized.

[Two cases of severe eye and cranial injuries due to firework explosions].

PubMed

Saunte, J P; Trojaborg, N S; Nielsen, O A; Thygesen, J

1999-12-20

Two patients who sustained serious facial, cranial and eye trauma secondary to recreational fireworks injuries are reported. Initial assessment included axial and coronary computerized tomography, control of haemorrhage, debridement of wound and brain, and in one patient bilateral excenteration of the globe. Both patients suffered from intracranial haemorrhage, but both recovered without severe neurological sequelae.

Penetrating gunshot wound to the head: transotic approach to remove the bullet and masseteric-facial nerve anastomosis for early facial reanimation.

PubMed

Donnarumma, Pasquale; Tarantino, Roberto; Gennaro, Paolo; Mitro, Valeria; Valentini, Valentino; Magliulo, Giuseppe; Delfini, Roberto

2014-01-01

Gunshot wounds to the head (GSWH) account for the majority of penetrating brain injuries, and are the most lethal. Since they are rare in Europe, the number of neurosurgeons who have experienced this type of traumatic injury is decreasing, and fewer cases are reported in the literature. We describe a case of gunshot to the temporal bone in which the bullet penetrated the skull resulting in the facial nerve paralysis. It was excised with the transotic approach. Microsurgical anastomosis among the masseteric nerve and the facial nerve was performed. GSWH are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is very high. Survivors often have high rate of complications. When facial paralysis is present, masseteric-facial direct neurorraphy represent a good treatment.

Long-term functional recovery after facial nerve transection and repair in the rat.

PubMed

Banks, Caroline A; Knox, Christopher; Hunter, Daniel A; Mackinnon, Susan E; Hohman, Marc H; Hadlock, Tessa A

2015-03-01

The rodent model is commonly used to study facial nerve injury. Because of the exceptional regenerative capacity of the rodent facial nerve, it is essential to consider the timing when studying facial nerve regeneration and functional recovery. Short-term functional recovery data following transection and repair of the facial nerve has been documented by our laboratory. However, because of the limitations of the head fixation device, there is a lack of long-term data following facial nerve injury. The objective of this study was to elucidate the long-term time course and functional deficit following facial nerve transection and repair in a rodent model. Adult rats were divided into group 1 (controls) and group 2 (experimental). Group 1 animals underwent head fixation, followed by a facial nerve injury, and functional testing was performed from day 7 to day 70. Group 2 animals underwent facial nerve injury, followed by delayed head fixation, and then underwent functional testing from months 6 to 8. There was no statistical difference between the average whisking amplitudes in group 1 and group 2 animals. Functional whisking recovery 6 months after facial nerve injury is comparable to recovery within 1 to 4 months of transection and repair, thus the ideal window for evaluating facial nerve recovery falls within the 4 months after injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Facial gunshot wound debridement: debridement of facial soft tissue gunshot wounds.

PubMed

Shvyrkov, Michael B

2013-01-01

Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology. This article is intended to explore modern wound debridement. The management of 502 isolated soft tissue injuries is presented. Existing principles recommend the sparing of damaged tissues. The author's experience was that tissue sparing lead to a high rate of complications (47.6%). Radical primary surgical debridement (RPSD) of wounds was then adopted with radical excision of necrotic non-viable wound margins containing infection to the point of active capillary bleeding and immediate primary wound closure. After radical debridement wound infection and breakdown decreased by a factor of 10. Plastic operations with local and remote soft tissue were made on 14, 7% of the wounded. Only 0.7% patients required discharge from the army due to facial muscle paralysis and/or facial skin impregnation with particles of gunpowder from mine explosions. Gunshot face wound; modern debridement. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Transtympanic Facial Nerve Paralysis: A Review of the Literature

PubMed Central

Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter

2015-01-01

Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

Prevalence and patterns of combat sport related maxillofacial injuries.

PubMed

Shirani, Gholamreza; Kalantar Motamedi, Mohammad Hosein; Ashuri, Alireza; Eshkevari, Pooyan Sadr

2010-10-01

, prevalence of facial injuries from combat sports professionals was significantly high (roughly 80%), especially in kickboxing (in part due to use of less protective gear). Because the nose and teeth sustained the most injuries, they require more attention with regard to prevention. Kickboxing was the most injurious of these combat sports and caused the most significant number of maxillofacial trauma. More safety apparel and protective guards seem warranted in athletes of combat sports if facial injury is to be prevented.

Fractional CO2 laser resurfacing of photoaged facial and non-facial skin: histologic and clinical results and side effects.

PubMed

Sasaki, Gordon H; Travis, Heather M; Tucker, Barbara

2009-12-01

CO(2) fractional ablation offers the potential for facial and non-facial skin resurfacing with minimal downtime and rapid recovery. The purpose of this study was (i) to document the average depths and density of adnexal structures in non-lasered facial and non-facial body skin; (ii) to determine injury in ex vivo human thigh skin with varying fractional laser modes; and (iii) to evaluate the clinical safety and efficacy of treatments. Histologies were obtained from non-lasered facial and non-facial skin from 121 patients and from 14 samples of excised lasered thigh skin. Seventy-one patients were evaluated after varying energy (mJ) and density settings by superficial ablation, deeper penetration, and combined treatment. Skin thickness and adnexal density in non-lasered skin exhibited variable ranges: epidermis (47-105 mum); papillary dermis (61-105 mum); reticular dermis (983-1986 mum); hair follicles (2-14/ HPF); sebaceous glands (2-23/HPF); sweat glands (2-7/HPF). Histological studies of samples from human thigh skin demonstrated that increased fluencies in the superficial, deep and combined mode resulted in predictable deeper levels of ablations and thermal injury. An increase in density settings results in total ablation of the epidermis. Clinical improvement of rhytids and pigmentations in facial and non-facial skin was proportional to increasing energy and density settings. Patient assessments and clinical gradings by the Wilcoxon's test of outcomes correlated with more aggressive settings. Prior knowledge of normal skin depths and adnexal densities, as well as ex vivo skin laser-injury profiles at varying fluencies and densities, improve the safety and efficiency of fractional CO(2) for photorejuvenation of facial and non-facial skin.

Improving posttraumatic facial scars.

PubMed

Ardeshirpour, Farhad; Shaye, David A; Hilger, Peter A

2013-10-01

Posttraumatic soft-tissue injuries of the face are often the most lasting sequelae of facial trauma. The disfigurement of posttraumatic scarring lies in both their physical deformity and psychosocial ramifications. This review outlines a variety of techniques to improve facial scars and limit their lasting effects. Copyright © 2013 Elsevier Inc. All rights reserved.

Determining the role of nasolaryngoscopy in the initial evaluation for upper airway injury in patients with facial burns.

PubMed

Freno, Daniel; Sahawneh, James; Harrison, Sarah; Sahawneh, Tim; Patterson, Scott; Kahn, Steven A

2018-05-01

Upper airway injuries can be fatal in burn patients if not recognized, a scenario that causes a significant amount of anxiety for physicians providing initial assessment of burn patients. Early elective intubation is often performed; sometimes unnecessarily. However, some providers employ nasolaryngoscopy for patients presenting with facial burns or signs/symptoms of upper airway injury in order to assess the need for intubation, but this practice is not considered standard of care and may also be unnecessary. Evidence is currently lacking about the utility of nasolaryngoscopy as an adjuvant assessment during evaluation of potential upper airway burn injuries. The objective of this study was to determine if nasolaryngoscopy provides additional information to the history and physical in making the decision to electively intubate patients with facial burns. This study was a retrospective analysis of all patients who underwent fiberoptic nasolaryngoscopy after facial burn injury to evaluate for upper airway injury associated with burns over a 2 year period at a regional burn center. During this time period, all patients who presented with facial burns, soot, or carbonaceous sputum underwent nasolaryngoscopy to look for upper airway injury regardless of mechanism of injury. Patients intubated prior to arrival were excluded from the study. Patients were considered to have signs/symptoms of airway injury (symptomatic) if they presented with dyspnea, tachypnea, hypoxia, or significant burns to buccal mucosa. Procedure notes were used to determine if supraglottic/glottic injury (erythema or edema) was present on nasolaryngoscopy. Presence of pathologic changes and whether they led to intubation were evaluated in the asymptomatic and the symptomatic groups of patients. Select individual records were inspected further to help determine if the nasolaryngoscopy findings altered management plans and if intubation was ultimately necessary based upon the presence or absence of a

Craniomaxillofacial falling bullet injuries and management.

PubMed

Shuker, Sabri T; Sadda, Raid

2010-07-01

The purpose of this study was to bring attention to craniocerebral maxillofacial perforating/penetrating injuries due to AK-47 Kalashnikov falling bullets (FBs); these dangerous injuries to both civilians and soldiers are rare. A review of the literature shows no reports on AK-47 FBs leading to double craniocerebral perforation and settling into the maxillofacial region. The number of victims, the AK-47's availability, the associated morbidity and mortality rates, and the rarity of cases prompted this article. The treatment of injuries to the craniocerebral facial clinical profile due to FBs is challenging, and an understanding of the neurosurgical and maxillofacial management of these low-velocity FB injuries is required. We treated 11 cases due to AK-47 rifle FBs and 1 due to anti-aircraft Dashka 12.7-mm FBs. Craniocerebral facial injuries were treated and lodged bullets removed from different challenging locations in the base of the skull, without increasing morbidity and with avoidance of unnecessary surgical trauma to the affected area by the bullets. The required identification of such injuries can be difficult, and the removal of the lodged bullet to prevent secondary complications and reduce the chance of secondary infection can be graver than in other parts of the body. AK-47 FBs are a major public health concern internationally and require serious attention in terms of protection and management for civilians and soldiers in uniform. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Relationship between individual differences in functional connectivity and facial-emotion recognition abilities in adults with traumatic brain injury.

PubMed

Rigon, A; Voss, M W; Turkstra, L S; Mutlu, B; Duff, M C

2017-01-01

Although several studies have demonstrated that facial-affect recognition impairment is common following moderate-severe traumatic brain injury (TBI), and that there are diffuse alterations in large-scale functional brain networks in TBI populations, little is known about the relationship between the two. Here, in a sample of 26 participants with TBI and 20 healthy comparison participants (HC) we measured facial-affect recognition abilities and resting-state functional connectivity (rs-FC) using fMRI. We then used network-based statistics to examine (A) the presence of rs-FC differences between individuals with TBI and HC within the facial-affect processing network, and (B) the association between inter-individual differences in emotion recognition skills and rs-FC within the facial-affect processing network. We found that participants with TBI showed significantly lower rs-FC in a component comprising homotopic and within-hemisphere, anterior-posterior connections within the facial-affect processing network. In addition, within the TBI group, participants with higher emotion-labeling skills showed stronger rs-FC within a network comprised of intra- and inter-hemispheric bilateral connections. Findings indicate that the ability to successfully recognize facial-affect after TBI is related to rs-FC within components of facial-affective networks, and provide new evidence that further our understanding of the mechanisms underlying emotion recognition impairment in TBI.

Late revision or correction of facial trauma-related soft-tissue deformities.

PubMed

Rieck, Kevin L; Fillmore, W Jonathan; Ettinger, Kyle S

2013-11-01

Surgical approaches used in accessing the facial skeleton for fracture repair are often the same as or similar to those used for cosmetic enhancement of the face. Rarely does facial trauma result in injuries that do not in some way affect the facial soft-tissue envelope either directly or as sequelae of the surgical repair. Knowledge of both skeletal and facial soft-tissue anatomy is paramount to successful clinical outcomes. Facial soft-tissue deformities can arise that require specific evaluation and management for correction. This article focuses on revision and correction of these soft-tissue-related injuries secondary to facial trauma. Copyright © 2013. Published by Elsevier Inc.

Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach.

PubMed

Vaca, Elbert E; Bellamy, Justin L; Sinno, Sammy; Rodriguez, Eduardo D

2018-03-01

High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author's early and definitive staged reconstructive approach to these challenging patients. A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.

Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach

PubMed Central

Vaca, Elbert E.; Bellamy, Justin L.; Sinno, Sammy

2018-01-01

Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author’s early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Results: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Conclusions: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries. PMID:29707453

The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016.

PubMed

Lanigan, Alexander; Lindsey, Brentley; Maturo, Stephen; Brennan, Joseph; Laury, Adrienne

2017-10-01

Objective Define the number and type of facial and penetrating neck injuries sustained in combat operations in Iraq and Afghanistan from 2011 to 2016. Compare recent injury trends to prior years of modern conflict. Study Design Case series with chart review. Setting Tertiary care hospital. Methods The Joint Theater Trauma Registry (JTTR) was queried for facial and neck injuries from Iraq and Afghanistan from June 2011 to May 2016. Injury patterns, severity, and patient demographics were analyzed and compared to previously published data from combat operations during January 2003 to May 2011. Results A total of 5312 discrete facial and neck injuries among 922 service members were identified. There were 3842 soft tissue injuries (72.3%) of the head/neck and 1469 (27.7%) facial fractures. Soft tissue injuries of the face/cheek (31.4%) and neck/larynx/trachea (18.8%) were most common. The most common facial fractures were of the orbit (26.3%) and maxilla/zygoma (25.1%). Injuries per month were highest in 2011 to 2012 and steadily declined through 2016. The percentage of nonbattle injuries trended up over time, ranging from 14.7% to 65%. Concurrent facial/neck soft tissue trauma or fracture was associated with an overall mortality rate of 2.44%. Comparison of our data to that previously published revealed no statistical difference in concurrent mortality (3.5%-2.2%, P = .053); an increase in orbital fractures ( P < .005), facial nerve injury ( P < .0005), and ear/tympanic membrane perforations ( P < .0005); and a decrease in mandible fractures ( P < .005). Conclusion Penetrating neck and facial injuries remain common in modern warfare. Assessing injury characteristics and trends supports continued improvements in battlefield protection and identifies areas requiring further intervention.

Prevalence of facial trauma and associated factors in victims of road traffic accidents.

PubMed

Nóbrega, Lorena Marques; Cavalcante, Gigliana M S; Lima, Monalyza M S M; Madruga, Renata C R; Ramos-Jorge, Maria Letícia; d'Avila, Sérgio

2014-11-01

The aim of this study was to determine the prevalence of facial trauma among victims of road traffic accidents and investigate factors associated with it. A cross-sectional study was carried out using the medical and dental charts of 2570 victims of road traffic accidents with bodily and/or facial injuries between 2008 and 2011. Sociodemographic variables of the victims and characteristics of the accidents and injuries were evaluated. Statistical analyses included the χ(2) test as well as the Poisson univariate and multivariate regression analyses for the determination of the final hierarchical model. The prevalence of facial injuries was 16.4%. Most of the victims were male. Among the victims with facial injuries, 44.3% had polytrauma to the face. The prevalence of facial injuries was high among accidents that occurred at night (Prevalence Ratio (PR), 1.42; 95% confidence interval [CI], 1.10-1.84; P = .007) and victims up to 9 years of age (PR, 2.31; 95% CI, 1.03-5.17; P = .041). Moreover, the prevalence of facial injuries was lower among victims of motorcycle accidents than victims of automobile accidents (PR, 0.59; 95% CI, 0.44-0.89; P = .001). The prevalence of facial injuries was high in this study and was significantly associated with the place of residence, time of day, age group, and type of accident. Copyright © 2014 Elsevier Inc. All rights reserved.

Developing psychological services following facial trauma.

PubMed

Choudhury-Peters, Deba; Dain, Vicky

2016-01-01

Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress. Most facial injury patients were not receiving mental health assessment or treatment, and the maxillofacial team did not have direct access to psychological services. Based on these research findings, an innovative one-year pilot psychology service was designed and implemented within the facial trauma clinic. The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress.

Facial dog bite injuries in children: treatment and outcome assessment.

PubMed

Eppley, Barry L; Schleich, Arno Rene

2013-03-01

Dog bite injuries to a child's face are not an infrequent occurrence. They may require primary and revisional surgery. All result in permanent facial scars. This report describes the treatment and outcomes of dog bites of the face, scalp, and neck based on a case series of 107 children over a 10-year period.The average children's age was 5.9 years. In cases where the dog was identified (95%), it was known to the victim and their family. The events leading to the dog bite were categorized as provoked (77%) in the majority of the cases.The majority of wounds could be closed primarily without a significant risk of wound infection. Complex reconstructions were required in more severe cases. The majority of families (77%) opted for scar revision between 9 and 18 months after initial treatment to improve the aesthetic outcome.Lawsuit actions resulted in 39 of the cases making good documentation an essential part of treatment. Dogbite injuries to the face in children frequently require multiple scar revisions to obtain the best possible aesthetic outcome, and the family should be so counseled at the onset of treatment.

Hard tissue pediatric facial trauma: a review.

PubMed

Hogg, Nicholas J V; Horswell, Bruce B

2006-01-01

Although hard tissue injuries are uncommon in the pediatric patient, dentists may be involved in the initial assessment of these patients. In this paper, we review fractures of the facial skeleton with a focus on dentoalveolar injuries. Minimally displaced fractures in pediatric patients can be managed conservatively, while displaced fractures may require open approaches and rigid fixation. New fixation stratagems are presented, and possible facial growth disturbances resulting from trauma are discussed.

Age and sex-related differences in 431 pediatric facial fractures at a level 1 trauma center.

PubMed

Hoppe, Ian C; Kordahi, Anthony M; Paik, Angie M; Lee, Edward S; Granick, Mark S

2014-10-01

Age and sex-related changes in the pattern of fractures and concomitant injuries observed in this patient population is helpful in understanding craniofacial development and the treatment of these unique injuries. The goal of this study was to examine all facial fractures occurring in a child and adolescent population (age 18 or less) at a trauma center to determine any age or sex-related variability amongst fracture patterns and concomitant injuries. All facial fractures occurring at a trauma center were collected over a 12-year period based on International Classification of Disease, rev. 9 codes. This was delimited to include only those patients 18 years of age or younger. Age, sex, mechanism, and fracture types were collected and analyzed. During this time period, there were 3147 patients with facial fractures treated at our institution, 353 of which were in children and adolescent patients. Upon further review 68 patients were excluded due to insufficient data for analysis, leaving 285 patients for review, with a total of 431 fractures. The most common etiology of injury was assault for males and motor vehicle accidents (MVA) for females. The most common fracture was of the mandible in males and of the orbit in females. The most common etiology in younger age groups includes falls and pedestrian struck. Older age groups exhibit a higher incidence of assault-related injuries. Younger age groups showed a propensity for orbital fractures as opposed to older age groups where mandibular fractures predominated. Intracranial hemorrhage was the most common concomitant injury across most age groups. The differences noted in etiology of injury, fracture patterns, and concomitant injuries between sexes and different age groups likely reflects the differing activities that each group engages in predominantly. In addition the growing facial skeleton offers varying degrees of protection to the cranial contents as force-absorbing mechanisms develop. Copyright © 2014

Surgical Approaches to Facial Nerve Deficits

PubMed Central

Birgfeld, Craig; Neligan, Peter

2011-01-01

The facial nerve is one of the most commonly injured cranial nerves. Once injured, the effects on form, function, and psyche are profound. We review the anatomy of the facial nerve from the brain stem to its terminal branches. We also discuss the physical exam findings of facial nerve injury at various levels. Finally, we describe various reconstructive options for reanimating the face and restoring both form and function. PMID:22451822

Deficient functional recovery after facial nerve crush in rats is associated with restricted rearrangements of synaptic terminals in the facial nucleus.

PubMed

Hundeshagen, G; Szameit, K; Thieme, H; Finkensieper, M; Angelov, D N; Guntinas-Lichius, O; Irintchev, A

2013-09-17

Crush injuries of peripheral nerves typically lead to axonotmesis, axonal damage without disruption of connective tissue sheaths. Generally, human patients and experimental animals recover well after axonotmesis and the favorable outcome has been attributed to precise axonal reinnervation of the original peripheral targets. Here we assessed functionally and morphologically the long-term consequences of facial nerve axonotmesis in rats. Expectedly, we found that 5 months after crush or cryogenic nerve lesion, the numbers of motoneurons with regenerated axons and their projection pattern into the main branches of the facial nerve were similar to those in control animals suggesting precise target reinnervation. Unexpectedly, however, we found that functional recovery, estimated by vibrissal motion analysis, was incomplete at 2 months after injury and did not improve thereafter. The maximum amplitude of whisking remained substantially, by more than 30% lower than control values even 5 months after axonotmesis. Morphological analyses showed that the facial motoneurons ipsilateral to injury were innervated by lower numbers of glutamatergic terminals (-15%) and cholinergic perisomatic boutons (-26%) compared with the contralateral non-injured motoneurons. The structural deficits were correlated with functional performance of individual animals and associated with microgliosis in the facial nucleus but not with polyinnervation of muscle fibers. These results support the idea that restricted CNS plasticity and insufficient afferent inputs to motoneurons may substantially contribute to functional deficits after facial nerve injuries, possibly including pathologic conditions in humans like axonotmesis in idiopathic facial nerve (Bell's) palsy. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Developing psychological services following facial trauma

PubMed Central

Choudhury-Peters, Deba; Dain, Vicky

2016-01-01

Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress. Most facial injury patients were not receiving mental health assessment or treatment, and the maxillofacial team did not have direct access to psychological services. Based on these research findings, an innovative one-year pilot psychology service was designed and implemented within the facial trauma clinic. The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress. PMID:27493750

SURGICAL TREATMENT OF UPPER AND MIDDLE FACIAL ZONE TRAUMAS IN PROGRESS OF CONCOMITANT TRAUMATIC CRANIOFACIAL INJURIES.

PubMed

Lagvilava, G; Gvenetadze, Z; Toradze, G; Devidze, I; Gvenetadze, G

2015-09-01

In 2012-2015, 207 patients with concomitant craniofacial injuries, who underwent surgical treatment, were observed; among them 176 were men and 31- women. Age of the patients ranged from 16 to 60 years. According to localization and severity of trauma and a priority of surgical intervention, the patients conventionally were divided into 3 groups by the authors: I group (65 patients) - craniofacial injuries; the skull as well as upper and middle areas of face (subcranial and frontobasal fractures) were affected (fractured). II group (80 patients) - severe traumatic injuries of upper and especially middle zones of the face, accompanied with closed craniocerebral trauma, no need in neurosurgery. III group (62 patients) -on the background of serious head traumas, the injuries of face bones were less severe (injury of one or two anatomic areas with displacement of fractured fragments but without bone tissue defects) According to the obtained results a priority was always given to the neurosurgery (vital testimony).The reconstructive surgeries on face skeleton was conducted in combination involving neurosurgeons (I group patients). Reconstructive surgeries of facial bones were conducted in the patients of II group, immediately or at primary deferred period of time but in the patients of III group the surgical procedures for removal of early secondary or traumatic residual fractures have been performed. Reposition of the fractured facial bone fragments was performed in an open way and fixation was carried out by titanium plates and mesh cage (at bone tissue defect). For prevention and elimination of post-traumatic inflammatory processes, the final stage of surgical intervention was: sanation of nasal accessory sinuses and catheterization (5-7 days) of external carotid arteries for administration of antibiotics and other medical preparations. Early and differentiated approach to face injuries, worsening in the course of craniocephalic trauma was not revealed in any patient

Macroscopic in vivo imaging of facial nerve regeneration in Thy1-GFP rats.

PubMed

Placheta, Eva; Wood, Matthew D; Lafontaine, Christine; Frey, Manfred; Gordon, Tessa; Borschel, Gregory H

2015-01-01

Facial nerve injury leads to severe functional and aesthetic deficits. The transgenic Thy1-GFP rat is a new model for facial nerve injury and reconstruction research that will help improve clinical outcomes through translational facial nerve injury research. To determine whether serial in vivo imaging of nerve regeneration in the transgenic rat model is possible, facial nerve regeneration was imaged under the main paradigms of facial nerve injury and reconstruction. Fifteen male Thy1-GFP rats, which express green fluorescent protein (GFP) in their neural structures, were divided into 3 groups in the laboratory: crush-injury, direct repair, and cross-face nerve grafting (30-mm graft length). The distal nerve stump or nerve graft was predegenerated for 2 weeks. The facial nerve of the transgenic rats was serially imaged at the time of operation and after 2, 4, and 8 weeks of regeneration. The imaging was performed under a GFP-MDS-96/BN excitation stand (BLS Ltd). Facial nerve injury. Optical fluorescence of regenerating facial nerve axons. Serial in vivo imaging of the regeneration of GFP-positive axons in the Thy1-GFP rat model is possible. All animals survived the short imaging procedures well, and nerve regeneration was followed over clinically relevant distances. The predegeneration of the distal nerve stump or the cross-face nerve graft was, however, necessary to image the regeneration front at early time points. Crush injury was not suitable to sufficiently predegenerate the nerve (and to allow for degradation of the GFP through Wallerian degeneration). After direct repair, axons regenerated over the coaptation site in between 2 and 4 weeks. The GFP-positive nerve fibers reached the distal end of the 30-mm-long cross-face nervegrafts after 4 to 8 weeks of regeneration. The time course of facial nerve regeneration was studied by serial in vivo imaging in the transgenic rat model. Nerve regeneration was followed over clinically relevant distances in a small

Language and affective facial expression in children with perinatal stroke.

PubMed

Lai, Philip T; Reilly, Judy S

2015-08-01

Children with perinatal stroke (PS) provide a unique opportunity to understand developing brain-behavior relations. Previous research has noted distinctive differences in behavioral sequelae between children with PS and adults with acquired stroke: children fare better, presumably due to the plasticity of the developing brain for adaptive reorganization. Whereas we are beginning to understand language development, we know little about another communicative domain, emotional expression. The current study investigates the use and integration of language and facial expression during an interview. As anticipated, the language performance of the five and six year old PS group is comparable to their typically developing (TD) peers, however, their affective profiles are distinctive: those with right hemisphere injury are less expressive with respect to affective language and affective facial expression than either those with left hemisphere injury or TD group. The two distinctive profiles for language and emotional expression in these children suggest gradients of neuroplasticity in the developing brain. Copyright © 2015 Elsevier Inc. All rights reserved.

The localization of facial motor impairment in sporadic Möbius syndrome.

PubMed

Cattaneo, L; Chierici, E; Bianchi, B; Sesenna, E; Pavesi, G

2006-06-27

To investigate the neurophysiologic aspects of facial motor control in patients with sporadic Möbius syndrome defined as nonprogressive congenital facial and abducens palsy. The authors assessed 24 patients with sporadic Möbius syndrome by performing a complete clinical examination and neurophysiologic tests including facial nerve conduction studies, needle electromyography examination of facial muscles, and recording of the blink reflex and of the trigeminofacial inhibitory reflex. Two distinct groups of patients were identified according to neurophysiologic testing. The first group was characterized by increased facial distal motor latencies (DMLs) and poor recruitment of small and polyphasic motor unit action potentials (MUAPs). The second group was characterized by normal facial DMLs and neuropathic MUAPs. It is hypothesized that in the first group, the disorder is due to a rhombencephalic maldevelopment with selective sparing of small-size MUs, and in the second group, the disorder is related to an acquired nervous injury during intrauterine life, with subsequent neurogenic remodeling of MUs. The trigeminofacial reflexes showed that in most subjects of both groups, the functional impairment of facial movements was caused by a nuclear or peripheral site of lesion, with little evidence of brainstem interneuronal involvement. Two different neurophysiologically defined phenotypes can be distinguished in sporadic Möbius syndrome, with different pathogenetic implications.

Facial approximation-from facial reconstruction synonym to face prediction paradigm.

PubMed

Stephan, Carl N

2015-05-01

Facial approximation was first proposed as a synonym for facial reconstruction in 1987 due to dissatisfaction with the connotations the latter label held. Since its debut, facial approximation's identity has morphed as anomalies in face prediction have accumulated. Now underpinned by differences in what problems are thought to count as legitimate, facial approximation can no longer be considered a synonym for, or subclass of, facial reconstruction. Instead, two competing paradigms of face prediction have emerged, namely: facial approximation and facial reconstruction. This paper shines a Kuhnian lens across the discipline of face prediction to comprehensively review these developments and outlines the distinguishing features between the two paradigms. © 2015 American Academy of Forensic Sciences.

Soccer-related Facial Trauma: Multicenter Experience in 2 Brazilian University Hospitals

PubMed Central

Dini, Gal M.; Pereira, Max D.; Gurgel, Augusto; Bastos, Endrigo O.; Nagarkar, Purushottam; Gemperli, Rolf; Ferreira, Lydia M.

2014-01-01

Background: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers. Methods: A retrospective review of trauma medical records from the Plastic Surgery Divisions at the Universidade Federal de São Paulo–Escola Paulista de Medicina and the Hospital das Clinicas–Universidade de São Paulo was carried out to identify patients who underwent invasive surgical procedures due to acute soccer-related facial fractures. Data points reviewed included gender, date of injury, type of fracture, date of surgery, and procedure performed. Results: A total of 45 patients (31 from Escola Paulista de Medicina and 14 from Universidade de São Paulo) underwent surgical procedures to address facial fractures between March 2000 and September 2013. Forty-four patients were men, and mean age was 28 years. The fracture patterns seen were nasal bones (16 patients, 35%), orbitozygomatic (16 patients, 35%), mandibular (7 patients, 16%), orbital (6 patients, 13%), frontal (1 patient, 2%), and naso-orbito-ethmoid (1 patient, 2%). Mechanisms of injury included collisions with another player (n = 39) and being struck by the ball (n = 6). Conclusions: Although it is less common than orthopedic injuries, soccer players do sustain maxillofacial trauma. Knowledge of its frequency is important to first responders, nurses, and physicians who have initial contact with patients. Missed diagnosis or delayed treatment can lead to facial deformities and functional problems in the physiological actions of breathing, vision, and chewing. PMID:25289361

Delayed presentation of traumatic facial nerve (CN VII) paralysis.

PubMed

Napoli, Anthony M; Panagos, Peter

2005-11-01

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

Realistic facial animation generation based on facial expression mapping

NASA Astrophysics Data System (ADS)

Yu, Hui; Garrod, Oliver; Jack, Rachael; Schyns, Philippe

2014-01-01

Facial expressions reflect internal emotional states of a character or in response to social communications. Though much effort has been taken to generate realistic facial expressions, it still remains a challenging topic due to human being's sensitivity to subtle facial movements. In this paper, we present a method for facial animation generation, which reflects true facial muscle movements with high fidelity. An intermediate model space is introduced to transfer captured static AU peak frames based on FACS to the conformed target face. And then dynamic parameters derived using a psychophysics method is integrated to generate facial animation, which is assumed to represent natural correlation of multiple AUs. Finally, the animation sequence in the intermediate model space is mapped to the target face to produce final animation.

Epidemiology and resource utilization in pediatric facial fractures.

PubMed

Soleimani, Tahereh; Greathouse, Shawn Travis; Sood, Rajiv; Tahiri, Youssef H; Tholpady, Sunil S

2016-02-01

Pediatric facial fractures, although uncommon, have a significant impact on public health and the US economy by the coexistence of other injuries and developmental deformities. Violence is one of the most frequent mechanisms leading to facial fracture. Teaching hospitals, while educating future medical professionals, have been linked to greater resource utilization in differing scenarios. This study was designed to compare the differences in patient characteristics and outcomes between teaching and non-teaching hospitals for violence-related pediatric facial fractures. Using the 2000-2009 Kids' Inpatient Database, 3881 patients younger than 18 years were identified with facial fracture and external cause of injury code for assault, fight, or abuse. Patients admitted at teaching hospitals were compared to those admitted at non-teaching hospitals in terms of demographics, injuries, and outcomes. Overall, 76.2% of patients had been treated at teaching hospitals. Compared to those treated at non-teaching hospitals, these patients were more likely to be younger, non-white, covered by Medicaid, from lower income zip codes, and have thoracic injuries; but mortality rate was not significantly different. After adjusting for potential confounders, teaching status of the hospital was not found as a predictor of either longer lengths of stay (LOS) or charges. There is an insignificant difference between LOS and charges at teaching and non-teaching hospitals after controlling for patient demographics. This suggests that the longer LOS observed at teaching hospitals is related to these institutions being more often involved in the care of underserved populations and patients with more severe injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

Preventing Facial Pressure Ulcers in Acute Respiratory Distress Syndrome (ARDS).

PubMed

Kim, Ruth S; Mullins, Kimberly

2016-01-01

In patients with acute lung injury and/or severe acute respiratory distress syndrome (ARDS), prone positioning is a therapeutic intervention to improve oxygenation. Positioning a patient in a prone position increases the risk of medical device-related pressure ulcers in the facial area. This article summarizes experience with 4 patients with ARDS. Two did not receive pressure ulcer preventive measures and subsequently developed multiple necrotic facial pressure ulcers related to prone positioning for treatment of ARDS. The other 2 patients were managed on a thin silicone foam dressing; neither of these patients developed facial pressure ulcers during pronation therapy. The use of thin soft silicone foam dressings may prevent the development of facial deep tissue injuries in patients receiving prolonged pronation therapy.

The possibility of application of spiral brain computed tomography to traumatic brain injury.

PubMed

Lim, Daesung; Lee, Soo Hoon; Kim, Dong Hoon; Choi, Dae Seub; Hong, Hoon Pyo; Kang, Changwoo; Jeong, Jin Hee; Kim, Seong Chun; Kang, Tae-Sin

2014-09-01

The spiral computed tomography (CT) with the advantage of low radiation dose, shorter test time required, and its multidimensional reconstruction is accepted as an essential diagnostic method for evaluating the degree of injury in severe trauma patients and establishment of therapeutic plans. However, conventional sequential CT is preferred for the evaluation of traumatic brain injury (TBI) over spiral CT due to image noise and artifact. We aimed to compare the diagnostic power of spiral facial CT for TBI to that of conventional sequential brain CT. We evaluated retrospectively the images of 315 traumatized patients who underwent both brain CT and facial CT simultaneously. The hemorrhagic traumatic brain injuries such as epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and contusional hemorrhage were evaluated in both images. Statistics were performed using Cohen's κ to compare the agreement between 2 imaging modalities and sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT to conventional sequential brain CT. Almost perfect agreement was noted regarding hemorrhagic traumatic brain injuries between spiral facial CT and conventional sequential brain CT (Cohen's κ coefficient, 0.912). To conventional sequential brain CT, sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT were 92.2%, 98.1%, 95.9%, and 96.3%, respectively. In TBI, the diagnostic power of spiral facial CT was equal to that of conventional sequential brain CT. Therefore, expanded spiral facial CT covering whole frontal lobe can be applied to evaluate TBI in the future. Copyright © 2014 Elsevier Inc. All rights reserved.

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

PubMed

Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

2017-06-01

To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

Complications in Pediatric Facial Fractures

PubMed Central

Chao, Mimi T.; Losee, Joseph E.

2009-01-01

Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications. PMID:22110803

Constriction of the buccal branch of the facial nerve produces unilateral craniofacial allodynia.

PubMed

Lewis, Susannah S; Grace, Peter M; Hutchinson, Mark R; Maier, Steven F; Watkins, Linda R

2017-08-01

Despite pain being a sensory experience, studies of spinal cord ventral root damage have demonstrated that motor neuron injury can induce neuropathic pain. Whether injury of cranial motor nerves can also produce nociceptive hypersensitivity has not been addressed. Herein, we demonstrate that chronic constriction injury (CCI) of the buccal branch of the facial nerve results in long-lasting, unilateral allodynia in the rat. An anterograde and retrograde tracer (3000MW tetramethylrhodamine-conjugated dextran) was not transported to the trigeminal ganglion when applied to the injury site, but was transported to the facial nucleus, indicating that this nerve branch is not composed of trigeminal sensory neurons. Finally, intracisterna magna injection of interleukin-1 (IL-1) receptor antagonist reversed allodynia, implicating the pro-inflammatory cytokine IL-1 in the maintenance of neuropathic pain induced by facial nerve CCI. These data extend the prior evidence that selective injury to motor axons can enhance pain to supraspinal circuits by demonstrating that injury of a facial nerve with predominantly motor axons is sufficient for neuropathic pain, and that the resultant pain has a neuroimmune component. Copyright © 2016 Elsevier Inc. All rights reserved.

