RESUMO
BACKGROUND: Keratinocyte carcinoma (KC) is the commonest type of malignancy in humans; however, the impact of KC on survival is poorly understood. OBJECTIVES: This study characterizes the impact of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and squamous cell carcinoma in situ (SCCis) on the survival of Icelanders. METHODS: This whole population study evaluated relative survival of KC in Iceland by using a cancer registry containing records of all BCC, SCCis, and SCC cases recorded in Iceland between 1981 and 2015. RESULTS: Between 1981 and 2015, 8767 Icelanders were diagnosed with their first localized KC. A total of 6473 individuals with BCC, 1194 with SCCis, and 1100 with invasive SCC, respectively. BCC was not associated with decreased survival except for men diagnosed with BCC between 1981 and 1995 for whom decreased 10-year relative survival was observed (85.3, 95% CI [77.9-92.7]). SCC and SCCis were both associated with a decrease in relative survival for certain population subgroups such as individuals <50 years of age at time of diagnosis. CONCLUSION: Our whole population cohort survival study examining the Icelandic Cancer Registry supports prior studies demonstrating that BCC is not associated with a reduction in relative survival and that SCC and SCCis are associated with comparatively poor relative survival in certain population subgroups.
Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutâneas , Masculino , Humanos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Queratinócitos/patologiaRESUMO
The intent of this brief communication is to describe a unique incomplete staining frozen section pathology artifact encountered during Mohs Micrographic Surgery. At the authors’ institution, an amorphous, eosinophilic artifact that obscured cellular architecture was observed multiple times during histological interpretation. It was determined that incomplete tissue staining was likely caused by weak staining, possibly related to an interaction between hematoxylin dye solution and acetone. We adjusted our SLS stain line protocol by adding a 15 second water rinse between the acetone and hematoxylin pots and then compared the old fixation protocol with our new fixation protocol. This artifact, which was regularly found intraoperatively at five separate MMS laboratories has sustainably resolved. Mohs Micrographic Surgery (MMS) is a dermatologic procedure that includes tumor extirpation, tissue grossing, slide preparation, and microscopic histologic interpretation. Tissue grossing and slide preparation are vital components of the MMS procedure. There are many steps throughout tissue processing that can result in frozen section pathology artifacts. Frequently encountered frozen section pathology artifacts include vacuolation of cytoplasm or “freeze artifact,” overstaining and understaining with hematoxylin and eosin, incomplete dehydration, and splaying of collagen in the dermis.1-3 We describe a unique incomplete staining frozen section pathology artifact. J Drugs Dermatol. 2022;21(5):542-544. doi:10.36849/JDD.6722.
Assuntos
Cirurgia de Mohs , Neoplasias Cutâneas , Acetona , Artefatos , Secções Congeladas/métodos , Hematoxilina , Humanos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Coloração e RotulagemRESUMO
Parkes Weber syndrome is associated with autosomal dominant inheritance, caused by germline heterozygous inactivating changes in the RASA1 gene, characterized by multiple micro arteriovenous fistulas and segmental overgrowth of soft tissue and skeletal components. The focal nature and variable expressivity associated with this disease has led to the hypothesis that somatic "second hit" inactivating changes in RASA1 are necessary for disease development. We report a 2-yr-old male with extensive capillary malformation and segmental overgrowth of his lower left extremity. Ultrasound showed subcutaneous phlebectasia draining the capillary malformation; magnetic resonance imaging showed overgrowth of the extremity with prominence of fatty tissues, fatty infiltration, and enlargement of all the major muscle groups. Germline RASA1 testing was normal. Later somatic testing from affected tissue showed two pathogenic variants in RASA1 consistent with the c.934_938del, p.(Glu312Argfs*14) and the c.2925del, p.(Asn976Metfs*20) with variant allele fractions of 3.6% and 4.2%, respectively. The intrafamilial variability of Parkes Weber syndrome involving segmental overgrowth of soft tissue, endothelium, and bone is strongly suggestive of a somatic second-hit model. There are at least two reports of confirmed second somatic hits in RASA1 To our knowledge, this is the first report of an individual with two somatic pathogenic variants in the RASA1 gene in DNA from a vascular lesion.
