Virtual planning as a resource for correcting severe facial asymmetry ­ case report / Planejamento virtual como recurso para correção de assimetria facial severa ­ relato de caso

A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

Observer-generated maps of diagnostic facial features enable categorization and prediction of emotion expressions.

According to one prominent model, facial expressions of emotion can be categorized into depicting happiness, disgust, anger, sadness, fear and surprise. One open question is which facial features observers use to recognize the different expressions and whether the features indicated by observers can be used to predict which expression they saw. We created fine-grained maps of diagnostic facial features by asking participants to use mouse clicks to highlight those parts of a face that they deem useful for recognizing its expression. We tested how well the resulting maps align with models of emotion expressions (based on Action Units) and how the maps relate to the accuracy with which observers recognize full or partly masked faces. As expected, observers focused on the eyes and mouth regions in all faces. However, each expression deviated from this global pattern in a unique way, allowing to create maps of diagnostic face regions. Action Units considered most important for expressing an emotion were highlighted most often, indicating their psychological validity. The maps of facial features also allowed to correctly predict which expression a participant had seen, with above-chance accuracies for all expressions. For happiness, fear and anger, the face half which was highlighted the most was also the half whose visibility led to higher recognition accuracies. The results suggest that diagnostic facial features are distributed in unique patterns for each expression, which observers seem to intuitively extract and use when categorizing facial displays of emotion.

Analysis of risk factors for patients with traumatic optic neuropathy and comparison of visual outcomes of management strategies.

BACKGROUND: Traumatic optic neuropathy (TON) is a rare complication of facial trauma that results in vision loss. Clinical diagnosis of TON is based on a history of head trauma and an ophthalmic examination; however, the risk factors for TON and the ideal treatment strategy remain undetermined. This study aimed to identify predictive risk factors for TON and evaluate the effectiveness of current treatments with respect to visual outcomes in patients with TON. METHODS: This study retrospectively enrolled patients with periorbital facial bone fracture between 2008 and 2019. Initial facial bone computed tomography, ophthalmic exam results, initial Glasgow Coma Scale, and Injury Severity Score were recorded. This study classified patients into 4 intervention groups (i.e., medication, surgery, combination therapy, and observation) to compare the outcome of visual acuity. RESULTS: This study enrolled 1168 patients with facial bone fractures, 93 (7.96%) of whom were diagnosed as having TON. Independent risk factors for TON included optic canal fracture, medial orbital wall fracture, retrobulbar hematoma, and head Abbreviated Injury Scale ≥4. Patients with TON who initially presented with no light perception tended to have poor final visual acuity (VA) outcomes. The results indicated no significant difference in VA improvement among patients receiving observation, megadose corticosteroid therapy, surgical decompression, or combined steroid therapy and decompression. CONCLUSION: Clinicians can achieve early prediction of TON in patients with an initial unconscious state and the identified risk factors. The results indicated that the conservative observation yielded noninferior VA outcomes in patients with TON compared with those receiving medication or surgical treatment.

Effective encoder-decoder network for pupil light reflex segmentation in facial photographs of ptosis patients.

Accurate segmentation of pupil light reflexes is essential for the reliable assessment of ptosis severity, a condition characterized by the drooping of the upper eyelid. This study introduces a novel encoder-decoder network specialized in reflex segmentation by focusing on addressing issues related to very small regions of interest from an architectural perspective. Specifically, the proposed network is designed to exploit low-level features effectively by integrating a multi-level skip connection and a 1 × 1 convolution-enhanced initial encoding stage. Assessed using a photograph image dataset from Chung-Ang University Hospital, which includes 87 healthy subjects, 64 with ptosis, and 257 with Graves' orbitopathy (collected between January 2010 and February 2023), the proposed network outperforms five conventional encoder-decoders. Over 30 trials, the proposed network achieved a mean Dice coefficient of 0.767 and an Intersection over Union of 0.653, indicating a statistically significant improvement in the segmentation of reflex. Our findings show that an elaborate design based on the lowest-level skip connection and 1 × 1 convolution at initial stage enhances the segmentation of pupil light reflexes. The source code of the proposed network is available at https://github.com/tkdgur658/ReflexNet .

Technical report on intra-operative trigeminal root mapping in percutaneous lesioning for trigeminal neuralgias.

