The Ability to Sustain Facial Expressions.

To gain more insight into facial muscle function, imaging during action would be optimal. Magnetic resonance imaging is highly suitable for visualizing facial muscles. However, magnetic resonance imaging requires the individual to remain as still as possible for a while. Knowledge of the ability to sustain facial expressions is requisite before scanning individuals. This could help adapting the scanning protocol to obtain optimal quality of imaging the muscles in action. A study, including 10 healthy volunteers, was done to perceive the extent of movement while holding facial expressions of smiling and pouting. During 6 minutes, 3-dimensional photographs were taken every consecutive minute while the participants maintained their facial expressions as motionless as possible. The movement was objectified by creating distance maps between the 2 models and calculating the Root Mean Square using the software 3DMedX. The results showed that most movements occurred in the first minute, with a decrease of the intensity of the expression. After the first minute, the expression, although less intense, could be held stable. This implies that magnetic resonance imaging scanning during facial expression is possible, provided that the scanning starts after the first minute has elapsed. In addition, results demonstrated that more slackening of the muscles while smiling compared with pouting.

The Average Facial Expressions: A Range of Motion Analysis for Different Sex and Age Groups.

Facial expressions are ubiquitous in communication. Therefore, assessment of mimic function is essential in facial surgery, but no reference standards are currently available. This prospective study aims to create reference values of three-dimensional landmark displacement for different sex and age groups. Methods: Three-dimensional photographs were taken from healthy subjects in rest, maximum closed smile, and pouting. Displacement for both exercises of perioral landmarks was analyzed with MATLAB as absolute displacement and as the ratio of mouth width. Additionally, displacement in three planes was analyzed for each landmark. Averages were calculated for both genders in four age groups: 4-8, 8-12, 12-16, and >16 years. Results: In total, 328 subjects were included. Oral landmarks predominantly moved forward and backward for both exercises. Nasal landmarks predominantly moved vertically. Growing up, oral landmark displacement decreased for smiling, whereas nasal landmark displacement increased. For pouting, oral landmark displacement increased while growing up, whereas nasal landmark displacement decreased. Conclusions: The present study creates reference values for movement of perioral structures for different sex and age groups, for two facial expressions. These data are of great value for the assessment of mimic function and give insight into the development of facial animation over time.

Creating Three-Dimensional Templates of Smiling and Pouting Faces for Different Sex- and Age Groups.

Smile appearance has a major psychological impact. Orthognathic surgery, which has harmonizing results on skeletal structures, can negatively influence the smile appearance due to soft tissue effects. To enhance the aesthetic effects of orthognathic surgery on soft tissues, reference models for large parts of the hospital's adherent area are called for. This study aims to create average facial models for different sex and age groups in two facial exercises: maximum closed smile, and pouting. These models were created using coherent point drift and Procrustes algorithms in MATLAB. Principal component analysis was performed, and of 20 surgical landmarks, the in-group variation using standard deviation was calculated. Three distances were analyzed: nasal width, philtral width, and mouth width. To correct for facial size, these distances were analyzed as a ratio of intercanthal width. In total, 328 healthy subjects were included in the study. Subjects were grouped by sex, and in age categories spanning four years each, with an adult group with all ages >16 years. For both smiling and pouting faces, all ratios increased with ageing. These templates and data can benefit facial surgeons, to obtain an expected outcome according to the age of the patient.

Identification of the Peri-oral Mimic Muscles on Cadaver Slices and 3 and 7 Tesla MRI Scans.