Facial Transplantation Surgery Introduction

PubMed Central

2015-01-01

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea. PMID:26028914

Facial transplantation surgery introduction.

PubMed

Eun, Seok-Chan

2015-06-01

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.

Pediatric Facial Fractures: A Review of 2071 Fractures.

PubMed

Ferreira, Pedro Costa; Barbosa, Joselina; Braga, José Miguel; Rodrigues, Acácio; Silva, Álvaro Catarino; Amarante, José Manuel

2016-01-01

Facial fractures are infrequent in children and adolescents, and there are only few reports that review a significant number of patients. The objective of this study was to analyze the pattern of maxillofacial fractures in pediatric patients of Portugal. We reviewed the clinical records of a series of 1416 patients 18 years or younger with facial fractures, treated by the Department of Plastic Reconstructive, Aesthetic and of Maxillofacial Surgery of São João Hospital, Porto, Portugal, between 1993 and 2012. The following parameters were evaluated: age; sex; cause of the accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. A total of 2071 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (43.9%). Motor vehicle accident was the most common cause of injuries (48.7% of patients). Mandibular fractures were the most common (44.4%). Associated injuries occurred in 1015 patients (71.7%). Pediatric facial fractures are usually associated with severe trauma. There has been a highly significant decrease (P < 0.001) in pediatric facial fractures in Portugal for the past 20 years.

Temporal distribution of alcohol related facial fractures.

PubMed

Lee, Kai H; Qiu, Michael; Sun, Jiandong

2017-11-01

This study aimed to address 2 important aspects of temporal pattern in alcohol-related facial fractures: (1) comparison of temporal pattern of alcohol-related facial fracture (alcohol group) presentation with non-alcohol-related fracture (non-alcohol group) presentation; (2) temporal pattern of patient demographic characteristics, injury characteristics, and surgical management in the alcohol group presentation. This study retrospectively examined the Victorian admitted episodes data set (VAED) for the years 2010 to 2013. VAED is a standardized set of data collected during all hospital presentations in Victoria. The study found higher incidence of alcohol-related facial fracture presentations during weekends and during the summer and spring months compared with non-alcohol-related fractures (statistically significant). Alcohol-related facial fractures are more likely to involve male patients in the 20- to 29-year age group, occur as a result of interpersonal violence, and require shorter hospital stays during weekend admissions (statistically significant). No statistically significant relationship has been observed in seasonal variation across all variables. This study found distinct characteristics in temporal distribution of alcohol-related facial fractures. These characteristics are, in particular, significant in weekend trauma admissions. Such information is important in workforce planning, resource distribution, and implementation of injury prevention programs. Copyright © 2017 Elsevier Inc. All rights reserved.

Periocular Reconstruction in Patients with Facial Paralysis.

PubMed

Joseph, Shannon S; Joseph, Andrew W; Douglas, Raymond S; Massry, Guy G

2016-04-01

Facial paralysis can result in serious ocular consequences. All patients with orbicularis oculi weakness in the setting of facial nerve injury should undergo a thorough ophthalmologic evaluation. The main goal of management in these patients is to protect the ocular surface and preserve visual function. Patients with expected recovery of facial nerve function may only require temporary and conservative measures to protect the ocular surface. Patients with prolonged or unlikely recovery of facial nerve function benefit from surgical rehabilitation of the periorbital complex. Current reconstructive procedures are most commonly intended to improve coverage of the eye but cannot restore blink. Copyright © 2016 Elsevier Inc. All rights reserved.

[Surgical treatment in otogenic facial nerve palsy].

PubMed

Feng, Guo-Dong; Gao, Zhi-Qiang; Zhai, Meng-Yao; Lü, Wei; Qi, Fang; Jiang, Hong; Zha, Yang; Shen, Peng

2008-06-01

To study the character of facial nerve palsy due to four different auris diseases including chronic otitis media, Hunt syndrome, tumor and physical or chemical factors, and to discuss the principles of the surgical management of otogenic facial nerve palsy. The clinical characters of 24 patients with otogenic facial nerve palsy because of the four different auris diseases were retrospectively analyzed, all the cases were performed surgical management from October 1991 to March 2007. Facial nerve function was evaluated with House-Brackmann (HB) grading system. The 24 patients including 10 males and 14 females were analysis, of whom 12 cases due to cholesteatoma, 3 cases due to chronic otitis media, 3 cases due to Hunt syndrome, 2 cases resulted from acute otitis media, 2 cases due to physical or chemical factors and 2 cases due to tumor. All cases were treated with operations included facial nerve decompression, lesion resection with facial nerve decompression and lesion resection without facial nerve decompression, 1 patient's facial nerve was resected because of the tumor. According to HB grade system, I degree recovery was attained in 4 cases, while II degree in 10 cases, III degree in 6 cases, IV degree in 2 cases, V degree in 2 cases and VI degree in 1 case. Removing the lesions completely was the basic factor to the surgery of otogenic facial palsy, moreover, it was important to have facial nerve decompression soon after lesion removal.

Facial nerve conduction after sclerotherapy in children with facial lymphatic malformations: report of two cases.

PubMed

Lin, Pei-Jung; Guo, Yuh-Cherng; Lin, Jan-You; Chang, Yu-Tang

2007-04-01

Surgical excision is thought to be the standard treatment of choice for lymphatic malformations. However, when the lesions are limited to the face only, surgical scar and facial nerve injury may impair cosmetics and facial expression. Sclerotherapy, an injection of a sclerosing agent directly through the skin into a lesion, is an alternative method. By evaluating facial nerve conduction, we observed the long-term effect of facial lymphatic malformations after intralesional injection of OK-432 and correlated the findings with anatomic outcomes. One 12-year-old boy with a lesion over the right-side preauricular area adjacent to the main trunk of facial nerve and the other 5-year-old boy with a lesion in the left-sided cheek involving the buccinator muscle were enrolled. The follow-up data of more than one year, including clinical appearance, computed tomography (CT) scan and facial nerve evaluation were collected. The facial nerve conduction study was normal in both cases. Blink reflex in both children revealed normal results as well. Complete resolution was noted on outward appearance and CT scan. The neurophysiologic data were compatible with good anatomic and functional outcomes. Our report suggests that the inflammatory reaction of OK-432 did not interfere with adjacent facial nerve conduction.

Assessment of head injury of children due to golf ball impact.

PubMed

Lee, Heow Pueh; Wang, Fang

2010-10-01

Head trauma injury due to impact by a flying golf ball is one of the most severe possible injury accidents on the golf course. Numerical simulations based on the finite element method are presented to investigate head injury in children due to impact by a flying golf ball. The stress and energy flow patterns in a head model during the golf ball impact are computed for various combinations of striking speed, falling angle of the golf ball before impact, and impact location. It is found that a child is more prone to head injury due to golf ball impact on the frontal and side/temporal areas. The simulated results are found to conform to the clinical reports on children's head injuries from flying golf balls.

Occupational injuries due to violence.

PubMed

Hales, T; Seligman, P J; Newman, S C; Timbrook, C L

1988-06-01

Each year in the United States, an estimated 800 to 1,400 people are murdered at work, and an unknown number of nonfatal injuries due to workplace violence occur. Based on Ohio's workers' compensation claims from 1983 through 1985, police officers, gasoline service station employees, employees of the real estate industry, and hotel/motel employees were found to be at the highest risk for occupational violent crime (OVC) injury and death. Grocery store employees, specifically those working in convenience food stores, and employees of the real estate industry had the most reported rapes. Four previously unidentified industries at increased risk of employee victimization were described. Identification of industries and occupations at high risk for crime victimization provides the opportunity to focus preventive strategies to promote employee safety and security in the workplace.

Injury due to leg bands in willow flycatchers

USGS Publications Warehouse

Sedgwick, J.A.; Klus, R.J.

1997-01-01

We report an apparently unusually high incidence of leg injury in Willow Flycatchers (Empidonax traillii) as a result of banding and color banding. Color bands and U.S. Fish and Wildlife Service (USFWS) bands applied to Willow Flycatchers from 1988-1995 resulted in an overall leg injury rate of 9.6% to birds returning to our study areas in subsequent years. Most injuries occurred on legs with only color band(s) (58.3%) or on legs with both a USFWS band and a color band (35%); only 6.7% of injuries (4/60) were due to USFWS bands alone, yielding an overall USFWS band injury rate of only 0.6%. Injuries ranged from severe (swollen, bleeding legs; a missing foot) to relatively minor (irritations on the tarsus). Amputation of the foot occurred in 33.9% of the cases. Return rates of adult injured birds in the year(s) following injury were significantly lower than for the population at large.

[An individual facial shield for a sportsman with an orofacial injury].

PubMed

de Baat, C; Peters, R; van Iperen-Keiman, C M; de Vleeschouwer, M

2005-05-01

Facial shields are used when practising contact sports, high speed sports, sports using hard balls, sticks or bats, sports using protective shields or covers, and sports using hard boardings around the sports ground. Examples of facial shields are commercially available, per branch of sport standardised helmets. Fabricating individual protective shields is primarily restricted to mouth guards. In individual cases a more extensive facial shield is demanded, for instance in case of a surgically stabilised facial bone fracture. In order to be able to fabricate an extensive individual facial shield, an accurate to the nearest model of the anterior part of the head is required. An accurate model can be provided by making an impression of the face, which is poured in dental stone. Another method is producing a stereolithographic model using computertomography or magnetic resonance imaging. On the accurate model the facial shield can be designed and fabricated from a strictly safe material, such as polyvinylchloride or polycarbonate.

Trauma of facial skeleton in children: An indian perspective.

PubMed

Karim, Tanweer; Khan, Arshad Hafeez; Ahmed, Syed Saeed

2010-06-01

Both children and adults are subject to similar types of injuries but fractures of facial bones in children are relatively uncommon. The aim of this study was to evaluate the epidemiology of facial bone fractures among children of <12 years, their management and outcome in an Indian city. This retrospective study included children of <12 years of age with facial bone fractures admitted over a span of 3 years. In order to compare our results we reviewed the existing literature related to pediatric facial bone fractures. A total of 45 children were admitted for facial bone fractures. Forty (89%) of them were above 5 years of age and male to female ratio was 2:1. About 53.33% of these injuries were because of fall from height. Mandible fracture was the most common facial bone fracture among admitted patients. Symphysis and para-symphysis was the commonest site of mandibular fractures, seen in 49% cases. Majority of these fractures were managed by Inter-maxillary fixation and inter-osseous wiring. Mini-plates were used for widely displaced compound fractures. For un-displaced fractures observation alone was sufficient. Mandible is the commonest facial bone fracture in children, more often caused by accidental fall from height. The high osteogenic potential of pediatric mandible allows non-surgical management to be successful in an increased proportion of younger patients.

Facial nerve palsy associated with a cystic lesion of the temporal bone.

PubMed

Kim, Na Hyun; Shin, Seung-Ho

2014-03-01

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone lesions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

External auditory canal cholesteatoma and keratosis obturans: the role of imaging in preventing facial nerve injury.

PubMed

McCoul, Edward D; Hanson, Matthew B

2011-12-01

We conducted a retrospective study to compare the clinical characteristics of external auditory canal cholesteatoma (EACC) with those of a similar entity, keratosis obturans (KO). We also sought to identify those aspects of each disease that may lead to complications. We identified 6 patients in each group. Imaging studies were reviewed for evidence of bony erosion and the proximity of disease to vital structures. All 6 patients in the EACC group had their diagnosis confirmed by computed tomography (CT), which demonstrated widening of the bony external auditory canal; 4 of these patients had critical erosion of bone adjacent to the facial nerve. Of the 6 patients with KO, only 2 had undergone CT, and neither exhibited any significant bony erosion or expansion; 1 of them developed osteomyelitis of the temporal bone and adjacent temporomandibular joint. Another patient manifested KO as part of a dermatophytid reaction. The essential component of treatment in all cases of EACC was microscopic debridement of the ear canal. We conclude that EACC may produce significant erosion of bone with exposure of vital structures, including the facial nerve. Because of the clinical similarity of EACC to KO, misdiagnosis is possible. Temporal bone imaging should be obtained prior to attempts at debridement of suspected EACC. Increased awareness of these uncommon conditions is warranted to prompt appropriate investigation and prevent iatrogenic complications such as facial nerve injury.

Effects of ozone therapy on facial nerve regeneration.

PubMed

Ozbay, Isa; Ital, Ilker; Kucur, Cuneyt; Akcılar, Raziye; Deger, Aysenur; Aktas, Savas; Oghan, Fatih

Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Bell palsy in lyme disease-endemic regions of canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease.

PubMed

Ho, Karen; Melanson, Michel; Desai, Jamsheed A

2012-09-01

Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.

Deep Temporal Nerve Transfer for Facial Reanimation: Anatomic Dissections and Surgical Case Report.

PubMed

Mahan, Mark A; Sivakumar, Walavan; Weingarten, David; Brown, Justin M

2017-09-08

Facial nerve palsy is a disabling condition that may arise from a variety of injuries or insults and may occur at any point along the nerve or its intracerebral origin. To examine the use of the deep temporal branches of the motor division of the trigeminal nerve for neural reconstruction of the temporal branches of the facial nerve for restoration of active blink and periorbital facial expression. Formalin-fixed human cadaver hemifaces were dissected to identify landmarks for the deep temporal branches and the tension-free coaptation lengths. This technique was then utilized in 1 patient with a history of facial palsy due to a brainstem cavernoma. Sixteen hemifaces were dissected. The middle deep temporal nerve could be consistently identified on the deep side of the temporalis, within 9 to 12 mm posterior to the jugal point of the zygoma. From a lateral approach through the temporalis, the middle deep temporal nerve could be directly coapted to facial temporal branches in all specimens. Our patient has recovered active and independent upper facial muscle contraction, providing the first case report of a distinct distal nerve transfer for upper facial function. The middle deep temporal branches can be readily identified and utilized for facial reanimation. This technique provided a successful reanimation of upper facial muscles with independent activation. Utilizing multiple sources for neurotization of the facial muscles, different potions of the face can be selectively reanimated to reduce the risk of synkinesis and improved control. Copyright © 2017 by the Congress of Neurological Surgeons

Genetic Factors That Increase Male Facial Masculinity Decrease Facial Attractiveness of Female Relatives

PubMed Central

Lee, Anthony J.; Mitchem, Dorian G.; Wright, Margaret J.; Martin, Nicholas G.; Keller, Matthew C.; Zietsch, Brendan P.

2014-01-01

For women, choosing a facially masculine man as a mate is thought to confer genetic benefits to offspring. Crucial assumptions of this hypothesis have not been adequately tested. It has been assumed that variation in facial masculinity is due to genetic variation and that genetic factors that increase male facial masculinity do not increase facial masculinity in female relatives. We objectively quantified the facial masculinity in photos of identical (n = 411) and nonidentical (n = 782) twins and their siblings (n = 106). Using biometrical modeling, we found that much of the variation in male and female facial masculinity is genetic. However, we also found that masculinity of male faces is unrelated to their attractiveness and that facially masculine men tend to have facially masculine, less-attractive sisters. These findings challenge the idea that facially masculine men provide net genetic benefits to offspring and call into question this popular theoretical framework. PMID:24379153

Genetic factors that increase male facial masculinity decrease facial attractiveness of female relatives.

PubMed

Lee, Anthony J; Mitchem, Dorian G; Wright, Margaret J; Martin, Nicholas G; Keller, Matthew C; Zietsch, Brendan P

2014-02-01

For women, choosing a facially masculine man as a mate is thought to confer genetic benefits to offspring. Crucial assumptions of this hypothesis have not been adequately tested. It has been assumed that variation in facial masculinity is due to genetic variation and that genetic factors that increase male facial masculinity do not increase facial masculinity in female relatives. We objectively quantified the facial masculinity in photos of identical (n = 411) and nonidentical (n = 782) twins and their siblings (n = 106). Using biometrical modeling, we found that much of the variation in male and female facial masculinity is genetic. However, we also found that masculinity of male faces is unrelated to their attractiveness and that facially masculine men tend to have facially masculine, less-attractive sisters. These findings challenge the idea that facially masculine men provide net genetic benefits to offspring and call into question this popular theoretical framework.

Comparison of Direct Side-to-End and End-to-End Hypoglossal-Facial Anastomosis for Facial Nerve Repair.

PubMed

Samii, Madjid; Alimohamadi, Maysam; Khouzani, Reza Karimi; Rashid, Masoud Rafizadeh; Gerganov, Venelin

2015-08-01

The hypoglossal facial anastomosis (HFA) is the gold standard for facial reanimation in patients with severe facial nerve palsy. The major drawbacks of the classic HFA technique are lingual morbidities due to hypoglossal nerve transection. The side-to-end HFA is a modification of the classic technique with fewer tongue-related morbidities. In this study we compared the outcome of the classic end-to-end and the direct side-to-end HFA surgeries performed at our center in regards to the facial reanimation success rate and tongue-related morbidities. Twenty-six successive cases of HFA were enrolled. In 9 of them end-to-end anastomoses were performed, and 17 had direct side-to-end anastomoses. The House-Brackmann (HB) and Pitty and Tator (PT) scales were used to document surgical outcome. The hemiglossal atrophy, swallowing, and hypoglossal nerve function were assessed at follow-up. The original pathology was vestibular schwannoma in 15, meningioma in 4, brain stem glioma in 4, and other pathologies in 3. The mean interval between facial palsy and HFA was 18 months (range: 0-60). The median follow-up period was 20 months. The PT grade at follow-up was worse in patients with a longer interval from facial palsy and HFA (P value: 0.041). The lesion type was the only other factor that affected PT grade (the best results in vestibular schwannoma and the worst in the other pathologies group, P value: 0.038). The recovery period for facial tonicity was longer in patients with radiation therapy before HFA (13.5 vs. 8.5 months) and those with a longer than 2-year interval from facial palsy to HFA (13.5 vs. 8.5 months). Although no significant difference between the side-to-end and the end-to-end groups was seen in terms of facial nerve functional recovery, patients from the side-to-end group had a significantly lower rate of lingual morbidities (tongue hemiatrophy: 100% vs. 5.8%, swallowing difficulty: 55% vs. 11.7%, speech disorder 33% vs. 0%). With the side-to-end HFA

Reconstruction of massive facial avulsive injury, secondary to animal bite.

PubMed

Motamed, Sadrollah; Niazi, Feizollah; Moosavizadeh, Seyed Mehdi; Gholizade Pasha, Abdolhamid; Motamed, Ali

2014-02-01

Management of facial soft tissue trauma requires complex reconstruction surgery. Animal bite on face is a common cause of facial tissue trauma with severe destruction. Evaluation of unit involvement is the first effort, followed by designation of reconstruction. In this case, we performed multiple reconstruction options.

Effects of local application of methylprednisolone delivered by the C/GP-hydrogel on the recovery of facial nerves.

PubMed

Chao, Xiuhua; Fan, Zhaomin; Han, Yuechen; Wang, Yan; Li, Jianfeng; Chai, Renjie; Xu, Lei; Wang, Haibo

2015-01-01

Local administration of MP delivered by the C/GP-MP-hydrogel can improve the recovery of facial nerve following crush injury. The findings suggested that locally injected MP delivered by C/GP-hydrogel might be a promising treatment for facial nerve damage. In this study, the aim is to assess the effectiveness of locally administrating methylprednisolone(MP) loaded by chitosan-β-glycerophosphate hydrogel (C/GP-hydrogel) on the regeneration of facial nerve crush injury. After the crush of left facial nerves, Wistar rats were randomly divided into four different groups. Then, four different therapies were used to treat the damaged facial nerves. At the 1(st), 2(nd), 3(rd), and 4(th) week after injury, the functional recovery of facial nerves and the morphological changes of facial nerves were assessed. The expression of growth associated protein-43 (GAP-43) protein in the facial nucleus were also evaluated. Locally injected MP delivered by C/GP-hydrogel effectively accelerated the facial functional recovery. In addition, the regenerated facial nerves in the C/GP-MP group were more mature than those in the other groups. The expression of GAP-43 protein was also improved by the MP, especially in the C/GP-MP group.

A profile of the oro-facial injuries in child physical abuse at a children's hospital.

PubMed

Naidoo, S

2000-04-01

The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa. A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out. The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures. The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.

Analysis of 809 Facial Bone Fractures in a Pediatric and Adolescent Population

PubMed Central

Kim, Sang Hun; Lee, Soo Hyang

2012-01-01

Background Facial fractures are infrequent in children and adolescents and have different clinical features from those in adults. The low incidence in children and adolescents reflects the flexibility and underdevelopment of their facial skeletons, as well as their more protected environments. Only a few reports have reviewed such patients in Korea. The authors performed a retrospective study to analyze the characteristics of facial fractures in the Korean pediatric population. Methods We conducted a retrospective review on a series of 741 patients, aged <18 years, with facial fractures who had been treated at our hospital between 2006 and 2010. The following parameters were evaluated: age, sex, cause, location and type of fractures, associated injuries, treatment and complications. Results A total of 741 consecutive patients met the inclusion criteria. The ratio of boys to girls was 5.7:1. Facial fractures most commonly occurred in patients between 13 and 15 years of age (36.3%). The most common causes of injury was violence. The nasal fracture was the most common type of fracture (69%) and the blowout fracture was the second most common (20%). Associated injuries occurred in 156 patients (21%). Conclusions The incidence of pediatric facial fractures caused by violence is high in Korea. Our results show that as age increases, etiological factors and fracture patterns gradually shift towards those found in adults. This study provides an overview of facial fractures in these age groups that helps illustrate the trends and characteristics of the fractures and may be helpful in further evaluation and management. PMID:23233885

Hyphema due to blunt injury: a review of 118 patients

PubMed Central

Ulagantheran, V; Ahmad Fauzi, M S; Reddy, S C

2010-01-01

AIM To determine the causes, associated ocular findings and visual acuity on presentation, complications and visual outcome following treatment in patients of hyphema due to blunt injury METHODS A retrospective study was performed in 118 patients with hyphema due to blunt injury admitted in University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The gender, age, race, cause of blunt injury resulting in hyphema, eye involved, vision at admission, other associated ophthalmological findings, complications and visual outcome were noted from the case records of patients. The data were analyzed using SPSS programme. RESULTS Males were more predominantly affected (93.2%). Two-thirds of patients (67.8%) were aged below 30 years. Sports related injury (38.1%) was the most common cause for hyphema. Hyphema disappeared within 5 days in 66.9% of patients. Iris injuries were very commonly associated in the form of mydriasis, sphincter tear and iridodialysis. Associated vitreous haemorrhage was noted in 11.9% of patients. During the hospital stay, secondary haemorrhage was observed in 3.4% of patients. The best corrected vision of 6/18 or better was noted in 85.4% of patients at the last follow-up. The follow-up of these subjects was very poor and thus the incidence of secondary glaucoma could not be established. Moderate blood staining of cornea occurred in 0.8% of patients. CONCLUSION Sports related injury is the most common cause of hyphema in Malaysia. Good visual recovery, without serious complications, is possible with appropriate and in-time treatment in hyphema patients due to blunt injury. PMID:22553571

Sensitive and Motor Neuroanastomosis After Facial Trauma.

PubMed

Ribeiro-Junior, Paulo Domingos; Senko, Ricardo Alexandre Galdioli; Mendes, Gabriel Cury Batista; Peres, Fernando Gianzanti

2016-10-01

Facial nerve has great functional and aesthetic importance to the face, and damage to its structure can lead to major complications. This article reports a clinical case of neuroanastomosis of the facial nerve after facial trauma, describing surgical procedure and postoperative follow-up. A trauma patient with extensive injury cut in right mandibular body causing neurotmesis of the VIIth cranial nerve and mandibular angle fracture right side was treated. During surgical exploration, the nerve segments were identified and a neuroanastomosis was performed using nylon 10-0, after reduction and internal fixation of the mandibular fracture. Postoperatively, an 8-month follow-up showed good evolution and preservation of motor function of the muscles of facial mime, highlighting the success of the surgical treatment. Nerve damage because of facial trauma can be a surgical treatment challenge, but when properly conducted can functionally restore the damaged nerve.

Quantitative Magnetic Resonance Imaging Volumetry of Facial Muscles in Healthy Patients with Facial Palsy

PubMed Central

Volk, Gerd F.; Karamyan, Inna; Klingner, Carsten M.; Reichenbach, Jürgen R.

2014-01-01

Background: Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for facial muscles. Methods: Ten healthy subjects and 5 patients with facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory muscles for control. Results: All muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side. Conclusions: First systematic quantitative MRI volume measures of 5 different clinical presentations of facial paralysis are provided. PMID:25289366

Weapon identification using antemortem CT with 3D reconstruction, is it always possible?--A report in a case of facial blunt and sharp injuries using an ashtray.

PubMed

Aromatario, Mariarosaria; Cappelletti, Simone; Bottoni, Edoardo; Fiore, Paola Antonella; Ciallella, Costantino

2016-01-01

An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Facial Gunshot Wounds: Trends in Management

PubMed Central

Kaufman, Yoav; Cole, Patrick; Hollier, Larry H.

2009-01-01

Facial gunshot wounds, often comprising significant soft and bone tissue defects, pose a significant challenge for reconstructive surgeons. Whether resulting from assault, accident, or suicide attempt, a thorough assessment of the defects is essential for devising an appropriate tissue repair and replacement with a likely secondary revision. Immediately after injury, management is centered on advanced trauma life support with patient stabilization as the primary goal. Thorough examination along with appropriate imaging is critical for identifying any existing defects. Whereas past surgical management advocated delayed definitive treatment using serial debridement, today’s management favors use of more immediate reconstruction. Recent advances in microsurgical technique have shifted favor from local tissue advancement to distant free flap transfers, which improve cosmesis and function. This has resulted in a lower number of surgeries required to achieve reconstruction. Because of the diversity of injury and the complexity of facial gunshot injuries, a systematic algorithm is essential to help manage the different stages of healing and to ensure that the best outcome is achieved. PMID:22110801

Facial diplegia: a clinical dilemma.

PubMed

Chakrabarti, Debaprasad; Roy, Mukut; Bhattacharyya, Amrit K

2013-06-01

Bilateral facial paralysis is a rare clinical entity and presents as a diagnostic challenge. Unlike its unilateral counterpart facial diplegia is seldom secondary to Bell's palsy. Occurring at a frequency of 0.3% to 2% of all facial palsies it often indicates ominous medical conditions. Guillian-Barre syndrome needs to be considered as a differential in all given cases of facial diplegia where timely treatment would be rewarding. Here a case of bilateral facial palsy due to Guillian-Barre syndrome with atypical presentation is reported.

[Analysis of volcanic-ash-based insoluble ingredients of facial cleansers].

PubMed

Ikarashi, Yoshiaki; Uchino, Tadashi; Nishimura, Tetsuji

2011-01-01

The substance termed "Shirasu balloons", produced by the heat treatment of volcanic silicates, is in the form of hollow glass microspheres. Recently, this substance has gained popularity as an ingredient of facial cleansers currently available in the market, because it lends a refreshing and smooth feeling after use. However, reports of eye injury after use of a facial cleanser containing a substance made from volcanic ashes are on the rise. We presumed that the shape and size of these volcanic-ash-based ingredients would be the cause of such injuries. Therefore, in this study, we first developed a method for extracting water-insoluble ingredients such as "Shirasu balloons" from the facial cleansers, and then, we examined their shapes and sizes. The insoluble ingredients extracted from the cleansers were mainly those derived from volcanic silicates. A part of the ingredients remained in the form of glass microspheres, but for the most part, the ingredients were present in various forms, such as fragments of broken glass. Some of the fragments were larger than 75 microm in length. Foreign objects having a certain hardness, shape, and size (e.g., size greater than 75 microm) can possibly cause eye injury. We further examined insoluble ingredients of facial scrubs, such as artificial mineral complexes, mud, charcoal, and polymers, except for volcanic-silicate-based ingredients. The amounts of insoluble ingredients extracted from these scrubs were small and did not have a sharp edge. Some scrubs had ingredients with particles larger than 75 microm in size, but their specific gravities were small and their hardness values were much lower than those of glass microspheres of ingredients such as "Shirasu balloons". Because the fragments of glass microspheres can possibly cause eye injury, the facial cleansers containing large insoluble ingredients derived from volcanic ashes should be avoided to use around eyes.

A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

PubMed Central

Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray

2015-01-01

The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case. PMID:26339511

Unique fatality due to claw injuries in a tiger attack: a case report.

PubMed

Pathak, Hrishikesh; Dixit, Pradeep; Dhawane, Shailendra; Meshram, Satin; Shrigiriwar, Manish; Dingre, Niraj

2014-11-01

This paper describes a unique case of a fatal tiger attack in the wild. In the present case, a tiger fatally mauled a 34-year-old female with its claws, instead of the usual mechanism of killing by the bite injury to the neck. The autopsy revealed multiple fatal and non-fatal injuries caused by the tiger claws. The characteristic injuries due to the tooth impacts were absent as the teeth of the offending tiger were either fallen or non-functional. To the best of our knowledge, probably this rare case would be the first reported human fatality due to the tiger claw injuries in the world. The purpose of the present article is to highlight the fatal injuries due to the tiger claws, as the claw-induced fatal injuries in a tiger attack are not reported in the medico-legal literature. Moreover, this report would be an illustrative one for differentiation between the fatal injuries due to the claws and tooth impacts in a tiger attack. Furthermore, the present report establishes the importance of the tiger claws as a source of fatal injuries in a tiger attack. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Outcomes of Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release.

PubMed

Jacobson, Joel; Rihani, Jordan; Lin, Karen; Miller, Phillip J; Roland, J Thomas

2011-01-01

Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face.

AORTIC INJURY DUE TO PARAGLIDING: A CASE REPORT

PubMed Central

Omori, Kazuhiko; Jitsuiki, Kei; Majima, Takashi; Takeuchi, Ikuto; Yoshizaw, Toshihiko; Ishikawa, Kouhei; Ohsaka, Hiromichi; Tambara, Keiichi

2017-01-01

A 64-year-old male fell from an altitude of 10 m while paragliding after stalling due to the wind. The purpose of this case report is to describe the outcomes after multiple injuries sustained during a paragliding accident, including a potentially life-threating injury to the thoracic aorta. The subject sustained a bite wound on his tongue, injuries to his chest (left side) and back, and a right forearm deformity. Enhanced whole body computed tomography (CT) revealed fractures of the bilateral laminae of the second and third cervical bones, right first rib, the tenth thoracic vertebral body (compression type), second lumbar vertebral body (burst type) and the right radius, Other injuries included an injury to the thoracic aortic arch and the presence of intraabdominal fluid collection without perforation of the digestive tract. Endovascular treatment was selected for the aortic injury because of multiple injuries. Immediate management included hypotensive rate control therapy using calcium and a beta blocker. On the fourth hospital day, the subject underwent deployment of a stent-graft to the aorta and subsequent surgical immobilization for the lumbar burst fracture. He also underwent surgical immobilization of the radial fracture and was discharged on the 28th hospital day. First responders or physicians should consider the possibility of aortic injury when treating patients who suffer falls while paragliding and provide appropriate management. Failure to provide appropriate management of an aortic injury could result in death. Level of Evidence 4 PMID:28593092

Multi-channel orbicularis oculi stimulation to restore eye-blink function in facial paralysis.

PubMed

Somia, N N; Zonnevijlle, E D; Stremel, R W; Maldonado, C; Gossman, M D; Barker, J H

2001-01-01

Facial paralysis due to facial nerve injury results in the loss of function of the muscles of the hemiface. The most serious complication in extreme cases is the loss of vision. In this study, we compared the effectiveness of single- and multiple-channel electrical stimulation to restore a complete and cosmetically acceptable eye blink. We established bilateral orbicularis oculi muscle (OOM) paralysis in eight dogs; the OOM of one side was directly stimulated using single-channel electrical stimulation and the opposite side was stimulated using multi-channel electrical stimulation. The changes in the palpebral fissure and complete palpebral closure were measured. The difference in current intensities between the multi-channel and single-channel simulation groups was significant, while only multi-channel stimulation produced complete eyelid closure. The latest electronic stimulation circuitry with high-quality implantable electrodes will make it possible to regulate precisely OOM contractions and thus generate complete and cosmetically acceptable eye-blink motion in patients with facial paralysis. Copyright 2001 Wiley-Liss, Inc.

Electrical injuries due to railway high tension cables.

PubMed

Reichl, M; Kay, S

1985-08-01

We have noted a large number of young boys being admitted to our Unit with burns due to railway high tension cables. On review of these cases we have noted: most of the burns were due to arcing, there is a high level of ignorance among the population at risk. We propose some ways of preventing these injuries.

The Prevalence of Cosmetic Facial Plastic Procedures among Facial Plastic Surgeons.

PubMed

Moayer, Roxana; Sand, Jordan P; Han, Albert; Nabili, Vishad; Keller, Gregory S

2018-04-01

This is the first study to report on the prevalence of cosmetic facial plastic surgery use among facial plastic surgeons. The aim of this study is to determine the frequency with which facial plastic surgeons have cosmetic procedures themselves. A secondary aim is to determine whether trends in usage of cosmetic facial procedures among facial plastic surgeons are similar to that of nonsurgeons. The study design was an anonymous, five-question, Internet survey distributed via email set in a single academic institution. Board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) were included in this study. Self-reported history of cosmetic facial plastic surgery or minimally invasive procedures were recorded. The survey also queried participants for demographic data. A total of 216 members of the AAFPRS responded to the questionnaire. Ninety percent of respondents were male ( n  = 192) and 10.3% were female ( n  = 22). Thirty-three percent of respondents were aged 31 to 40 years ( n  = 70), 25% were aged 41 to 50 years ( n  = 53), 21.4% were aged 51 to 60 years ( n  = 46), and 20.5% were older than 60 years ( n  = 44). Thirty-six percent of respondents had a surgical cosmetic facial procedure and 75% has at least one minimally invasive cosmetic facial procedure. Facial plastic surgeons are frequent users of cosmetic facial plastic surgery. This finding may be due to access, knowledge base, values, or attitudes. By better understanding surgeon attitudes toward facial plastic surgery, we can improve communication with patients and delivery of care. This study is a first step in understanding use of facial plastic procedures among facial plastic surgeons. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effective treatment of permanent tattoos with combustible particles due to blast injuries with a V-shaped device.

PubMed

Kalbermatten, D F; Wettstein, R; Haug, M; du Croo de Jongh, N T; Pierer, G

2006-01-01

Permanent tattooing due to blast injuries is a rare condition. Treatment with various different methods often yields unsatisfactory results. An innovative way to remove permanent traumatic tattoos is presented. A normal curettage blade is simply compressed with a pincer in order to create the new device. This V-shaped blade was used for surgical excision of the particles. No suture material or special dressing was used. Four patients with multiple explosive tattoos on the face were treated with the V-shaped knife. Due to the ease and speed of this method up to 300 particles were removed in one session. Histological analysis of the tissue samples showed deep dermal and subcutaneous particle location. At follow-up transient hypopigmentation but only minimal scarring was seen. Patients suffered less from itching, a chief complaint preoperatively, and aesthetic appearance of the facial skin was improved. In conclusion, treatment of traumatic tattoos with the V-shaped knife is effective, results in minimal scaring and restores the natural colour of the skin because the particle is completely removed. It is a promising method for treating multiple deep skin inclusions.

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives.

PubMed

Aslıer, Mustafa; Aslıer, Nesibe Gül Yüksel

2017-06-01

The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma.

Combinatorial treatments enhance recovery following facial nerve crush.