PURPOSE: Percutaneous lesioning-techniques for treating refractory Trigeminal Neuralgias not amenable to Micro-Vascular Decompression remain useful in neurosurgical practice. Success, avoidance of complications and reduction of side-effects depend on the accurate location of the lesion-maker especially for Radio-Frequency-Thermo-Rhizotomy (RF-Th-Rh). Added to X-ray-guidance, Intra-Operative Neurophysiology can be of significant help to achieve optimal accuracy of the surgery. Based on previous research, this article aims to describe the simplest way to use direct electrical stimulation of the trigeminal root to evoke clinically observable muscle responses allowing to precisely position the tip of the needle for accurate lesioning. TECHNIQUE TO EVOKE SPECIFIC LOCALIZING MUSCLE RESPONSES: Masticatory twitches can be easily produced by stimulating the motor root, through orthodromic conduction to the masticatory muscles. Evoked Muscle Responses (EMRs) can be elicited in the facial nerve territory by stimulating the sensory rootlets, through Trigemino-Facial Reflexes' pathways (TFRs). Responses in the Orbicularis Oculi is the well-known and readily used "Blink reflex". On the contrary, TFRs in the lower territory of the facial nerve escaped clinical investigations not having been explored under direct stimulation of the trigeminal root. For both, stimulation at 5 c/s produces better observable twitches (because saccadic) than at 50 c/s which elicits tetanic contractions. CONCLUSION: The localizing-value of these facial EMRs (associated to evocation of paresthesias) and of the masticatory responses, justifies mapping the trigeminal root before lesioning. Their use could be extended to the other lesioning-techniques: not only Glycerol Neurolysis but also to Balloon Compression (to ascertain location of the trocar at the contact of the TGN inside the Meckel cave) and Open partial Rhizotomies (before deciding to cut the rootlets corresponding to the trigger-zone). This is of importance since lesioning-techniques are needed because not all trigeminal neuralgias are responsive to or even indications of Micro-Vascular Decompression.

A modified deep learning method for Alzheimer's disease detection based on the facial submicroscopic features in mice.

Alzheimer's disease (AD) is a chronic disease among people aged 65 and older. As the aging population continues to grow at a rapid pace, AD has emerged as a pressing public health issue globally. Early detection of the disease is important, because increasing evidence has illustrated that early diagnosis holds the key to effective treatment of AD. In this work, we developed and refined a multi-layer cyclic Residual convolutional neural network model, specifically tailored to identify AD-related submicroscopic characteristics in the facial images of mice. Our experiments involved classifying the mice into two distinct groups: a normal control group and an AD group. Compared with the other deep learning models, the proposed model achieved a better detection performance in the dataset of the mouse experiment. The accuracy, sensitivity, specificity and precision for AD identification with our proposed model were as high as 99.78%, 100%, 99.65% and 99.44%, respectively. Moreover, the heat maps of AD correlation in the facial images of the mice were acquired with the class activation mapping algorithm. It was proven that the facial images contained AD-related submicroscopic features. Consequently, through our mouse experiments, we validated the feasibility and accuracy of utilizing a facial image-based deep learning model for AD identification. Therefore, the present study suggests the potential of using facial images for AD detection in humans through deep learning-based methods.

Cross-cultural comparison of the influence of skin-color change on facial impressions.

Skin color is one of the colors we are most frequently exposed to. It contains information, such as ethnic group and health status, and numerous studies have demonstrated the influence of various facial attributes on the formation of impressions. However, no research has specifically explored the repercussions of treating changes in skin color as a singular variable. We cross-culturally examined skin color changes along with the red-yellow axis and how they influence facial impressions across six face shapes from three types of ethnicities. A 7-point scale was used for evaluation, and the observers evaluated the impression of face images according to the following six evaluation items: healthiness, preference, brightness, whiteness, transparency, and skin tone. The observers were divided into the following four groups: Japan, China, Thailand, and the Caucasus. Differences in the evaluation and association of skin color with various traits emerged between cultures. For instance, East Asian cultures associated positive attributes with reddish skin colors, whereas Caucasians often linked positive traits with yellowish skin colors. These cultural disparities emphasize the dynamic interplay between culture and perception in assessing facial impressions.

The relationship of tooth shade and skin tone and its influence on smile attractiveness in native South Indians: A web-based cross sectional survey.

