[Aplasia cutis congenita]. / Aplasia cutis congenita.

BACKGROUND: Aplasia cutis congenita is a rare congenital disorder characterised by the absence of skin. It mostly affects the scalp, but may also involve deeper tissue layers such as bone or dura mater. Bleeding from the sagittal sinus and infections are the most common complications. Numerous case reports have been published, but there is no consensus on therapeutic management, which includes both conservative and surgical treatment. METHODS: We report on 3 newborns with aplasia cutis congenita solely affecting the skin without involvement of deeper tissue layers. All 3 patients were treated conservatively with fatty gauze being used as a wound dressing. The patients were monitored in tight intervals. RESULTS: In all 3 newborns, the skin defects healed within a few months without any complications. CONCLUSION: Conservative treatment with fatty gauze represents a reliable therapeutic option in case the disease solely affects the skin.

[Proven and innovative operative techniques for reanimation of the paralyzed face]. / Bewährte und innovative operative Techniken zur Reanimation des gelähmten Gesichtes.

This overview on the currently most effective reconstructive techniques for reanimation of the unilaterally or bilaterally paralysed face includes all important techniques of neuromuscular reconstruction as well as of supplementary static procedures, which contribute significantly to the efficiency and quality of the functional overall result. Attention is paid to the best indications at the best time since onset of the facial palsy, depending on the age of the patient, the cause of the lesion, and the compliance of the patient for a long-lasting and complex rehabilitation programme. Immediate neuromuscular reconstruction of mimic function is favourable by nerve suture or nerve grafting of the facial nerve, or by using the contralateral healthy facial nerve via cross-face nerve grafting as long as the time since onset of the irreversible palsy is short enough that the paralysed mimic muscles can still be reinnervated. For the most frequent indication, the unilateral irreversible and complete palsy, a three-stage concept is described including cross-face nerve grafting, free functional gracilis muscle transplantation, and several supplementary procedures. In patients with limited life expectancy, transposition of the masseteric muscles is favoured. Bilateral facial palsy is treated by bilateral free gracilis muscle transplantation with the masseteric nerve branches for motor reinnervation. Functional upgrading in incomplete lesions is achieved by cross-face nerve grafting with distal end-to-side neurorrhaphy or by functional muscle transplantation with ipsilateral facial nerve supply.

Are there ethnic differences of facial movements between Europeans and Asians?

PURPOSE: Due to the widespread use of Free Functional Muscle Transplant (FFMT) around the world to reanimate the paralysed face, it is important to be aware of ethnic differences in facial movements. METHODS AND MATERIAL: Participants in this study were born in Taiwan (n=24) and Austria (n=24). Analyses were conducted applying the digitised three-dimensional video-analysis system. All 48 subjects have never undergone any treatments in the face nor did they have previous histories of craniofacial anomalies. RESULTS: In general, Europeans were observed to have larger facial movements than Asians, from 0.4 mm (e.g. 5.7%) up to 3.9 mm (e.g. 30.3%), on average 1.3 mm+/-0.82 SD (e.g. 20.6%). Particularly the eyebrow, nose and mouth regions show statistically significant larger excursions on average 1.4 mm (e.g. 19.9%), 1.3 mm (e.g. 34.6%) and 3.0 mm (e.g. 30.3%). One exception is in the eye region, where Asians have a larger excursion (1.4 mm, e.g. 15.8%) of the eyelids, due to the larger distances between the upper and lower eyelids in the rest position. CONCLUSION: Europeans have generally larger facial movements than Asians. Particularly the eyebrow, nose and mouth regions show statistically significant larger excursions; exception must be made to the eye region, where Asians have a larger excursion of the eyelids. This is the first step to gather essential information about the ethnical differences in facial movements, a factor that should be considered as FFMT is becoming more popular worldwide.

Three-dimensional video-analysis of facial movements in healthy volunteers.

The aim of this study was to determine the mean distances of facial movements in 24 healthy individuals aged between 22 and 70 years, using the digitised three-dimensional video-analysis system developed by Frey et al. The subjects were divided into three groups of eight. The first group consisted of individuals aged between 20 and 30 years (mean+/-s.d.=25.0+/-2.33 years). Subjects in the second group were aged between 40 and 50 years (mean+/-s.d.=46.8+/-2.53 years), and the third group consisted of subjects aged between 60 and 70 years (mean+/-s.d.=63.6+/-3.07 years). In all groups the sexes were equally represented. No subject had had treatment to the face, nor did they have paralysis, scars or diseases of the skin. Males showed larger movements of the face than females, on average by 1.40+/-0.73 mm (15.08%). Subjects aged between 60 and 70 years demonstrated the largest movements of the face. The evaluation of facial movements in 24 healthy volunteers showed that sex and age affect facial dynamics. Thus study generated three-dimensional standard values for healthy facial movements.