PubMed

Sharma, Nijee; Moeller, Carl W; Marzo, Sam J; Jones, Kathryn J; Foecking, Eileen M

2010-08-01

To investigate the effects of various combinatorial treatments, consisting of a tapering dose of prednisone (P), a brief period of nerve electrical stimulation (ES), and systemic testosterone propionate (TP) on improving functional recovery following an intratemporal facial nerve crush injury. Prospective, controlled animal study. After a right intratemporal facial nerve crush, adult male Sprague-Dawley rats were divided into the following eight treatment groups: 1) no treatment, 2) P only, 3) ES only, 4) ES + P, 5) TP only, 6) TP + P, 7) ES + TP, and 8) ES + TP + P. For each group n = 4-8. Recovery of the eyeblink reflex and vibrissae orientation and movement were assessed. Changes in peak amplitude and latency of evoked response, in response to facial nerve stimulation, was also recorded weekly. : Brief ES of the proximal nerve stump most effectively accelerated the initiation of functional recovery. Also, ES or TP treatments enhanced recovery of some functional parameters more than P treatment. When administered alone, none of the three treatments improved recovery of complete facial function. Only the combinatorial treatment of ES + TP, regardless of the presence of P, accelerated complete functional recovery and return of normal motor nerve conduction. Our findings suggest that a combinatorial treatment strategy of using brief ES and TP together promises to be an effective therapeutic intervention for promoting regeneration following facial nerve injury. Administration of P neither augments nor hinders recovery.

FGF–2 is required to prevent astrogliosis in the facial nucleus after facial nerve injury and mechanical stimulation of denervated vibrissal muscles

PubMed Central

Hizay, Arzu; Seitz, Mark; Grosheva, Maria; Sinis, Nektarios; Kaya, Yasemin; Bendella, Habib; Sarikcioglu, Levent; Dunlop, Sarah A.; Angelov, Doychin N.

2016-01-01

Abstract Recently, we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking. Using gene knock outs, we found a differential dependence of manual stimulation effects on growth factors. Thus, insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements, whereas FGF-2 is not. The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally, i.e. within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows "synaptic stripping". We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein (GFAP) as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2 (FGF-2-/- mice). There was no difference in GFAP-Cy3-fluorescence (pixel number, gray value range 17–103) between intact wildtype mice (2.12± 0.37×107) and their intact FGF-2-/- counterparts (2.12± 0.27×107) nor after facial-facial anastomosis +handling (wildtype: 4.06± 0.32×107; FGF-2-/-: 4.39±0.17×107). However, after facial-facial anastomosis, GFAP-Cy3-fluorescence remained elevated in FGF-2-/--animals (4.54±0.12×107), whereas manual stimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice (2.63± 0.39×10 ). We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction, but it is required to minimize astrogliosis in the brainstem and, by implication, restore synaptic coverage of recovering facial motoneurons. PMID:28276669

Full-face motorcycle helmet protection from facial impacts: an investigation using THOR dummy impacts and SIMon finite element head model.

PubMed

Whyte, Thomas; Gibson, Tom; Eager, David; Milthorpe, Bruce

2017-06-01

Facial impacts are both common and injurious for helmeted motorcyclists who crash; however, there is no facial impact requirement in major motorcycle helmet standards. This study examined the effect of full-face motorcycle helmet protection on brain injury risk in facial impacts using a test device with biofidelic head and neck motion. A preliminary investigation of energy absorbing foam in the helmet chin bar was carried out. Flat-faced rigid pendulum impacts were performed on a THOR dummy in an unprotected (no helmet) and protected mode (two full-face helmet conditions). The head responses of the dummy were input into the simulated injury monitor finite element head model to analyse the risk of brain injury in these impacts. Full-face helmet protection provides a significant reduction in brain injury risk in facial impacts at increasing impact speeds compared with an unprotected rider (p<0.05). The effect of low-density crushable foam added to the chin bar could not be distinguished from an unpadded chin bar impact. Despite the lack of an impact attenuation requirement for the face, full-face helmets do provide a reduction in head injury risk to the wearer in facial impacts. The specific helmet design factors that influence head injury risk in facial impacts need further investigation if improved protection for helmeted motorcyclists is to be achieved. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Outcomes of Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release

PubMed Central

Jacobson, Joel; Rihani, Jordan; Lin, Karen; Miller, Phillip J.; Roland, J. Thomas

2010-01-01

Lesions of the temporal bone and cerebellopontine angle and their management can result in facial nerve paralysis. When the nerve deficit is not amenable to primary end-to-end repair or interpositional grafting, nerve transposition can be used to accomplish the goals of restoring facial tone, symmetry, and voluntary movement. The most widely used nerve transposition is the hypoglossal-facial nerve anastamosis, of which there are several technical variations. Previously we described a technique of single end-to-side anastamosis using intratemporal facial nerve mobilization and parotid release. This study further characterizes the results of this technique with a larger patient cohort and longer-term follow-up. The design of this study is a retrospective chart review and the setting is an academic tertiary care referral center. Twenty-one patients with facial nerve paralysis from proximal nerve injury at the cerebellopontine angle underwent facial-hypoglossal neurorraphy with parotid release. Outcomes were assessed using the Repaired Facial Nerve Recovery Scale, questionnaires, and patient photographs. Of the 21 patients, 18 were successfully reinnervated to a score of a B or C on the recovery scale, which equates to good oral and ocular sphincter closure with minimal mass movement. The mean duration of paralysis between injury and repair was 12.1 months (range 0 to 36 months) with a mean follow-up of 55 months. There were no cases of hemiglossal atrophy, paralysis, or subjective dysfunction. Direct facial-hypoglossal neurorrhaphy with parotid release achieved a functional reinnervation and good clinical outcome in the majority of patients, with minimal lingual morbidity. This technique is a viable option for facial reanimation and should be strongly considered as a surgical option for the paralyzed face. PMID:22451794

Facial Nerve Trauma: Evaluation and Considerations in Management

PubMed Central

Gordin, Eli; Lee, Thomas S.; Ducic, Yadranko; Arnaoutakis, Demetri

2014-01-01

The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm. PMID:25709748

Management of synkinesis and asymmetry in facial nerve palsy: a review article.

PubMed

Pourmomeny, Abbas Ali; Asadi, Sahar

2014-10-01

The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

Tricuspid valve chordal rupture due to airbag injury and review of pathophysiological mechanisms.

PubMed

Thekkudan, Joyce; Luckraz, Heyman; Ng, Alex; Norell, Mike

2012-09-01

Blunt trauma to the chest is associated with significant morbidity and mortality. The latter is usually due to an aortic transection, whereas the former is related to myocardial contusion, cardiac valve injury, coronary artery disruption and intracardiac shunts due to the formation of septal defects. The main mechanisms causing these injuries are due to the sudden deceleration force and compression within the chest cavity. Moreover, there is also the sudden increase in intravascular pressure due to a mechanical compression effect and a hormonal adrenergic surge during the event. We report a case of a tricuspid valve injury caused by the deployment of the airbag during a high-speed impact car accident and the subsequent damage to the tricuspid valve chordal mechanism. The patient's management and the pathophysiological mechanisms involved in the injury are reviewed.

Analysis of Otologic Injuries Due to Blast Trauma by Handmade Explosives

PubMed Central

Aslıer, Mustafa; Aslıer, Nesibe Gül Yüksel

2017-01-01

Objective The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. Methods Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. Results Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. Conclusion Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma. PMID:29392057

Comparison of facial features of DiGeorge syndrome (DGS) due to deletion 10p13-10pter with DGS due to 22q11 deletion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goodship, J.; Lynch, S.; Brown, J.

1994-09-01

DiGeorge syndrome (DGS) is a congenital anomaly consisting of cardiac defects, aplasia or hypoplasia of the thymus and parathroid glands, and dysmorphic facial features. The majority of DGS cases have a submicroscopic deletion within chromosome 22q11. However there have been a number of reports of DGS in association with other chromosomal abnormalities including four cases with chromosome 10p deletions. We describe a further 10p deletion case and suggest that the facial features in children with DGS due to deletions of 10p are different from those associated with chromosome 22 deletions. The propositus was born at 39 weeks gestation to unrelatedmore » caucasian parents, birth weight 2580g (10th centile) and was noted to be dysmorphic and cyanosed shortly after birth. The main dysmorphic facial features were a broad nasal bridge with very short palpebral fissures. Echocardiography revealed a large subsortic VSD and overriding aorta. She had a low ionised calcium and low parathroid hormone level. T cell subsets and PHA response were normal. Abdominal ultrasound showed duplex kidneys and on further investigation she was found to have reflux and raised plasma creatinine. She had an anteriorly placed anus. Her karyotype was 46,XX,-10,+der(10)t(3;10)(p23;p13)mat. The dysmorphic facial features in this baby are strikingly similar to those noted by Bridgeman and Butler in child with DGS as the result of a 10p deletion and distinct from the face seen in children with DiGeorge syndrome resulting from interstitial chromosome 22 deletions.« less

Facial transplantation: A concise update

PubMed Central

Barrera-Pulido, Fernando; Gomez-Cia, Tomas; Sicilia-Castro, Domingo; Garcia-Perla-Garcia, Alberto; Gacto-Sanchez, Purificacion; Hernandez-Guisado, Jose-Maria; Lagares-Borrego, Araceli; Narros-Gimenez, Rocio; Gonzalez-Padilla, Juan D.

2013-01-01

Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients. Study design: MEDLINE search of articles published on “face transplantation” until March 2012. Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation. Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients. Key words:Face transplantation, composite tissue transplantation, face allograft, facial reconstruction, outcomes and complications of face transplantation. PMID:23229268

Facial nerve paralysis in children

PubMed Central

Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

2015-01-01

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

Facial palsy following trauma to the external ear: 3 case reports.

PubMed

Vögelin, E; Jones, B M

1997-12-01

We report two children and a young adult who developed unilateral facial palsy shortly after injury to the external ear. In two instances the paralysis followed a prominent ear correction and in the other a laceration to the concha. The trauma-triggered facial palsy was most likely idiopathic although the anatomy of the facial nerve near the ear leads one to speculate on a possible pathway of a virally induced palsy (Bell's palsy). Each patient recovered over a period of 6 months.

Facial Nerve Injury and Other Complications Following Retromandibular Subparotid Approach for the Management of Condylar Fractures.

PubMed

Bruneau, Stéphane; Courvoisier, Delphine S; Scolozzi, Paolo

2018-04-01

To estimate the prevalence and identify risk factors for facial nerve paralysis (FNP) and other postoperative complications after the use of the retromandibular subparotid approach (RMSA) for the treatment of condylar fractures. Radiologic and clinical data from all patients who underwent an RMSA from 2007 through 2015 at the University Hospital of Geneva (Geneva, Switzerland) were retrospectively reviewed. The primary and secondary outcome variables were, respectively, FNP and other complications (unesthetic scars, infection, nonunion, malocclusion, salivary fistula, Frey syndrome, and loosening or breaking of plates and screws). Predictor variables included age, gender, mechanism of injury, delay from injury to surgery, surgeon's experience, location of fracture, side and pattern of fracture, concomitant facial fractures, and status of healing. Univariable logistic regression statistics were computed. Forty-eight subcondylar fractures in 43 consecutive patients were treated using the RMSA. Six fracture sites (12.5%) developed a temporary FNP that completely resolved within 4 months. Fractures at the neck level and with the comminution pattern were significant risk factors of postoperative FNP (P = .04 and P < .001, respectively; odds ratio = 82). Eight patients (18.6%) developed a slight transient malocclusion that was completely corrected within 3 to 4 weeks using guiding elastics and 1 patient (2.3%) had a wound dehiscence that resolved with a visible but thin and linear scar. The present study showed that 1) the FNP rate after the RMSA to surgery for condylar fractures was similar to that reported after the transparotid variant; 2) the FNP was transient and completely resolved in all patients; 3) neck and comminuted condylar fractures were statistically associated with increased risk of developing a postoperative temporary FNP; and 4) the final outcome was favorable with no major complications in any of the patients. Copyright © 2017 American

The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan 2003-2011

DTIC Science & Technology

2013-01-01

Original Research— Facial Plastic and Reconstructive Surgery The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan 2003...number and type of facial and penetrat- ing neck trauma injuries sustained in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Study...queried for data from OIF and OEF from January 2003 to May 2011. Information on demographics; type and severity of facial , neck, and associated trauma

Custom-fit polymeric membrane dressing masks in the treatment of second degree facial burns.

PubMed

Weissman, Oren; Hundeshagen, Gabriel; Harats, Moti; Farber, Nimrod; Millet, Eran; Winkler, Eyal; Zilinsky, Isaac; Haik, Josef

2013-09-01

Second degree facial burns usually impart high wound site pain levels and patient discomfort due to the abundance of facial sensory innervation, as well as the development of edema and inflammation that accompany wound healing. Frequent changing of adherent dressings causes additional procedural pain and may prolong healing due to recurring damage to the wound bed. We applied face masks, made on-site from a drug free polymeric membrane dressing, to 8 patients with superficial and deep 2nd degree facial burns. Time to full re-epithlialization was recorded during treatment. Pain, overall comfort, and result satisfaction were evaluated using a questionnaire (10-point Likert scales. From 1=minimum to 10=maximum) on follow-up (mean follow up 14.4 months, range 9-18). These results were compared to a historical cohort of patients with facial burns that were treated with an antibiotic ointment. Results showed mean re-epithelialization time of 6.5 days (as compared to 8.5 days in the cohort group), low pain ratings (mean: 2.6; range: 4.7 in the control group), mixed comfort levels (mean: 4.7/10; 4 in the control group) and high result satisfaction (mean: 7.8; 6.2 in the control group). Nursing staff described pain-free dressing changes and positively noted non-adherence and high absorbance capacity of the polymer, necessitating less dressing changes. Inflammation was contained to the actual site of injury. No complications in terms of infection or allergic reaction were observed. Overall, the polymeric membrane facial dressing seems to be a promising means of reducing pain and ensuring uninterrupted wound healing in 2nd degree facial burns. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Facial nerve mapping and monitoring in lymphatic malformation surgery.

PubMed

Chiara, Jospeh; Kinney, Greg; Slimp, Jefferson; Lee, Gi Soo; Oliaei, Sepehr; Perkins, Jonathan A

2009-10-01

Establish the efficacy of preoperative facial nerve mapping and continuous intraoperative EMG monitoring in protecting the facial nerve during resection of cervicofacial lymphatic malformations. Retrospective study in which patients were clinically followed for at least 6 months postoperatively, and long-term outcome was evaluated. Patient demographics, lesion characteristics (i.e., size, stage, location) were recorded. Operative notes revealed surgical techniques, findings, and complications. Preoperative, short-/long-term postoperative facial nerve function was standardized using the House-Brackmann Classification. Mapping was done prior to incision by percutaneously stimulating the facial nerve and its branches and recording the motor responses. Intraoperative monitoring and mapping were accomplished using a four-channel, free-running EMG. Neurophysiologists continuously monitored EMG responses and blindly analyzed intraoperative findings and final EMG interpretations for abnormalities. Seven patients collectively underwent 8 lymphatic malformation surgeries. Median age was 30 months (2-105 months). Lymphatic malformation diagnosis was recorded in 6/8 surgeries. Facial nerve function was House-Brackmann grade I in 8/8 cases preoperatively. Facial nerve was abnormally elongated in 1/8 cases. EMG monitoring recorded abnormal activity in 4/8 cases--two suggesting facial nerve irritation, and two with possible facial nerve damage. Transient or long-term facial nerve paresis occurred in 1/8 cases (House-Brackmann grade II). Preoperative facial nerve mapping combined with continuous intraoperative EMG and mapping is a successful method of identifying the facial nerve course and protecting it from injury during resection of cervicofacial lymphatic malformations involving the facial nerve.

Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

PubMed

Jaiswal, Rohit; Pu, Lee L Q

2013-04-01

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

Management of Chronic Facial Pain

PubMed Central

Williams, Christopher G.; Dellon, A. Lee; Rosson, Gedge D.

2009-01-01

Pain persisting for at least 6 months is defined as chronic. Chronic facial pain conditions often take on lives of their own deleteriously changing the lives of the sufferer. Although much is known about facial pain, it is clear that those physicians who treat these conditions should continue elucidating the mechanisms and defining successful treatment strategies for these life-changing conditions. This article will review many of the classic causes of chronic facial pain due to the trigeminal nerve and its branches that are amenable to surgical therapies. Testing of facial sensibility is described and its utility introduced. We will also introduce some of the current hypotheses of atypical facial pain and headaches secondary to chronic nerve compressions and will suggest possible treatment strategies. PMID:22110799

Laryngeal fracture due to blunt trauma presenting with pneumothorax and pneumomediastinum.

PubMed

Narcı, Adnan; Embleton, Didem Baskın; Ayçiçek, Abdullah; Yücedağ, Fatih; Cetinkurşun, Salih

2011-01-01

Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis. Copyright © 2011 S. Karger AG, Basel.

Evidence-Based Medicine in Facial Trauma.

PubMed

Dougherty, William M; Christophel, John Jared; Park, Stephen S

2017-11-01

This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors. Copyright © 2017 Elsevier Inc. All rights reserved.

Retrospective study of primary reconstruction of facial traumatic events.

PubMed

Chen, Baoguo; Song, Huifeng; Gao, Quanwen; Xu, Minghuo; Chai, Jiake

2017-02-01

Facial traumatic events are commonly encountered in plastic and reconstructive surgery. Primary reconstruction is a reliable procedure with function and aesthetic considerations. We conduct a retrospective study of the experience of reconstructing facial traumatic defects in the first stage. One hundred and thirty-two cases (aged 18-65) with facial traumatic events were recruited in the study from 2008 to 2014. Facial traumatic events included injured soft tissue, maxillofacial fractures and facial nerve rupture, which were repaired primarily. After primary reconstruction, encouraging functional and aesthetic outcomes were attained. Ten cases were re-operated to reconstruct partial nasal defect. Four patients who had trouble with disabled occluding relations sought help from dentists. Inconspicuous scar and function restoration were presented. Facial wounds should be reconstructed in the first stage as far as possible. Then, satisfactory functional and aesthetic results can be achieved. However, combined injury should be carefully considered in those traumatic cases before we carry out the reconstructive surgery on the face. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Quantitative facial asymmetry: using three-dimensional photogrammetry to measure baseline facial surface symmetry.

PubMed

Taylor, Helena O; Morrison, Clinton S; Linden, Olivia; Phillips, Benjamin; Chang, Johnny; Byrne, Margaret E; Sullivan, Stephen R; Forrest, Christopher R

2014-01-01

subjectively, can be easily and reproducibly measured using three-dimensional photogrammetry. The RMSD for facial asymmetry of healthy volunteers clusters at approximately 0.80 ± 0.24 mm. Patients with facial asymmetry due to a pathologic process can be differentiated from normative facial asymmetry based on their RMSDs.

A System for Studying Facial Nerve Function in Rats through Simultaneous Bilateral Monitoring of Eyelid and Whisker Movements

PubMed Central

Heaton, James T.; Kowaleski, Jeffrey M.; Bermejo, Roberto; Zeigler, H. Philip; Ahlgren, David J.; Hadlock, Tessa A.

2008-01-01

The occurrence of inappropriate co-contraction of facially innervated muscles in humans (synkinesis) is a common sequela of facial nerve injury and recovery. We have developed a system for studying facial nerve function and synkinesis in restrained rats using non-contact opto-electronic techniques that enable simultaneous bilateral monitoring of eyelid and whisker movements. Whisking is monitored in high spatio-temporal resolution using laser micrometers, and eyelid movements are detected using infrared diode and phototransistor pairs that respond to the increased reflection when the eyelids cover the cornea. To validate the system, eight rats were tested with multiple five-minute sessions that included corneal air puffs to elicit blink and scented air flows to elicit robust whisking. Four rats then received unilateral facial nerve section and were tested at weeks 3–6. Whisking and eye blink behavior occurred both spontaneously and under stimulus control, with no detectable difference from published whisking data. Proximal facial nerve section caused an immediate ipsilateral loss of whisking and eye blink response, but some ocular closures emerged due to retractor bulbi muscle function. The independence observed between whisker and eyelid control indicates that this system may provide a powerful tool for identifying abnormal co-activation of facial zones resulting from aberrant axonal regeneration. PMID:18442856

Otologic blast injuries due to the Kenya embassy bombing.

PubMed

Helling, Eric Robert

2004-11-01

Otologic injuries are frequently associated with large blasts. On August 7, 1998, a large truck bomb exploded next to the U.S. Embassy in Nairobi, Kenya. Initial patient findings and care are reviewed. Five months later, an otologic screening and care mission was then sent to comprehensively screen all remaining blast victims on site in Nairobi and to determine degree of persistent injury. Surgical care appropriate for an outpatient environment was provided. Five of 14 tympanic membranes without intervention failed to heal, while 3 of 3 with previous intervention had. Blast injury severity did not correlate to distance from blast epicenter. This may be due to channeling of the blast through the embassy building and an unpredictable pattern of blast overpressure within the building. It is recommended that comprehensive otologic screening be performed after blast events to identify occult injuries and improve outcomes. Early intervention for tympanic membrane perforation (suctioning, eversion of perforations, and paper patch) is recommended.

Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012.

PubMed

Lee, Rachel; Fredrick, Douglas

2015-04-01

To identify epidemiologic trends in nonpowder gun-related pediatric eye injuries and to determine factors associated with severe injury requiring hospital admission. US emergency department data on pediatric eye injuries between 2002 and 2012 were reviewed using the National Electronic Injury Surveillance System. Literature review was conducted to determine trends in visual outcomes after treatment and use of eye protection. In 2012 roughly 3,161 children were treated in US emergency departments for nonpowder gun-related eye injuries. Since 2010 rates of severe nonpowder gun pediatric eye injury have increased by over 500% (P = 0.039). Specifically, while rates of hospital admission due to paintball gun eye injury have dropped precipitously (P = 0.0077), rates of admissions for air gun eye injuries have increased by over 600% since 2010 (P = 0.033). Children sustaining eye injury due to air guns are more likely to be diagnosed and admitted with foreign body or ocular puncture injury. Roughly 28% of documented cases of airsoft or BB gun-related injury had visual acuity worse than 20/50 after initial treatment. Over 98% of injuries occurred without eye protection. Air guns are rising in popularity and now account for the majority of pediatric eye injuries requiring hospital admissions. These eye injuries occur without ocular protection and may lead to permanent eye injury. Increasing regulations for eye protection, sales, and usage of air guns are needed to prevent serious pediatric eye injuries. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

Exposure to Surgery and Anesthesia After Concussion Due to Mild Traumatic Brain Injury.

PubMed

Abcejo, Arnoley S; Savica, Rodolfo; Lanier, William L; Pasternak, Jeffrey J

2017-07-01

To describe the epidemiology of surgical and anesthetic procedures in patients recently diagnosed as having a concussion due to mild traumatic brain injury. Study patients presented to a tertiary care center after a concussion due to mild traumatic brain injury from July 1, 2005, through June 30, 2015, and underwent a surgical procedure and anesthesia support under the direct or indirect care of a physician anesthesiologist. During the study period, 1038 patients met all the study inclusion criteria and subsequently received 1820 anesthetics. In this population of anesthetized patients, rates of diagnosed concussions due to sports injuries, falls, and assaults, but not motor vehicle accidents, increased during 2010-2011. Concussions were diagnosed in 965 patients (93%) within 1 week after injury. In the 552 patients who had surgery within 1 week after concussive injury, 29 (5%) had anesthesia and surgical procedures unrelated to their concussion-producing traumatic injury. The highest use of surgery occurred early after injury and most frequently required general anesthesia. Orthopedic and general surgical procedures accounted for 57% of procedures. Nine patients received 29 anesthetics before a concussion diagnosis, and all of these patients had been involved in motor vehicle accidents and received at least 1 anesthetic within 1 week of injury. Surgical and anesthesia use are common in patients after concussion. Clinicians should have increased awareness for concussion in patients who sustain a trauma and may need to take measures to avoid potentially injury-augmenting cerebral physiology in these patients. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Promising Technique for Facial Nerve Reconstruction in Extended Parotidectomy

PubMed Central

Villarreal, Ithzel Maria; Rodríguez-Valiente, Antonio; Castelló, Jose Ramon; Górriz, Carmen; Montero, Oscar Alvarez; García-Berrocal, Jose Ramon

2015-01-01

Introduction: Malignant tumors of the parotid gland account scarcely for 5% of all head and neck tumors. Most of these neoplasms have a high tendency for recurrence, local infiltration, perineural extension, and metastasis. Although uncommon, these malignant tumors require complex surgical treatment sometimes involving a total parotidectomy including a complete facial nerve resection. Severe functional and aesthetic facial defects are the result of a complete sacrifice or injury to isolated branches becoming an uncomfortable distress for patients and a major challenge for reconstructive surgeons. Case Report: A case of a 54-year-old, systemically healthy male patient with a 4 month complaint of pain and swelling on the right side of the face is presented. The patient reported a rapid increase in the size of the lesion over the past 2 months. Imaging tests and histopathological analysis reported an adenoid cystic carcinoma. A complete parotidectomy was carried out with an intraoperative notice of facial nerve infiltration requiring a second intervention for nerve and defect reconstruction. A free ALT flap with vascularized nerve grafts was the surgical choice. A 6 month follow-up showed partial facial movement recovery and the facial defect mended. Conclusion: It is of critical importance to restore function to patients with facial nerve injury. Vascularized nerve grafts, in many clinical and experimental studies, have shown to result in better nerve regeneration than conventional non-vascularized nerve grafts. Nevertheless, there are factors that may affect the degree, speed and regeneration rate regarding the free fasciocutaneous flap. In complex head and neck defects following a total parotidectomy, the extended free fasciocutaneous ALT (anterior-lateral thigh) flap with a vascularized nerve graft is ideally suited for the reconstruction of the injured site. Donor–site morbidity is low and additional surgical time is minimal compared with the time of a single

Promising Technique for Facial Nerve Reconstruction in Extended Parotidectomy.

PubMed

Villarreal, Ithzel Maria; Rodríguez-Valiente, Antonio; Castelló, Jose Ramon; Górriz, Carmen; Montero, Oscar Alvarez; García-Berrocal, Jose Ramon

2015-11-01

Malignant tumors of the parotid gland account scarcely for 5% of all head and neck tumors. Most of these neoplasms have a high tendency for recurrence, local infiltration, perineural extension, and metastasis. Although uncommon, these malignant tumors require complex surgical treatment sometimes involving a total parotidectomy including a complete facial nerve resection. Severe functional and aesthetic facial defects are the result of a complete sacrifice or injury to isolated branches becoming an uncomfortable distress for patients and a major challenge for reconstructive surgeons. A case of a 54-year-old, systemically healthy male patient with a 4 month complaint of pain and swelling on the right side of the face is presented. The patient reported a rapid increase in the size of the lesion over the past 2 months. Imaging tests and histopathological analysis reported an adenoid cystic carcinoma. A complete parotidectomy was carried out with an intraoperative notice of facial nerve infiltration requiring a second intervention for nerve and defect reconstruction. A free ALT flap with vascularized nerve grafts was the surgical choice. A 6 month follow-up showed partial facial movement recovery and the facial defect mended. It is of critical importance to restore function to patients with facial nerve injury. Vascularized nerve grafts, in many clinical and experimental studies, have shown to result in better nerve regeneration than conventional non-vascularized nerve grafts. Nevertheless, there are factors that may affect the degree, speed and regeneration rate regarding the free fasciocutaneous flap. In complex head and neck defects following a total parotidectomy, the extended free fasciocutaneous ALT (anterior-lateral thigh) flap with a vascularized nerve graft is ideally suited for the reconstruction of the injured site. Donor-site morbidity is low and additional surgical time is minimal compared with the time of a single ALT flap transfer.

Enhancing facial features by using clear facial features

NASA Astrophysics Data System (ADS)

Rofoo, Fanar Fareed Hanna

2017-09-01

The similarity of features between individuals of same ethnicity motivated the idea of this project. The idea of this project is to extract features of clear facial image and impose them on blurred facial image of same ethnic origin as an approach to enhance a blurred facial image. A database of clear images containing 30 individuals equally divided to five different ethnicities which were Arab, African, Chines, European and Indian. Software was built to perform pre-processing on images in order to align the features of clear and blurred images. And the idea was to extract features of clear facial image or template built from clear facial images using wavelet transformation to impose them on blurred image by using reverse wavelet. The results of this approach did not come well as all the features did not align together as in most cases the eyes were aligned but the nose or mouth were not aligned. Then we decided in the next approach to deal with features separately but in the result in some cases a blocky effect was present on features due to not having close matching features. In general the available small database did not help to achieve the goal results, because of the number of available individuals. The color information and features similarity could be more investigated to achieve better results by having larger database as well as improving the process of enhancement by the availability of closer matches in each ethnicity.

Maxillofacial injuries in the workplace.

PubMed

Burnham, Richard; Martin, Tim

2013-04-01

Over a 2-year period we reviewed patients who presented to a UK maxillofacial unit with facial injuries sustained at work. We looked at links between the mechanism, injury, and characteristics of such injuries. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Rigid fixation of facial fractures in children.

PubMed

Koltai, P J; Rabkin, D; Hoehn, J

1995-01-01

This article presents a retrospective analysis of a selective use of rigid fixation among 62 children with facial fractures, treated at a Level I trauma center over a 5-year period (1986-1991). There were 21 mandible fractures, 11 orbital fractures, 11 zygomaticomalar complex fractures, 7 nasal fractures, 5 maxillary fractures, 3 pan-facial fractures, 2 nasal-orbital-ethmoidal complex fractures, and 2 frontal sinus fractures. Only 18 children had rigid fixation of their injuries. Complications of Le Fort upper facial fractures repaired with rigid fixation involved perioperative sinusitis; one case required oral antibiotics, the other ethmoidectomy and maxillary antrostomy. One child with a Le Fort fracture had delayed exposure of a zygomaticomalar buttress plate, which required surgical removal. Permanent enophthalmos occurred in two children with Le Fort fractures. The authors conclude that traditional conservative management is appropriate in most cases. However, in children aged 13 and older with mandible fractures and children with complex mid- and upper facial fractures, a judicious use of rigid fixation has advantages over the traditional techniques.

Lumbopelvic control and days missed due to injury in professional baseball pitchers

PubMed Central

Chaudhari, Ajit M.W.; McKenzie, Christopher S.; Pan, Xueliang; Oñate, James A.

2014-01-01

Background Recently lumbopelvic control has been linked to pitching performance, kinematics and loading; however, poor lumbopelvic control has not been prospectively investigated as a risk factor for injury in baseball pitchers. Hypothesis Pitchers with poor lumbopelvic control during spring training are more likely to miss 30 or more days due to injury through an entire baseball season than pitchers with good lumbopelvic control. Study design Cohort study. Methods Three hundred forty-seven professional baseball pitchers were enrolled into the study during the last 2 weeks of spring training and stayed with the same team for the entire season. Lumbopelvic control was quantified by peak anterior-posterior deviation of the pelvis relative to starting position during a single leg raise test (APScore). Days missed due to injury through the entire season were recorded by each team's medical staff. Results Higher APScore was significantly associated with a higher likelihood of missing 30 days or more (Chi-Square, p=0.023). When divided into tertiles based on their APScore, participants in the highest tertile were 3.0 times and 2.2 times more likely to miss at least 30 days throughout the course of a baseball season relative to those in the lowest or middle tertiles, respectively. Higher APScore was also significantly associated with missing more days due to injury within participants who missed at least one day to injury (ANOVA, p=0.018), with the highest tertile missing significantly more days (mean=98.6 d) than the middle tertile (mean=45.8d, p=0.017) or the lowest tertile (mean=43.8, p=0.017). Conclusion This study found that poor lumbopelvic control in professional pitchers was associated with increased risk of missing significant time due to injury. PMID:25159541

Health-related quality of life two years after injury due to terrorism.

PubMed

Tuchner, Maya; Meiner, Zeev; Parush, Shula; Hartman-Maeir, Adina

2010-01-01

During the past few decades, terrorist acts have been an unfortunate reality worldwide. There is a striking paucity of research investigating the multitude of long-term outcomes after severe physical injury due to terrorist attacks, a unique subgroup of trauma patients. The purpose of this study was to provide a profile of the long-term health-related quality of life (HR-QOL) after injury due to terrorist attacks and to explore the relationships between Post Traumatic Stress Disorder (PTSD), occupational status and injury severity with HR-QOL. We included 35 survivors of terrorist attacks living in the community, two years on average after the injury, mean age at follow-up = 32.1 (±13.8), mean Injury Severity Score (ISS) = 27 (±14.2). The subjects were recruited from consecutive admissions to a rehabilitation department in a tertiary care center between September 2000 - June 2004. Most of the subjects suffered multiple trauma. The main outcome measures were the Short-Form Health Survey (SF-36), Post Traumatic Diagnostic Scale and return to work rates. The mean scores on 6/8 of the SF-36 subscales were significantly lower among the survivors compared to normative population norms. Post Traumatic Stress Disorder (PTSD) was found in 39% of the sample and 43% did not resume their main occupation two years after the injury. Multivariate analysis of variance of PTSD and occupational status (returned vs. did not return to work) on quality of life scores revealed significant main effects for both PTSD (p=. 000) and occupational status (p=. 005) with no interaction effect (p=. 476). No significant correlations were found between injury severity and the SF-36 scores. This study demonstrated the long-term impact of injury due to terrorism. Results showed independent effects of PTSD and occupational status on health related quality of life, two years after injury. These findings suggest that this group may benefit from intervention focusing on their emotional and

[Facial paralysis in children].

PubMed

Muler, H; Paquelin, F; Cotin, G; Luboinski, B; Henin, J M

1975-01-01

Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.

Crash and Burn: Ocular Injuries due to Fireworks.

PubMed

Patel, Ravija; Mukherjee, Bipasha

2016-01-01

To identify the patterns of ocular injury and to determine ocular morbidity resulting from the use of firecrackers. A prospective observational study of all patients presenting with ocular trauma consequent to fireworks usage in a tertiary eye care center in South India over a one-month period around the autumn festival of Diwali. We also reviewed the published literature from around the world reporting ocular injuries due to firecrackers. 49 patients were included in the study, out of which the vast majority (40/81%) were males. The mean age was 17 years. Almost an equal number of bystanders (24/48.9%) was affected as compared to people handling the fireworks (25/51%). 13 (26.53%) patients had open-globe injury whereas 33 (67.34%) patients had closed-globe injury. Twenty-two (44.8%) patients underwent surgical intervention. Eighteen (36.7%) patients had final vision less then 20/40 (range = 20/50 to No Perception of Light) with eight patients having no perception of light in the affected eye. Unregulated use of firecrackers can lead to significant ocular morbidity, mainly involving children, young males, and even innocent bystanders. A combination of public awareness and appropriate legislative laws should be formulated regarding the use of fireworks to decrease the load of needless blindness on society.

Epidemiologic study of deaths and injuries due to tornadoes.

PubMed

Carter, A O; Millson, M E; Allen, D E

1989-12-01

A case-control study, using both matched and unmatched controls, was carried out on individuals who were injured or killed by a series of tornadoes that passed through Ontario, Canada, on May 31, 1985. Many serious injuries (25%) and almost all (83%) deaths were the result of becoming airborne, while most minor injuries (94%) were due to being struck by objects. Head injury was the most common injury type. Few (21%) of those in buildings chose the recommended location, and most (61%) were not in the least damaged part. Most (91%) had less than one minute's warning, and only 47% had a functioning radio at the time the tornado hit. The following risk factors for injury and death were identified: poor building anchorage; location other than in a basement, especially outdoors; age over 70 years; and high wind strength. These findings support previous findings and point to measures which have potential for preventing death or serious injury in future tornadoes: adequate warning systems and public education to ensure that individuals understand the warning and respond by seeking appropriate shelter. Those in adequately anchored buildings should shelter in an interior room or basement. Those who are outdoors, in poorly anchored buildings, mobile homes, or portable classrooms require access to an adequately anchored building, preferably with a basement, during severe storm warnings. This should be arranged by local authorities.

Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury.