Assuntos
Síndrome de Sturge-Weber/genética , Proteína p120 Ativadora de GTPase/genética , Alelos , Capilares/anormalidades , Pré-Escolar , Humanos , Masculino , Mutação/genética , Síndrome de Sturge-Weber/metabolismo , Malformações Vasculares/genética , Proteína p120 Ativadora de GTPase/metabolismoRESUMO
BACKGROUND: Cutaneous angiosarcoma (CAS) is a rare, malignant tumor of vascular mesenchymal origin accounting for less than 1% of all sarcomas. OBJECTIVE: To examine epidemiologic trends and outcomes in CAS. METHODS: In this retrospective, population-based study, patients with CAS were identified from the Surveillance Epidemiology and End Results database. Age, sex, and race-standardized incidence rates (IRs) were calculated. Survival was assessed with Kaplan-Meier curves and Cox proportional hazards models. RESULTS: Of 811 patients with CAS, 43% had a prior primary cancer. CAS IR for patients without prior primary cancers dropped from 5.88 per 100,000 in 1973 to 1984 to 2.87 per 100,000 in 2005 to 2014. In those with prior primary cancers, IR rose from 0.03 per 100,000 in 1973 to 1984 to 2.25 per 100,000 in 2005 to 2014. On multivariate analysis, patients older than 70 years of age had a higher risk of death compared with those younger than 50 years (hazard ratio, 2.16; 95% confidence interval 1.33-3.57; P = .002), and distant disease was associated with increased risk of death compared with localized disease (hazard ratio, 1.50; 95% confidence interval, 1.11-2.03; P = .008). Receipt of surgery and/or radiation therapy was not associated with survival. LIMITATIONS: Potential selection and miscoding bias, retrospective nature. CONCLUSION: CAS rates are rising among those with other prior primary cancers. Survival is not affected by current therapeutic strategies, highlighting the need for additional treatment options.
Assuntos
Hemangiossarcoma/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Cutâneas/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/estatística & dados numéricos , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Feminino , Hemangiossarcoma/terapia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/estatística & dados numéricos , Segunda Neoplasia Primária/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Neoplasias Cutâneas/terapia , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
A case of a 15-year-old male patient with a 3-year history of linear, segmental amyopathic dermatomyositis with calcinosis cutis is presented. The calcinosis was recalcitrant to treatment with topical steroids and hydroxychloroquine. Topical 10% sodium thiosulfate use for 8 weeks resulted in improvement. The use of topical sodium thiosulfate for patients in whom surgical extraction is not an option is detailed.
Assuntos
Calcinose/diagnóstico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/patologia , Tiossulfatos/uso terapêutico , Administração Tópica , Adolescente , Biópsia por Agulha , Calcinose/complicações , Doença Crônica , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Humanos , Imuno-Histoquímica , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/etiologia , Masculino , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Resultado do TratamentoRESUMO
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by proximal muscle weakness associated with a distinct cutaneous eruption. The association of DM with malignancy has been extensively described in the literature. Patients with DM that also have transcriptional intermediary factor 1γ (TIF1γ) autoantibodies (anti-p155, anti-p155/140) have higher rates of malignancy when compared to those without the autoantibody. We report the case of a 65-year-old woman with TIF1γautoantibody positive dermatomyositis associated with a non-functional pancreatic neuroendocrine tumor (PNET). Surgical resection of the PNET resulted in significant clinical improvement and a reduction of TIF1γ autoantibody levels in our patient.