Objectives: This study aimed to investigate the influence of tooth shade and skin tone on smile attractiveness among native South Indians. The primary research question was whether there is a significant relationship between these variables and perceived smile attractiveness. Materials and methods: A web-based cross-sectional survey was conducted with approval from the Institutional Review Board of (Thai Moogambigai Dental College and Hospital, Chennai). Standardized smile photographs of two South Indian models (one male and one female) were digitally modified to display four different tooth shades and four different skin tones, resulting in 32 images. These images were incorporated into a Google Form along with a questionnaire and a Visual Analog Scale (VAS) for attractiveness rating. The survey was distributed to 1200 participants, including both dental professionals and the general population, with 1000 valid responses recorded. Statistical analysis was performed using IBM SPSS Statistics, employing parametric tests to evaluate the data. Results: The study found that lighter tooth shades were consistently rated higher in attractiveness for both genders. Lighter tooth shades such as FS1T1 and FS2T1 scored means of 6.88 and 7.27 respectively for females, while darker shades like FS1T4 scored lower with a mean of 4.95. Similarly, males showed a preference for lighter tooth shades with MS1T1 and MS2T1 scoring means of 5.57 and 5.78 respectively compared to darker shades like MS1T4 with a mean of 3.63. Significant differences were noted across age groups and genders, with younger participants and females showing a stronger preference for lighter tooth shades. Conclusions: The study concludes that both tooth shade and skin tone significantly influence smile attractiveness, with a clear preference for lighter tooth shades among the surveyed population. These findings suggest the importance of considering these factors in aesthetic dental treatments to enhance patient satisfaction and achieve optimal results. Clinical relevance: The results underscore the necessity for dental practitioners to take into account both tooth shade and skin tone when planning aesthetic dental treatments. This approach will help in achieving a more harmonious and natural appearance, ultimately improving patient satisfaction with the treatment outcomes. Future research should continue to explore the cultural and individual factors that contribute to these preferences in dental aesthetics.

Analyzing Discrepancies and Correlations in Soft and Hard Tissue Asymmetry: A Focused Study on Hemifacial Microsomia and Isolated Microtia.

BACKGROUND: This study aims to thoroughly investigate the distinctions and relationships between facial hard and soft tissue asymmetry, as well as their variations within different conditions and age groups. METHODS: This cross-sectional study analyzed pre-treatment computed tomography (CT) images from 120 male patients aged 5 to 12 years with unilateral HFM (Pruzansky-Kaban types I and IIA) or isolated microtia. The 120 patients were categorized into four groups by condition (HFM or isolated microtia) and age (5-7, 8-12 years). Segmentation and extraction of anatomical landmarks were performed using Mimics software, followed by generating root-mean-square (RMS) values for facial asymmetry. Statistical analysis, including the Wilcoxon signed-rank test and Spearman correlation coefficient, was conducted to assess differences and correlations in asymmetry. RESULTS: The study found that soft tissue asymmetry was generally greater than hard tissue asymmetry across all facial regions. The complexity of regional asymmetry correlations increased with age in HFM patients but decreased in isolated microtia patients. Significant correlations between hard and soft tissues were observed within the same anatomical regions, particularly in HFM patients aged 8-12 years. CONCLUSION: The intricate interplay between hard and soft tissues was observed in HFM and isolated microtia patients. Personalized analysis of the causes of asymmetry in different regions is crucial for the formulation of effective treatment plans. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of microneedling and CO2 laser with adipose-derived stem cells for facial rejuvenation: a randomized split-face study.

BACKGROUND: Facial aging, characterized by structural decline and loss of collagen and elastin, has led to increased demand for rejuvenation treatments. Adipose-derived stem cells (ADSCs) have emerged as a promising option, but comparative studies on their application methods are limited. OBJECTIVE: Our aim was to compare the efficacy of ADSC combined with microneedling or CO2 laser for facial rejuvenation. METHODS: Twenty-seven participants were randomized into two groups: Microneedling (MN, n = 14) or CO2 laser (n = 13). Each group underwent three treatment sessions at 4-week intervals. The ADSC solution was applied to one side and the placebo to the other using a split-face design. We performed objective evaluations (UV spots, brown spots, wrinkles, texture, pores, red areas, and porphyrins) and subjective assessments, including clinical photographs, patient satisfaction scales, and histological analysis of skin biopsies. RESULTS: The CO2 laser with the ADSC group showed significantly more significant improvements in UV spots (P = 0.002) and wrinkles (P = 0.002) compared to the MN with the ADSC group. Histological analysis revealed superior elastin fibers and epidermal thickness improvements with CO2 laser treatment. Patient satisfaction was higher in the CO2 laser group, with 84.6% reporting complete satisfaction compared to 50% in the MN group. CONCLUSIONS: The combination of CO2 laser with ADSCs demonstrated superior efficacy for facial rejuvenation compared to MN with ADSCs. This approach improved UV spots, wrinkles, skin structure, and overall patient satisfaction. Further studies with larger cohorts and extended follow-up are needed to confirm long-term efficacy.