PubMed

Lee, Hyung-Joo; Kim, Youn-Jung; Seo, Dong-Woo; Sohn, Chang Hwan; Ryoo, Seung Mok; Ahn, Shin; Lee, Yoon-Seon; Kim, Won Young; Lim, Kyoung Soo

2018-05-01

The detection of intracranial injury in patients with facial injury rather than traumatic brain injury (TBI) remains a challenge for emergency physicians. This study aimed to evaluate the incidence and risk factors of intracranial injury in patients with orbital wall fracture (OWF), who were classified with a chief complaint of facial injury rather than TBI. This retrospective case-control study enrolled adult OWF patients (age ≥18 years) who presented at the hospital between January 2004 and March 2016. Patients with definite TBI were excluded because non-contrast head computed tomography (CT) is recommended for such patients. A total of 1220 patients with OWF were finally enrolled. CT of the head was performed on 677 patients, and the incidence of concomitant intracranial injury was found to be 9% (62/677). Patients with definite TBI were excluded. Symptoms raising a suspicion of TBI, such as loss of consciousness, alcohol intoxication, or vomiting, were present in 347 of the patients, with 44 of these patients (13%) showing a concomitant intracranial injury. Of the 330 patients without such symptoms, 18 (6%) demonstrated a concomitant intracranial injury. In OWF patients, superior wall fracture (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.06-8.34; P < 0.001), associated frontal bone fracture (OR, 4.38; 95% CI, 2.08-9.23; P < 0.001), and older age (decades) (OR, 1.03; 95% CI, 1.01-1.04; P = 0.002) were independent risk factors for concomitant intracranial injury. Emergency physicians should maintain a high degree of suspicion of TBI, even when their primary concern is facial trauma with OWF. Head CT is recommended for OWF patients with a superior OWF, frontal bone fracture, or increased age. Copyright © 2018 Elsevier Ltd. All rights reserved.

Computerized tomography assessment of cranial and mid-facial fractures in patients following road traffic accident in South-West Nigeria.

PubMed

Abiodun, Adeyinka; Atinuke, Agunloye; Yvonne, Osuagwu

2012-01-01

Globally, the most common cause of cranio-facial fractures is road traffic accident (RTA) with computerized tomography (CT) scan as the gold standard in the diagnosis of patients with cranial and facial fractures. The purpose of this study is to assess the pattern of cranial and facial fractures on CT in head injured patients following RTA. Using CT, detailed analyses of 236 patients with head injury following RTA were performed between 2006 and 2008, Data recorded included cause of injury, age and gender distribution, cranial and mid-facial fractures sustained, associated intracranial and soft tissue injury and the types of vehicular accident. The peak age of the patients was between 30 and 39 years. RTA was more common in males than females. Motor-vehicle was the most common cause of RTA in the present study (66.9%). More passengers were involved in the motor vehicle (87.3%) and motorcycle (52.0%) accidents than their corresponding drivers, and they were predominantly males. Majority of the patients involved in pedestrian road traffic accident (PRTA) were motor vehicle victims (93.3%). There were more patients with cranial (59.8%) than mid-facial fractures (40.2%). Majority of the patients had temporal bone cranial fracture (31.1%) and combined or mixed type of mid-facial fractures (41.3%). Intracranial bleeding (31.7%) was the most common associated intracranial finding. RTAs continue to be a menace and are the main cause of craniofacial injury in Nigeria. This pattern of etiologic factors is in accordance with data from most developing countries. Special attention should be paid to reinforcement of legislation and enactment of laws aimed at the reduction of head injury and provision for easy access to CT for the head injured patient.

The Axillary Approach to Raising the Latissimus Dorsi Free Flap for Facial Re-Animation: A Descriptive Surgical Technique

PubMed Central

Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time. PMID:25606493

The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

PubMed

Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

Facial mimicry in its social setting

PubMed Central

Seibt, Beate; Mühlberger, Andreas; Likowski, Katja U.; Weyers, Peter

2015-01-01

In interpersonal encounters, individuals often exhibit changes in their own facial expressions in response to emotional expressions of another person. Such changes are often called facial mimicry. While this tendency first appeared to be an automatic tendency of the perceiver to show the same emotional expression as the sender, evidence is now accumulating that situation, person, and relationship jointly determine whether and for which emotions such congruent facial behavior is shown. We review the evidence regarding the moderating influence of such factors on facial mimicry with a focus on understanding the meaning of facial responses to emotional expressions in a particular constellation. From this, we derive recommendations for a research agenda with a stronger focus on the most common forms of encounters, actual interactions with known others, and on assessing potential mediators of facial mimicry. We conclude that facial mimicry is modulated by many factors: attention deployment and sensitivity, detection of valence, emotional feelings, and social motivations. We posit that these are the more proximal causes of changes in facial mimicry due to changes in its social setting. PMID:26321970

Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

PubMed Central

Choi, Kyung-Sik; Kim, Min-Su; Kwon, Hyeok-Gyu; Jang, Sung-Ho

2014-01-01

Objective Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. Results Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. Conclusion This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation. PMID:25289119

Intracardiac Penetrating Injury with Right Femoral Artery Embolism due to Blast Injury

PubMed Central

Abuzaid, Ahmed Abdulaziz; Al-Abbasi, Thamer; Arekat, Zaid

2016-01-01

Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy. PMID:28400939

Intracardiac Penetrating Injury with Right Femoral Artery Embolism due to Blast Injury.

PubMed

Abuzaid, Ahmed Abdulaziz; Al-Abbasi, Thamer; Arekat, Zaid

2016-01-01

Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy.

Injuries to Cyclists due to a Dog-Bicycle Interaction.

PubMed

Loder, Randall T; Yaacoub, Alan P

2018-05-01

 Both dogs and bicycles are common in our society and thus a dog-bicycle interaction resulting in an injury to a cyclist is possible. It was the purpose of this study to investigate such injuries.  The National Electronic Injury Surveillance System (NEISS) data for the 10-year period from 2006 through 2015 associated with bicycles were accessed. Injuries involving dogs were identified and the mechanism of injury determined. Due to the stratified and weighted nature of the NEISS data, statistical analyses were performed with SUDAAN 10 software (RTI International, Research Triangle Park, North Carolina, United States). A p  < 0.05 was considered statistically significant.  There were 5,184,057 emergency department visits for bicycle-associated injuries; dogs were involved in 35,254 (0.67%) cases. The average age for those involved with a dog was 33.2 years and it was 25.5 years for those in which dogs were not involved. There were more females in the dog group (34.1 vs. 27.6%). Dog involvement increased from ages 0 to 14 years, then decreased until the age of 20 years and then progressively increased. Dog-associated injuries most frequently occurred away from home, involved the knee and distal lower extremity, 49.1% sustaining dog bites. Dog bites were more common in younger individuals. Four injury mechanisms (chased by a dog, hit/collided with a dog, swerved/tried to avoid a dog or riding with a dog) accounted for 97.5% of the injuries. Those chased by a dog were younger, more commonly released from the emergency department, had an injury involving the lower extremity and frequently sustained a bite. The most severe injuries were in those who swerved/tried to avoid a dog or hit a dog.  Approximately 1% of injuries to bicyclists are associated with dogs; one-half sustained a bite. Potential/proposed prevention strategies could be educational materials regarding bicycles and dogs to owners, dog restraint, student/parent education and educational materials

Middle ear osteoma causing progressive facial nerve weakness: a case report.

PubMed

Curtis, Kate; Bance, Manohar; Carter, Michael; Hong, Paul

2014-09-18

Facial nerve weakness is most commonly due to Bell's palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction. We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery of facial nerve function. Facial nerve dysfunction is rarely caused by middle ear tumors. The weakness is typically due to a compressive effect on the middle ear portion of the facial nerve. Early recognition is crucial since removal of these lesions may lead to the recuperation of facial nerve function.

Assessing the Risk of Crew Injury Due to Dynamic Loads During Spaceflight

NASA Technical Reports Server (NTRS)

Somers, J. T.; Gernhardt, M.; Newby, N.

2014-01-01

Spaceflight requires tremendous amounts of energy to achieve Earth orbit and to attain escape velocity for interplanetary missions. Although the majority of the energy is managed in such a way as to limit the accelerations on the crew, several mission phases may result in crew exposure to dynamic loads. In the automotive industry, risk of serious injury can be tolerated because the probability of a crash is remote each time a person enters a vehicle, resulting in a low total risk of injury. For spaceflight, the level of acceptable injury risk must be lower to achieve a low total risk of injury because the dynamic loads are expected on each flight. To mitigate the risk of injury due to dynamic loads, the NASA Human Research Program has developed a research plan to inform the knowledge gaps and develop relevant tools for assessing injury risk. The risk of injury due to dynamic loads can be further subdivided into extrinsic and intrinsic risk factors. Extrinsic risk factors include the vehicle dynamic profile, seat and restraint design, and spacesuit design. Human tolerance to loads varies considerably depending on the direction, amplitude, and rise-time of acceleration therefore the orientation of the body to the dynamic vector is critical to determining crew risk of injury. Although a particular vehicle dynamic profile may be safe for a particular design, the seat, restraint, and suit designs can affect the risk of injury due to localized effects. In addition, characteristics intrinsic to the crewmember may also contribute to the risk of injury, such as crewmember sex, age, anthropometry, and deconditioning due to spaceflight, and each astronaut may have a different risk profile because of these factors. The purpose of the research plan is to address any knowledge gaps in the risk factors to mitigate injury risk. Methods for assessing injury risk have been well documented in other analogous industries and include human volunteer testing, human exposure to dynamic

[Recognition of facial emotions and theory of mind in schizophrenia: could the theory of mind deficit be due to the non-recognition of facial emotions?].

PubMed

Besche-Richard, C; Bourrin-Tisseron, A; Olivier, M; Cuervo-Lombard, C-V; Limosin, F

2012-06-01

The deficits of recognition of facial emotions and attribution of mental states are now well-documented in schizophrenic patients. However, we don't clearly know about the link between these two complex cognitive functions, especially in schizophrenia. In this study, we attempted to test the link between the recognition of facial emotions and the capacities of mentalization, notably the attribution of beliefs, in health and schizophrenic participants. We supposed that the level of performance of recognition of facial emotions, compared to the working memory and executive functioning, was the best predictor of the capacities to attribute a belief. Twenty schizophrenic participants according to DSM-IVTR (mean age: 35.9 years, S.D. 9.07; mean education level: 11.15 years, S.D. 2.58) clinically stabilized, receiving neuroleptic or antipsychotic medication participated in the study. They were matched on age (mean age: 36.3 years, S.D. 10.9) and educational level (mean educational level: 12.10, S.D. 2.25) with 30 matched healthy participants. All the participants were evaluated with a pool of tasks testing the recognition of facial emotions (the faces of Baron-Cohen), the attribution of beliefs (two stories of first order and two stories of second order), the working memory (the digit span of the WAIS-III and the Corsi test) and the executive functioning (Trail Making Test A et B, Wisconsin Card Sorting Test brief version). Comparing schizophrenic and healthy participants, our results confirmed a difference between the performances of the recognition of facial emotions and those of the attribution of beliefs. The result of the simple linear regression showed that the recognition of facial emotions, compared to the performances of working memory and executive functioning, was the best predictor of the performances in the theory of mind stories. Our results confirmed, in a sample of schizophrenic patients, the deficits in the recognition of facial emotions and in the

Electrical injuries due to theft of copper.

PubMed

Curinga, Giuseppe; Pietramaggiori, Giorgio; Scherer, Sandra Saja; Masellis, Alessandro; Gherardini, Giulio; Brancato, Renato; Conte, Francesco; Bistoni, Giovanni

2010-01-01

This study shows that the theft of copper, mainly from electrical wires, is becoming a more frequent crime as the value of this metal rises. We have collected all the data from the Burn Centre of the Hospital of Palermo, Italy, from 1992 to 2007. Over the last two decades, we assisted to a dramatic increase of patients admitted to our hospital, reporting burn injuries while attempting to steal it in dangerous conditions. The circumstances of the injury, the clinical management of the case, and the long-term consequences are presented and discussed. We found that the electrical burn related to the theft of copper is often a life-threatening event because of the high-voltage electrical current passing through the patients. Patients, due to the type of activity, often requiring physical effort, were generally young and healthy. From a review of the literature on the subject, we have noticed that theft of copper is not reported as an important risk factor for electrical burns. Our report clearly shows that theft of copper-related electrical injury is becoming more frequent in the community and should be added as a "new" risk factor. The already high incidence reported here may actually be lower than the actual incidence because many patients tend not to come to the hospital because of the risk of being prosecuted by the police.

Diagnosis of unsuspected facial fractures on routine head computerized tomographic scans in the unconscious multiply injured patient.

PubMed

Rehm, C G; Ross, S E

1995-05-01

This article assessed the value of routine head computerized axial tomographic (CT) scans for diagnosis of unsuspected facial fractures and its clinical implications in the multiply injured patient who is intubated, unconscious, or sedated at the time of initial assessment and requires a head CT scan to assess for brain injury. At a level I trauma center from June 1, 1992 to June 1, 1993 all intubated blunt trauma patients who required routine CT scan evaluation at initial assessment were studied prospectively. Routine scanning started at the foramen magnum and included the maxilla. Patients who died within the first 24 hours were excluded. The study population included 116 patients (85 male, 21 female) aged 12 to 85 years (mean, 28 years) with injury severity scores ranging from 1 to 50 (mean, 23). The mechanism of injury was: motor vehicle accidents (n = 74), motorcycling (n = 5), pedestrians accidents (n = 13), falls (n = 10), bicycling (n = 5), assaults (n = 8), and boating accident (n = 1). There were 19 suspected facial fractures; 18 required surgical repair. There were 27 unsuspected facial fractures; 13 required surgical care. Three suspected fractures were ruled out. Routine head CT scans to assess for brain injury in the multiply injured patient are also very useful in the diagnosis of unsuspected facial fractures, almost half of which will require surgical intervention.

Workdays lost due to occupational injuries among young workers in Brazil.

PubMed

Santana, Vilma S; Villaveces, Andrés; Bangdiwala, Shrikant I; Runyan, Carol W; Albuquerque-Oliveira, Paulo Rogério

2012-10-01

The severity of non-fatal work-related injuries has seldom been examined among young workers. We estimated the extent and distribution of workdays lost due to non-fatal work injuries using compensation data. Data are from the Brazilian Institute of Social Insurance, for 2006. The study population is comprised of all insured workers of age 16-24. Descriptive statistics reflect workdays lost due to health-related disability, according to sex, age group, wage, and trade. Out of 4.8 million insured workers ages 16-24 years, we estimated 1,282,940 workdays lost. We observed a larger number of median workdays lost among males age 20-24 in retail and service trades (83 days) and among 16-19-year-old females in the agriculture/fish/forestry/cattle (142 days). Young workers experience a heavy burden of work-related injuries. Disability workdays may compromise school attendance and performance. Other potential impacts affect productivity and social insurance costs. Copyright © 2012 Wiley Periodicals, Inc.

Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety.

PubMed

Lambert, Peggy; Chaisson, Kristine; Horton, Susan; Petrin, Carmen; Marshall, Emily; Bowden, Sue; Scott, Lynn; Conley, Sheila; Stender, Janette; Kent, Gertrude; Hopkins, Ellen; Smith, Brian; Nicholson, Anita; Roy, Nancy; Homsted, Brenda; Downs, Cindy; Ross, Cathy S; Brown, Jeremiah

2017-02-01

Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m 2 . Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material. ©2017 American Association of Critical-Care Nurses.

Clinical characteristics of patients with facial psoriasis in Malaysia.

PubMed

Syed Nong Chek, Sharifah Rosniza; Robinson, Suganthy; Mohd Affandi, Azura; Baharum, Nurakmal

2016-10-01

Psoriasis involving the face is visible and can cause considerable emotional distress to patients. Its presence may also confer a poorer prognosis for the patient. This study sought to evaluate the characteristics of facial psoriasis in Malaysia. A cross-sectional study conducted using data from the Malaysian Psoriasis Registry from 2007 to 2011. Specific risk factors, i.e., age, age of onset, gender, duration of disease, obesity group, body surface area, Dermatology Life Quality Index (DLQI), family history of psoriasis, nail involvement, psoriatic arthritis, phototherapy, systemic therapy, clinic visit, days of work/school, and hospital admission due to psoriasis in the last 6 months were analyzed. A total of 48.4% of patients had facial psoriasis. Variables significantly associated with facial psoriasis are younger age, younger age of onset of psoriasis of ≤ 40 years, male, severity of psoriasis involving >10% of the body surface area, higher DLQI of >10, nail involvement, and history of hospitalization due to psoriasis. This study found that facial psoriasis is not as rare as previously thought. Ambient ultraviolet light, sebum, and contact with chemicals from facial products may reduce the severity of facial psoriasis, but these factors do not reduce the prevalence of facial psoriasis. The association with younger age, younger age of onset, higher percentage of body surface area involvement, higher DLQI of > 10, nail involvement, and hospitalization due to psoriasis support the notion that facial psoriasis is a marker of severe disease. © 2016 The International Society of Dermatology.

[Risk of injury in and adolescent and junior competitive karate].

PubMed

Müller-Rath, R; Miltner, O; Mamarvar, M; Mumme, T

2005-12-01

Increasing professionalism in competitive karate has led to a specific injury pattern. The aim of our study was to investigate the injury pattern in junior competitive karate and to evaluate the prophylactic effect of fist padding. During the 4 (th) Junior World Championships of the World Karate Confederation (WKC) 2004 235 karate fights were observed and injury-related data were recorded. Fist padding was used in 183 fights, 52 fights were carried out without. In 22 % of all fights we saw an injury. Most of them were mild injuries of the head and face: 32 bruises of the face (13 with epistaxis), 7 facial lacerations and 3 concussions (mild brain injury). 14 fights were stopped due to an injury. Only in the category male 18 - 20 years a higher rate of injuries was seen without fist padding (shobu ippon) compared to shobu sanbon (with fist padding). The injury pattern of junior competitive karate is comparable to senior karate. Fist padding does not generally reduce the incidence or severity of injuries.

Facial-affect recognition deficit as a predictor of different aspects of social-communication impairment in traumatic brain injury.

PubMed

Rigon, Arianna; Turkstra, Lyn S; Mutlu, Bilge; Duff, Melissa C

2018-05-01

To examine the relationship between facial-affect recognition and different aspects of self- and proxy-reported social-communication impairment following moderate-severe traumatic brain injury (TBI). Forty-six adults with chronic TBI (>6 months postinjury) and 42 healthy comparison (HC) adults were administered the La Trobe Communication Questionnaire (LCQ) Self and Other forms to assess different aspects of communication competence and the Emotion Recognition Test (ERT) to measure their ability to recognize facial affects. Individuals with TBI underperformed HC adults in the ERT and self-reported, as well as were reported by close others, as having more communication problems than did HC adults. TBI group ERT scores were significantly and negatively correlated with LCQ-Other (but not LCQ-Self) scores (i.e., participants with lower emotion-recognition scores were rated by close others as having more communication problems). Multivariate regression analysis revealed that adults with higher ERT scores self-reported more problems with disinhibition-impulsivity and partner sensitivity and had fewer other-reported problems with disinhibition-impulsivity and conversational effectiveness. Our findings support growing evidence that emotion-recognition deficits play a role in specific aspects of social-communication outcomes after TBI and should be considered in treatment planning. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture.

PubMed

Bai, Rong-Jie; Zhang, Hui-Bo; Zhan, Hui-Li; Qian, Zhan-Hua; Wang, Nai-Li; Liu, Yue; Li, Wen-Ting; Yin, Yu-Ming

2018-05-05

Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities. Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed. The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons. Sports

Comparison of Facial Nerve Paralysis in Adults and Children

PubMed Central

Cha, Chang Il; Hong, Chang Kee; Park, Moon Suh

2008-01-01

Purpose Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. Materials and Methods We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. Results The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. Conclusion These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different. PMID:18972592

IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery.

PubMed

Akulov, Mihail A; Orlova, Ol'ga R; Orlova, Aleksandra S; Usachev, Dmitrij J; Shimansky, Vadim N; Tanjashin, Sergey V; Khatkova, Svetlana E; Yunosha-Shanyavskaya, Anna V

2017-10-15

This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

An Ecological Approach to the Prevention of Injuries Due to Drinking and Driving.

ERIC Educational Resources Information Center

Simons-Morton, Bruce G.; And Others

1989-01-01

Taking an ecological perspective of individuals within their social and physical environments, a diagnostic framework is employed in reviewing the literature on factors associated with drinking and driving injuries and on interventions to prevent injuries due to drinking and driving. (JOW)

Does physical fitness affect injury occurrence and time loss due to injury in elite vocational ballet students?

PubMed

Twitchett, Emily; Brodrick, Anna; Nevill, Alan M; Koutedakis, Yiannis; Angioi, Manuela; Wyon, Matthew

2010-01-01

Most ballet dancers will suffer at least one injury a year. There are numerous causes of injury in dance, and while many investigators have documented risk factors such as anatomical characteristics, past medical history, menstrual history, dance experience, length of dance training, fatigue, and stress, risk factors related to body characteristics and nutrient intake, levels of conditioning, or physical fitness parameters have only recently received the same amount of attention. The aim of the present study was, therefore, to investigate correlations between ballet injury and body fat percentage, active and passive flexibility, lower limb power, upper body and core endurance, and aerobic capacity. Low levels of aerobic fitness were significantly associated with many of the injuries sustained over a 15-week period (r=.590, p=0.034), and body fat percentage was significantly associated with the length of time a dancer was forced to modify activity due to injury (r=-.614, p=0.026). This information may be of benefit to dancers, teachers, physical therapists and physicians in dance schools and companies when formulating strategies to prevent injury.

Facial Scar Revision: Understanding Facial Scar Treatment

MedlinePlus

... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving ...

An Assessment of How Facial Mimicry Can Change Facial Morphology: Implications for Identification.

PubMed

Gibelli, Daniele; De Angelis, Danilo; Poppa, Pasquale; Sforza, Chiarella; Cattaneo, Cristina

2017-03-01

The assessment of facial mimicry is important in forensic anthropology; in addition, the application of modern 3D image acquisition systems may help for the analysis of facial surfaces. This study aimed at exposing a novel method for comparing 3D profiles in different facial expressions. Ten male adults, aged between 30 and 40 years, underwent acquisitions by stereophotogrammetry (VECTRA-3D ® ) with different expressions (neutral, happy, sad, angry, surprised). The acquisition of each individual was then superimposed on the neutral one according to nine landmarks, and the root mean square (RMS) value between the two expressions was calculated. The highest difference in comparison with the neutral standard was shown by the happy expression (RMS 4.11 mm), followed by the surprised (RMS 2.74 mm), sad (RMS 1.3 mm), and angry ones (RMS 1.21 mm). This pilot study shows that the 3D-3D superimposition may provide reliable results concerning facial alteration due to mimicry. © 2016 American Academy of Forensic Sciences.

Maxillofacial Injuries in Children: A 10 year Retrospective Study.

PubMed

Kambalimath, H V; Agarwal, S M; Kambalimath, Deepashri H; Singh, Mamta; Jain, Neha; Michael, P

2013-06-01

Fractures of facial bones in children are relatively uncommon although both children and adults are subjected to similar types of injuries. This study aims to evaluate the epidemiology of facial bone fractures among children under 14 years, their management and outcome. This retrospective study included maxillofacial injuries treated in 112 children under 14 years admitted due to maxillofacial injuries during the period from 2001 to 2011. Of them ten (8.93 %) were below 5 years, 44 (39.29 %) between 6 and 10 years and 58 (51.78 %) between 11 and 14 years of age. Male to female ratio was 1.8:1. Fall from a height was the most common etiology. The most common jaw involved in the fracture was the mandible. Conservative management was done in 83.04 % of cases and open reduction and internal fixation was performed in 16.96 % of cases. Five (4.46 %) cases accounted for post-operative wound infection. Fracture of the mandible is the most common maxillofacial injury in children, most often caused by fall from a height. The osteogenic potential of the mandible in children leads to conservative management of these fractures. Opportunities for prevention of maxillofacial trauma should be taken into consideration by parents and care takers.

Factors contributing to the adaptation aftereffects of facial expression.

PubMed

Butler, Andrea; Oruc, Ipek; Fox, Christopher J; Barton, Jason J S

2008-01-29

Previous studies have demonstrated the existence of adaptation aftereffects for facial expressions. Here we investigated which aspects of facial stimuli contribute to these aftereffects. In Experiment 1, we examined the role of local adaptation to image elements such as curvature, shape and orientation, independent of expression, by using hybrid faces constructed from either the same or opposing expressions. While hybrid faces made with consistent expressions generated aftereffects as large as those with normal faces, there were no aftereffects from hybrid faces made from different expressions, despite the fact that these contained the same local image elements. In Experiment 2, we examined the role of facial features independent of the normal face configuration by contrasting adaptation with whole faces to adaptation with scrambled faces. We found that scrambled faces also generated significant aftereffects, indicating that expressive features without a normal facial configuration could generate expression aftereffects. In Experiment 3, we examined the role of facial configuration by using schematic faces made from line elements that in isolation do not carry expression-related information (e.g. curved segments and straight lines) but that convey an expression when arranged in a normal facial configuration. We obtained a significant aftereffect for facial configurations but not scrambled configurations of these line elements. We conclude that facial expression aftereffects are not due to local adaptation to image elements but due to high-level adaptation of neural representations that involve both facial features and facial configuration.

Facial and Periorbital Cellulitis due to Skin Peeling with Jet Stream by an Unauthorized Person.

PubMed

Kaptanoglu, Asli Feride; Mullaaziz, Didem; Suer, Kaya

2014-01-01

Technologies and devices for cosmetic procedures are developing with each passing day. However, increased and unauthorized use of such emerging technologies may also lead to increases in unexpected results and complications as well. Here, we report a case of facial cellulitis after a "beauty parlor" session of skin cleaning with jet stream peeling device in 19-year old female patient for the first time. Complications due to improper and unauthorized use of jet stream peeling devices may also cause doubts about the safety and impair the reputation of the technology as well. In order to avoid irreversible complications, local authorities should follow the technology and update the regulations where the dermatologists should take an active role.

Biomask: An Advanced Robotic System for the Real-time, Autonomous Monitoring and Treatment of Facial Burns of Wounded Soldiers

DTIC Science & Technology

2013-04-01

bioreactor systems, a microfluidic -based flexible fluid exchange patch was developed for porcine wound models. A novel design and fabrication process...to be established. 15. SUBJECT TERMS Biomask, burn injury, facial reconstruction, wound-healing, bioreactor, flexible microfluidic , and...and layers of facial skin using different cell types and matrices to produce a reliable, physiologic facial and skin construct to restore functional

Enhanced Facial Symmetry Assessment in Orthodontists

PubMed Central

Jackson, Tate H.; Clark, Kait; Mitroff, Stephen R.

2013-01-01

Assessing facial symmetry is an evolutionarily important process, which suggests that individual differences in this ability should exist. As existing data are inconclusive, the current study explored whether a group trained in facial symmetry assessment, orthodontists, possessed enhanced abilities. Symmetry assessment was measured using face and non-face stimuli among orthodontic residents and two control groups: university participants with no symmetry training and airport security luggage screeners, a group previously shown to possess expert visual search skills unrelated to facial symmetry. Orthodontic residents were more accurate at assessing symmetry in both upright and inverted faces compared to both control groups, but not for non-face stimuli. These differences are not likely due to motivational biases or a speed-accuracy tradeoff—orthodontic residents were slower than the university participants but not the security screeners. Understanding such individual differences in facial symmetry assessment may inform the perception of facial attractiveness. PMID:24319342

Agency and facial emotion judgment in context.

PubMed

Ito, Kenichi; Masuda, Takahiko; Li, Liman Man Wai

2013-06-01

Past research showed that East Asians' belief in holism was expressed as their tendencies to include background facial emotions into the evaluation of target faces more than North Americans. However, this pattern can be interpreted as North Americans' tendency to downplay background facial emotions due to their conceptualization of facial emotion as volitional expression of internal states. Examining this alternative explanation, we investigated whether different types of contextual information produce varying degrees of effect on one's face evaluation across cultures. In three studies, European Canadians and East Asians rated the intensity of target facial emotions surrounded with either affectively salient landscape sceneries or background facial emotions. The results showed that, although affectively salient landscapes influenced the judgment of both cultural groups, only European Canadians downplayed the background facial emotions. The role of agency as differently conceptualized across cultures and multilayered systems of cultural meanings are discussed.

Patterns, severity, and management of maxillofacial injuries in a suburban South Western Nigeria tertiary center.

PubMed

Ogunmuyiwa, Stella Aimiede; Gbolahan, Olalere Omoyosola; Ayantunde, Abiodun Abraham; Odewabi, Adenike Abidemi

2015-01-01

Trauma remains a leading cause of maxillofacial injury globally. Changing etiological factors and patterns of maxillofacial injury continue to be reported and are largely modulated by socio-geographic and environmental factors. It is important to have an in-depth understanding of the pattern and etiology in a particular region before effective preventive measures can be developed. The aim was to evaluate the patterns, etiological factors, and management of maxillofacial injuries in Ogun state, Nigeria. A prospective descriptive cohort study of all consecutive patients that presented with maxillofacial injuries at our center between January and December 2013. Information about demographic data, types of maxillofacial and associated injury, etiology of injury, treatment received and complications were collected and analyzed. Seventy patients presented with maxillofacial injury during the study period with a male to female ratio of 4:1. The age range was 9 months to 60 years with a mean of 30.11 ± standard deviation 14.97 years. Majority of the facial fractures were due to motorcycle related crashes. There were 57.1% mandibular fractures and 55.7% middle third fractures. Closed reduction with maxillo-mandibular fixation was the major method of treatment of facial fractures. Postoperative complications were observed in 11.4% of patients. Road traffic crashes (RTCs) remain the leading etiological factor of maxillofacial injuries in our center. Enforcement of stricter traffic regulations and possibly replacement of motorcycles with tricycles for commercial transportation may help to reduce the incidence of RTCs.

[Effects of a Facial Muscle Exercise Program including Facial Massage for Patients with Facial Palsy].

PubMed

Choi, Hyoung Ju; Shin, Sung Hee

2016-08-01

The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher's exact test and independent sample t-test with the SPSS 18.0 program. Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.

Characteristics of ballistic and blast injuries.

PubMed

Powers, David B; Delo, Robert I

2013-03-01

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

[Regeneration and repair of peripheral nerves: clinical implications in facial paralysis surgery].

PubMed

Hontanilla, B; Vidal, A

2000-01-01

Peripheral nerve lesions are one of the most frequent causes of chronic incapacity. Upper or lower limb palsies due to brachial or lumbar plexus injuries, facial paralysis and nerve lesions caused by systemic diseases are one of the major goals of plastic and reconstructive surgery. However, the poor results obtained in repaired peripheral nerves during the Second World War lead to a pessimist vision of peripheral nerve repair. Nevertheless, a well understanding of microsurgical principles in reconstruction and molecular biology of nerve regeneration have improved the clinical results. Thus, although the results obtained are quite far from perfect, these procedures give to patients a hope in the recuperation of their lesions and then on function. Technical aspects in nerve repair are well established; the next step is to manipulate the biology. In this article we will comment the biological processes which appear in peripheral nerve regeneration, we will establish the main concepts on peripheral nerve repair applied in facial paralysis cases and, finally, we will proportionate some ideas about how clinical practice could be affected by manipulation of the peripheral nerve biology.

Deficits in facial emotion recognition indicate behavioral changes and impaired self-awareness after moderate to severe traumatic brain injury.

PubMed

Spikman, Jacoba M; Milders, Maarten V; Visser-Keizer, Annemarie C; Westerhof-Evers, Herma J; Herben-Dekker, Meike; van der Naalt, Joukje

2013-01-01

Traumatic brain injury (TBI) is a leading cause of disability, specifically among younger adults. Behavioral changes are common after moderate to severe TBI and have adverse consequences for social and vocational functioning. It is hypothesized that deficits in social cognition, including facial affect recognition, might underlie these behavioral changes. Measurement of behavioral deficits is complicated, because the rating scales used rely on subjective judgement, often lack specificity and many patients provide unrealistically positive reports of their functioning due to impaired self-awareness. Accordingly, it is important to find performance based tests that allow objective and early identification of these problems. In the present study 51 moderate to severe TBI patients in the sub-acute and chronic stage were assessed with a test for emotion recognition (FEEST) and a questionnaire for behavioral problems (DEX) with a self and proxy rated version. Patients performed worse on the total score and on the negative emotion subscores of the FEEST than a matched group of 31 healthy controls. Patients also exhibited significantly more behavioral problems on both the DEX self and proxy rated version, but proxy ratings revealed more severe problems. No significant correlation was found between FEEST scores and DEX self ratings. However, impaired emotion recognition in the patients, and in particular of Sadness and Anger, was significantly correlated with behavioral problems as rated by proxies and with impaired self-awareness. This is the first study to find these associations, strengthening the proposed recognition of social signals as a condition for adequate social functioning. Hence, deficits in emotion recognition can be conceived as markers for behavioral problems and lack of insight in TBI patients. This finding is also of clinical importance since, unlike behavioral problems, emotion recognition can be objectively measured early after injury, allowing for early

Changes in the Severity and Injury Sources of Thoracic Aorta Injuries due to Vehicular Crashes.

PubMed

Ryb, Gabriel; Dischinger, Patricia; Kerns, Timothy; Burch, Cynthia; Rabin, Joseph; Ho, Shiu

Research using the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) suggested a decreased adjusted risk of thoracic aorta injuries (TAI) for newer vehicles during near-side crashes and an increased adjusted TAI risk during frontal crashes. This study attempted to explore possible explanations of these findings. Adult front seat occupants in the Crash Injury Research and Engineering Network (CIREN) database through June 2012 were studied. TAI cases were compared with remaining cases in relation to crash and vehicular characteristics. TAI cases of later crash year (CY) (2004-2012) were compared to those in earlier CY (1996-2003) in relation to TAI severity (minor, moderate, severe and non-survivable). TAI cases in newer model year (MY) vehicles (1999-2012) were compared to those in older vehicles (1988-98) in relation to injury source (steering wheel, front, left, seat belt, air bag and other or unknown). Analysis was stratified by direction of impact (frontal and near-side) and the use of restraints. The similar TAI severity of earlier and later CY among frontal crashes suggests that the observed changes in the adjusted odds of injury seen in NASS-CDS are not due to an increase in injury detection. The decrease in TAI severity among newer vehicles in near-side crashes of later CY is consistent with a beneficial effect of crashworthiness improvements for this crash configuration. A shift of injury source in frontal crashes from the steering wheel in older vehicles to "front of vehicle structures", "seat belts" and "unknown and other" in newer vehicles should suggest potential sites for crashworthiness improvements.

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

PubMed

Nowak, Dennis A; Linder, Stefan; Topka, Helge

2005-09-01

Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.

PubMed

Terrell, J E; Kileny, P R; Yian, C; Esclamado, R M; Bradford, C R; Pillsbury, M S; Wolf, G T

1997-10-01

To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring. A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring. University medical center. Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used. (1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring. Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379. The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.

Motorcycle accident is the main cause of maxillofacial injuries in the Penang Mainland, Malaysia.

PubMed

Hashim, Hasnah; Iqbal, Syed

2011-02-01

Maxillofacial injuries are among the commonest forms of body injuries. There are three divisions, namely, facial bone fractures, soft tissue injuries, and dentoalveolar injuries. Etiologies include motor vehicle accidents, assaults, falls, and sporting injuries. The aim of this study was to determine the profiles including the causes of maxillofacial injuries seen in an urban government hospital in the mainland of Penang State, Malaysia. This was a cross-sectional study that recruited cases reported within a period of 1 year. The source population was maxillofacial injury patients presenting to the Oral and Maxillofacial Surgery Department of an urban hospital in the Penang Mainland, North Malaysia between May 2007 and May 2008. Cases of patients involved in accidents that occurred outside the reference vicinity were excluded. A case report form was developed and completed by the attending clinicians. Data were analyzed using spss version 12.0. A total of 194 cases were studied, with the mean patient age being 27.8 (SD 15.20) years. The majority of patients were Malay men between 20 and 29 years of age. The main cause of injury was motorcycle accident (53.6%). The commonest injury (in isolation/combination with other injuries) involved the soft tissues (87.2%), dentoalveolar region (33.4%), and facial bones (23.9%). Laceration was the commonest soft tissue injury, and crown fracture was the most frequent dentoalveolar injury. The facial bone that was most highly involved in the injury was the zygoma. Subjects involved in motorcycle accidents had a significantly higher incidence of sustaining facial bone fractures. Motorcycle accidents were the commonest cause of maxillofacial injuries in the Penang Mainland, Malaysia. Most patients were young men. Hence, it is prudent to reinforce appropriate road safety and awareness interventions particularly focusing young male motorcyclists so as to reduce the risk of accidents. © 2011 John Wiley & Sons A/S.