Assuntos
Dermatomiosite/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Idoso , Autoanticorpos/imunologia , Dermatomiosite/etiologia , Dermatomiosite/imunologia , Feminino , Humanos , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/imunologia , Fatores de Transcrição/imunologiaRESUMO
BACKGROUND: Metabolic alterations as hyperglycemia and inflammation induce myocardial molecular events enhancing oxidative stress and mitochondrial dysfunction. Those alterations are responsible for a progressive loss of cardiomyocytes, cardiac stem cells, and consequent cardiovascular complications. Currently, there are no effective pharmacological measures to protect the heart from these metabolic modifications, and the development of new therapeutic approaches, focused on improvement of the oxidative stress condition, is pivotal. The protective effects of levocarnitine (LC) in patients with ischemic heart disease are related to the attenuation of oxidative stress, but LC mechanisms have yet to be fully understood. OBJECTIVE: The aim of this work was to investigate LC's role in oxidative stress condition, on ROS production and mitochondrial detoxifying function in H9c2 rat cardiomyocytes during hyperglycemia. METHODS: H9c2 cells in the hyperglycemic state (25 mmol/L glucose) were exposed to 0.5 or 5 mM LC for 48 and 72 h: LC effects on signaling pathways involved in oxidative stress condition were studied by Western blot and immunofluorescence analysis. To evaluate ROS production, H9c2 cells were exposed to H2O2 after LC pretreatment. RESULTS: Our in vitro study indicates how LC supplementation might protect cardiomyocytes from oxidative stress-related damage, preventing ROS formation and activating antioxidant signaling pathways in hyperglycemic conditions. In particular, LC promotes STAT3 activation and significantly increases the expression of antioxidant protein SOD2. Hyperglycemic cardiac cells are characterized by impairment in mitochondrial dysfunction and the CaMKII signal: LC promotes CaMKII expression and activation and enhancement of AMPK protein synthesis. Our results suggest that LC might ameliorate metabolic aspects of hyperglycemic cardiac cells. Finally, LC doses herein used did not modify H9c2 growth rate and viability. CONCLUSIONS: Our novel study demonstrates that LC improves the microenvironment damaged by oxidative stress (induced by hyperglycemia), thus proposing this nutraceutical compound as an adjuvant in diabetic cardiac regenerative medicine.
Assuntos
Antioxidantes/farmacologia , Carnitina/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Hiperglicemia/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Animais , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/metabolismo , Linhagem Celular , Regulação para Baixo/efeitos dos fármacos , Peróxido de Hidrogênio/farmacologia , Miócitos Cardíacos/metabolismo , Ratos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacosRESUMO
BACKGROUND: Elicitation of eye closure and other movements via electrical stimulation may provide effective treatment for facial paralysis. The authors performed a human feasibility study to determine whether transcutaneous neural stimulation can elicit a blink in individuals with acute facial palsy and to obtain feedback from participants regarding the tolerability of surface electrical stimulation for daily blink restoration. METHODS: Forty individuals with acute unilateral facial paralysis, HB grades 4 through 6, were prospectively studied between 6 and 60 days of onset. Unilateral stimulation of zygomatic facial nerve branches to elicit eye blink was achieved with brief bipolar, charge-balanced pulse trains, delivered transcutaneously by adhesive electrode placement; results were recorded on a high-speed video camera. The relationship between stimulation parameters and cutaneous sensation was analyzed using the Wong-Baker Faces Pain Rating Scale. RESULTS: Complete eye closure was achieved in 55 percent of participants using stimulation parameters reported as tolerable. In those individuals, initial eye twitch was observed at an average current of 4.6 mA (±1.7; average pulse width of 0.7 ms, 100 to 150 Hz), with complete closure requiring a mean of 7.2 mA (±2.6). CONCLUSIONS: Transcutaneous facial nerve stimulation may artificially elicit eye blink in a majority of patients with acute facial paralysis. Although individuals varied widely in their reported degrees of discomfort from blink-eliciting stimulation, most of them indicated that such stimulation would be tolerable if it could restore eye closure. These patients would therefore benefit from a biomimetic device to facilitate eye closure until the recovery process is complete. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Piscadela , Paralisia Facial/terapia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Biônica , Nervo Facial , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Different subspecialists treat benign intraoral lesions using various approaches including surgical excision, medical therapy, sclerotherapy, and laser photocoagulation. The goal of this study was to establish whether lasers could effectively target and destroy oral lesions containing endogenous chromophores, while minimizing injury to unaffected adjacent tissues and critical structures. MATERIALS AND METHODS: This retrospective study involved 26 cases of benign oral lesions, both vascular and pigmented, which were addressed by means of selective laser treatment. Pathologies were port-wine stains, hereditary hemorragic teleangectasia, hemangiomas, venous and arteriovenous malformations, pyogenic granuloma, and hairy reconstructive flaps. Electronic medical records and photographic documentation were reviewed. Three blinded staff personnel not involved with patient care in this study evaluated photographs taken prior to the first and after the final laser treatments. Observers rated the percentage clearance of the lesions or the ablation of bleeding, and the assessed values were averaged for each patient. RESULTS: An average of 30-95% lightening was observed in the intraoral port-wine stains, 90% in the hemangiomas, 70% in arteriovenous malformations, 81% for venous malformations, 86% for venous lakes, and 100% for the pyogenic granuloma. Bleeding was ablated in all hereditary hemorrhagic telangiectasia lesions treated using the pulsed dye laser with or without the Alexandrite laser. Intraoral hair growing on the skin paddle of microvascular flaps was completely removed in one of the three cases treated using the Alexandrite laser. In the two remaining cases, some hair removal was achieved, but because the residual hairs were grey or white (absence of melanocytic chromophore), photocoagulation was less effective. CONCLUSION: Lasers are a safe and effective means to selectively destroy specific chromphores. Such specific targeting ensures complete destruction of pathological tissue, decreasing the possibility of relapse and/or recurrence. Selective laser treatment of benign intraoral lesions represents a niche application that fills a gap in the multidisciplinary management of several conditions such as oral vascular anomalies and hairy reconstructive flaps.
Assuntos
Lasers de Corante/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Doenças da Boca/cirurgia , Adulto , Criança , Feminino , Granuloma Piogênico/cirurgia , Hemangioma/cirurgia , Humanos , Masculino , Fotografação , Mancha Vinho do Porto/cirurgia , Estudos Retrospectivos , Método Simples-Cego , Telangiectasia Hemorrágica Hereditária/cirurgia , Resultado do Tratamento , Malformações Vasculares/cirurgiaRESUMO
BACKGROUND: Port-wine stains (PWS) are capillary malformations, typically located in the dermis of the head and neck, affecting 0.3% of the population. Current theories suggest that port-wine stains are caused by somatic mutations that disrupt vascular development. OBJECTIVES: Understanding PWS genetic determinants could provide insight into new treatments. METHODS: Our study used a custom next generation sequencing (NGS) panel and digital polymerase chain reaction to investigate genetic variants in 12 individuals with isolated port-wine stains. Importantly, affected and healthy skin tissue from the same individual were compared. A subtractive correction method was developed to eliminate background noise from NGS data. This allowed the detection of a very low level of mosaicism. RESULTS: A novel somatic variant GNAQ, c.547C>G, p.Arg183Gly was found in one case with 4% allele frequency. The previously reported GNAQ c.548G>A, p.Arg183Gln was confirmed in 9 of 12 cases with an allele frequency ranging from 1.73 to 7.42%. Digital polymerase chain reaction confirmed novel variants detected by next generation sequencing. Two novel somatic variants were also found in RASA1, although neither was predicted to be deleterious. CONCLUSIONS: This is the second largest study on isolated, non-syndromic PWS. Our data suggest that GNAQ is the main genetic determinant in this condition. Moreover, isolated port-wine stains are distinct from capillary malformations seen in RASA1 disorders, which will be helpful in clinical evaluation.