Cross Cultural Validation of Oral Health Index Profile for Temporomandibular Disorders in Spanish Speaking Population.

OBJECTIVES: Structured patient-centred assessment is critical for improving care. OHIP-TMDs are a validated English-language outcome measure for temporomandibular disorders (TMD) which evaluates the biopsychosocial impact of TMD. Due to language and cultural changes, the original instrument's phrasing of its items may change when translated to Spanish. This study cross-culturally adapted and validated OHIP-TMDs for Spanish-speaking individuals with TMD. METHODS: OHIP-TMDs was forward-backward translated into Spanish (OHIP-TMDs-Sp) and cross-culturally adapted to a Hispanic population with TMD (Diagnostic Criteria for TMD n = 154) according to international norms. All patients completed the OHIP-TMDs-Sp, the Graded Chronic Pain Scale (GCPS), and Jaw Functional Limitation Scale (JFLS-20). A subsample (n = 30) recompleted the OHIP-TMDs-Sp after a 3-week washout to measure test-retest reliability using an intra-class correlation coefficient (ICC 2.1). OHIP-TMDs-Sp, JFLS-20, and GCPS were analysed for convergent validity and internal consistency. RESULTS: The sample with articular and muscular TMD diagnoses was 85.7% female with a mean age of 29.5. (SD 9.01). OHIP-TMDs-Sp had high internal reliability (Cronbach's Alpha = 0.95) and good test-retest reliability (ICC = 0.82; 95% CI = 0.57-0.93). In terms of convergent validity, the OHIP-TMDs-Sp demonstrated moderate to large positive correlations with the total JLFS-20 score (ρ = 0.72; p < 0.01), Mastication (ρ = 0.68; p < 0.01), Communication (ρ = 0.68; p < 0.001), as well to GCPS disability score (ρ = 0.59; p < 0.01), and characteristic pain intensity (ρ = 0.69; p < 0.01). CONCLUSIONS: The total score of OHIP-TMDs-Sp is reliable for assessing quality-of-life in Spanish-speaking TMD patients.

Dupilumab Facial Redness (DFR) Cleared With Oral Itraconazole.

Dupilumab is the first US FDA-approved biologic for moderate to severe atopic dermatitis (AD) in adults and children of age more than six months. It is a fully monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signal transmission. The initial product monograph mentioned major side effects like hypersensitivity reactions and eye problems like conjunctivitis, dry eye, and keratitis. Persistent facial redness with dupilumab administration has been reported in the past, and itraconazole proved to be effective for its treatment. We report a case of adult AD, on treatment with dupilumab, experiencing dupilumab facial redness (DFR), giving a positive response to itraconazole. DFR is a recognized complication of dupilumab therapy for AD. Clinicians should maintain a high index of suspicion for DFR, especially in patients presenting with new-onset facial symptoms during dupilumab treatment. Itraconazole can be considered a standard therapy for DFR, given its efficacy and tolerability profile in this context.

The Survival Rate of the Retention System for Extraoral Maxillofacial Prosthetic Implant: A Systematic Review.

This systematic review examines the survival rate of retention systems available for extraoral implant-supported prosthesis as there appears to be a lack of information in the literature regarding the same due to the limited data that represents the benefits and drawbacks of each system. The current investigation addresses this gap. If clinicians recognize the optimal survival rate of each retention system, they can select the appropriate retentive attachments increasing patient satisfaction regarding the use craniofacial prosthesis. The objective of this systematic review is to determine the optimal retention system for implant-retained craniofacial prosthesis. This systematic review has followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive electronic database search was performed to locate research articles on implant-retained craniofacial prostheses published from 2002 to 2024. The included studies were conducted in the English language and specifically compared various retention techniques or provided information on the survival rate, mechanical behavior, and prosthetic complications. Ten of 2857 satisfied the requirements for inclusion and were analyzed.

Prevalence and characteristics of facial nerve bifurcation in the mastoid segment: a retrospective analysis using temporal bone CT scans.