[Application of grading evaluation on facial nerve function of Bell's palsy treated with electroacupuncture].

PubMed

Zhou, Zhang-Ling; Zuo, Cong; Cheng, Shu-Luo; Shao, Wei-Wei; Liu, Li-Ping

2013-08-01

To explore the correlation of facial nerve injury degree with facial contraction degree induced by electric stimulation in the treatment of Bell's palsy with electroacupuncture, and the significance in elec tric reaction grading evaluation. Sixty-eight cases of Bell's palsy were enrolled. The positive and negative electrodes of the acupuncture treatment apparatus were attached to the needle handles at the 3 groups of points, named Taiyang (EX-HN 5)-Yangbai(GB 14), Xiaguan (ST 7)-Quanliao (SI 18) and Heliao (LI 19)-Jiachengjiang (Extra). The disperse-dense wave was applied. According to the severity of local muscle contraction after needling, the electric reaction was divided into 4 grades, named superior, moderate, poor and no reaction. After acupuncture and electroacupuncture, the efficacy was evaluated in accordance with the different electric reaction grades. The curative rate was 100.0% (44/44) in patients with superior electric reaction, was 100.0% (7/7) in patients with moderate electric reaction, was 18.2% (2/11) in patients with poor electric reaction and was 0 (0/6) in patients with noelectric reaction. The difference was significant statistically in comparison of 4 groups (P<0.01). The superiority correlation presented between the efficacy and electric reaction grade (P< 0.001). The higher the superiority of electric reaction grade was, the better the efficacy was. The difference in the efficacy among different electric reaction grades was significant statistically (P<0.001). And the course of treatment was the shortest for those with the high superiority of electric reaction. The reaction grade of electric stimulation is conform to the facial nerve injury grading in Bell's palsy. The contraction degree of facial mimetic muscle induced by electroacupuncture stimulation is closely correlated with severity of disease. Based on the electric reaction, the facial nerve injury severity can be understood generally and the prognosis be judged.

Hepatitis Diagnosis Using Facial Color Image

NASA Astrophysics Data System (ADS)

Liu, Mingjia; Guo, Zhenhua

Facial color diagnosis is an important diagnostic method in traditional Chinese medicine (TCM). However, due to its qualitative, subjective and experi-ence-based nature, traditional facial color diagnosis has a very limited application in clinical medicine. To circumvent the subjective and qualitative problems of facial color diagnosis of Traditional Chinese Medicine, in this paper, we present a novel computer aided facial color diagnosis method (CAFCDM). The method has three parts: face Image Database, Image Preprocessing Module and Diagnosis Engine. Face Image Database is carried out on a group of 116 patients affected by 2 kinds of liver diseases and 29 healthy volunteers. The quantitative color feature is extracted from facial images by using popular digital image processing techni-ques. Then, KNN classifier is employed to model the relationship between the quantitative color feature and diseases. The results show that the method can properly identify three groups: healthy, severe hepatitis with jaundice and severe hepatitis without jaundice with accuracy higher than 73%.

Fatal pediatric head injury due to toppled television: does the injury pattern overlap with abusive head trauma?

PubMed

Kodikara, Sarathchandra; Pollanen, Michael

2012-07-01

Pediatric head injuries can occur from abusive head trauma (AHT) or accidents. Accidental pediatric head injuries caused by cathode-ray tube televisions (CRTT) toppling have become a 'silent epidemic'. Differentiation between a fatal case of AHT and CRTT toppling could be vexing when the historical and scene evidence are subtle. A 2-year-old girl was found unresponsive in her house and could not be resuscitated. A 27" CRTT was found fallen from its stand onto the floor at the scene. The siblings report that the deceased was climbing on the television stand when it toppled. Autopsy revealed a spectrum of head injuries including, contusions, fractures, bilateral acute subdural hemorrhages, subarachnoid hemorrhages, brain contusion-lacerations and corpus callosal hemorrhages. Microscopy of the eyes revealed bilateral acute retinal hemorrhages. The cause of death was given as crushing injuries of head and brain. The skull fracture pattern is compatible with an accident causing crush injury due to the toppled CRTT rather than AHT. The injury pattern reconfirms that the head is the most vulnerable site in case of CRTT tipover. Although there may be an overlap between the injury pattern in AHT and in CRTT tipover cases, a careful evaluation of the history and scene and autopsy findings such as the crushing nature of the skull fractures and distribution of injury, can solve this problem. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A facial reconstruction and identification technique for seriously devastating head wounds.

PubMed

Joukal, Marek; Frišhons, Jan

2015-07-01

Many authors have focused on facial identification techniques, and facial reconstructions for cases when skulls have been found are especially well known. However, a standardized facial identification technique for an unknown body with seriously devastating head injuries has not yet been developed. A reconstruction and identification technique was used in 7 cases of accidents involving trains striking pedestrians. This identification technique is based on the removal of skull bone fragments, subsequent fixation of soft tissue onto a universal commercial polystyrene head model, precise suture of dermatomuscular flaps, and definitive adjustment using cosmetic treatments. After reconstruction, identifying marks such as scars, eyebrows, facial lines, facial hair and partly hairstyle become evident. It is then possible to present a modified picture of the reconstructed face to relatives. After comparing the results with photos of the person before death, this technique has proven to be very useful for identifying unknown bodies when other identification techniques are not available. This technique is useful for its being rather quick and especially for its results. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Unexpected rare complication of the facial paralysis in a patient with an antrochoanal polyp following canine fossa puncture.

PubMed

Kim, Ah-Young; Choi, Myoung Su

2015-05-14

Canine fossa puncture (CFP) combined with endoscopic sinus surgery is a simple and effective method for treating antrochoanal polyps, particularly those that originate in the anterior, inferior or medial aspect of the antrum. Several complications can occur following CFP, including facial paraesthesia and dental numbness. However, facial palsy is extremely rare after CFP. We postulated that a possible mechanism of facial palsy is pressure injury to the soft tissues adjacent to the puncture site, which can damage the buccal branch of the facial nerve during CFP. 2015 BMJ Publishing Group Ltd.

Nerve compression injuries due to traumatic false aneurysm.

PubMed Central

Robbs, J V; Naidoo, K S

1984-01-01

Experience with 17 patients with delayed onset of compression neuropraxia due to hemorrhage following nonoperative treatment of penetrating arterial injuries is presented. Fifteen cases involved the arteries of the neck shoulder girdle and upper extremity and two the gluteal vessels. This resulted in dysfunction of components of the brachial plexus, median ulnar, and sciatic nerves. Follow-up extended from 3 to 18 months. Of 10 brachial plexus lesions two recovered fully, five partially, and three not at all. Of seven peripheral nerve injuries, full recovery occurred in two patients and none in five. Adverse prognostic factors for neurological recovery are sepsis, involvement of intrinsic hand innervation and the sciatic nerve. An improved prognosis may be expected for upper trunk lesions of the brachial plexus and radial nerve lesions. The complication is essentially avoidable and a careful appraisal of the circulatory status must be made in all patients with penetrating trauma in the neck and shoulder girdle and buttock. PMID:6732331

Opposite effects on facial morphology due to gene dosage sensitivity.

PubMed

Hammond, Peter; McKee, Shane; Suttie, Michael; Allanson, Judith; Cobben, Jan-Maarten; Maas, Saskia M; Quarrell, Oliver; Smith, Ann C M; Lewis, Suzanne; Tassabehji, May; Sisodiya, Sanjay; Mattina, Teresa; Hennekam, Raoul

2014-09-01

Sequencing technology is increasingly demonstrating the impact of genomic copy number variation (CNV) on phenotypes. Opposing variation in growth, head size, cognition and behaviour is known to result from deletions and reciprocal duplications of some genomic regions. We propose normative inversion of face shape, opposing difference from a matched norm, as a basis for investigating the effects of gene dosage on craniofacial development. We use dense surface modelling techniques to match any face (or part of a face) to a facial norm of unaffected individuals of matched age, sex and ethnicity and then we reverse the individual's face shape differences from the matched norm to produce the normative inversion. We demonstrate for five genomic regions, 4p16.3, 7q11.23, 11p15, 16p13.3 and 17p11.2, that such inversion for individuals with a duplication or (epi)-mutation produces facial forms remarkably similar to those associated with a deletion or opposite (epi-)mutation of the same region, and vice versa. The ability to visualise and quantify face shape effects of gene dosage is of major benefit for determining whether a CNV is the cause of the phenotype of an individual and for predicting reciprocal consequences. It enables face shape to be used as a relatively simple and inexpensive functional analysis of the gene(s) involved.

Facial trauma as physical violence markers against elderly Brazilians: A comparative analysis between genders.

PubMed

de Sousa, Rayanne Izabel Maciel; de Macedo Bernardino, Ítalo; Castro, Ricardo Dias; Cavalcanti, Alessandro Leite; Bento, Patricia Meira; d'Ávila, Sérgio

2016-01-01

The aim of this study was to characterize the profile of elderly Brazilians with injuries resulting from physical violence and identify victimization differences. A descriptive and exploratory study was conducted involving the analysis of medico-legal and social records of 259 elderly victims of physical violence treated at an Institute of Forensic Medicine and Dentistry over four years (from January 2008 to December 2011). The forensic service database was evaluated by researchers properly trained and calibrated to perform this function between January and March 2013. Socio-demographic variables of victims, aggression characteristics, aggressor's profile and types of lesions were evaluated. Descriptive and multivariate statistics using Multiple Correspondence Analysis (MCA) were performed. The prevalence of facial trauma was 42.9%. Based on the MCA results, two groups with different victimization profiles were identified: married men aged 70-79 years, victims of community violence at night, suffering facial injuries; and single, widowed or separated women aged 60-69 years, victims of domestic violence during the day, suffering trauma in other areas of the body. The results suggest that there is a high prevalence of facial injuries among elderly Brazilians victims of physical violence and there are important differences related to victimization characteristics according to gender. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Facial animation on an anatomy-based hierarchical face model

NASA Astrophysics Data System (ADS)

Zhang, Yu; Prakash, Edmond C.; Sung, Eric

2003-04-01

In this paper we propose a new hierarchical 3D facial model based on anatomical knowledge that provides high fidelity for realistic facial expression animation. Like real human face, the facial model has a hierarchical biomechanical structure, incorporating a physically-based approximation to facial skin tissue, a set of anatomically-motivated facial muscle actuators and underlying skull structure. The deformable skin model has multi-layer structure to approximate different types of soft tissue. It takes into account the nonlinear stress-strain relationship of the skin and the fact that soft tissue is almost incompressible. Different types of muscle models have been developed to simulate distribution of the muscle force on the skin due to muscle contraction. By the presence of the skull model, our facial model takes advantage of both more accurate facial deformation and the consideration of facial anatomy during the interactive definition of facial muscles. Under the muscular force, the deformation of the facial skin is evaluated using numerical integration of the governing dynamic equations. The dynamic facial animation algorithm runs at interactive rate with flexible and realistic facial expressions to be generated.

Changes in the Severity and Injury Sources of Thoracic Aorta Injuries due to Vehicular Crashes

PubMed Central

Ryb, Gabriel; Dischinger, Patricia; Kerns, Timothy; Burch, Cynthia; Rabin, Joseph; Ho, Shiu

2013-01-01

Research using the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) suggested a decreased adjusted risk of thoracic aorta injuries (TAI) for newer vehicles during near-side crashes and an increased adjusted TAI risk during frontal crashes. This study attempted to explore possible explanations of these findings. Adult front seat occupants in the Crash Injury Research and Engineering Network (CIREN) database through June 2012 were studied. TAI cases were compared with remaining cases in relation to crash and vehicular characteristics. TAI cases of later crash year (CY) (2004–2012) were compared to those in earlier CY (1996–2003) in relation to TAI severity (minor, moderate, severe and non-survivable). TAI cases in newer model year (MY) vehicles (1999–2012) were compared to those in older vehicles (1988–98) in relation to injury source (steering wheel, front, left, seat belt, air bag and other or unknown). Analysis was stratified by direction of impact (frontal and near-side) and the use of restraints. The similar TAI severity of earlier and later CY among frontal crashes suggests that the observed changes in the adjusted odds of injury seen in NASS-CDS are not due to an increase in injury detection. The decrease in TAI severity among newer vehicles in near-side crashes of later CY is consistent with a beneficial effect of crashworthiness improvements for this crash configuration. A shift of injury source in frontal crashes from the steering wheel in older vehicles to “front of vehicle structures”, “seat belts” and “unknown and other” in newer vehicles should suggest potential sites for crashworthiness improvements. PMID:24406956

[Facial palsy].

PubMed

Cavoy, R

2013-09-01

Facial palsy is a daily challenge for the clinicians. Determining whether facial nerve palsy is peripheral or central is a key step in the diagnosis. Central nervous lesions can give facial palsy which may be easily differentiated from peripheral palsy. The next question is the peripheral facial paralysis idiopathic or symptomatic. A good knowledge of anatomy of facial nerve is helpful. A structure approach is given to identify additional features that distinguish symptomatic facial palsy from idiopathic one. The main cause of peripheral facial palsies is idiopathic one, or Bell's palsy, which remains a diagnosis of exclusion. The most common cause of symptomatic peripheral facial palsy is Ramsay-Hunt syndrome. Early identification of symptomatic facial palsy is important because of often worst outcome and different management. The prognosis of Bell's palsy is on the whole favorable and is improved with a prompt tapering course of prednisone. In Ramsay-Hunt syndrome, an antiviral therapy is added along with prednisone. We also discussed of current treatment recommendations. We will review short and long term complications of peripheral facial palsy.

Analysis of facial bone fractures: An 11-year study of 2,094 patients

PubMed Central

Hwang, Kun; You, Sun Hye

2010-01-01

Purpose: The medical records of these patients were reviewed and analysed to determine the clinical characteristics and treatment of facial bone fractures. Patients and Methods: This is a retrospective study of 2,094 patients with facial bone fractures from various accidents that were treated at the Inha University Hospital from 1996 to 2007. Results: The most common age group was the third decade of life (29%). Males were more common than females (3.98:1). The most common aetiology was violent assault or nonviolent traumatic injury (49.4%). The most common isolated fracture site was the nasal bone (37.7%), followed by the mandible (30%), orbital bones (7.6%), zygoma (5.7%), maxilla (1.3%) and the frontal bone (0.3%). The largest group with complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (14%). Closed reduction was performed in 46.3% of the cases while 39.7% of the cases required open reduction. For open reductions, the most commonly used soft-tissue approach was the intraoral approach (32.3%). The complication rate was 6.4% and the most common complication was hypoesthesia (68.4%) followed by diplopia (25.6%). Conclusion: Long-term collection of epidemiological data regarding facial fractures and concomitant injuries is important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment. PMID:20924449

Reconstruction of large unilateral hemi-facial scar contractures with supercharged expanded forehead flaps based on the anterofrontal superficial temporal vessels.

PubMed

Gan, Cheng; Fan, Jincai; Liu, Liqiang; Tian, Jia; Jiao, Hu; Chen, Wenlin; Fu, Siqi; Feng, Suyun

2013-11-01

The expanded forehead flap, using temporal pedicles, has been employed extensively in facial reconstruction. To overcome the disadvantages of the traditional dual temporal pedicles, such as the limited transfer range and the short length of the flap, the distal supercharging technique can be applied to lengthen the flap and extend the transfer range, especially in the cases with a past temporal burn injury. This article aims to present an application of the distal supercharged expanded forehead flap procedure for hemi-facial reconstruction and discuss the haemodynamics of the expanded forehead flap. The tissue expander implantation and the following forehead tissue expansion were performed regularly. When the forehead skin expansion was completed, an expanded forehead flap was created and transferred to the damaged facial area with one distal temporal vessel pedicle that was anastomosed with facial vessels in a supercharged way. All patients were analysed retrospectively. From September 2009 to September 2011, eight male patients and one female patient were treated using this method. Their flaps size ranged from 20 cm × 8 cm to 30 cm × 11 cm and no flap loss occurred. Patients came in for follow-ups 9-16 months after the procedures. All the patients were satisfied with the results. The supercharging expanded forehead flap procedure can provide reliable flap vascularity due to its elastic transferring abilities. By using a distal supercharging technique, we can lengthen and widen the flap to tailor it to the defect, while also minimising the donor defect in the patients with a past temporal injury. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Facial reconstruction--anatomical art or artistic anatomy?

PubMed

Wilkinson, Caroline

2010-02-01

Facial reconstruction is employed in the context of forensic investigation and for creating three-dimensional portraits of people from the past, from ancient Egyptian mummies and bog bodies to digital animations of J. S. Bach. This paper considers a facial reconstruction method (commonly known as the Manchester method) associated with the depiction and identification of the deceased from skeletal remains. Issues of artistic licence and scientific rigour, in relation to soft tissue reconstruction, anatomical variation and skeletal assessment, are discussed. The need for artistic interpretation is greatest where only skeletal material is available, particularly for the morphology of the ears and mouth, and with the skin for an ageing adult. The greatest accuracy is possible when information is available from preserved soft tissue, from a portrait, or from a pathological condition or healed injury.

Facial dynamics and emotional expressions in facial aging treatments.

PubMed

Michaud, Thierry; Gassia, Véronique; Belhaouari, Lakhdar

2015-03-01

Facial expressions convey emotions that form the foundation of interpersonal relationships, and many of these emotions promote and regulate our social linkages. Hence, the facial aging symptomatological analysis and the treatment plan must of necessity include knowledge of the facial dynamics and the emotional expressions of the face. This approach aims to more closely meet patients' expectations of natural-looking results, by correcting age-related negative expressions while observing the emotional language of the face. This article will successively describe patients' expectations, the role of facial expressions in relational dynamics, the relationship between facial structures and facial expressions, and the way facial aging mimics negative expressions. Eventually, therapeutic implications for facial aging treatment will be addressed. © 2015 Wiley Periodicals, Inc.

Amblyopia Associated with Congenital Facial Nerve Paralysis.

PubMed

Iwamura, Hitoshi; Kondo, Kenji; Sawamura, Hiromasa; Baba, Shintaro; Yasuhara, Kazuo; Yamasoba, Tatsuya

2016-01-01

The association between congenital facial paralysis and visual development has not been thoroughly studied. Of 27 pediatric cases of congenital facial paralysis, we identified 3 patients who developed amblyopia, a visual acuity decrease caused by abnormal visual development, as comorbidity. These 3 patients had facial paralysis in the periocular region and developed amblyopia on the paralyzed side. They started treatment by wearing an eye patch immediately after diagnosis and before the critical visual developmental period; all patients responded to the treatment. Our findings suggest that the incidence of amblyopia in the cases of congenital facial paralysis, particularly the paralysis in the periocular region, is higher than that in the general pediatric population. Interestingly, 2 of the 3 patients developed anisometropic amblyopia due to the hyperopia of the affected eye, implying that the periocular facial paralysis may have affected the refraction of the eye through yet unspecified mechanisms. Therefore, the physicians who manage facial paralysis should keep this pathology in mind, and when they see pediatric patients with congenital facial paralysis involving the periocular region, they should consult an ophthalmologist as soon as possible. © 2016 S. Karger AG, Basel.

Patterns, Severity, and Management of Maxillofacial Injuries in a Suburban South Western Nigeria Tertiary Center

PubMed Central

Ogunmuyiwa, Stella Aimiede; Gbolahan, Olalere Omoyosola; Ayantunde, Abiodun Abraham; Odewabi, Adenike Abidemi

2015-01-01

Background: Trauma remains a leading cause of maxillofacial injury globally. Changing etiological factors and patterns of maxillofacial injury continue to be reported and are largely modulated by socio-geographic and environmental factors. It is important to have an in-depth understanding of the pattern and etiology in a particular region before effective preventive measures can be developed. Aim: The aim was to evaluate the patterns, etiological factors, and management of maxillofacial injuries in Ogun state, Nigeria. Materials and Methods: A prospective descriptive cohort study of all consecutive patients that presented with maxillofacial injuries at our center between January and December 2013. Information about demographic data, types of maxillofacial and associated injury, etiology of injury, treatment received and complications were collected and analyzed. Results: Seventy patients presented with maxillofacial injury during the study period with a male to female ratio of 4:1. The age range was 9 months to 60 years with a mean of 30.11 ± standard deviation 14.97 years. Majority of the facial fractures were due to motorcycle related crashes. There were 57.1% mandibular fractures and 55.7% middle third fractures. Closed reduction with maxillo-mandibular fixation was the major method of treatment of facial fractures. Postoperative complications were observed in 11.4% of patients. Conclusion: Road traffic crashes (RTCs) remain the leading etiological factor of maxillofacial injuries in our center. Enforcement of stricter traffic regulations and possibly replacement of motorcycles with tricycles for commercial transportation may help to reduce the incidence of RTCs. PMID:25838765

Multiracial Facial Golden Ratio and Evaluation of Facial Appearance.

PubMed

Alam, Mohammad Khursheed; Mohd Noor, Nor Farid; Basri, Rehana; Yew, Tan Fo; Wen, Tay Hui

2015-01-01

This study aimed to investigate the association of facial proportion and its relation to the golden ratio with the evaluation of facial appearance among Malaysian population. This was a cross-sectional study with 286 randomly selected from Universiti Sains Malaysia (USM) Health Campus students (150 females and 136 males; 100 Malaysian Chinese, 100 Malaysian Malay and 86 Malaysian Indian), with the mean age of 21.54 ± 1.56 (Age range, 18-25). Facial indices obtained from direct facial measurements were used for the classification of facial shape into short, ideal and long. A validated structured questionnaire was used to assess subjects' evaluation of their own facial appearance. The mean facial indices of Malaysian Indian (MI), Malaysian Chinese (MC) and Malaysian Malay (MM) were 1.59 ± 0.19, 1.57 ± 0.25 and 1.54 ± 0.23 respectively. Only MC showed significant sexual dimorphism in facial index (P = 0.047; P<0.05) but no significant difference was found between races. Out of the 286 subjects, 49 (17.1%) were of ideal facial shape, 156 (54.5%) short and 81 (28.3%) long. The facial evaluation questionnaire showed that MC had the lowest satisfaction with mean score of 2.18 ± 0.97 for overall impression and 2.15 ± 1.04 for facial parts, compared to MM and MI, with mean score of 1.80 ± 0.97 and 1.64 ± 0.74 respectively for overall impression; 1.75 ± 0.95 and 1.70 ± 0.83 respectively for facial parts. 1) Only 17.1% of Malaysian facial proportion conformed to the golden ratio, with majority of the population having short face (54.5%); 2) Facial index did not depend significantly on races; 3) Significant sexual dimorphism was shown among Malaysian Chinese; 4) All three races are generally satisfied with their own facial appearance; 5) No significant association was found between golden ratio and facial evaluation score among Malaysian population.

Multiracial Facial Golden Ratio and Evaluation of Facial Appearance

PubMed Central

2015-01-01

This study aimed to investigate the association of facial proportion and its relation to the golden ratio with the evaluation of facial appearance among Malaysian population. This was a cross-sectional study with 286 randomly selected from Universiti Sains Malaysia (USM) Health Campus students (150 females and 136 males; 100 Malaysian Chinese, 100 Malaysian Malay and 86 Malaysian Indian), with the mean age of 21.54 ± 1.56 (Age range, 18–25). Facial indices obtained from direct facial measurements were used for the classification of facial shape into short, ideal and long. A validated structured questionnaire was used to assess subjects’ evaluation of their own facial appearance. The mean facial indices of Malaysian Indian (MI), Malaysian Chinese (MC) and Malaysian Malay (MM) were 1.59 ± 0.19, 1.57 ± 0.25 and 1.54 ± 0.23 respectively. Only MC showed significant sexual dimorphism in facial index (P = 0.047; P<0.05) but no significant difference was found between races. Out of the 286 subjects, 49 (17.1%) were of ideal facial shape, 156 (54.5%) short and 81 (28.3%) long. The facial evaluation questionnaire showed that MC had the lowest satisfaction with mean score of 2.18 ± 0.97 for overall impression and 2.15 ± 1.04 for facial parts, compared to MM and MI, with mean score of 1.80 ± 0.97 and 1.64 ± 0.74 respectively for overall impression; 1.75 ± 0.95 and 1.70 ± 0.83 respectively for facial parts. In conclusion: 1) Only 17.1% of Malaysian facial proportion conformed to the golden ratio, with majority of the population having short face (54.5%); 2) Facial index did not depend significantly on races; 3) Significant sexual dimorphism was shown among Malaysian Chinese; 4) All three races are generally satisfied with their own facial appearance; 5) No significant association was found between golden ratio and facial evaluation score among Malaysian population. PMID:26562655

Case Report of a Pressure Ulcer Occurring Over the Nasal Bridge Due to a Non-Invasive Ventilation Facial Mask.

PubMed

Rathore, Farooq A; Ahmad, Faria; Zahoor, Muhammad Umar U

2016-10-03

Non-invasive ventilation (NIV) is used in patients with respiratory failure, sleep apnoea, and dyspnoea related to pulmonary oedema. NIV is provided through a facial mask. Many complications of NIV facial masks have been reported, including the breakdown of facial skin. We report a case of an elderly male admitted with multiple co-morbidities. The facial mask was applied continuously for NIV, without any relief or formal monitoring of the underlying skin. It resulted in a Grade II pressure ulcer. We discuss the possible mechanism and offer advice for prevention of such device-related pressure ulcers.

Economic Burden of Hospitalization Due to Injuries in North India: A Cohort Study

PubMed Central

Prinja, Shankar; Jagnoor, Jagnoor; Chauhan, Akashdeep Singh; Aggarwal, Sameer; Nguyen, Ha; Ivers, Rebecca

2016-01-01

There is little documentation of the potential catastrophic effects of injuries on families due to out of pocket (OOP) expenditure for medical care. Patients who were admitted for at least one night in a tertiary care hospital of Chandigarh city due to injury were recruited and were followed-up at 1, 2 and 12 months after discharge to collect information on OOP expenditure. Out of the total 227 patients, 60% (137/227) had sustained road traffic injuries (RTI). The average OOP expenditure per hospitalisation and up to 12 months post discharge was USD 388 (95% CI: 332–441) and USD 1046 (95% CI: 871–1221) respectively. Mean OOP expenditure for RTI and non-RTI cases during hospitalisation was USD 400 (95% CI: 344–456) and USD 369 (95% CI: 313–425) respectively. The prevalence of catastrophic expenditure was 30%, and was significantly higher among those belonging to the lowest income quartile (OR-26.50, 95% CI: 6.70–105.07, p-value: <0.01) and with an inpatient stay greater than 7 days (OR-10.60, 95% CI: 4.21–26.64, p-value: <0.01). High OOP expenditure for treatment of injury puts a significant economic burden on families. Measures aimed at increasing public health spending for prevention of injury and providing financial risk protection are urgently required in India. PMID:27384572

Facial Fractures: Pearls and Perspectives.

PubMed

Chaudhry, Obaid; Isakson, Matthew; Franklin, Adam; Maqusi, Suhair; El Amm, Christian

2018-05-01

After studying this article, the participant should be able to: 1. Describe the A-frame configuration of anterior facial buttresses, recognize the importance of restoring anterior projection in frontal sinus fractures, and describe an alternative design and donor site of pericranial flaps in frontal sinus fractures. 2. Describe the symptoms and cause of pseudo-Brown syndrome, describe the anatomy and placement of a buttress-spanning plate in nasoorbitoethmoid fractures, and identify appropriate nasal support alternatives for nasoorbitoethmoid fractures. 3. Describe the benefits and disadvantages of different lower lid approaches to the orbital floor and inferior rim, identify late exophthalmos as a complication of reconstructing the orbital floor with nonporous alloplast, and select implant type and size for correction of secondary enophthalmos. 4. Describe closed reduction of low-energy zygomatic body fractures with the Gillies approach and identify situations where internal fixation may be unnecessary, identify situations where plating the inferior orbital rim may be avoided, and select fixation points for osteosynthesis of uncomplicated displaced zygomatic fractures. 5. Understand indications and complications of use for intermaxillary screw systems, understand sequencing panfacial fractures, describe the sulcular approach to mandible fractures, and describe principles and techniques of facial reconstruction after self-inflicted firearm injuries. Treating patients with facial trauma remains a core component of plastic surgery and a significant part of the value of a plastic surgeon to a health system.

Traumatic facial nerve neuroma with facial palsy presenting in infancy.

PubMed

Clark, James H; Burger, Peter C; Boahene, Derek Kofi; Niparko, John K

2010-07-01

To describe the management of traumatic neuroma of the facial nerve in a child and literature review. Sixteen-month-old male subject. Radiological imaging and surgery. Facial nerve function. The patient presented at 16 months with a right facial palsy and was found to have a right facial nerve traumatic neuroma. A transmastoid, middle fossa resection of the right facial nerve lesion was undertaken with a successful facial nerve-to-hypoglossal nerve anastomosis. The facial palsy improved postoperatively. A traumatic neuroma should be considered in an infant who presents with facial palsy, even in the absence of an obvious history of trauma. The treatment of such lesion is complex in any age group but especially in young children. Symptoms, age, lesion size, growth rate, and facial nerve function determine the appropriate management.

Peripheral facial weakness (Bell's palsy).

PubMed

Basić-Kes, Vanja; Dobrota, Vesna Dermanović; Cesarik, Marijan; Matovina, Lucija Zadro; Madzar, Zrinko; Zavoreo, Iris; Demarin, Vida

2013-06-01

Peripheral facial weakness is a facial nerve damage that results in muscle weakness on one side of the face. It may be idiopathic (Bell's palsy) or may have a detectable cause. Almost 80% of peripheral facial weakness cases are primary and the rest of them are secondary. The most frequent causes of secondary peripheral facial weakness are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immune disorders, drugs, degenerative diseases of the central nervous system, etc. The diagnosis relies upon the presence of typical signs and symptoms, blood chemistry tests, cerebrospinal fluid investigations, nerve conduction studies and neuroimaging methods (cerebral MRI, x-ray of the skull and mastoid). Treatment of secondary peripheral facial weakness is based on therapy for the underlying disorder, unlike the treatment of Bell's palsy that is controversial due to the lack of large, randomized, controlled, prospective studies. There are some indications that steroids or antiviral agents are beneficial but there are also studies that show no beneficial effect. Additional treatments include eye protection, physiotherapy, acupuncture, botulinum toxin, or surgery. Bell's palsy has a benign prognosis with complete recovery in about 80% of patients, 15% experience some mode of permanent nerve damage and severe consequences remain in 5% of patients.

Facial burns in children: a series analysis with implications for resuscitation and forensic odontology.

PubMed

Acton, C; Nixon, J; Pearn, J; Williams, D; Leditschke, F

1999-03-01

This study comprises a continuous (1981-1995) unselected series of all children who died from thermal injuries in the State of Queensland, Australia. One hundred and six children, so identified, died from incineration (35 per cent), respiratory burns with smoke or carbon monoxide inhalation (33 per cent), body surface area burns comprising greater than 60 per cent (9 per cent) and electrocution (20 per cent). The burn fatality rate was 0.98 per hundred thousand children (0-14 years) per year, with no secular trend and, specifically, no reduction in the annual rate of such fatalities. Eighty-two children (49 males) had concomitant facial injuries, both thermal and nonthermal; of whom 55 per cent were under the age of five years. Sixty (73 per cent) child burn victims died in house fires. Forensic odontology is important in confirming the age of such victims in single incinerations but is of limited value when larger numbers of children are incinerated, because of the relative lack of dental restorations in the infant and pre-school age group. Of the 82 children with facial and airway injuries, 12 per cent had only mild or superficial facial damage and only seven (8 per cent) were alive or resuscitable at the time of rescue from the conflagration or burning injury. child deaths from burns contributed an annual loss rate of 506 years of potential life lost (YPLL) in a population of 3 million of whom 21.5 per cent were children under the age of 15 years. Airway management and resuscitation, in the context of managing surviving burn victims of any age with facial injuries, pose special difficulties. Inhalational burns (smoke and the gases of conflagration) result in a mortality greater than 60 per cent. Although 81 per cent of children showed evidence of airway obstruction, analysis of current data indicates that a maximum of 8 per cent could have survived with airway maintenance and protection. Inhalational burns (to both upper and lower airways) grossly reduce

Clothing hanger injuries: pediatric head and neck traumas in the United States, 2002-2012.

PubMed

Walls, Andrew; Pierce, Matthew; Wang, Hongkun; Harley, Earl H

2014-02-01

To discuss pediatric clothing hanger injuries and review the National Electronic Injury Surveillance System to elucidate frequency and promote increased public awareness among pediatric otolaryngologists. Cross-sectional analysis of a national database. National Electronic Injury Surveillance System Database. A retrospective review of the National Electronic Injury Surveillance System provided a nationally weighted sampling estimate of 394 pediatric incident reports involving clothing hangers. Each incident report was analyzed for impalement, facial laceration, and contusion injuries to the mouth, face, and head. In addition, hospital disposition and location of the described incident were also obtained. Upon review of the National Electronic Injury Surveillance System, incident rates of pediatric oral impalement (95% confidence interval [CI], 0.10-0.41), facial laceration (95% CI, 0.22-0.41), and facial abrasion injuries (95% CI, 0.15-0.44) frequently involved the metal clothing hanger design. In addition, most of the reported injuries occurred within the home and involved lacerations to the oral cavity. This is the first multiyear, nationally representative study to analyze clothing hanger injuries in the pediatric population. We demonstrate that these injuries occur more frequently than the medical literature currently reports and also elucidate that children are more likely to obtain laceration injuries by metal clothing hangers within the home. Furthermore, we provide a recommendation for standardization of the National Electronic Injury Surveillance System such that product safety analysis may occur and reduce further pediatric incidents.

Facial nerve paralysis associated with temporal bone masses.

PubMed

Nishijima, Hironobu; Kondo, Kenji; Kagoya, Ryoji; Iwamura, Hitoshi; Yasuhara, Kazuo; Yamasoba, Tatsuya

2017-10-01

To investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy. FNP assessed by the House-Brackmann (HB) grading system and by electroneurography (ENoG) were compared retrospectively. We reviewed 914 patient records and identified 31 patients with FNP due to benign TBMs. Moderate FNP (HB Grades II-IV) was dominant for facial nerve schwannoma (FNS) (n=15), whereas severe FNP (Grades V and VI) was dominant for cholesteatomas (n=8) and hemangiomas (n=3). The average ENoG value was 19.8% for FNS, 15.6% for cholesteatoma, and 0% for hemangioma. Analysis of the correlation between HB grade and ENoG value for FNP due to TBMs and Bell's palsy revealed that given the same ENoG value, the corresponding HB grade was better for FNS, followed by cholesteatoma, and worst in Bell's palsy. Facial nerve damage caused by benign TBMs could depend on the underlying pathology. Facial movement and ENoG values did not correlate when comparing TBMs and Bell's palsy. When the HB grade is found to be unexpectedly better than the ENoG value, TBMs should be included in the differential diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

Spontaneous Facial Mimicry in Response to Dynamic Facial Expressions

ERIC Educational Resources Information Center

Sato, Wataru; Yoshikawa, Sakiko

2007-01-01

Based on previous neuroscientific evidence indicating activation of the mirror neuron system in response to dynamic facial actions, we hypothesized that facial mimicry would occur while subjects viewed dynamic facial expressions. To test this hypothesis, dynamic/static facial expressions of anger/happiness were presented using computer-morphing…

Facial emotion recognition deficits following moderate-severe Traumatic Brain Injury (TBI): re-examining the valence effect and the role of emotion intensity.