Assuntos
Subunidades alfa de Proteínas de Ligação ao GTP/genética , Polimorfismo Genético , Mancha Vinho do Porto/genética , Proteína p120 Ativadora de GTPase/genética , Adolescente , Adulto , Feminino , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP , Variação Genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Mancha Vinho do Porto/patologia , Análise de Sequência de DNA , Pele/metabolismo , Pele/patologia , Adulto JovemRESUMO
The choice of the motor donor nerve is a crucial point in free flap transfer algorithms. In the case of unilateral facial paralysis, the contralateral healthy facial nerve can provide coordinated smile animation and spontaneous emotional expression, but with unpredictable axonal ingrowth into the recipient muscle. Otherwise, the masseteric nerve ipsilateral to the paralysis can provide a powerful neural input, without a spontaneous trigger of the smile. Harvesting a bulky muscular free flap may enhance the quantity of contraction but esthetic results are unpleasant. Therefore, the logical solution for obtaining high amplitude of smiling combined with spontaneity of movement is to couple the neural input: the contralateral facial nerve plus the ipsilateral masseteric nerve. Thirteen patients with unilateral dense facial paralysis underwent a one-stage facial reanimation with a gracilis flap powered by a double donor neural input, provided by both the ipsilateral masseteric nerve (coaptation by an end-to-end neurorrhaphy with the obturator nerve) and the contralateral facial nerve (coaptation through a cross-face nerve graft: end-to-end neurorrhaphy on the healthy side and end-to-side neurorrhaphy on the obturator nerve, distal to the masseteric/obturator neurorrhaphy). Their facial movements were evaluated with an optoelectronic motion analyzer. Before surgery, on average, the paretic side exhibited a smaller total three-dimensional mobility than the healthy side, with a 52% activation ratio and >30% of asymmetry. After surgery, the differences significantly decreased (analysis of variance (ANOVA), p < 0.05), with an activation ratio between 75% (maximum smile) and 91% (maximum smile with teeth clenching), and <20% of asymmetry. Similar modifications were seen for the performance of spontaneous smiles. The significant presurgical asymmetry of labial movements reduced after surgery. The use of a double donor neural input permitted both movements that were similar in force to that of the healthy side, and spontaneous movements elicited by emotional triggering.
Assuntos
Estética , Paralisia Facial/cirurgia , Retalhos de Tecido Biológico , Músculo Esquelético/transplante , Recuperação de Função Fisiológica/fisiologia , Sorriso/fisiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Eletromiografia , Expressão Facial , Músculos Faciais/cirurgia , Nervo Facial/crescimento & desenvolvimento , Nervo Facial/fisiopatologia , Retalhos de Tecido Biológico/inervação , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Movimento/fisiologia , Músculo Esquelético/inervação , Transferência de Nervo , Procedimentos de Cirurgia Plástica/métodos , Coxa da Perna/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
IMPORTANCE: Facial paralysis is a life-altering condition that significantly impairs function, appearance, and communication. Facial rehabilitation via closed-loop pacing represents a potential but as yet theoretical approach to reanimation. A first critical step toward closed-loop facial pacing in cases of unilateral paralysis is the detection of healthy movements to use as a trigger to prosthetically elicit automatic artificial movements on the contralateral side of the face. OBJECTIVES: To test and to maximize the performance of an electromyography (EMG)-based blink detection system for applications in closed-loop facial pacing. DESIGN, SETTING, AND PARTICIPANTS: Blinking was detected across the periocular region by means of multichannel surface EMG at an academic neuroengineering and medical robotics laboratory among 15 healthy volunteers. MAIN OUTCOMES AND MEASURES: Real-time blink detection was accomplished by mapping the surface of the orbicularis oculi muscle on one side of the face with a multichannel surface EMG. The biosignal from each channel was independently processed; custom software registered a blink when an amplitude-based or slope-based suprathreshold activity was detected. The experiments were performed when participants were relaxed and during the production of particular orofacial movements. An F1 score metric was used to analyze software performance in detecting blinks. RESULTS: The maximal software performance was achieved when a blink was recorded from the superomedial orbit quadrant. At this recording location, the median F1 scores were 0.89 during spontaneous blinking, 0.82 when chewing gum, 0.80 when raising the eyebrows, and 0.70 when smiling. The overall performance of blink detection was significantly better at the superomedial quadrant (F1 score, 0.75) than at the traditionally used inferolateral quadrant (F1 score, 0.40) (P < .05). CONCLUSIONS AND RELEVANCE: Electromyographic recording represents an accurate tool to detect spontaneous blinks as part of closed-loop facial pacing systems. The early detection of blink activity may allow real-time pacing via rapid triggering of contralateral muscles. Moreover, an EMG detection system can be integrated in external devices and in implanted neuroprostheses. A potential downside to this approach involves cross talk from adjacent muscles, which can be notably reduced by recording from the superomedial quadrant of the orbicularis oculi muscle and by applying proper signal processing. LEVEL OF EVIDENCE: NA.