PURPOSE: To investigate the prevalence and characteristics of bifurcation of the facial nerve (FN) in the mastoid segment using temporal bone CT scans. METHODS: A total of 970 cases (1931 ears) of temporal bone CT scans were reviewed, including 463 females and 498 males, aged 1 to 95 years (interquartile range: 20-69 years). CT imaging with multiplanar reconstruction (MPR) was used to identify and evaluate the bifurcation of the FN. Cases showing branching were confirmed by consensus among three physicians. RESULTS: We identified 10 cases (10 ears) with facial nerve branching in the vertical segment, yielding an incidence rate of 0.52% (10/1931 ears). Every cases were unilateral, predominantly on the left side. Age analysis revealed 1 case (0.22%) in individuals under 20 years and 9 cases (0.61%) in those over 20 years. Bifurcation generally occurred near the middle to lower vertical segment, with the closest proximity to the second genu observed in a 15-year-old patient. CONCLUSIONS: Bifurcation of the FN in the mastoid segment, though rare, can be encountered in otologic surgery. Detailed preoperative imaging evaluations are crucial for surgical planning to minimize the risk of nerve damage. Our findings emphasize the importance of recognizing anatomical variations in the FN for improving surgical outcomes and patient safety.

The effects of professional expertise on perceptions of treatment need in patients with class II division 1 malocclusion: a comparison between orthodontists, general dentists, and lay people in Germany.

PURPOSE: This study aimed to compare the perception of practitioners with varying levels of expertise and laypeople regarding the orthodontic treatment need and facial harmony in patients with increased anterior overjet. METHODS: Three groups of observers (orthodontists, general dentists, and laypeople, in total n = 48) were asked to rate on images-using a 10-point visual analog scale (VAS)-the facial harmony and treatment need of a sample of 8 patients with class II division 1 malocclusion and overjets of 2, 4, 6, and 8 mm. RESULTS: Statistically significant differences were observed between the three groups of observers regarding patients with an overjet of 4 mm and above (p < 0.001). Treatment need was perceived at an overjet of 4 mm by orthodontists and 6 mm by general dentists, whereas laypeople did not perceive a need for treatment in any of the groups (p < 0.001). Regarding perception of facial harmony, orthodontists had the lowest threshold (4 mm overjet), while dentists followed at a greater overjet of 6 mm or more (p < 0.001). A statistically significant correlation between the noticed facial harmony and the perceived orthodontic treatment need was found in all observers (p < 0.001). CONCLUSION: The perceived orthodontic treatment need for class II division 1 malocclusion increased with increasing professional expertise.

Rare skin manifestation of juvenile dermatomyositis: peri-orbital oedema and facial swelling.

Juvenile dermatomyositis (JDM) is an auto-immune disease characterised by muscle weakness and typical skin findings. Although peri-orbital oedema and facial swelling are compatible cutaneous findings in JDM, they are extremely rare. A 7-year-old boy who presented with peri-orbital oedema and facial swelling without muscle weakness is reported. In addition, he had cholestasis and marked cytopenia, which are uncommon in JDM, and malignancy and metabolic disorders were primarily considered in the aetiology. He had no musculoskeletal complaints other than elevated muscle enzymes on presentation but developed muscle weakness during follow-up, and a muscle biopsy was compatible with inflammatory myopathy. He responded favourably to conventional treatment and there were no physical limitations or skin findings by the 14th month of follow-up. Although patients presenting with typical clinical features are easy to diagnose, atypical skin findings are challenging for the clinician. In the presence of atypical skin and clinical findings in addition to muscle enzyme elevation, JDM should be considered in the differential diagnosis.Abbreviations: AHCE: asymptomatic hyper-CKemia; AST: aspartate aminotransferase; C: complement; CK: creatine kinase; IVIG: intravenous immunoglobulin; IIM: idiopathic inflammatory myopathy; JDM: juvenile dermatomyositis; LDH: lactate dehydrogenase; MAA: myositis-associated antibodies; MDA5: melanoma differentiation-associated gene 5; MRC: Medical Research Council; MRI: magnetic resonance imaging; MSA: myositis-specific antibodies; MTX: methotrexate NXP2: nuclear matrix protein 2; STIR: short tau inversion recovery; US: ultrasound.

Acceptance and willingness of patients with chronic facial nerve palsy for an implantable device that assists with eye closure.