PubMed

Rosenberg, Hannah; McDonald, Skye; Dethier, Marie; Kessels, Roy P C; Westbrook, R Frederick

2014-11-01

Many individuals who sustain moderate-severe traumatic brain injuries (TBI) are poor at recognizing emotional expressions, with a greater impairment in recognizing negative (e.g., fear, disgust, sadness, and anger) than positive emotions (e.g., happiness and surprise). It has been questioned whether this "valence effect" might be an artifact of the wide use of static facial emotion stimuli (usually full-blown expressions) which differ in difficulty rather than a real consequence of brain impairment. This study aimed to investigate the valence effect in TBI, while examining emotion recognition across different intensities (low, medium, and high). Twenty-seven individuals with TBI and 28 matched control participants were tested on the Emotion Recognition Task (ERT). The TBI group was more impaired in overall emotion recognition, and less accurate recognizing negative emotions. However, examining the performance across the different intensities indicated that this difference was driven by some emotions (e.g., happiness) being much easier to recognize than others (e.g., fear and surprise). Our findings indicate that individuals with TBI have an overall deficit in facial emotion recognition, and that both people with TBI and control participants found some emotions more difficult than others. These results suggest that conventional measures of facial affect recognition that do not examine variance in the difficulty of emotions may produce erroneous conclusions about differential impairment. They also cast doubt on the notion that dissociable neural pathways underlie the recognition of positive and negative emotions, which are differentially affected by TBI and potentially other neurological or psychiatric disorders.

Clinical management of microstomia due to the static treatment of facial paralysis and oral rehabilitation with dental implants.

PubMed

Selvi, Firat; Guven, Erdem; Mutlu, Deniz

2011-05-01

Facial-nerve paralysis is seldom seen and may occur because of a broad spectrum of causes. The most commonly seen cause of facial paralysis is the Bell palsy; iatrogenic causes and tumors are relatively rare. Facial asymmetry, drooling, garbled speech, and difficulty in feeding: all adversely affect the psychosocial conditions of the patients. Fascial and tendon sling procedures may be performed for the static treatment of the unilateral permanent facial paralysis. These techniques are used both for the correction of the asymmetry of the face, especially by providing static support for the corner of the mouth, and to prevent drooling. Microstomia after a sling procedure is not a previously observed complication in the literature. A patient is presented with the surgical management of the complication of microstomia that had risen because of a static treatment of his unilateral facial paralysis via a tendon that passes circularly through his orbicularis oris muscle. Oral rehabilitation thereafter was maintained with the support of dental implants and fixed prosthodontics. The most efficient treatment protocol was decided with an interdisciplinary consultation of the oral and maxillofacial surgeon, the plastic surgeon, and the prosthodontist.

Injury risk in professional boxing.

PubMed

Bledsoe, Gregory H; Li, Guohu; Levy, Fred

2005-10-01

Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003. Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury. The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.

Nitric Oxide as a Mediator of Oxidant Lung Injury Due to Paraquat

NASA Astrophysics Data System (ADS)

Berisha, Hasan I.; Pakbaz, Hedayatollah; Absood, Afaf; Said, Sami I.

1994-08-01

At low concentrations, nitric oxide is a physiological transmitter, but in excessive concentrations it may cause cell and tissue injury. We report that in acute oxidant injury induced by the herbicide paraquat in isolated guinea pig lungs, nitric oxide synthesis was markedly stimulated, as evidenced by increased levels of cyclic GMP in lung perfusate and of nitrite and L-citrulline production in lung tissue. All signs of injury, including increased airway and perfusion pressures, pulmonary edema, and protein leakage into the airspaces, were dose-dependently attenuated or totally prevented by either N^G-nitro-L-arginine methyl ester or N^ω-nitro-L-arginine, selective and competitive inhibitors of nitric oxide synthase. Protection was reversed by excess L-arginine but not by its enantiomer D-arginine. When blood was added to the lung perfusate, the paraquat injury was moderated or delayed as it was when paraquat was given to anesthetized guinea pigs. The rapid onset of injury and its failure to occur in the absence of Ca2+ suggest that constitutive rather than inducible nitric oxide synthase was responsible for the stimulated nitric oxide synthesis. The findings indicate that nitric oxide plays a critical role in the production of lung tissue injury due to paraquat, and it may be a pathogenetic factor in other forms of oxidant tissue injury.

Injury patterns of child abuse: Experience of two Level 1 pediatric trauma centers.

PubMed

Yu, Yangyang R; DeMello, Annalyn S; Greeley, Christopher S; Cox, Charles S; Naik-Mathuria, Bindi J; Wesson, David E

2018-05-01

This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. We reviewed all children (<5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0-12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6-5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4-5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8-8.8). Although 76% of head injuries occurred in infants <1year, children ages 1-4years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p<0.001). Child abuse accounts for a large proportion of trauma fatalities in children under 5years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority. Retrospective Review. II. Copyright © 2018. Published by Elsevier Inc.

A non-surgical approach to the management of exposure keratitis due to facial palsy by using mini-scleral lenses.

PubMed

Zaki, Victor

2017-02-01

This is a retrospective study aimed to determine the efficacy of mini-scleral contact lens in protecting the cornea and improving vision in cases of facial palsy. Patients with facial palsy get exposure keratitis because the cornea is dry. They feel pain, discomfort and excessive watering. If left untreated, it leads to permanent damage to the cornea and loss of good functional vision. Mini-scleral lens keep the cornea covered by saline solution all wearing hours. Three patients (4 eyes) with acoustic neuroma, two unilateral and one bilateral, who underwent acoustic neuroma surgeries resulting in facial palsy, are presented.The gold implant and lateral tarsorrhaphy were not enough for corneal protection.Two patients (patients 1 and 2) suffered continuous pain and watering. They had to apply thick lubricant, Lacri-Lube ointment (Allergan, Inc., Dublin, Ireland), several times daily to the affected eye for 15 years. The vision of these patients in the affected eyes were counting fingers (CF) at one foot.Patient 3 with bilateral facial palsy had exposure keratitis in both eyes resulting in constant watering, pain and blurred vision. The 4 eyes were fitted with mini-scleral lenses. The lenses were 15.8 mm rigid gas permeable filled with preservative free saline solution that continuously covers the cornea all wearing hours. In patients 1 and 2 with unilateral facial palsy, vision improved through the mini-scleral lenses to 20/30 and all their symptoms disappeared.The keratitis in case 3 with bilateral facial palsy disappeared within one week of mini-scleral lens use.Follow up for 2 years showed that these patients maintained good vision with no side effects. Mini-scleral lenses protected the cornea, gave comfort and improved the vision and the quality of life of these three patients with facial palsy and should be considered for all patients with facial palsy.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma.

PubMed

Tawfik, Kareem O; Harmon, Jeffrey J; Walters, Zoe; Samy, Ravi; de Alarcon, Alessandro; Stevens, Shawn M; Abruzzo, Todd

2018-05-01

To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

Drug-induced liver injury due to antibiotics.

PubMed

Björnsson, Einar S

Drug-induced liver injury (DILI) is an important differential diagnosis in patients with abnormal liver tests and normal hepatobiliary imaging. Of all known liver diseases, the diagnosis of DILI is probably one of the most difficult one to be established. In all major studies on DILI, antibiotics are the most common type of drugs that have been reported. The clinical phenotype of different types of antibiotics associated with liver injury is highly variable. Some widely used antibiotics such as amoxicillin-clavulanate have been shown to have a delayed onset on liver injury and recently cefazolin has been found to lead to liver injury 1-3 weeks after exposure of a single infusion. The other extreme is the nature of nitrofurantoin-induced liver injury, which can occur after a few years of treatment and lead to acute liver failure (ALF) or autoimmune-like reaction. Most patients with liver injury associated with use of antibiotics have a favorable prognosis. However, patients with jaundice have approximately 10% risk of death from liver failure and/or require liver transplantation. In rare instances, the hepatoxicity can lead to chronic injury and vanishing bile duct syndrome. Given, sometimes very severe consequences of the adverse liver reactions, it cannot be over emphasized that the indication for the different antibiotics should be evidence-based and symptoms and signs of liver injury from the drugs should lead to prompt cessation of therapy.

A unified probabilistic framework for spontaneous facial action modeling and understanding.

PubMed

Tong, Yan; Chen, Jixu; Ji, Qiang

2010-02-01

Facial expression is a natural and powerful means of human communication. Recognizing spontaneous facial actions, however, is very challenging due to subtle facial deformation, frequent head movements, and ambiguous and uncertain facial motion measurements. Because of these challenges, current research in facial expression recognition is limited to posed expressions and often in frontal view. A spontaneous facial expression is characterized by rigid head movements and nonrigid facial muscular movements. More importantly, it is the coherent and consistent spatiotemporal interactions among rigid and nonrigid facial motions that produce a meaningful facial expression. Recognizing this fact, we introduce a unified probabilistic facial action model based on the Dynamic Bayesian network (DBN) to simultaneously and coherently represent rigid and nonrigid facial motions, their spatiotemporal dependencies, and their image measurements. Advanced machine learning methods are introduced to learn the model based on both training data and subjective prior knowledge. Given the model and the measurements of facial motions, facial action recognition is accomplished through probabilistic inference by systematically integrating visual measurements with the facial action model. Experiments show that compared to the state-of-the-art techniques, the proposed system yields significant improvements in recognizing both rigid and nonrigid facial motions, especially for spontaneous facial expressions.

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage.

PubMed

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Rat models of facial nerve cut (FC), facial nerve end to end anastomosis (FF), facial-great auricular neurorrhaphy (FG), and control (Ctrl) were established. Apex nasi amesiality observation, electrophysiology and immunofluorescence assays were employed to investigate the function and mechanism. In apex nasi amesiality observation, it was found apex nasi amesiality of FG group was partly recovered. Additionally, electrophysiology and immunofluorescence assays revealed that facial-great auricular neurorrhaphy could transfer nerve impulse and express AChR which was better than facial nerve cut and worse than facial nerve end to end anastomosis. The present study indicated that great auricular-facial nerve neurorrhaphy is a substantial solution for facial lesion repair, as it is efficiently preventing facial muscles atrophy by generating neurotransmitter like ACh.

Targeting Epigenetic Mechanisms in Pain Due to Trauma and Traumatic Brain Injury (TBI)

DTIC Science & Technology

2015-10-01

particularly likely to involve TBI, peripheral trauma or both. Disability due to pain and other causes is very high amongst such patients. We have no...effective approaches to reducing the likelihood of developing chronic pain after TBI or peripheral injuries, and the mechanisms supporting such pain...brain or peripheral trauma may support chronic pain. Our work to-date has established a rodent model of TBI in combination with injury to a limb as a

Giant spigelian hernia due to abdominal wall injury: a case report.

PubMed

Topal, Ersun; Kaya, Ekrem; Topal, Naile Bolca; Sahin, Ilker

2007-02-01

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study

PubMed Central

Jones, S; Lyons, R; Evans, R; Newcombe, R; Nash, P; McCabe, M; Palmer, S

2004-01-01

Objective: To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. Methods: An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries). Results: In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant. Conclusions: The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further. PMID:15039251

A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value

PubMed Central

Timashpolsky, Alisa; Dagum, Alexander B; Sayeed, Syed M; Romeiser, Jamie L; Rosenfeld, Elisheva A; Conkling, Nicole

2016-01-01

BACKGROUND There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources. OBJECTIVE A blinded prospective study was undertaken to assess the predictive value of physical examination findings in detecting maxillofacial fracture in trauma patients, and in determining whether a patient will require surgical intervention. METHODS Over a four-month period, the authors’ team examined patients admitted with facial trauma to the emergency department of their hospital. The evaluating physician completed a standardized physical examination evaluation form indicating the physical findings. Corresponding CT scans and surgical records were then reviewed, and the results recorded by a plastic surgeon who was blinded to the results of the physical examination. RESULTS A total of 57 patients met the inclusion criteria; there were 44 male and 13 female patients. The sensitivity, specificity, positive predictive value and negative predictive value of grouped physical examination findings were determined in major areas. In further analysis, specific examination findings with n≥9 (15%) were also reported. CONCLUSIONS The data demonstrated a high negative predictive value of at least 90% for orbital floor, zygomatic, mandibular and nasal bone fractures compared with CT scan. Furthermore, none of the patients who did not have a physical examination finding for a particular facial fracture required surgery for that fracture. Thus, the instrument performed well at ruling out fractures in these areas when there were none. Ultimately, these results may help reduce unnecessary radiation and costly imaging in patients with facial trauma without

A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value.

PubMed

Timashpolsky, Alisa; Dagum, Alexander B; Sayeed, Syed M; Romeiser, Jamie L; Rosenfeld, Elisheva A; Conkling, Nicole

2016-01-01

There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources. A blinded prospective study was undertaken to assess the predictive value of physical examination findings in detecting maxillofacial fracture in trauma patients, and in determining whether a patient will require surgical intervention. Over a four-month period, the authors' team examined patients admitted with facial trauma to the emergency department of their hospital. The evaluating physician completed a standardized physical examination evaluation form indicating the physical findings. Corresponding CT scans and surgical records were then reviewed, and the results recorded by a plastic surgeon who was blinded to the results of the physical examination. A total of 57 patients met the inclusion criteria; there were 44 male and 13 female patients. The sensitivity, specificity, positive predictive value and negative predictive value of grouped physical examination findings were determined in major areas. In further analysis, specific examination findings with n≥9 (15%) were also reported. The data demonstrated a high negative predictive value of at least 90% for orbital floor, zygomatic, mandibular and nasal bone fractures compared with CT scan. Furthermore, none of the patients who did not have a physical examination finding for a particular facial fracture required surgery for that fracture. Thus, the instrument performed well at ruling out fractures in these areas when there were none. Ultimately, these results may help reduce unnecessary radiation and costly imaging in patients with facial trauma without facial fractures.

Human Facial Expressions as Adaptations:Evolutionary Questions in Facial Expression Research

PubMed Central

SCHMIDT, KAREN L.; COHN, JEFFREY F.

2007-01-01

The importance of the face in social interaction and social intelligence is widely recognized in anthropology. Yet the adaptive functions of human facial expression remain largely unknown. An evolutionary model of human facial expression as behavioral adaptation can be constructed, given the current knowledge of the phenotypic variation, ecological contexts, and fitness consequences of facial behavior. Studies of facial expression are available, but results are not typically framed in an evolutionary perspective. This review identifies the relevant physical phenomena of facial expression and integrates the study of this behavior with the anthropological study of communication and sociality in general. Anthropological issues with relevance to the evolutionary study of facial expression include: facial expressions as coordinated, stereotyped behavioral phenotypes, the unique contexts and functions of different facial expressions, the relationship of facial expression to speech, the value of facial expressions as signals, and the relationship of facial expression to social intelligence in humans and in nonhuman primates. Human smiling is used as an example of adaptation, and testable hypotheses concerning the human smile, as well as other expressions, are proposed. PMID:11786989

Misinterpretation of facial expression: a cross-cultural study.

PubMed

Shioiri, T; Someya, T; Helmeste, D; Tang, S W

1999-02-01

Accurately recognizing facial emotional expressions is important in psychiatrist-versus-patient interactions. This might be difficult when the physician and patients are from different cultures. More than two decades of research on facial expressions have documented the universality of the emotions of anger, contempt, disgust, fear, happiness, sadness, and surprise. In contrast, some research data supported the concept that there are significant cultural differences in the judgment of emotion. In this pilot study, the recognition of emotional facial expressions in 123 Japanese subjects was evaluated using the Japanese and Caucasian Facial Expression of Emotion (JACFEE) photos. The results indicated that Japanese subjects experienced difficulties in recognizing some emotional facial expressions and misunderstood others as depicted by the posers, when compared to previous studies using American subjects. Interestingly, the sex and cultural background of the poser did not appear to influence the accuracy of recognition. The data suggest that in this young Japanese sample, judgment of certain emotional facial expressions was significantly different from the Americans. Further exploration in this area is warranted due to its importance in cross-cultural clinician-patient interactions.

Optimising ballistic facial coverage from military fragmenting munitions: a consensus statement.

PubMed

Breeze, J; Tong, D C; Powers, D; Martin, N A; Monaghan, A M; Evriviades, D; Combes, J; Lawton, G; Taylor, C; Kay, A; Baden, J; Reed, B; MacKenzie, N; Gibbons, A J; Heppell, S; Rickard, R F

2017-02-01

VIRTUS is the first United Kingdom (UK) military personal armour system to provide components that are capable of protecting the whole face from low velocity ballistic projectiles. Protection is modular, using a helmet worn with ballistic eyewear, a visor, and a mandibular guard. When all four components are worn together the face is completely covered, but the heat, discomfort, and weight may not be optimal in all types of combat. We organized a Delphi consensus group analysis with 29 military consultant surgeons from the UK, United States, Canada, Australia, and New Zealand to identify a potential hierarchy of functional facial units in order of importance that require protection. We identified the causes of those facial injuries that are hardest to reconstruct, and the most effective combinations of facial protection. Protection is required from both penetrating projectiles and burns. There was strong consensus that blunt injury to the facial skeleton was currently not a military priority. Functional units that should be prioritised are eyes and eyelids, followed consecutively by the nose, lips, and ears. Twenty-nine respondents felt that the visor was more important than the mandibular guard if only one piece was to be worn. Essential cover of the brain and eyes is achieved from all directions using a combination of helmet and visor. Nasal cover currently requires the mandibular guard unless the visor can be modified to cover it as well. Any such prototype would need extensive ergonomics and assessment of integration, as any changes would have to be acceptable to the people who wear them in the long term. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Effect of Restraining Devices on Facial Fractures in Motor Vehicle Collisions.

PubMed

Hwang, Kun; Kim, Joo Ho

2015-09-01

The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on facial fractures in motor vehicle collisions (MVCs).In a PubMed search, the search terms "facial bone fracture and seat belt," "facial bone fracture and air bag," and "facial bone fracture and restraining" were used. The authors abstracted the odds ratio (OR) and 95% confidence intervals (CIs) from each study. Weighted mean differences and 95% CIs were also calculated. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).The authors found 30 potentially relevant articles, of which 6 articles met our inclusion criteria. Five studies were subgrouped, and a meta-analysis of these data suggested beneficial effects of seat belts on decreasing facial fractures in MVCs (n = 15,768,960, OR, 0.46, 95% CI = 0.35-0.60). Three studies were subgrouped, and a meta-analysis of these data suggested that there were beneficial effects of seat belts and air bags on decreasing facial fractures in MVCs (n = 15,768,021, OR, 0.59, 95% CI = 0.47-0.74). Four studies were subgrouped, and a meta-analysis of these data suggested there were no significant effects of an air bag on decreasing facial fracture in MVCs (n = 15,932,259, OR, 1.00, 95% CI = 0.72-1.39).A seat belt alone (OR, 0.46) or a seat belt and an air bag (OR, 0.59) were effective to decrease facial fractures in MVCs. However, air bags alone had no significant effect (OR, 1.00). In using air bags, seat belt should be applied together to prevent facial fractures in motor vehicle injuries.

The role of great auricular-facial nerve neurorrhaphy in facial nerve damage

PubMed Central

Sun, Yan; Liu, Limei; Han, Yuechen; Xu, Lei; Zhang, Daogong; Wang, Haibo

2015-01-01

Background: Facial nerve is easy to be damaged, and there are many reconstructive methods for facial nerve reconstructive, such as facial nerve end to end anastomosis, the great auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. However, there is still little study about great auricular-facial nerve neurorrhaphy. The aim of the present study was to identify the role of great auricular-facial nerve neurorrhaphy and the mechanism. Methods: Rat models of facial nerve cut (FC), facial nerve end to end anastomosis (FF), facial-great auricular neurorrhaphy (FG), and control (Ctrl) were established. Apex nasi amesiality observation, electrophysiology and immunofluorescence assays were employed to investigate the function and mechanism. Results: In apex nasi amesiality observation, it was found apex nasi amesiality of FG group was partly recovered. Additionally, electrophysiology and immunofluorescence assays revealed that facial-great auricular neurorrhaphy could transfer nerve impulse and express AChR which was better than facial nerve cut and worse than facial nerve end to end anastomosis. Conclusions: The present study indicated that great auricular-facial nerve neurorrhaphy is a substantial solution for facial lesion repair, as it is efficiently preventing facial muscles atrophy by generating neurotransmitter like ACh. PMID:26550216

Influence of gravity upon some facial signs.

PubMed

Flament, F; Bazin, R; Piot, B

2015-06-01

Facial clinical signs and their integration are the basis of perception than others could have from ourselves, noticeably the age they imagine we are. Facial modifications in motion and their objective measurements before and after application of skin regimen are essential to go further in evaluation capacities to describe efficacy in facial dynamics. Quantification of facial modifications vis à vis gravity will allow us to answer about 'control' of facial shape in daily activities. Standardized photographs of the faces of 30 Caucasian female subjects of various ages (24-73 year) were successively taken at upright and supine positions within a short time interval. All these pictures were therefore reframed - any bias due to facial features was avoided when evaluating one single sign - for clinical quotation by trained experts of several facial signs regarding published standardized photographic scales. For all subjects, the supine position increased facial width but not height, giving a more fuller appearance to the face. More importantly, the supine position changed the severity of facial ageing features (e.g. wrinkles) compared to an upright position and whether these features were attenuated or exacerbated depended on their facial location. Supine station mostly modifies signs of the lower half of the face whereas those of the upper half appear unchanged or slightly accentuated. These changes appear much more marked in the older groups, where some deep labial folds almost vanish. These alterations decreased the perceived ages of the subjects by an average of 3.8 years. Although preliminary, this study suggests that a 90° rotation of the facial skin vis à vis gravity induces rapid rearrangements among which changes in tensional forces within and across the face, motility of interstitial free water among underlying skin tissue and/or alterations of facial Langer lines, likely play a significant role. © 2015 Society of Cosmetic Scientists and the Société Fran

Risk factors for unintentional injuries due to falls in children aged 0–6 years: a systematic review

PubMed Central

Khambalia, A; Joshi, P; Brussoni, M; Raina, P; Morrongiello, B; Macarthur, C

2006-01-01

Objective To identify risk factors for unintentional injuries due to falls in children aged 0–6 years. Design A systematic review of the literature. Methods Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0–6 years and included a comparison group. Results 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. Conclusion Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0–6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children. PMID:17170185

Experience-based human perception of facial expressions in Barbary macaques (Macaca sylvanus)

PubMed Central

Levy, Xandria; Meints, Kerstin; Majolo, Bonaventura

2017-01-01

Background Facial expressions convey key cues of human emotions, and may also be important for interspecies interactions. The universality hypothesis suggests that six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) should be expressed by similar facial expressions in close phylogenetic species such as humans and nonhuman primates. However, some facial expressions have been shown to differ in meaning between humans and nonhuman primates like macaques. This ambiguity in signalling emotion can lead to an increased risk of aggression and injuries for both humans and animals. This raises serious concerns for activities such as wildlife tourism where humans closely interact with wild animals. Understanding what factors (i.e., experience and type of emotion) affect ability to recognise emotional state of nonhuman primates, based on their facial expressions, can enable us to test the validity of the universality hypothesis, as well as reduce the risk of aggression and potential injuries in wildlife tourism. Methods The present study investigated whether different levels of experience of Barbary macaques, Macaca sylvanus, affect the ability to correctly assess different facial expressions related to aggressive, distressed, friendly or neutral states, using an online questionnaire. Participants’ level of experience was defined as either: (1) naïve: never worked with nonhuman primates and never or rarely encountered live Barbary macaques; (2) exposed: shown pictures of the different Barbary macaques’ facial expressions along with the description and the corresponding emotion prior to undertaking the questionnaire; (3) expert: worked with Barbary macaques for at least two months. Results Experience with Barbary macaques was associated with better performance in judging their emotional state. Simple exposure to pictures of macaques’ facial expressions improved the ability of inexperienced participants to better discriminate neutral and distressed

Experience-based human perception of facial expressions in Barbary macaques (Macaca sylvanus).

PubMed

Maréchal, Laëtitia; Levy, Xandria; Meints, Kerstin; Majolo, Bonaventura

2017-01-01

Facial expressions convey key cues of human emotions, and may also be important for interspecies interactions. The universality hypothesis suggests that six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) should be expressed by similar facial expressions in close phylogenetic species such as humans and nonhuman primates. However, some facial expressions have been shown to differ in meaning between humans and nonhuman primates like macaques. This ambiguity in signalling emotion can lead to an increased risk of aggression and injuries for both humans and animals. This raises serious concerns for activities such as wildlife tourism where humans closely interact with wild animals. Understanding what factors (i.e., experience and type of emotion) affect ability to recognise emotional state of nonhuman primates, based on their facial expressions, can enable us to test the validity of the universality hypothesis, as well as reduce the risk of aggression and potential injuries in wildlife tourism. The present study investigated whether different levels of experience of Barbary macaques, Macaca sylvanus , affect the ability to correctly assess different facial expressions related to aggressive, distressed, friendly or neutral states, using an online questionnaire. Participants' level of experience was defined as either: (1) naïve: never worked with nonhuman primates and never or rarely encountered live Barbary macaques; (2) exposed: shown pictures of the different Barbary macaques' facial expressions along with the description and the corresponding emotion prior to undertaking the questionnaire; (3) expert: worked with Barbary macaques for at least two months. Experience with Barbary macaques was associated with better performance in judging their emotional state. Simple exposure to pictures of macaques' facial expressions improved the ability of inexperienced participants to better discriminate neutral and distressed faces, and a trend was found

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space.

PubMed

Bector, Aditi; Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-11-05

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents.

Facial burns from exploding microwaved foods: Case series and review.

PubMed

Bagirathan, Shenbana; Rao, Krishna; Al-Benna, Sammy; O'Boyle, Ciaran P

2016-03-01

Microwave ovens allow for quick and simple cooking. However, the importance of adequate food preparation, prior to microwave cooking, and the consequences of inadequate preparation are not well-known. The authors conducted a retrospective outcome analysis of all patients who sustained facial burns from microwaved foods and were treated at a UK regional burns unit over a six-year period. Patients were identified from clinical records. Eight patients presented following inadequate preparation of either tinned potatoes (n=4) or eggs (n=4). All patients sustained <2% total body surface area facial burns. Mean age was 41 years (range 21-68 years). Six cases (75%) had associated ocular injury. One received amniotic membrane grafts; this individual's vision remains poor twelve months after injury. Rapid dielectric heating of water within foods may produce high steam and vapour pressure gradients and cause explosive decompression [1,5,11]. Consumers may fail to recognise differential heating and simply cook foods for longer if they remain cool on the outer surface. Education on safe use and risks of microwave-cooked foods may help prevent these potentially serious injuries. Microwave ovens have become ubiquitous. The authors recognise the need for improved public awareness of safe microwave cooking. Burns resulting from microwave-cooked foods may have life-changing consequences. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Easy facial analysis using the facial golden mask.

PubMed

Kim, Yong-Ha

2007-05-01

For over 2000 years, many artists and scientists have tried to understand or quantify the form of the perfect, ideal, or most beautiful face both in art and in vivo (life). A mathematical relationship has been consistently and repeatedly reported to be present in beautiful things. This particular relationship is the golden ratio. It is a mathematical ratio of 1.618:1 that seems to appear recurrently in beautiful things in nature as well as in other things that are seen as beautiful. Dr. Marquardt made the facial golden mask that contains and includes all of the one-dimensional and two-dimensional geometric golden elements formed from the golden ratio. The purpose of this study is to evaluate the usefulness of the golden facial mask. In 40 cases, the authors applied the facial golden mask to preoperative and postoperative photographs and scored each photograph on a 1 to 5 scale from the perspective of their personal aesthetic views. The score was lower when the facial deformity was severe, whereas it was higher when the face was attractive. Compared with the average scores of facial mask applied photographs and nonapplied photographs using a nonparametric test, statistical significance was not reached (P > 0.05). This implies that the facial golden mask may be used as an analytical tool. The facial golden mask is easy to apply, inexpensive, and relatively objective. Therefore, the authors introduce it as a useful facial analysis.

Decoding facial expressions based on face-selective and motion-sensitive areas.

PubMed

Liang, Yin; Liu, Baolin; Xu, Junhai; Zhang, Gaoyan; Li, Xianglin; Wang, Peiyuan; Wang, Bin

2017-06-01

Humans can easily recognize others' facial expressions. Among the brain substrates that enable this ability, considerable attention has been paid to face-selective areas; in contrast, whether motion-sensitive areas, which clearly exhibit sensitivity to facial movements, are involved in facial expression recognition remained unclear. The present functional magnetic resonance imaging (fMRI) study used multi-voxel pattern analysis (MVPA) to explore facial expression decoding in both face-selective and motion-sensitive areas. In a block design experiment, participants viewed facial expressions of six basic emotions (anger, disgust, fear, joy, sadness, and surprise) in images, videos, and eyes-obscured videos. Due to the use of multiple stimulus types, the impacts of facial motion and eye-related information on facial expression decoding were also examined. It was found that motion-sensitive areas showed significant responses to emotional expressions and that dynamic expressions could be successfully decoded in both face-selective and motion-sensitive areas. Compared with static stimuli, dynamic expressions elicited consistently higher neural responses and decoding performance in all regions. A significant decrease in both activation and decoding accuracy due to the absence of eye-related information was also observed. Overall, the findings showed that emotional expressions are represented in motion-sensitive areas in addition to conventional face-selective areas, suggesting that motion-sensitive regions may also effectively contribute to facial expression recognition. The results also suggested that facial motion and eye-related information played important roles by carrying considerable expression information that could facilitate facial expression recognition. Hum Brain Mapp 38:3113-3125, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Intraoperative identification of the facial nerve by needle electromyography stimulation with a burr

PubMed Central

KHAMGUSHKEEVA, N.N.; ANIKIN, I.A.; KORNEYENKOV, A.A.

2016-01-01

The purpose of this research is to improve the safety of surgery for patients with a pathology of the middle and inner ear by preventing damage to the facial nerve by conducting intraoperative monitoring of the facial nerve by needle electromyography with continuous stimulation with a burr. Patients and Methods The clinical part of the prospective study was carried out on 48 patients that were diagnosed with suppurative otitis media. After the surgery with intraoperative monitoring, the facial nerve with an intact bone wall was stimulated electrically in the potentially dangerous places of damage. Minimum (threshold) stimulation (mA) of the facial nerve with a threshold event of 100 μV was used to register EMG events. The anatomical part of the study was carried out on 30 unformalinized cadaver temporal bones from adult bodies. The statistical analysis of obtained data was carried out with parametric methods (Student’s t-test), non-parametric correlation (Spearman’s method) and regression analysis. Results It was found that 1 mA of threshold amperage corresponded to 0.8 mm thickness of the bone wall of the facial canal. Values of transosseous threshold stimulation in potentially dangerous sections of the injury to the facial nerve were obtained. Conclusion These data lower the risk of paresis (paralysis) of the facial muscles during otologic surgery. PMID:27142821

Selective stimulation of facial muscles with a penetrating electrode array in the feline model

PubMed Central

Sahyouni, Ronald; Bhatt, Jay; Djalilian, Hamid R.; Tang, William C.; Middlebrooks, John C.; Lin, Harrison W.

2017-01-01

Objective Permanent facial nerve injury is a difficult challenge for both patients and physicians given its potential for debilitating functional, cosmetic, and psychological sequelae. Although current surgical interventions have provided considerable advancements in facial nerve rehabilitation, they often fail to fully address all impairments. We aim to introduce an alternative approach to facial nerve rehabilitation. Study design Acute experiments in animals with normal facial function. Methods The study included three anesthetized cats. Four facial muscles (levator auris longus, orbicularis oculi, nasalis, and orbicularis oris) were monitored with a standard electromyographic (EMG) facial nerve monitoring system with needle electrodes. The main trunk of the facial nerve was exposed and a 16-channel penetrating electrode array was placed into the nerve. Electrical current pulses were delivered to each stimulating electrode individually. Elicited EMG voltage outputs were recorded for each muscle. Results Stimulation through individual channels selectively activated restricted nerve populations, resulting in selective contraction of individual muscles. Increasing stimulation current levels resulted in increasing EMG voltage responses. Typically, selective activation of two or more distinct muscles was successfully achieved via a single placement of the multi-channel electrode array by selection of appropriate stimulation channels. Conclusion We have established in the animal model the ability of a penetrating electrode array to selectively stimulate restricted fiber populations within the facial nerve and to selectively elicit contractions in specific muscles and regions of the face. These results show promise for the development of a facial nerve implant system. PMID:27312936

Microsurgical dissection of facial nerve in parotidectomy: a discussion of techniques and long-term results

PubMed Central

Nicoli, Fabio; D’Ambrosia, Christopher; Lazzeri, Davide; Orfaniotis, Georgios; Ciudad, Pedro; Maruccia, Michele; Shiun, Li Tzong; Sacak, Bulent; Chen, Shih-Heng

2017-01-01

Background Parotidectomy has well-documented post-operative complications. Dissection of the facial nerve branches can be challenging even under loupe magnification, and partial, or complete injury of the nerve branches can occur during surgery. To reduce this risk and the associated complications, we propose a number of microsurgical best practices, which can be performed during parotidectomy. Methods A retrospective survey was conducted on 109 patients (45 males and 64 females, average age 46.2 years, range of 6 to 74 years) who underwent parotidectomy in two different institutions. Results Our data showed no permanent injury to the facial nerve, and 17% of neuroapraxia that had resolved with time. Post-operative complications have occurred in 33 cases (30% rate). In the superficial parotidectomy cohort (78 patients), the number of complications was 17 (21%). In the total parotidectomy cohort (31 patients), the number of complications was 16 (51%). Conclusions Based on our results, we believe that the use of microsurgical techniques during parotidectomy may represent a useful tool in improving accuracy and minimising local tissue trauma that can affect nerve recovery. This is particularly true in situations such as tumor recurrence, tissue fibrosis or in case of sizeable tumors around the facial nerve branches. We believe that the decreased risk of facial nerve post-operative symptoms outweigh the disadvantage of increased operative time of this procedure. PMID:28861369

38 CFR 3.310 - Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (Authority: 38 U.S.C. 1110 and 1131) (c) Cardiovascular disease. Ischemic heart disease or other... proximately due to, or aggravated by, service-connected disease or injury. 3.310 Section 3.310 Pensions... are proximately due to, or aggravated by, service-connected disease or injury. (a) General. Except as...

38 CFR 3.310 - Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... (Authority: 38 U.S.C. 1110 and 1131) (c) Cardiovascular disease. Ischemic heart disease or other... proximately due to, or aggravated by, service-connected disease or injury. 3.310 Section 3.310 Pensions... are proximately due to, or aggravated by, service-connected disease or injury. (a) General. Except as...

Reproducibility of the dynamics of facial expressions in unilateral facial palsy.

PubMed

Alagha, M A; Ju, X; Morley, S; Ayoub, A

2018-02-01

The aim of this study was to assess the reproducibility of non-verbal facial expressions in unilateral facial paralysis using dynamic four-dimensional (4D) imaging. The Di4D system was used to record five facial expressions of 20 adult patients. The system captured 60 three-dimensional (3D) images per second; each facial expression took 3-4seconds which was recorded in real time. Thus a set of 180 3D facial images was generated for each expression. The procedure was repeated after 30min to assess the reproducibility of the expressions. A mathematical facial mesh consisting of thousands of quasi-point 'vertices' was conformed to the face in order to determine the morphological characteristics in a comprehensive manner. The vertices were tracked throughout the sequence of the 180 images. Five key 3D facial frames from each sequence of images were analyzed. Comparisons were made between the first and second capture of each facial expression to assess the reproducibility of facial movements. Corresponding images were aligned using partial Procrustes analysis, and the root mean square distance between them was calculated and analyzed statistically (paired Student t-test, P<0.05). Facial expressions of lip purse, cheek puff, and raising of eyebrows were reproducible. Facial expressions of maximum smile and forceful eye closure were not reproducible. The limited coordination of various groups of facial muscles contributed to the lack of reproducibility of these facial expressions. 4D imaging is a useful clinical tool for the assessment of facial expressions. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Neurophysiological mechanism of possibly confounding peripheral activation of the facial nerve during corticobulbar tract monitoring.