Assuntos
Piscadela/fisiologia , Eletromiografia/métodos , Músculos Faciais/fisiologia , Adulto , Paralisia Facial/fisiopatologia , Paralisia Facial/reabilitação , Feminino , Voluntários Saudáveis , Humanos , MasculinoRESUMO
PURPOSE: To characterize intraosseous vascular malformations and describe the most appropriate approach for treatment according to clinical experience and a review of the published data. MATERIALS AND METHODS: We performed a retrospective review of 11 vascular malformations (7 venous and 4 arteriovenous) of the facial bones treated during a 10-year period using en bloc resection or intraoral aggressive curettage alone or preceded by endovascular embolization. Corrective surgery was planned to address any residual bone deformities. The cases were reviewed at a mean follow-up point of 6 years. RESULTS: Facial symmetry was restored in the cases requiring reconstruction. Tooth sparing was possible in the case of jaw and/or maxillary localization. Recanalization occurred in 14% of the venous and 33% of the arteriovenous malformations. CONCLUSIONS: Facial intraosseous venous malformations can be successfully treated using surgery alone. Facial intraosseous arteriovenous malformations will be better addressed using combined approaches. Aggressive curettage will obviate the need for extensive surgical resection in selected cases.
Assuntos
Malformações Arteriovenosas/cirurgia , Ossos Faciais/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares , Veias/anormalidades , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veias/cirurgiaRESUMO
IMPORTANCE Facial paralysis remains one of the most challenging conditions to effectively manage, often causing life-altering deficits in both function and appearance. Facial rehabilitation via pacing and robotic technology has great yet unmet potential. A critical first step toward reanimating symmetrical facial movement in cases of unilateral paralysis is the detection of healthy movement to use as a trigger for stimulated movement. OBJECTIVE To test a blink detection system that can be attached to standard eyeglasses and used as part of a closed-loop facial pacing system. DESIGN, SETTING, AND PARTICIPANTS Standard safety glasses were equipped with an infrared (IR) emitter-detector unit, oriented horizontally across the palpebral fissure, creating a monitored IR beam that became interrupted when the eyelids closed, and were tested in 24 healthy volunteers from a tertiary care facial nerve center community. MAIN OUTCOMES AND MEASURES Video-quantified blinking was compared with both IR sensor signal magnitude and rate of change in healthy participants with their gaze in repose, while they shifted their gaze from central to far-peripheral positions, and during the production of particular facial expressions. RESULTS Blink detection based on signal magnitude achieved 100% sensitivity in forward gaze but generated false detections on downward gaze. Calculations of peak rate of signal change (first derivative) typically distinguished blinks from gaze-related eyelid movements. During forward gaze, 87% of detected blink events were true positives, 11% were false positives, and 2% were false negatives. Of the 11% false positives, 6% were associated with partial eyelid closures. During gaze changes, false blink detection occurred 6% of the time during lateral eye movements, 10% of the time during upward movements, 47% of the time during downward movements, and 6% of the time for movements from an upward or downward gaze back to the primary gaze. Facial expressions disrupted sensor output if they caused substantial squinting or shifted the glasses. CONCLUSIONS AND RELEVANCE Our blink detection system provides a reliable, noninvasive indication of eyelid closure using an invisible light beam passing in front of the eye. Future versions will aim to mitigate detection errors by using multiple IR emitter-detector units mounted on glasses, and alternative frame designs may reduce shifting of the sensors relative to the eye during facial movements.