Decreased smile dynamics is reported as an unwanted side effect after Le Fort I osteotomies. It is assumed that this negative sequela might be caused by postoperative changes in the anatomy of peri-oral mimic muscles. Due to a lack of specific anatomical knowledge, the exact mechanism is not yet clarified. This makes prevention of the undesired changes in smile dynamics difficult. The first aim of this study is to increase basic anatomical and radiological MRI knowledge of the peri-oral mimic muscles. The second aim is to investigate if 7 Tesla MRI scans are better suited to identify these muscles than 3 Tesla MRI scans. METHODS: Eleven peri-oral mimic muscles were chosen as subjects of the present study. Three and 7 Tesla MRI scans of a cadaver head were made. The same head was cut in axial slices using a cryomacrotome. Every second slice was digitally photographed. A three-dimensional model was created utilizing EMAC software, which served as gold standard for the identification and comparison of the chosen peri-oral mimic muscles on both MRI scans. RESULTS: All predetermined peri-oral mimic muscles could be identified in the cadaver head, and a detailed radiological atlas was created. The ease of identification and separation of the peri-oral mimic muscles was significantly higher on the 7 Tesla MRI than on the 3 Tesla MRI scan (P < 0.001). CONCLUSION: A 7 Tesla MRI scanner offers great improvement in the identification of peri-oral mimic muscles compared with a 3 Tesla scanner.

Traumatic Sternal Fractures can be Safely Treated Conservatively - A 13-Year Retrospective Cohort Study.

Background: Traumatic sternal fractures are rare injuries with little evidence supporting the best treatment strategy. This study assessed treatment outcomes from our level-I trauma centre. Methods: A retrospective cohort study was conducted, including all sternal fracture patients admitted to our level-I trauma centre between 2007 and 2019. Patients with sternal fractures due to cardiopulmonary resuscitation, patients <16 years, patients who died during initial hospital stay, and patients lost to follow-up were excluded from analysis. Results: In 13 years, 355 patients with traumatic sternal fractures were admitted, corresponding to 2% of all trauma patients. 262 patients were included in analysis. Mean age was 52 years and 71% of patients were male. Mean ISS was 19 (range 4-66). The majority of sternal fractures was located in the sternal body. Six patients (2%) underwent primary sternal fixation. Treatment failure occurred in three patients (1%) and was significantly higher in the surgical treatment group (p=0.001). There was no difference in treatment failure between patients with and without concomitant spinal fractures. Conclusions: Conservative treatment is safe and effective for traumatic sternal fractures. Surgical treatment should be reserved for rare cases, such as imminent respiratory failure or debilitating symptomatic non-union.

Prognostic biomarker soluble ST2 exhibits diurnal variation in chronic heart failure patients.

AIM: Soluble suppression of tumorigenicity-2 (sST2) is a strong prognostic biomarker in heart failure. The emerging understanding of circadian biology in cardiovascular disease may lead to novel applications in prognosis and diagnosis and may provide insight into mechanistic aspects of the disease-biomarker interaction. So far, it is unknown whether sST2 exhibits a diurnal rhythm. Repeated measurements of sST2 may aid in clinical decision making. The goal of this study was to investigate whether sST2 exhibits diurnal variation in patients with heart failure with reduced ejection fraction (HFrEF) and in control subjects, thereby enhancing its diagnostic and prognostic values. METHODS AND RESULTS: The study comprised 32 subjects: 16 HFrEF patients and 16 controls. Blood was collected at seven subsequent time points during a 24 h time period. sST2, N-terminal pro-B-type natriuretic peptide (NT-proBNP), melatonin, and cortisol were measured from serum. Peak values of sST2 clustered at daytime (modal value: 5 p.m.) in 87.6% of all subjects (81.3% of patients, P = 0.021; 93.8% of controls, P = 0.001), and minimum concentrations at night-time (modal value: 5 a.m.) in 84.4% (87.5% of patients, P = 0.004 81.3% of controls, P = 0.021). A cosinor analysis of mean normalized sST2 values revealed significant cosine shaped 24 h oscillations of patients (P = 0.026) and controls (P = 0.037). NT-proBNP in contrast did not show a diurnal rhythm, while melatonin and cortisol patterns were intact in all subjects. CONCLUSIONS: sST2 exhibits a diurnal rhythm with lower values in the morning than in the late afternoon. This new insight could lead to refinement of its diagnostic and prognostic values through specified and consistent sampling times with repeated measurements. For example, by measuring sST2 during the afternoon, when levels are at their highest, false negatives on prognosis prediction could be avoided.