PubMed

Téllez, Maria J; Ulkatan, Sedat; Urriza, Javier; Arranz-Arranz, Beatriz; Deletis, Vedran

2016-02-01

To improve the recognition and possibly prevent confounding peripheral activation of the facial nerve caused by leaking transcranial electrical stimulation (TES) current during corticobulbar tract monitoring. We applied a single stimulus and a short train of electrical stimuli directly to the extracranial portion of the facial nerve. We compared the peripherally elicited compound muscle action potential (CMAP) of the facial nerve with the responses elicited by TES during intraoperative monitoring of the corticobulbar tract. A single stimulus applied directly to the facial nerve at subthreshold intensities did not evoke a CMAP, whereas short trains of subthreshold stimuli repeatedly evoked CMAPs. This is due to the phenomenon of sub- or near-threshold super excitability of the cranial nerve. Therefore, the facial responses evoked by short trains TES, when the leaked current reaches the facial nerve at sub- or near-threshold intensity, could lead to false interpretation. Our results revealed a potential pitfall in the current methodology for facial corticobulbar tract monitoring that is due to the activation of the facial nerve by subthreshold trains of stimuli. This study proposes a new criterion to exclude peripheral activation during corticobulbar tract monitoring. The failure to recognize and avoid facial nerve activation due to leaking current in the peripheral portion of the facial nerve during TES decreases the reliability of corticobulbar tract monitoring by increasing the possibility of false interpretation. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space

PubMed Central

Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-01-01

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents. PMID:26918101

Cognitive contributions to theory of mind ability in children with a traumatic head injury.

PubMed

Levy, Naomi Kahana; Milgram, Noach

2016-01-01

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7-13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other's characteristics based on motive and outcome, Raven's Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children - Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other's thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.

Child Deaths Due to Injury in the Four UK Countries: A Time Trends Study from 1980 to 2010

PubMed Central

Hardelid, Pia; Davey, Jonathan; Dattani, Nirupa; Gilbert, Ruth

2013-01-01

Background Injuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010. Methods We obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period. Results Child mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country. Conclusion Whilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children. PMID:23874585

Facial reconstruction – anatomical art or artistic anatomy?

PubMed Central

Wilkinson, Caroline

2010-01-01

Facial reconstruction is employed in the context of forensic investigation and for creating three-dimensional portraits of people from the past, from ancient Egyptian mummies and bog bodies to digital animations of J. S. Bach. This paper considers a facial reconstruction method (commonly known as the Manchester method) associated with the depiction and identification of the deceased from skeletal remains. Issues of artistic licence and scientific rigour, in relation to soft tissue reconstruction, anatomical variation and skeletal assessment, are discussed. The need for artistic interpretation is greatest where only skeletal material is available, particularly for the morphology of the ears and mouth, and with the skin for an ageing adult. The greatest accuracy is possible when information is available from preserved soft tissue, from a portrait, or from a pathological condition or healed injury. PMID:20447245

Computational Simulation on Facial Expressions and Experimental Tensile Strength for Silicone Rubber as Artificial Skin

NASA Astrophysics Data System (ADS)

Amijoyo Mochtar, Andi

2018-02-01

Applications of robotics have become important for human life in recent years. There are many specification of robots that have been improved and encriched with the technology advances. One of them are humanoid robot with facial expression which closer with the human facial expression naturally. The purpose of this research is to make computation on facial expressions and conduct the tensile strength for silicone rubber as artificial skin. Facial expressions were calculated by determining dimension, material properties, number of node elements, boundary condition, force condition, and analysis type. A Facial expression robot is determined by the direction and the magnitude external force on the driven point. The expression face of robot is identical with the human facial expression where the muscle structure in face according to the human face anatomy. For developing facial expression robots, facial action coding system (FACS) in approached due to follow expression human. The tensile strength is conducting due to check the proportional force of artificial skin that can be applied on the future of robot facial expression. Combining of calculated and experimental results can generate reliable and sustainable robot facial expression that using silicone rubber as artificial skin.

Possible gasoline-induced chronic liver injury due to occupational malpractice in a motor mechanic: a case report.

PubMed

Gunathilaka, Mahesh Lakmal; Niriella, Madunil Anuk; Luke, Nathasha Vihangi; Piyarathna, Chathura Lakmal; Siriwardena, Rohan Chaminda; De Silva, Arjuna Priyadarshin; de Silva, Hithanadura Janaka

2017-07-03

Hydrocarbon-induced occupational liver injury is a well-known clinical entity among petroleum industry workers. There are many types of hydrocarbon exposure, with inhalation being the most common. Hydrocarbon-induced occupational liver injury is a rarely suspected and commonly missed etiological agent for liver injury. We report a case of a non-petroleum industry worker with chronic liver disease secondary to hydrocarbon-induced occupational liver injury caused by chronic low-grade hydrocarbon ingestion due to occupational malpractice. A 23-year-old Sri Lankan man who was a motor mechanic presented to our hospital with decompensated cirrhosis. He had been chronically exposed to gasoline via inadvertent ingestion due to occupational malpractice. He used to remove gasoline from carburetors by sucking and failed to practice mouth washing thereafter. On evaluation, he had histologically proven established cirrhosis. A comprehensive history and workup ruled out other nonoccupational etiologies for cirrhosis. The patient's long-term occupational gasoline exposure and clinical course led us to a diagnosis of hydrocarbon-induced occupational liver injury leading to decompensated cirrhosis. Hydrocarbon-induced occupational liver injury should be considered as a cause when evaluating a patient with liver injury with possible exposure in relevant occupations.

Mechanisms and Mitigation of Head and Spinal Injuries Due to Motor Vehicle Crashes.

PubMed

Ivancic, Paul C

2016-10-01

Synopsis Head and spinal injuries commonly occur during motor vehicle crashes (MVCs). The goal of this clinical commentary is to discuss real-life versus simulated MVCs and to present clinical, biomechanical, and epidemiological evidence of MVC-related injury mechanisms. It will also address how this knowledge may guide and inform the design of injury mitigation devices and assist in clinical decision making. Evidence indicates that there exists no universal injury tolerance applicable to the entire population of the occupants of MVCs. Injuries sustained by occupants depend on a number of factors, including occupant characteristics (age, height, weight, sex, bone mineral density, and pre-existing medical and musculoskeletal conditions), pre-MVC factors (awareness of the impending crash, occupant position, usage of and position of the seatbelt and head restraint, and vehicle specifications), and MVC-related factors (crash orientation, vehicle dynamics, type of active or passive safety systems, and occupant kinematic response). Injuries resulting from an MVC occur due to blunt impact and/or inertial loading. An S-shaped curvature of the cervical spine and associated injurious strains have been documented during rear-, frontal-, and side-impact MVCs. Data on the injury mechanism and the quantification of spinal instability guide and inform the emergent and subsequent conservative or surgical care. Such care may require determining optimal patient positioning during transport, which injuries may be treated conservatively, whether reduction should be performed, optimal patient positioning intraoperatively, and whether bracing should be worn prior to and/or following surgery. The continued improvement of traditional injury mitigation systems, such as seats, seatbelts, airbags, and head restraints, together with research of newer collision-avoidance technologies, will lead to safer motor vehicles and ultimately more effective injury management strategies. J Orthop Sports

Ethnic and Gender Considerations in the Use of Facial Injectables: Asian Patients.

PubMed

Liew, Steven

2015-11-01

Asians have distinct facial characteristics due to underlying skeletal and morphological features that differ greatly with those of whites. This together with the higher sun protection factor and the differences in the quality of the skin and soft tissue create a profound effect on their aging process. Understanding of these differences and their effects in the aging process in Asians is crucial in determining effective utilization and placement of injectable products to ensure optimal aesthetic outcomes. For younger Asian women, the main treatment goal is to address the inherent structural deficits through reshaping and the provision of facial support. Facial injectables are used to provide anterior projection, to reduce facial width, and to lengthen facial height. In the older group, the aim is for rejuvenation and also to address the underlying structural issues that has compounded due to age-related volume loss. Asian women requesting cosmetic procedures do not want to be Westernized but rather seeking to enhance and optimize their Asian ethnic features.

Ocular injuries due to projectile impacts.

PubMed

Scott, W R; Lloyd, W C; Benedict, J V; Meredith, R

2000-01-01

An animal model has been developed using enucleated porcine eyes to evaluate ocular trauma. The eyes were pressurized to approximately 18 mmHg and mounted in a container with a 10% gelatin mixture. The corneas of sixteen pressurized eyes were impacted by a blunt metal projectile (mass of 2.6 gm, 3.5 gm or 45.5 gm) at velocities of 4.0 to 38.1 m/s. The impacted eyes were evaluated by an ophthalmologist. A numerical classification scheme was used to categorize the severity of the ocular injury. A chi-squared test indicates that the injury level is associated with the kinetic energy (KE) and not the momentum of the projectile. The enucleated eyes began to experience lens dislocations when the KE of the projectile was approximately 0.75 Nm, and retinal injuries when the KE was approximately 1.20 Nm.

[Differences between immediate and 30-day deaths due to traffic injuries according to forensic sources].

PubMed

Barbería, Eneko; Suelves, Josep M; Xifró, Alexandre; Medallo, Jordi

2015-09-01

To study immediate (same day of the collision) and delayed (within 30 days of the collision) deaths due to traffic injuries in Catalonia (Spain) according to forensic sources and to assess the differences between the two kinds of deaths. An observational study was conducted of all the traffic accident deaths registered in the Institute of Legal Medicine of Catalonia between January 1(st) 2005 and December 31(st) 2014. Data analysis was performed using the SPSS v.18.0 statistical package. Comparisons of proportions were based on the χ(2) test. During the study period, 4044 deaths due to traffic injuries were recorded. Deaths within 30 days included more women, minors, elderly people, and pedestrians than immediate deaths. Traffic injury deaths in the 30 days following a crash differ from immediate deaths. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

The effect of methylprednisolone on facial nerve paralysis with different etiologies.

PubMed

Yildirim, Mehmet Akif; Karlidag, Turgut; Akpolat, Nusret; Kaygusuz, Irfan; Keles, Erol; Yalcin, Sinasi; Akyigit, Abdulvahap

2015-05-01

The objective of this study was to evaluate the effectiveness of methylprednisolone (MP) in models of facial nerve paralysis obtained by nerve section, compression, or inoculation with herpes simplex virus (HSV). Experimental controlled animal study. Tertiary referral center. A total of 30 female New Zealand rabbits weighing 1200-3000 g were used for the study. They were randomly assigned to one of 6 groups of 5 animals each. A nerve section injury was realized in Groups 1a (section and MP) and 1b (section, control) rabbits. A compression-type injury was inflicted to rabbits in Groups 2a (compression and MP) and 2b (compression, control). As for animals in Groups 3a (Type 1 HSV and MP) and 3b (Type 1 HSV, controls), facial nerve paralysis resulting from viral infection was obtained. Animals in the 3 treatment groups, designated with the letter "a", were administered MP, 1 mg/kg/d, whereas those in control groups "b" received 1 mL normal saline, both during 3 weeks. All subjects were followed up for 2 months. At the end of this period, all animals had the buccal branch of the facial nerve excised on the operated side. Semi-thin sections of these specimens were evaluated under light microscopy for the following: perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, Schwann cell proliferation, and edema. No significant difference was observed (P > 0.05) between the MP treatment group and the control group with regard to perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, edema, or Schwann cell proliferation. In the group with a compressive lesion (Group 2), controls were no different from MP-treated animals as to perineural fibrosis, increase in collagen fibers, or Schwann cell proliferation, whereas axonal degeneration, myelin degeneration, and edema were significantly higher (P < 0.05) in the control group. When comparing the treatment and control groups among the animals inoculated with

Facial trauma in the Trojan War.

PubMed

Ralli, Ioanna; Stathopoulos, Panagiotis; Mourouzis, Konstantinos; Piagkou, Mara; Rallis, George

2015-06-01

The Iliad and Odyssey of Homer represent the cornerstones of classical Greek literature and subsequently the foundations of literature of the Western civilization. The Iliad, particularly, is the most famous and influential epic poem ever conceived and is considered to be the most prominent and representative work of the ancient Greek epic poetry. We present the injuries that involve the face, mentioned so vividly in the Iliad, and discuss the aetiology of their extraordinary mortality rate. We recorded the references of the injuries, the attacker and defender involved, the weapons that were used, the site and the result of the injury. The face was involved in 21 trauma cases. The frontal area was traumatized in 7 cases; the oral cavity in 6; the auricular area in 4; the orbits and the retromandibular area in 3; the mandible and the nose in 2; and the maxilla, the submental and the buccal area in 1, respectively. The mortality rate concerning the facial injuries reaches 100%. Homer's literate dexterity, charisma and his unique aptitude in the narration of the events of the Trojan War have established him as the greatest epic poet. We consider the study of these vibrantly described events to be recreational and entertaining for everyone but especially for a surgeon.

Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury

PubMed Central

Yumoto, Tetsuya; Kondo, Yoshitaka; Kumon, Kento; Masaoka, Yoshihisa; Hiraki, Takao; Yamada, Taihei; Naito, Hiromichi; Nakao, Atsunori

2018-01-01

Abstract Rationale: Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. Patient concerns: A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. Diagnoses: CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. Interventions: Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. Outcomes: His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. Lessons: Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury. PMID:29879068

Spinal cord injuries due to close combat weapons.

PubMed

Fares, Youssef H; Fares, Jawad Y; Gebeily, Souheil E; Khazim, Rabi M

2013-10-01

A 17-year-old patient was aggressively attacked and stabbed in the dorsal region of his back by a knife. He was admitted to the emergency room of the Hammoud Hospital University Medical Center, Saida, Lebanon lying in the prone position. The neurological examination revealed that the stabbing object was fixed at the dorsal spine level at the T-7 level, where it was inserted inside the vertebral body. Luckily, the blade of the knife was parallel to the nervous tracts of the spinal cord; thus, he showed no neurological deficits. This case provides an overview of how neurosurgical principles can be applied to trauma patients with spine injuries due to close combat weapons.

Facial neuropathy with imaging enhancement of the facial nerve: a case report

PubMed Central

Mumtaz, Sehreen; Jensen, Matthew B

2014-01-01

A young women developed unilateral facial neuropathy 2 weeks after a motor vehicle collision involving fractures of the skull and mandible. MRI showed contrast enhancement of the facial nerve. We review the literature describing facial neuropathy after trauma and facial nerve enhancement patterns with different causes of facial neuropathy. PMID:25574155

Measuring Facial Movement

ERIC Educational Resources Information Center

Ekman, Paul; Friesen, Wallace V.

1976-01-01

The Facial Action Code (FAC) was derived from an analysis of the anatomical basis of facial movement. The development of the method is explained, contrasting it to other methods of measuring facial behavior. An example of how facial behavior is measured is provided, and ideas about research applications are discussed. (Author)

Effect of a Facial Muscle Exercise Device on Facial Rejuvenation

PubMed Central

Hwang, Ui-jae; Kwon, Oh-yun; Jung, Sung-hoon; Ahn, Sun-hee; Gwak, Gyeong-tae

2018-01-01

Abstract Background The efficacy of facial muscle exercises (FMEs) for facial rejuvenation is controversial. In the majority of previous studies, nonquantitative assessment tools were used to assess the benefits of FMEs. Objectives This study examined the effectiveness of FMEs using a Pao (MTG, Nagoya, Japan) device to quantify facial rejuvenation. Methods Fifty females were asked to perform FMEs using a Pao device for 30 seconds twice a day for 8 weeks. Facial muscle thickness and cross-sectional area were measured sonographically. Facial surface distance, surface area, and volumes were determined using a laser scanning system before and after FME. Facial muscle thickness, cross-sectional area, midfacial surface distances, jawline surface distance, and lower facial surface area and volume were compared bilaterally before and after FME using a paired Student t test. Results The cross-sectional areas of the zygomaticus major and digastric muscles increased significantly (right: P < 0.001, left: P = 0.015), while the midfacial surface distances in the middle (right: P = 0.005, left: P = 0.047) and lower (right: P = 0.028, left: P = 0.019) planes as well as the jawline surface distances (right: P = 0.004, left: P = 0.003) decreased significantly after FME using the Pao device. The lower facial surface areas (right: P = 0.005, left: P = 0.006) and volumes (right: P = 0.001, left: P = 0.002) were also significantly reduced after FME using the Pao device. Conclusions FME using the Pao device can increase facial muscle thickness and cross-sectional area, thus contributing to facial rejuvenation. Level of Evidence: 4 PMID:29365050

Rare and Severe Maxillofacial Injury Due to Tear Gas Capsules: Report of Three Cases.

PubMed

Çorbacɩoğlu, Şeref Kerem; Güler, Sertaç; Er, Erhan; Seviner, Meltem; Aslan, Şahin; Aksel, Gökhan

2016-03-01

Tear gases are used by police or armed forces for control of riots or social events or by the general population for private self-defense. These agents are used widely throughout the world, but some harmful effects have reported. In addition, despite well-defined chemical side effects documented in the literature, data are insufficient regarding mechanical injury due to tear gas capsules. We report three cases of severe maxillofacial injury in patients who had these capsules fired from tear gas guns directly to their faces. The capsules penetrated the patients' faces, causing potentially fatal injuries. To our knowledge, reports of this kind of injury related to tear gas capsules are very rare in the literature. In conclusion, tear gas guns may be very dangerous in terms of human health and they may cause severe injuries, especially when they are not used according to strict guidelines. © 2015 American Academy of Forensic Sciences.

Ocular Injuries Due to Projectile Impacts

PubMed Central

(Michael) Scott, William R.; Lloyd, William C.; Benedict, James V.; Meredith, Roy

2000-01-01

An animal model has been developed using enucleated porcine eyes to evaluate ocular trauma. The eyes were pressurized to approximately 18mmHg and mounted in a container with a 10% gelatin mixture. The corneas of sixteen pressurized eyes were impacted by a blunt metal projectile (mass of 2.6gm, 3.5gm or 45.5gm) at velocities of 4.0 to 38.1 m/s. The impacted eyes were evaluated by an ophthalmologist. A numerical classification scheme was used to categorize the severity of the ocular injury. A chi-squared test indicates that the injury level is associated with the kinetic energy (KE) and not the momentum of the projectile. The enucleated eyes began to experience lens dislocations when the KE of the projectile was approximately 0.75Nm, and retinal injuries when the KE was approximately 1.20Nm. PMID:11558084

Safety of definitive in-theater repair of facial fractures.

PubMed

Lopez, Manuel A; Arnholt, Jonathan L

2007-01-01

To determine the safety of definitive in-theater facial fracture repair on American military personnel wounded during Operation Iraqi Freedom. A retrospective review of all patients with head and neck trauma treated at the 322nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq, from May 7, 2005, through September 18, 2005, was performed. This study focused on the outcomes of wounded American military personnel whose facial fractures were definitively repaired in theater. The criteria used to determine candidacy for definitive in-theater facial fracture repair on American military personnel were (1) the fracture site was exposed through either a soft tissue wound or because of an adjacent surgical approach, (2) treatment would not delay evacuation from theater, and (3) treatment would allow the military member to remain in theater. From May 2005 to September 2005, 207 patients were taken to the operating room and required 388 procedures. A total of 175 patients (85%) were operated on for traumatic injuries, and 52 of these patients required open reduction and internal fixation (ORIF) of a facial fracture. Of the 52 patients who underwent an ORIF, 17 were American military personnel. Of the 17 American patients who were definitively treated for their facial fractures in theater, 16 were contacted and/or followed up on the global military medical database. None of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater ORIF. The range of follow-up was 2 months to 11 months, with a mean of 8.3 months. Definitive repair of facial fractures with ORIF on American military personnel in theater is advised when the aforementioned criteria are observed. An otolaryngologist is a crucial member of the head and neck trauma team.

The review and results of different methods for facial recognition

NASA Astrophysics Data System (ADS)

Le, Yifan

2017-09-01

In recent years, facial recognition draws much attention due to its wide potential applications. As a unique technology in Biometric Identification, facial recognition represents a significant improvement since it could be operated without cooperation of people under detection. Hence, facial recognition will be taken into defense system, medical detection, human behavior understanding, etc. Several theories and methods have been established to make progress in facial recognition: (1) A novel two-stage facial landmark localization method is proposed which has more accurate facial localization effect under specific database; (2) A statistical face frontalization method is proposed which outperforms state-of-the-art methods for face landmark localization; (3) It proposes a general facial landmark detection algorithm to handle images with severe occlusion and images with large head poses; (4) There are three methods proposed on Face Alignment including shape augmented regression method, pose-indexed based multi-view method and a learning based method via regressing local binary features. The aim of this paper is to analyze previous work of different aspects in facial recognition, focusing on concrete method and performance under various databases. In addition, some improvement measures and suggestions in potential applications will be put forward.

Expanded flap to repair facial scar left by radiotherapy of hemangioma.

PubMed

Zhao, Donghong; Ma, Xinrong; Li, Jiang; Zhang, Lingfeng; Zhu, Baozhen

2014-09-01

This study explored the feasibility and clinical efficacy of expanded flap to repair facial scar left by radiotherapy of hemangioma. From March 2000 to April 2011, 13 cases of facial cicatrices left by radiotherapy of hemangioma have been treated with implantation surgery of facial skin dilator under local anesthesia. After water flood expansion for 1-2 months, resection of facial scar was performed, and wound repairing with expansion flap transfer was done. Thirteen patients were followed up from 5 months to 3 years. All patients tolerated flap transfer well; no contracture occurred during the facial expansion flap transfer. The incision scar was not obvious, and its color and texture were identical to surrounding skin. In conclusion, the use of expanded flap transfer to repair the facial scar left by radiotherapy of hemangioma is advantageous due to its simplicity, flexibility, and large area of repairing. This method does not affect the subsequent facial appearance.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery

PubMed Central

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-01-01

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients’ ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. PMID:27106613

Three-dimensional assessment of facial asymmetry: A systematic review.

PubMed

Akhil, Gopi; Senthil Kumar, Kullampalayam Palanisamy; Raja, Subramani; Janardhanan, Kumaresan

2015-08-01

For patients with facial asymmetry, complete and precise diagnosis, and surgical treatments to correct the underlying cause of the asymmetry are significant. Conventional diagnostic radiographs (submento-vertex projections, posteroanterior radiography) have limitations in asymmetry diagnosis due to two-dimensional assessments of three-dimensional (3D) images. The advent of 3D images has greatly reduced the magnification and projection errors that are common in conventional radiographs making it as a precise diagnostic aid for assessment of facial asymmetry. Thus, this article attempts to review the newly introduced 3D tools in the diagnosis of more complex facial asymmetries.

Poor functional recovery and muscle polyinnervation after facial nerve injury in fibroblast growth factor-2-/- mice can be improved by manual stimulation of denervated vibrissal muscles.

PubMed

Seitz, M; Grosheva, M; Skouras, E; Angelova, S K; Ankerne, J; Jungnickel, J; Grothe, C; Klimaschewski, L; Hübbers, C U; Dunlop, S A; Angelov, D N

2011-05-19

Functional recovery following facial nerve injury is poor. Adjacent neuromuscular junctions (NMJs) are "bridged" by terminal Schwann cells and numerous regenerating axonal sprouts. We have recently shown that manual stimulation (MS) restores whisking function and reduces polyinnervation of NMJs. Furthermore, MS requires both insulin-like growth factor-1 (IGF-1) and brain-derived neurotrophic factor (BDNF). Here, we investigated whether fibroblast growth factor-2 (FGF-2) was also required for the beneficial effects of MS. Following transection and suture of the facial nerve (facial-facial anastomisis, FFA) in homozygous mice lacking FGF-2 (FGF-2(-/-)), vibrissal motor performance and the percentage of poly-innervated NMJ were quantified. In intact FGF-2(-/-) mice and their wildtype (WT) counterparts, there were no differences in amplitude of vibrissal whisking (about 50°) or in the percentage of polyinnervated NMJ (0%). After 2 months FFA and handling alone (i.e. no MS), the amplitude of vibrissal whisking in WT-mice decreased to 22±3°. In the FGF-2(-/-) mice, the amplitude was reduced further to 15±4°, that is, function was significantly poorer. Functional deficits were mirrored by increased polyinnervation of NMJ in WT mice (40.33±2.16%) with polyinnervation being increased further in FGF-2(-/-) mice (50.33±4.33%). However, regardless of the genotype, MS increased vibrissal whisking amplitude (WT: 33.9°±7.7; FGF-2(-/-): 33.4°±8.1) and concomitantly reduced polyinnervation (WT: 33.9%±7.7; FGF-2(-/-): 33.4%±8.1) to a similar extent. We conclude that, whereas lack of FGF-2 leads to poor functional recovery and target reinnervation, MS can nevertheless confer some functional benefit in its absence. Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.

Utilization of fluorescein for identification and preservation of the facial nerve and semicircular canals for safe mastoidectomy: a proof of concept laboratory cadaveric study.

PubMed

Gragnaniello, Cristian; Kamel, Mahmoud; Al-Mefty, Ossama

2010-01-01

Mastoidectomy can be a very challenging procedure for many reasons. The normal anatomy can be distorted because of inflammatory processes and tumors and recurrences. Avoiding injuries to the semicircular canals (SCCs) and facial canal is mandatory, and there is need to find a way to recognize the facial nerve and SCCs for safe performance of mastoidectomy. We describe, as a proof of concept, a novel technique to drill the mastoid while allowing the surgeon to recognize and avoid injuries to vital structures, in the cadaver. Four fresh cadaveric heads (8 sides) were prepared by cannulating the major vessels at the level of the neck. After removal of the mastoid cortex, indocyanine green was injected in the vessels. The sigmoid sinus alongside the facial nerve and SCCs was skeletonized using the drilling guidance provided by the fluorescence. The mucosa covering the air cells of the mastoid is very well vascularized compared with the thick bone representing the outer layer of the SCCs and facial canal. Consequently, after the indocyanine green injection, the mucosa shines whereas the bone does not. The fluorescence guides the drilling displaying air cells that are safe to remove. Eight mastoidectomies were performed, resulting in optimal drilling with no injuries to the facial canal and SCCs. With this novel technique, it is possible to perfectly skeletonize the facial nerve and the SCCs in the cadaver. We think that this technique can be an adjunct in the armamentarium of trainees that are not familiar with the anatomy of the temporal bone and eventually of neurosurgeons facing lesions that require the removal of various degrees of the mastoid.

[Applied anatomy of facial recess and posterior tympanum related to cochlear implantation].

PubMed

Zou, Tuanming; Xie, Nanping; Guo, Menghe; Shu, Fan; Zhang, Hongzheng

2012-05-01

To investigate the related parameters of temporal bone structure in the surgery of cochlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization. In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope. Distance between suprameatal spine and short process of incus was (12.44 +/- 0.51) mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was (2.67 +/- 0.51) mm. Distance between short process of incus and crotch of chorda tympani nerve was (15.22 +/- 0.83) mm. The location of maximal width of the facial recess into short process of incus, crotch of chorda tympani nerve were (6.28 +/- 0.41) mm, (9.81 +/- 0.71) mm, respectively. The maximal width of the facial recess was (2.73 +/- 0.20) mm. The value at level of stapes and round window were (2.48 +/- 0.20 mm) and (2.24 +/- 0.18) mm, respectively. Distance between pyramidalis eminence and anterior round window was (2.22 +/- 0.21) mm. Width from stapes to underneath round window was (2.16 +/- 0.14) mm. These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.

Automatic Contour Extraction of Facial Organs for Frontal Facial Images with Various Facial Expressions

NASA Astrophysics Data System (ADS)

Kobayashi, Hiroshi; Suzuki, Seiji; Takahashi, Hisanori; Tange, Akira; Kikuchi, Kohki

This study deals with a method to realize automatic contour extraction of facial features such as eyebrows, eyes and mouth for the time-wise frontal face with various facial expressions. Because Snakes which is one of the most famous methods used to extract contours, has several disadvantages, we propose a new method to overcome these issues. We define the elastic contour model in order to hold the contour shape and then determine the elastic energy acquired by the amount of modification of the elastic contour model. Also we utilize the image energy obtained by brightness differences of the control points on the elastic contour model. Applying the dynamic programming method, we determine the contour position where the total value of the elastic energy and the image energy becomes minimum. Employing 1/30s time-wise facial frontal images changing from neutral to one of six typical facial expressions obtained from 20 subjects, we have estimated our method and find it enables high accuracy automatic contour extraction of facial features.

Three-Dimensional Accuracy of Facial Scan for Facial Deformities in Clinics: A New Evaluation Method for Facial Scanner Accuracy.

PubMed

Zhao, Yi-Jiao; Xiong, Yu-Xue; Wang, Yong

2017-01-01

In this study, the practical accuracy (PA) of optical facial scanners for facial deformity patients in oral clinic was evaluated. Ten patients with a variety of facial deformities from oral clinical were included in the study. For each patient, a three-dimensional (3D) face model was acquired, via a high-accuracy industrial "line-laser" scanner (Faro), as the reference model and two test models were obtained, via a "stereophotography" (3dMD) and a "structured light" facial scanner (FaceScan) separately. Registration based on the iterative closest point (ICP) algorithm was executed to overlap the test models to reference models, and "3D error" as a new measurement indicator calculated by reverse engineering software (Geomagic Studio) was used to evaluate the 3D global and partial (upper, middle, and lower parts of face) PA of each facial scanner. The respective 3D accuracy of stereophotography and structured light facial scanners obtained for facial deformities was 0.58±0.11 mm and 0.57±0.07 mm. The 3D accuracy of different facial partitions was inconsistent; the middle face had the best performance. Although the PA of two facial scanners was lower than their nominal accuracy (NA), they all met the requirement for oral clinic use.

Video analysis of the biomechanics of a bicycle accident resulting in significant facial fractures.

PubMed

Syed, Shameer H; Willing, Ryan; Jenkyn, Thomas R; Yazdani, Arjang

2013-11-01

This study aimed to use video analysis techniques to determine the velocity, impact force, angle of impact, and impulse to fracture involved in a video-recorded bicycle accident resulting in facial fractures. Computed tomographic images of the resulting facial injury are presented for correlation with data and calculations. To our knowledge, such an analysis of an actual recorded trauma has not been reported in the literature. A video recording of the accident was split into frames and analyzed using an image editing program. Measurements of velocity and angle of impact were obtained from this analysis, and the force of impact and impulse were calculated using the inverse dynamic method with connected rigid body segments. These results were then correlated with the actual fracture pattern found on computed tomographic imaging of the subject's face. There was an impact velocity of 6.25 m/s, impact angles of 14 and 6.3 degrees of neck extension and axial rotation, respectively, an impact force of 1910.4 N, and an impulse to fracture of 47.8 Ns. These physical parameters resulted in clinically significant bilateral mid-facial Le Fort II and III pattern fractures. These data confer further understanding of the biomechanics of bicycle-related accidents by correlating an actual clinical outcome with the kinematic and dynamic parameters involved in the accident itself and yielding a concrete evidence of the velocity, force, and impulse necessary to cause clinically significant facial trauma. These findings can aid in the design of protective equipment for bicycle riders to help avoid this type of injury.

[Facial nerve monitoring during middle ear surgery: Results of a French survey].

PubMed

Mazzaschi, O; Juvanon, J-M; Mondain, M; Lavieile, J-P; Ayache, D

2014-01-01

Facial nerve injury is a rare complication of middle ear surgery. To date there is no widely accepted consensus on the use of intraoperative facial nerve monitoring during middle ear surgery, whereas its use has been proved as a valuable adjunct in neurotologic surgery. The purpose of our study was to identify introperative facial nerve monitoring practice patterns in France for middle ear surgery. A 19-item survey has been made up by three experienced otologists under the auspices of the French Otology and Neurotology Association. With the support of the French Society of Otolaryngology--Head and Neck Surgery, the survey was electronically sent by email to 1249 practicing ENT with a valid email address. Answers were analyzed two months later. Among 1249 email sent, 299 were opened (24%) and 83 answers were collected (6,6%). Of the respondents, 66% had access to intraoperative facial nerve monitoring. Otolaryngologists involved in academic setting were influenced by their teaching duty in 27%. Intraoperative facial nerve monitoring should not be required for stapes surgery, ossiculoplasty, myringoplasty for, respectively, 92%, 93 % and 98% of the respondents. In cochlear implantation, 78% of ear surgeons used facial nerve monitoring. Answers were more controversial for chronic ear surgery, ear atresia and middle ear implant. Revision surgery and CT scan can influence answers. Despite a low response rate, results of this national survey revealed interesting findings. For most of the respondents, intraoperative facial nerve monitoring was not indicated in stapes surgery, myringoplasty and ossiculoplasty. The use of intraoperative facial nerve monitoring for cochlear implantation was supported by the majority of respondents. Variations in response rate were more significant for chronic ear surgery, including middle ear cholesteatoma, and for ear atresia surgery.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.

PubMed

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-04-22

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

[Epidemiology and risk factors in injuries due to fall in infants under one year-old].

PubMed

Jiménez de Domingo, Ana; Rubio García, Elena; Marañon Pardillo, Rafael; Arias Constanti, Vanessa; Frontado Haiek, Luis Alberto; Soriano Arola, Marta; Ripoll Oliveras, Francesc; Remón García, Cristina; Estopiña Ferrer, Gloria; Lorente Romero, Jorge

2017-06-01

To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Emotional facial activation induced by unconsciously perceived dynamic facial expressions.

PubMed

Kaiser, Jakob; Davey, Graham C L; Parkhouse, Thomas; Meeres, Jennifer; Scott, Ryan B

2016-12-01

Do facial expressions of emotion influence us when not consciously perceived? Methods to investigate this question have typically relied on brief presentation of static images. In contrast, real facial expressions are dynamic and unfold over several seconds. Recent studies demonstrate that gaze contingent crowding (GCC) can block awareness of dynamic expressions while still inducing behavioural priming effects. The current experiment tested for the first time whether dynamic facial expressions presented using this method can induce unconscious facial activation. Videos of dynamic happy and angry expressions were presented outside participants' conscious awareness while EMG measurements captured activation of the zygomaticus major (active when smiling) and the corrugator supercilii (active when frowning). Forced-choice classification of expressions confirmed they were not consciously perceived, while EMG revealed significant differential activation of facial muscles consistent with the expressions presented. This successful demonstration opens new avenues for research examining the unconscious emotional influences of facial expressions. Copyright © 2016 Elsevier B.V. All rights reserved.