Assuntos
Piscadela , Dispositivos de Proteção dos Olhos , Paralisia Facial/reabilitação , Raios Infravermelhos , Adulto , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Gravação em VídeoRESUMO
OBJECT: Surgical treatment of parotid malignancies may frequently involve facial nerve amputation to achieve oncological radical resection. The entire facial nerve branching from its exit from the stylomastoid foramen to the periphery of the gland is often sacrificed. The first reconstructive strategy is the immediate reconstruction of the facial nerve by directly anastomosing the trunk of the facial nerve to its distal branches by interpositional nerve grafting. The present study was performed to determine the adequacy of thoracodorsal nerve grafting for immediate repair of the facial nerve. The anatomical features of the thoracodorsal nerve make it particularly appropriate to match its trunk to the stump of the facial nerve at its exit from the stylomastoid foramen. Up to seven branches of the thoracodorsal nerve may be distally anastomosed to the severed distal branches of the facial nerve. More complex reconstruction may be addressed simultaneously by contemporary harvesting a de-epithelialized free flap from the same site based on thoracodorsal vessel perforators and preparing a rib graft from the same donor site. METHODS: Between October 2003 and August 2010, seven patients affected by parotid tumors (6 with parotid malignancies and 1 with multiple recurrences of pleomorphic adenoma) underwent radical parotidectomy with intentional sacrifice of the facial nerve to obtain oncological radical resection. In all patients, the facial nerve was reconstructed with an interpositional thoracodorsal nerve graft. In four patients, a de-epithelialized free flap based on the latissimus dorsi was transposed to cover soft tissue defects. Moreover, two of these patients also required a rib graft to reconstruct both the condyle and ramus of the mandible. With the exception of one patient affected by recurrent pleomorphic adenoma, all patients underwent radiotherapy after surgical treatment. RESULTS: All patients in our study recovered mimetic facial function. Facial muscles showed clinical signs of recovery within 5-14 (mean: 7.8) months, with varying degrees of mimetic restoration, and almost complete facial symmetry at rest in all patients. The House-Brackmann final score was I in two patients, II in two patients, and III in three patients. CONCLUSIONS: A thoracodorsal nerve graft to replace extratemporal facial nerve branching is a valid alternative technique to multiple classical nerve grafts, with good matching at both the proximal and distal anastomoses.
Assuntos
Nervo Facial/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Nervos Espinhais/transplante , Adenocarcinoma/cirurgia , Adenoma Pleomorfo/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Transplante Ósseo/métodos , Dissecação/métodos , Músculos Faciais/fisiologia , Feminino , Seguimentos , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Mandíbula/cirurgia , Côndilo Mandibular/cirurgia , Músculo Esquelético/transplante , Recidiva Local de Neoplasia/cirurgia , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Retalho Perfurante/transplante , Radioterapia Adjuvante , Recuperação de Função Fisiológica/fisiologiaRESUMO
OBJECTIVES/HYPOTHESIS: To quantify the threshold for human perception of asymmetry for eyebrow elevation, eye closure, and smile, and to ascertain whether asymmetry detection thresholds and perceived severity of asymmetry differ in distinct facial zones. STUDY DESIGN: Online survey. METHODS: Photographs of a female volunteer performing eyebrow elevation, eye closure, and smile were digitally manipulated to introduce left-to-right asymmetry in 1-mm increments from 0 mm to 6 mm. One hundred and forty-five participants viewed these photographs using an online survey, measuring accuracy of asymmetry detection and perceived expression unnaturalness (on a scale of 1-5). RESULTS: Photographs of facial asymmetries were correctly judged as asymmetrical over 90% of the time for 2 mm or more of asymmetry in eyelid closure, and 3 mm or more of asymmetry during smiling. Identification of eyebrow elevation asymmetry gradually rose from 23% correct to 97% correct across the range of 1 mm to 6 mm of asymmetry. Greater degrees of asymmetry were ranked as significantly more unnatural across all expressions (3 tests; X(2) (6, N = 145) = 405.52 to 656.27, all P <0.001). CONCLUSION: Thresholds for asymmetry detection vary across different zones of the face; once detected, asymmetry in eyelid position is perceived as more unnatural than asymmetries in either brow elevation or smile. These data will inform counseling of patients with segmental facial weakness and may provide more objective goals for facial reanimation procedures. LEVEL OF EVIDENCE: 4.