BACKGROUND: Patients with facial nerve palsy often experience lagophthalmos (incomplete eye closure), which can lead to exposure keratitis. The Bionic Lid Implant for Natural Eye Closure (BLINC) is a medical device designed to mimic the more natural blink kinetics than traditional lid loading techniques. AIMS: This study aimed to evaluate potential factors that might influence the design of the BLINC device and willingness of participant to undergo the implant placement surgery. METHODS: Patients attending a multidisciplinary facial nerve clinic were invited to complete a survey addressing patient acceptance of the BLINC device implantation. RESULTS: Seventy-two patients were mailed the survey, of which 50 returned completed surveys (69%). The most important factor identified by participants was the device function (81% ranked as very important) and the least important factor was cost (16% ranked as very important). Median acceptable device function time was 5 years (range 1-10 years). Ten participants (20%) indicated willingness to be the first to trial BLINC. Women were more likely to rate visual appearance as important (OR 3.32, CI 1.14-9.62, p = 0.028), and less likely to rate user friendliness as important (OR 0.16, CI 0.04-0.52, p = 0.0021). Older participants were more likely to rate the length of recovery period as important (OR 1.04, CI 1.01-1.08, p = 0.006). Participants with complete eye closure were less likely to be willing to trial the implant (OR 0.08, CI 0.00-0.53, p = 0.006, whilst patients with eye irritation were more willing to trial the implant (OR 7.20, CI 1.12-142, p = 0.036). CONCLUSION: Certain patient demographics impact patient aesthetic and functional preferences and the willingness to trial the BLINC device.

Outcomes of a modified technique of partial parotidectomy and novel parotid tumour position classification from a single surgeon prospective database.

BACKGROUND: Conservative parotidectomy for benign tumours reduces facial nerve palsy, without increasing local recurrence. We report a modified technique of partial parotidectomy and using a novel description of tumour position, explore relationships between tumour position and histological margins, facial nerve palsy and local recurrence. METHODS: A prospectively collected single surgeon parotidectomy database was analysed, including tumour location (superficial/deep lobe; central/peripheral) and outcomes. A partial parotidectomy identified the facial nerve and the proximal portion of its branches with a macroscopically clear resection margin. Mean follow up was 5.9 years for pleomorphic adenomas. RESULTS: Three hundred and three patients underwent parotidectomy; 257 (84.8%) were superficial and 46 (15.2%) deep lobe. Tumour position was recorded in 291: 236 (81.1%) were peripheral tumours and 55 (18.9%) central. Histological margin involvement was similar in central and peripheral tumours, both overall and for superficial and deep lobe tumours, but was commoner in central deep lobe tumours, (P = 0.003). Temporary partial facial nerve palsy occurred in 21 (6.9%), with one permanent partial nerve palsy (0.3%). Deep lobe tumours and total parotidectomy were associated with facial nerve palsy (P = 0.01). Facial nerve monitoring reduced the risk of palsy (P < 0.01). Local recurrence of pleomorphic adenomas was uncommon, occurring in 3 (2.0%) of 151 patients. CONCLUSION: This series confirms the safety and adequacy of more conservative partial parotidectomy for benign tumours, highlighting most tumours are peripheral, but not more prone to histological margin involvement or local recurrence, and with routine intraoperative facial nerve monitoring, is achieved with low facial nerve palsy rates.

Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration.

Background: Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. Aim: This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Methods: Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Results: Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis. Conclusion: Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. Clinical trial registration: https://clinicaltrials.gov/study/NCT06538103, NCT06538103.

Injectable Platelet-Rich Fibrin and Hyaluronic Acid Mesotherapy for Management of Actinic Elastosis of Lower Eyelids: A Case Series.

Rejuvenating the skin on the lower eyelids is often complicated. Treatment alternatives that have been practiced in the past had several complications. Additionally, they were not completely effective in addressing skin aging or actinic elastosis symptoms such as dark circles under the eyes. A minimally invasive therapy approach that improves the above-mentioned issues in a desirable way has been discussed in this case series. The patients selected were of the age group between 20-40 years who had actinic elastosis of the lower eyelid. The patients were injected twice at one-month intervals with a combination of injectable platelet-rich fibrin (iPRF) and hyaluronic acid. The patients were examined on the day of treatment and one month after the second injection. A progressive improvement in the esthetic outcome and a high level of patient satisfaction were observed. Apart from the predicted visible swelling right away following the iPRF injection. The outcomes have shown that a series of iPRF with hyaluronic acid injections in the lower eyelid region is a safe, proficient, pain-free, simple and rapid treatment option for actinic elastosis.