Automatic Facial Expression Recognition and Operator Functional State

NASA Technical Reports Server (NTRS)

Blanson, Nina

2012-01-01

The prevalence of human error in safety-critical occupations remains a major challenge to mission success despite increasing automation in control processes. Although various methods have been proposed to prevent incidences of human error, none of these have been developed to employ the detection and regulation of Operator Functional State (OFS), or the optimal condition of the operator while performing a task, in work environments due to drawbacks such as obtrusiveness and impracticality. A video-based system with the ability to infer an individual's emotional state from facial feature patterning mitigates some of the problems associated with other methods of detecting OFS, like obtrusiveness and impracticality in integration with the mission environment. This paper explores the utility of facial expression recognition as a technology for inferring OFS by first expounding on the intricacies of OFS and the scientific background behind emotion and its relationship with an individual's state. Then, descriptions of the feedback loop and the emotion protocols proposed for the facial recognition program are explained. A basic version of the facial expression recognition program uses Haar classifiers and OpenCV libraries to automatically locate key facial landmarks during a live video stream. Various methods of creating facial expression recognition software are reviewed to guide future extensions of the program. The paper concludes with an examination of the steps necessary in the research of emotion and recommendations for the creation of an automatic facial expression recognition program for use in real-time, safety-critical missions

Automatic Facial Expression Recognition and Operator Functional State

NASA Technical Reports Server (NTRS)

Blanson, Nina

2011-01-01

The prevalence of human error in safety-critical occupations remains a major challenge to mission success despite increasing automation in control processes. Although various methods have been proposed to prevent incidences of human error, none of these have been developed to employ the detection and regulation of Operator Functional State (OFS), or the optimal condition of the operator while performing a task, in work environments due to drawbacks such as obtrusiveness and impracticality. A video-based system with the ability to infer an individual's emotional state from facial feature patterning mitigates some of the problems associated with other methods of detecting OFS, like obtrusiveness and impracticality in integration with the mission environment. This paper explores the utility of facial expression recognition as a technology for inferring OFS by first expounding on the intricacies of OFS and the scientific background behind emotion and its relationship with an individual's state. Then, descriptions of the feedback loop and the emotion protocols proposed for the facial recognition program are explained. A basic version of the facial expression recognition program uses Haar classifiers and OpenCV libraries to automatically locate key facial landmarks during a live video stream. Various methods of creating facial expression recognition software are reviewed to guide future extensions of the program. The paper concludes with an examination of the steps necessary in the research of emotion and recommendations for the creation of an automatic facial expression recognition program for use in real-time, safety-critical missions.

[Facial nerve neurinomas].

PubMed

Sokołowski, Jacek; Bartoszewicz, Robert; Morawski, Krzysztof; Jamróz, Barbara; Niemczyk, Kazimierz

2013-01-01

Evaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study. Seven cases of patients (2005-2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences. Neurinoma of the facial nerve occurred in the vertical segment (n=2), facial nerve geniculum (n=1) and the internal auditory canal (n=4). The symptoms observed in patients were analyzed: facial nerve paresis (n=3), hearing loss (n=2), dizziness (n=1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n=5) and by antromastoidectomy (n=2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation. Facial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis.

PubMed

Kim, Jin

2013-02-01

The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry. In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems. From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U). After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection. Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical

Estimation of human emotions using thermal facial information

NASA Astrophysics Data System (ADS)

Nguyen, Hung; Kotani, Kazunori; Chen, Fan; Le, Bac

2014-01-01

In recent years, research on human emotion estimation using thermal infrared (IR) imagery has appealed to many researchers due to its invariance to visible illumination changes. Although infrared imagery is superior to visible imagery in its invariance to illumination changes and appearance differences, it has difficulties in handling transparent glasses in the thermal infrared spectrum. As a result, when using infrared imagery for the analysis of human facial information, the regions of eyeglasses are dark and eyes' thermal information is not given. We propose a temperature space method to correct eyeglasses' effect using the thermal facial information in the neighboring facial regions, and then use Principal Component Analysis (PCA), Eigen-space Method based on class-features (EMC), and PCA-EMC method to classify human emotions from the corrected thermal images. We collected the Kotani Thermal Facial Emotion (KTFE) database and performed the experiments, which show the improved accuracy rate in estimating human emotions.

Peripheral Facial Palsy in Emergency Department

PubMed Central

Ferreira-Penêda, José; Robles, Raquel; Gomes-Pinto, Isabel; Valente, Pedro; Barros-Lima, Nuno; Condé, Artur

2018-01-01

Introduction: Peripheral facial palsy (PFP) is commonly diagnosed in every emergency department. Despite being a benign condition in most cases, PFP causes loss in quality of life mostly due to facial dysmorphia. The etiology of PFP remains unknown in most cases, while medical opinion on epidemiology, risk factors and optimal treatment is not consensual. The aim of this study was to review the demographic characteristics of our patients and the medical care administered in our emergency department. Materials and Methods: Emergency episodes occurring in a 4-year period and codified as facial nerve pathology were analyzed. IBM SPSS software was used for statistical analysis. Results: In total, 582 emergency episodes were obtained. Due to inexpressive representation of other causes of PFP in our study, we focused our analyses on the 495 patients who were considered to have idiopathic PFP. There was equal distribution among genders, and all age ranges were affected. There were no clear epidemic phenomena. Hypertension was not a statistically significant risk factor for Bell's palsy. Most patients sought medical care in the early stages of the disease and complained of isolated facial weakness. Most patients had mild-to-moderate symptoms. Previous upper way infections (PUAI) were more frequent among children. There was a statistically significant difference regarding computed tomography (CT) scan requests among specialties. Conclusion: Epidemiologic findings were consistent with most literature on Bell's palsy. Drug therapy is widely used and follows current guidelines. The role of PUAI in the pediatric population must be investigated. Despite evidence of good medical practice, there was an excess of CT scans requested by physicians other than otorhinolaryngologists. PMID:29876329

Novel dynamic Bayesian networks for facial action element recognition and understanding

NASA Astrophysics Data System (ADS)

Zhao, Wei; Park, Jeong-Seon; Choi, Dong-You; Lee, Sang-Woong

2011-12-01

In daily life, language is an important tool of communication between people. Besides language, facial action can also provide a great amount of information. Therefore, facial action recognition has become a popular research topic in the field of human-computer interaction (HCI). However, facial action recognition is quite a challenging task due to its complexity. In a literal sense, there are thousands of facial muscular movements, many of which have very subtle differences. Moreover, muscular movements always occur simultaneously when the pose is changed. To address this problem, we first build a fully automatic facial points detection system based on a local Gabor filter bank and principal component analysis. Then, novel dynamic Bayesian networks are proposed to perform facial action recognition using the junction tree algorithm over a limited number of feature points. In order to evaluate the proposed method, we have used the Korean face database for model training. For testing, we used the CUbiC FacePix, facial expressions and emotion database, Japanese female facial expression database, and our own database. Our experimental results clearly demonstrate the feasibility of the proposed approach.

Gunshot injuries due to celebratory gun shootings.

PubMed

Ozdemir, Mevci; Unlü, Ağahan

2009-01-01

Traditional shooting with guns often occurs and leads to unwanted gunshot injuries in areas where celebrations are held. Such injuries have been classified as celebratory gun shooting injury in the international disease classification system. An 8-year-old female patient presented with respiratory arrest. The heartbeats normalized upon cardiopulmonary resuscitation. On physical examination, the only pathological finding was a skin defect measuring 1 x 1 cm on the midline and located 2 cm in front of the coronal suture. Cranial CT revealed a bone defect of 0.5 cm in the area 2 cm in front of the coronal suture on the midline, tetraventricular and extensive subarachnoid hemorrhage and parenchymal hematoma in the frontal area. It was initially thought to be a gunshot injury; however, on cranial CT, no bullet fragments or bullet exit hole was observed. A cervicothoracal direct graph was obtained and an image that might have been compatible with a bullet core was detected at Th 2-3 vertebra level. Although gunshot injuries are generally well- known, this may not be a very familiar topic for neurosurgeons. The primary aim of this report is to emphasize that a bullet round randomly fired into the air ascends in reverse direction to gravity and after reaching a zero point, it returns to the ground at a high velocity that facilitates its penetration into the skull according to a principal physics law.

Maxillofacial fractures and craniocerebral injuries - stress propagation from face to neurocranium in a finite element analysis.

PubMed

Huempfner-Hierl, Heike; Schaller, Andreas; Hierl, Thomas

2015-04-21

Severe facial trauma is often associated with intracerebral injuries. So it seemed to be of interest to study stress propagation from face to neurocranium after a fistlike impact on the facial skull in a finite element analysis. A finite element model of the human skull without mandible consisting of nearly 740,000 tetrahedrons was built. Fistlike impacts on the infraorbital rim, the nasoorbitoethmoid region, and the supraorbital arch were simulated and stress propagations were depicted in a time-dependent display. Finite element simulation revealed von Mises stresses beyond the yield criterion of facial bone at the site of impacts and propagation of stresses in considerable amount towards skull base in the scenario of the fistlike impact on the infraorbital rim and on the nasoorbitoethmoid region. When impact was given on the supraorbital arch stresses seemed to be absorbed. As patients presenting with facial fractures have a risk for craniocerebral injuries attention should be paid to this and the indication for a CT-scan should be put widely. Efforts have to be made to generate more precise finite element models for a better comprehension of craniofacial and brain injury.

Primary and secondary management of pediatric soft tissue injuries.

PubMed

Hogg, Nicholas J V

2012-08-01

Injury is the most common cause of death in pediatric patients, with a large proportion related to head injury. The craniofacial region in children develops rapidly and at an early age, making the area more prominent compared with the remainder of the body, increasing the likelihood of injury. This article reviews the primary management of pediatric soft tissue injuries, including assessment, cleansing, surgical technique, anesthesia, and considerations for special wounds. The secondary management of pediatric facial injury is also discussed, including scar revision, management of scar hypertrophy/keloids, and staged surgical correction. Copyright © 2012 Elsevier Inc. All rights reserved.

Outcome of facial physiotherapy in patients with prolonged idiopathic facial palsy.

PubMed

Watson, G J; Glover, S; Allen, S; Irving, R M

2015-04-01

This study investigated whether patients who remain symptomatic more than a year following idiopathic facial paralysis gain benefit from tailored facial physiotherapy. A two-year retrospective review was conducted of all symptomatic patients. Data collected included: age, gender, duration of symptoms, Sunnybrook facial grading system scores pre-treatment and at last visit, and duration of treatment. The study comprised 22 patients (with a mean age of 50.5 years (range, 22-75 years)) who had been symptomatic for more than a year following idiopathic facial paralysis. The mean duration of symptoms was 45 months (range, 12-240 months). The mean duration of follow up was 10.4 months (range, 2-36 months). Prior to treatment, the mean Sunnybrook facial grading system score was 59 (standard deviation = 3.5); this had increased to 83 (standard deviation = 2.7) at the last visit, with an average improvement in score of 23 (standard deviation = 2.9). This increase was significant (p < 0.001). Tailored facial therapy can improve facial grading scores in patients who remain symptomatic for prolonged periods.

Differences in Presentation and Management of Pediatric Facial Lacerations by Type of Health Insurance.

PubMed

Amanullah, Siraj; Linakis, James G; Vivier, Patrick M; Clarke-Pearson, Emily; Steele, Dale W

2015-07-01

Limited data are available regarding differences in presentation and management of pediatric emergency department (PED) patients based on insurance status. The objective of the study was to assess the difference in management of pediatric facial lacerations based on medical insurance status. We conducted a retrospective cohort study with universal sampling of patients with facial lacerations who were treated in an urban PED (45K visits/year) over a one-year period. Demographic features and injury characteristics for patients with commercial (private) insurance and those with Medicaid or Medicare (public) insurance were compared. Of 1235 children included in the study, 667 (54%) had private insurance and 485 (39%) had public insurance. The two groups did not differ in age or gender, arrival by ambulance, location of injury occurrence, mechanism of injury, part of face involved, length or depth of laceration, use of local anesthetic, or method of repair but differed in acuity assigned at triage. Patients with public insurance were found less likely to have subspecialty consultation in bivariable (OR=0.41, 95% CI [0.24-0.68]) and multivariable logistic regression analyses (OR=0.45, 95% CI [0.25-0.78]). Patients with public insurance received procedural sedation significantly less often than those with private insurance (OR=0.48, 95% CI [0.29-0.76]). This difference was not substantiated in multivariable models (OR=0.74, 95% CI [0.40-1.31]). Patients with public insurance received less subspecialty consultation compared to privately insured patients despite a similarity in the presentation and characteristics of their facial lacerations. The reasons for these disparities require further investigation.

Selective impairment of facial recognition due to a haematoma restricted to the right fusiform and lateral occipital region

PubMed Central

Wada, Y; Yamamoto, T

2001-01-01

A 67 year old right handed Japanese man developed prosopagnosia caused by a haemorrhage. His only deficit was the inability to perceive and discriminate unfamiliar faces, and to recognise familiar faces. He did not show deficits in visual or visuospatial perception of non-facial stimuli, alexia, visual agnosia, or topographical disorientation. Brain MRI showed a haematoma limited to the right fusiform and the lateral occipital region. Single photon emission computed tomography confirmed that there was no decreased blood flow in the opposite left cerebral hemisphere. The present case indicates that a well placed small right fusiform gyrus and the adjacent area can cause isolated impairment of facial recognition. As far as we know, there has been no published case that has demonstrated this exact lesion site, which was indicated by recent functional MRI studies as the most critical area in facial recognition.

 PMID:11459906

A Multidisciplinary Evaluation of Traumatic Brain Injury: Early Predictors of Outcome

DTIC Science & Technology

2007-04-01

undergoing an acceleration/deceleration movement (i.e., whiplash ) without direct external trauma to the head . Computed tomography (CT...mild head injury. J Neurol Neurosurg Psychiatry. 1985;48:137-140. Geurts ACH , Ribbers GM, Knoop JA, van Limbeek J. Identification of static and...boney) Injury 30 Facial Injury 13 Skull Fracture/ Head CT Findings 7 Symptoms (i.e. dizziness, nausea, vomiting) 10 Past Medical History 6 The NBM

The Big Bang: Facial Trauma Caused by Recreational Fireworks

PubMed Central

Molendijk, Josher; Vervloet, Bob; Wolvius, Eppo B.; Koudstaal, Maarten J.

2015-01-01

In the Netherlands, it is a tradition of setting off fireworks to celebrate the turn of the year. In our medical facility, each year patients with severe skeletal maxillofacial trauma inflicted by recreational fireworks are encountered. We present two cases of patients with severe blast injury to the face, caused by direct impact of rockets, and thereby try to contribute to the limited literature on facial blast injuries, their treatment, and clinical outcome. These patients require multidisciplinary treatment, involving multiple reconstructive surgeries, and the overall recovery process is long. The severity of these traumas raises questions about the firework traditions and legislations not only in the Netherlands but also worldwide. Therefore, the authors support restrictive laws on personal use of fireworks in the Netherlands. PMID:27162578

The Big Bang: Facial Trauma Caused by Recreational Fireworks.

PubMed

Molendijk, Josher; Vervloet, Bob; Wolvius, Eppo B; Koudstaal, Maarten J

2016-06-01

In the Netherlands, it is a tradition of setting off fireworks to celebrate the turn of the year. In our medical facility, each year patients with severe skeletal maxillofacial trauma inflicted by recreational fireworks are encountered. We present two cases of patients with severe blast injury to the face, caused by direct impact of rockets, and thereby try to contribute to the limited literature on facial blast injuries, their treatment, and clinical outcome. These patients require multidisciplinary treatment, involving multiple reconstructive surgeries, and the overall recovery process is long. The severity of these traumas raises questions about the firework traditions and legislations not only in the Netherlands but also worldwide. Therefore, the authors support restrictive laws on personal use of fireworks in the Netherlands.

Qualitative and Quantitative Analysis for Facial Complexion in Traditional Chinese Medicine

PubMed Central

Zhao, Changbo; Li, Guo-zheng; Li, Fufeng; Wang, Zhi; Liu, Chang

2014-01-01

Facial diagnosis is an important and very intuitive diagnostic method in Traditional Chinese Medicine (TCM). However, due to its qualitative and experience-based subjective property, traditional facial diagnosis has a certain limitation in clinical medicine. The computerized inspection method provides classification models to recognize facial complexion (including color and gloss). However, the previous works only study the classification problems of facial complexion, which is considered as qualitative analysis in our perspective. For quantitative analysis expectation, the severity or degree of facial complexion has not been reported yet. This paper aims to make both qualitative and quantitative analysis for facial complexion. We propose a novel feature representation of facial complexion from the whole face of patients. The features are established with four chromaticity bases splitting up by luminance distribution on CIELAB color space. Chromaticity bases are constructed from facial dominant color using two-level clustering; the optimal luminance distribution is simply implemented with experimental comparisons. The features are proved to be more distinctive than the previous facial complexion feature representation. Complexion recognition proceeds by training an SVM classifier with the optimal model parameters. In addition, further improved features are more developed by the weighted fusion of five local regions. Extensive experimental results show that the proposed features achieve highest facial color recognition performance with a total accuracy of 86.89%. And, furthermore, the proposed recognition framework could analyze both color and gloss degrees of facial complexion by learning a ranking function. PMID:24967342

Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns.

PubMed

Klein, Matthew B; Engrav, Loren H; Holmes, James H; Friedrich, Jeffrey B; Costa, Beth A; Honari, Shari; Gibran, Nicole S

2005-05-01

Management of deep facial burns remains one of the greatest challenges in burn care. We have developed a protocol over the past 20 years for management of facial burns that includes excision and coverage with thick autograft. However, the results were not perfect. Deformities of the eyelids, nose and mouth as well as the prominence of skin graft junctures demonstrated the need to explore novel approaches. Integra has been used with success in the management of burns of the trunk and extremities. The purpose of this study was to prospectively evaluate the aesthetic outcome of the use of Integra for deep facial burns. Twelve consecutive patients underwent excision of large, deep facial burns and placement of Integra. Integra provides excellent color and minimally visible skin graft junctures. The texture is good but not as supple as thick autograft. Integra is not well suited for use in the coverage of eyelid burns due to the need to wait 2 weeks for adequate vascularization. In summary, thick autograft remains the gold standard for deep facial burns. However, for patients with extensive burns and limited donor sites, Integra provides an acceptable alternative.

The treatment of facial palsy from the point of view of physical and rehabilitation medicine.

PubMed

Shafshak, T S

2006-03-01

There are evidences to support recommending the early intake of prednisone (in its appropriate dose of 1 mg/kg body weight for up to 70 or 80 mg/day) or the combined use of prednisone and acyclovir (or valacyclovir) within 72 h following the onset of paralysis in order to improve the outcome of Bell's palsy (BP). Although there may be a controversy about the role of physiotherapy in BP or facial palsy, it seemed that local superficial heat therapy, massage, exercises, electrical stimulation and biofeedback training have a place in the treatment of lower motor facial palsy. However, each modality has its indications. Moreover, some rehabilitative surgical methods might be of benefit for some patients with traumatic facial injuries or long standing paralysis without recovery, but early surgery in BP is usually not recommended. However, few may recommend early surgery in BP when there is 90-100% facial nerve degeneration. The efficacy of acupuncture, magnetic pellets and other modalities of physiotherapy needs further investigation. The general principles and the different opinions in treating and rehabilitating facial palsy are discussed and the need for further research in this field is suggested.

Acute liver injury due to flavocoxid (Limbrel®), a medical food for osteoarthritis: A case series

PubMed Central

Chalasani, Naga; Vuppalanchi, Raj; Navarro, Victor; Fontana, Robert; Bonkovsky, Herbert; Barnhart, Huiman; Kleiner, David E.; Hoofnagle, Jay H.

2013-01-01

Background Flavocoxid is a medical food that is available with prescription for dietary management of osteoarthritis. It is a proprietary blend of two flavonoids, baicalin and catechins which are derived from botanicals Scutellaria baicalensis and Acacia catechu respectively. Objective To describe characteristics of patients with acute liver injury suspected due to flavocoxid. Design Case series Setting Prospective Study of the Drug Induced Liver Injury Network (DILIN) initiated at multiple academic medical centers in 2004. Patients 4 patients with liver injury suspected due to flavocoxid. Measurements Clinical characteristics, liver biochemistries, histology, and outcomes. Results Among 877 patients enrolled in the DILIN Prospective Study, 4 were attributed to flavocoxid. All 4 were women with a mean age of 61 years. The time to onset averaged 11.2 weeks (range 5–16) after initiating therapy with flavocoxid. Liver injury was characterized by marked elevations in alanine aminotransferase (mean peak ALT 1268 U/L, range 741 to 1540 U/L), with moderate elevations in alkaline phosphatase (mean peak 510 U/L, range 286 to 770 U/L) and serum bilirubin (mean peak 9.4 mg/dL, range 2.0 to 20.8 mg/dL). Liver biochemistries fell into the normal range within 3 to 12 weeks of stopping. The causality was adjudicated as highly likely in three and as possible in one patient. All recovered uneventfully with no evidence acute liver failure or chronic liver injury. Limitations The frequency or mechanism of liver injury caused by flavocoxid cannot be assessed. Conclusion Flavocoxid can cause significant liver injury which appears to resolve within weeks after its cessation. PMID:22711078

Mechanisms, injuries and helmet use in cyclists presenting to an inner city emergency department.

PubMed

Dinh, Michael M; Kastelein, Christopher; Hopkins, Roy; Royle, Timothy J; Bein, Kendall J; Chalkley, Dane R; Ivers, Rebecca

2015-08-01

The objectives of the present study were to describe the injury profiles of cyclists presenting to an ED and determine the risk of significant head injury associated with bicycle helmet use. This was a retrospective single trauma centre study of all adult cyclists presenting to an inner city ED and undergoing a trauma team review between January 2012 and June 2014. The outcome of interest was significant head injury defined as any head injury with an Abbreviated Injury Scale score of two or more. Variables analysed included demographic characteristics, helmet use at time of incident, location, time and the presence of intoxication. The most common body regions were upper limb injuries (57%), followed by head injuries (43%), facial injuries (30%) and lower limb injuries (24%). A lower proportion of people wearing helmets had significant head injury (17% vs 31%, P = 0.018) or facial injury (26% vs 48%, P = 0.0017) compared with non-helmet users. After adjustment for important covariates, helmet use was associated with a 70% decrease in the odds of significant head injury (odds ratio 0.34, 95% confidence interval 0.15, 0.76, P = 0.008). Head injuries were common after inner city cycling incidents. The use of helmets was associated with a reduction in significant head injury. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

[Progressive bone elongation of the maxillo-facial area: mandibular distraction].

PubMed

Sancho, M A; Parri, F J; Rivera, A; Grande, C; Sarget, R; Casal, C; Morales, L

2000-10-01

Thanks to the distraction osteogenesis technique, it is nowadays possible to create new bone in the facial area. Between january 1997 and march 1999 we have performed 20 such procedures, from which 15 were mandibular. We present our experience in 10 patients with this new technique, 5 unilateral and 5 bilateral. Those were 7 boys and 3 girls, aged 2 to 14 years, affected with hemifacial microsomia, Goldenhar syndrome: 3; retrognatism with severe malocclusion: 4; facial assimetry due temporomandibular joint abnormalities: 2; and facial assimetry: 1. The proposed elongation was achieved in all cases. There was not only a skeletal improvement, but also growth and remodeling of the facial soft tissues. Distraction osteogenesis is the early treatment of the mandibulofacial deformities and offers a great deal of advantages to the growing patient.

[Contribution of botulinum toxin to maxillo-facial surgery].

PubMed

Batifol, D; de Boutray, M; Goudot, P; Lorenzo, S

2013-04-01

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Vertical and horizontal facial proportions of Indian American men

PubMed Central

2016-01-01

The importance of understanding all gender facial differences is critical in providing a successful cosmetic outcome. Men are a growing segment of the cosmetic industry. Understanding of the male face and its appropriate treatment with minimally invasive cosmetic procedures are essential. The aim was to investigate various facial ratios in Indian American men and to compare them with the Indian and Caucasian norms. Additionally, we wanted to evaluate whether these values satisfy golden and silver ratios. Direct facial anthropometric measurements were made using a digital caliper in 100 Indian American men students (18–30 years) at the American University of Antigua (AUA), Antigua. A set of facial ratios were calculated and compared with coefficients of variation (CV). Most of the facial ratios had small CV thus making them highly reliable due to reduced intra-sample variability. The upper face to face height and mandibulo upper face height indices were close to golden ratios whereas mandibulo lower face height, upper face height biocular width, and nasal indices were close to silver ratios. There was significant difference in most of the values when compared with previous studies. The present facial ratios data can be used as a reference value for Indian American men. PMID:27382514

Vertical and horizontal facial proportions of Indian American men.

PubMed

Sadacharan, Chakravarthy Marx

2016-06-01

The importance of understanding all gender facial differences is critical in providing a successful cosmetic outcome. Men are a growing segment of the cosmetic industry. Understanding of the male face and its appropriate treatment with minimally invasive cosmetic procedures are essential. The aim was to investigate various facial ratios in Indian American men and to compare them with the Indian and Caucasian norms. Additionally, we wanted to evaluate whether these values satisfy golden and silver ratios. Direct facial anthropometric measurements were made using a digital caliper in 100 Indian American men students (18-30 years) at the American University of Antigua (AUA), Antigua. A set of facial ratios were calculated and compared with coefficients of variation (CV). Most of the facial ratios had small CV thus making them highly reliable due to reduced intra-sample variability. The upper face to face height and mandibulo upper face height indices were close to golden ratios whereas mandibulo lower face height, upper face height biocular width, and nasal indices were close to silver ratios. There was significant difference in most of the values when compared with previous studies. The present facial ratios data can be used as a reference value for Indian American men.

Epidemiology of injuries due to tropical cyclones in Hong Kong: a retrospective observational study.

PubMed

Rotheray, K R; Aitken, P; Goggins, W B; Rainer, T H; Graham, C A

2012-12-01

Tropical cyclones are huge circulating masses of wind which form over tropical and sub-tropical waters. They affect an average of 78 million people each year. Hong Kong is a large urban centre with a population of just over 7 million which is frequently affected by tropical cyclones. We aimed to describe the numbers and types of injuries due to tropical cyclones in Hong Kong, as well as their relation to tropical cyclone characteristics. The records of all patients presenting to Hong Kong's public hospital emergency departments from 1st January 2004 to 31st December 2009 with tropical cyclone related injuries were reviewed and information regarding patient and injury characteristics was collected. Meteorological records for the relevant periods were examined and data on wind speed, rainfall and timing of landfall and warning signals was recorded and compared with the timing of tropical cyclone related injuries. A total of 460 tropical cyclone related injuries and one fatality across 15 emergency departments were identified during the study period. The mean age of those injured was 48 years and 48% were female. 25.4% of injuries were work related. The head (33.5%) and upper limb (32.5%) were the most commonly injured regions, with contusions (48.6%) and lacerations (30.2%) being the most common injury types. Falls (42.6%) were the most common mechanism of injury, followed by being hit by a falling or flying object (22.0%). In univariable analysis the relative risk of injury increased with mean hourly wind speed and hourly maximum gust. Multivariable analysis, however, showed that relative risk of injury increased with maximum gust but not average wind speed, with relative risk of injury rising sharply above maximum gusts of greater than 20 m/s. Moderate wind speed with high gust (rather than high average and high gust) appears to be the most risky situation for injuries. Relative risk of injury was not associated with rainfall. The majority of injuries (56

Slowing down presentation of facial movements and vocal sounds enhances facial expression recognition and induces facial-vocal imitation in children with autism.

PubMed

Tardif, Carole; Lainé, France; Rodriguez, Mélissa; Gepner, Bruno

2007-09-01

This study examined the effects of slowing down presentation of facial expressions and their corresponding vocal sounds on facial expression recognition and facial and/or vocal imitation in children with autism. Twelve autistic children and twenty-four normal control children were presented with emotional and non-emotional facial expressions on CD-Rom, under audio or silent conditions, and under dynamic visual conditions (slowly, very slowly, at normal speed) plus a static control. Overall, children with autism showed lower performance in expression recognition and more induced facial-vocal imitation than controls. In the autistic group, facial expression recognition and induced facial-vocal imitation were significantly enhanced in slow conditions. Findings may give new perspectives for understanding and intervention for verbal and emotional perceptive and communicative impairments in autistic populations.

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

PubMed Central

Nellis, Jason C.; Ishii, Masaru; Byrne, Patrick J.; Boahene, Kofi D. O.; Dey, Jacob K.; Ishii, Lisa E.

2017-01-01

IMPORTANCE Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). OBJECTIVE To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic. DESIGN, SETTING, PARTICIPANTS Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis. MAIN OUTCOMES AND MEASURES Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. RESULTS There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13–22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77–3.39]; facial paralysis effect, 5.98 [95% CI, 4.38–7

Minimally invasive brow suspension for facial paralysis.

PubMed

Costantino, Peter D; Hiltzik, David H; Moche, Jason; Preminger, Aviva

2003-01-01

To report a new technique for unilateral brow suspension for facial paralysis that is minimally invasive, limits supraciliary scar formation, does not require specialized endoscopic equipment or expertise, and has proved to be equal to direct brow suspension in durability and symmetry. Retrospective survey of a case series of 23 patients between January 1997 and December 2000. Metropolitan tertiary care center. Patients with head and neck tumors and brow ptosis caused by facial nerve paralysis. The results of the procedure were determined using the following 3-tier rating system: outstanding (excellent elevation and symmetry); acceptable (good elevation and fair symmetry); and unacceptable (loss of elevation). The results were considered outstanding in 12 patients, acceptable in 9 patients, and unacceptable in only 1 patient. One patient developed a hematoma, and 1 patient required a secondary adjustment. The technique has proved to be superior to standard brow suspension procedures with regard to scar formation and equal with respect to facial symmetry and suspension. These results have caused us to abandon direct brow suspension and to use this minimally invasive method in all cases of brow ptosis due to facial paralysis.

Facial fractures in children.

PubMed

Boyette, Jennings R

2014-10-01

Facial trauma in children differs from adults. The growing facial skeleton presents several challenges to the reconstructive surgeon. A thorough understanding of the patterns of facial growth and development is needed to form an individualized treatment strategy. A proper diagnosis must be made and treatment options weighed against the risk of causing further harm to facial development. This article focuses on the management of facial fractures in children. Discussed are common fracture patterns based on the development of the facial structure, initial management, diagnostic strategies, new concepts and old controversies regarding radiologic examinations, conservative versus operative intervention, risks of growth impairment, and resorbable fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment of nostril and nasal stenosis due to facial burn using a self-expandable metallic esophageal stent.

PubMed

Sekine, Kuwon; Matsune, Shoji; Shiiba, Kyoko; Kimura, Maki; Okubo, Kimihiro; Kaneshiro, Tadashi; Tajima, Hiroyuki; Murakami, Masahiro; Kurokawa, Akira

2015-08-01

For the treatment of nasal and nostril stenosis caused by facial burn, it is necessary to perform rhinoplasty and nasal vestibuloplasty using various flaps, perform cicatrectomy of the nostrils with a rhinosurgical procedure, and prevent restenosis of the nostrils and nasal cavity for a certain period by methods such as placement of a nasal retainer or transnasal airway and gauze packing of the nasal cavity. With all methods, postoperative placement of a retainer or nasal treatment is necessary for the prevention of postoperative restenosis, and the patient's cooperation is essential. In a patient who did not cooperate in postoperative treatments due to autism and had recurrences of nasal and nostril stenosis after conventional surgical treatments, adequate patency of the nasal cavity and nostrils could be maintained with minimal postoperative treatment by placing a self-expandable metallic esophageal stent. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Slowing down Presentation of Facial Movements and Vocal Sounds Enhances Facial Expression Recognition and Induces Facial-Vocal Imitation in Children with Autism

ERIC Educational Resources Information Center

Tardif, Carole; Laine, France; Rodriguez, Melissa; Gepner, Bruno

2007-01-01

This study examined the effects of slowing down presentation of facial expressions and their corresponding vocal sounds on facial expression recognition and facial and/or vocal imitation in children with autism. Twelve autistic children and twenty-four normal control children were presented with emotional and non-emotional facial expressions on…

[Labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012].

PubMed

Cubí-Mollá, Patricia; Peña-Longobardo, Luz María; Casal, Bruno; Rivera, Berta; Oliva-Moreno, Juan

2015-09-01

To estimate the years of potential life lost, years of potential productive life lost and the labor productivity losses attributable to premature deaths due to traffic injuries between 2002 and 2012 in Spain. Several statistical sources were combined (Spanish Registry of Deaths, Labor Force Survey and Wage Structure Survey) to develop a simulation model based on the human capital approach. This model allowed us to estimate the loss of labor productivity caused by premature deaths following traffic injuries from 2002 to 2012. In addition, mortality tables with life expectancy estimates were used to compute years of potential life lost and years of potential productive life lost. The estimated loss of labour productivity caused by fatal traffic injuries between 2002 and 2012 in Spain amounted to 9,521 million euros (baseline year 2012). The aggregate number of years of potential life lost in the period amounted to 1,433,103, whereas the years of potential productive life lost amounted to 875,729. Throughout the period analyzed, labor productivity losses and years of life lost diminished substantially. Labor productivity losses due to fatal traffic injuries decreased throughout the period analyzed. Nevertheless, the cumulative loss was alarmingly high. Estimation of the economic impact of health problems can complement conventional indicators of distinct dimensions and be used to support public policy making. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Classifying Facial Actions

PubMed Central

Donato, Gianluca; Bartlett, Marian Stewart; Hager, Joseph C.; Ekman, Paul; Sejnowski, Terrence J.

2010-01-01

The Facial Action Coding System (FACS) [23] is an objective method for quantifying facial movement in terms of component actions. This system is widely used in behavioral investigations of emotion, cognitive processes, and social interaction. The coding is presently performed by highly trained human experts. This paper explores and compares techniques for automatically recognizing facial actions in sequences of images. These techniques include analysis of facial motion through estimation of optical flow; holistic spatial analysis, such as principal component analysis, independent component analysis, local feature analysis, and linear discriminant analysis; and methods based on the outputs of local filters, such as Gabor wavelet representations and local principal components. Performance of these systems is compared to naive and expert human subjects. Best performances were obtained using the Gabor wavelet representation and the independent component representation, both of which achieved 96 percent accuracy for classifying 12 facial actions of the upper and lower face. The results provide converging evidence for the importance of using local filters, high spatial frequencies, and statistical independence for classifying facial actions. PMID:21188284

Chronic, burning facial pain following cosmetic facial surgery.

PubMed

Eisenberg, E; Yaari, A; Har-Shai, Y

1996-01-01

Chronic, burning facial pain as a result of cosmetic facial surgery has rarely been reported. During the year of 1994, two female patients presented themselves at our Pain Relief Clinic with chronic facial pain that developed following aesthetic facial surgery. One patient underwent bilateral transpalpebral surgery for removal of intraorbital fat for the correction of the exophthalmus, and the other had classical face and anterior hairline forehead lifts. Pain in both patients was similar in that it was bilateral, symmetric, burning in quality, and aggravated by external stimuli, mainly light touch. It was resistant to multiple analgesic medications, and was associated with significant depression and disability. Diagnostic local (lidocaine) and systemic (lidocaine and phentolamine) nerve blocks failed to provide relief. Psychological evaluation revealed that the two patients had clear psychosocial factors that seemed to have further compounded their pain complaints. Tricyclic antidepressants (and biofeedback training in one patient) were modestly effective and produced only partial pain relief.

Facial attractiveness.

PubMed

Little, Anthony C

2014-11-01

Facial attractiveness has important social consequences. Despite a widespread belief that beauty cannot be defined, in fact, there is considerable agreement across individuals and cultures on what is found attractive. By considering that attraction and mate choice are critical components of evolutionary selection, we can better understand the importance of beauty. There are many traits that are linked to facial attractiveness in humans and each may in some way impart benefits to individuals who act on their preferences. If a trait is reliably associated with some benefit to the perceiver, then we would expect individuals in a population to find that trait attractive. Such an approach has highlighted face traits such as age, health, symmetry, and averageness, which are proposed to be associated with benefits and so associated with facial attractiveness. This view may postulate that some traits will be universally attractive; however, this does not preclude variation. Indeed, it would be surprising if there existed a template of a perfect face that was not affected by experience, environment, context, or the specific needs of an individual. Research on facial attractiveness has documented how various face traits are associated with attractiveness and various factors that impact on an individual's judgments of facial attractiveness. Overall, facial attractiveness is complex, both in the number of traits that determine attraction and in the large number of factors that can alter attraction to particular faces. A fuller understanding of facial beauty will come with an understanding of how these various factors interact with each other. WIREs Cogn Sci 2014, 5:621-634. doi: 10.1002/wcs.1316 CONFLICT OF INTEREST: The author has declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website. © 2014 John Wiley & Sons, Ltd.