Garlic-induced face burn.

There is inadequate research and study into the use of garlic and other herbal medicine in clinical practice; accordingly, the general population should be cautious when using such complementary and herbal treatments. We report a case which highlights the potential complications following the application of garlic-related naturopathic remedies mostly on skin burns.

A severe case of Ramsay Hunt Syndrome treated with acupuncture and related techniques.

Ramsay-Hunt syndrome presents with a vesicular eruption in the ear canal or oral cavity associated with ipsilateral peripheral facial paralysis. The cause is reactivation of the herpes zoster virus in the geniculate ganglion. It is the second most frequent cause of non-traumatic peripheral facial paralysis. Acupuncture is a medical procedure endorsed by the WHO with a wide range of indications. It consists of the application of very fine needles in certain points of the body to relieve pain and relieve certain diseases. We present a case of a young woman with unilateral facial paralysis as part of Ramsay Hunt syndrome. She received conventional treatment with acyclovir, analgesics, corticosteroids and eye protection measures 48 h after the onset of symptoms. At three weeks, due to the lack of improvement of the facial paralysis, manual acupuncture was started along with electroacupuncture, plum blossom hammer for facial stimulation and Chinese herbal medicine. An almost complete improvement was obtained at 14 weeks since the onset of the condition. Acupuncture and related techniques may be an effective intervention for this type of condition, and are associated with very few adverse effects.

Latrodectus Facies After Latrodectus Hesperus Envenomation in a Pediatric Patient.

BACKGROUND: Black widow spider (Latrodectus spp) envenomation represents the most medically significant spider envenomation in the United States, prompting more than 2500 calls to poison centers annually. The female spider, which is responsible for symptomatic envenomations, is classically described as a shiny black spider with a red hourglass-shaped marking on the ventral abdomen. Clinical features of envenomation include painful muscle cramping, abdominal pain, and autonomic disturbances, such as tachycardia, hypertension, and diaphoresis. "Latrodectus facies" or "facies latrodectismica" is an additional distinctive but rarely described clinical finding characterized by periorbital edema, lacrimation, and blepharospasm. CASE REPORT: A 6-year-old female developed the typical clinical features of Latrodectus envenomation after being found in bed with a Western black widow spider (Latrodectus hesperus) with no ventral marking. She initially improved with opioid analgesia, but 6 h later her symptoms worsened again, and concurrent with this worsening she developed Latrodectus facies. She received additional opioid analgesia and all her symptoms resolved within 24 h. Her mother provided informed and written consent for the acquisition and publication of the facial photographs presented. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A high degree of clinical suspicion is necessary to correctly diagnose Latrodectus envenomation, especially when the spider escapes unnoticed or in young children in whom the bite is not witnessed. To our knowledge, Latrodectus facies has not been reported previously in a young child, and recognition of this finding will aid clinicians in limiting unnecessary interventions and administering appropriate therapy.

Inhibitory effect of high-frequency greater occipital nerve electrical stimulation on trigeminovascular nociceptive processing in rats.

Electrical stimulation of the greater occipital nerve (GON) has recently shown promise as an effective non-pharmacological prophylactic therapy for drug-resistant chronic primary headaches, but the neurobiological mechanisms underlying its anticephalgic action are not elucidated. Considering that the spinal trigeminal nucleus (STN) is a key segmental structure playing a prominent role in pathophysiology of headaches, in the present study we evaluated the effects of GON electrical stimulation on ongoing and evoked firing of the dura-sensitive STN neurons. The experiments were carried out on urethane/chloralose-anesthetized, paralyzed and artificially ventilated male Wistar rats. Extracellular recordings were made from 11 neurons within the caudal part of the STN that received convergent input from the ipsilateral facial cutaneous receptive fields, dura mater and GON. In each experiment, five various combinations of the GON stimulation frequency (50, 75, 100 Hz) and intensity (1, 3, 6 V) were tested successively in 10 min interval. At all parameter sets, preconditioning GON stimulation (250 ms train of pulses applied before each recording) produced suppression of both the ongoing activity of the STN neurons and their responses to electrical stimulation of the dura mater. The inhibitory effect depended mostly on the GON stimulation intensity, being maximally pronounced when a stimulus of 6 V was applied. Thus, the GON stimulation-induced inhibition of trigeminovascular nociceptive processing at the level of STN has been demonstrated for the first time. The data obtained can contribute to a deeper understanding of neurophysiological mechanisms underlying the therapeutic efficacy of GON stimulation in primary headaches.

Soft Tissue Augmentation with Autologous Platelet Gel and ß-TCP: A Histologic and Histometric Study in Mice.

Background. Facial aging is a dynamic process involving both soft tissue and bony structures. Skin atrophy, with loss of tone, elasticity, and distribution of facial fat, coupled with gravity and muscle activity, leads to wrinkling and folds. Purpose. The aim of the study was to evaluate microporous tricalcium phosphate (ß-TCP) and autologous platelet gel (APG) mix in mice for oral and maxillofacial soft tissue augmentation. The hypothesis was that ß-TCP added with APG was able to increase the biostimulating effect on fibroblasts and quicken resorption. Materials and Methods. Ten female, 6-8-week-old black-haired mice were selected. ß-TCP/APG gel was injected into one cheek; the other was used as control. The animals were sacrificed at 8 weeks and histologically evaluated. Results. The new fibroblast was intensively stained with acid fuchsin and presented in contact with ß-TCP. At higher magnification, actively secreting fibroblasts were observed at the periphery of ß-TCP with a well differentiated fibroblast cell line and blood vessels. Acid fuchsin stained cutaneous structures in pink: no epidermal/dermal alterations or pathological inflammatory infiltrates were detected. The margins of ß-TCP granules were clear and not diffused near tissues. Conclusion. APG with ß-TCP preserves skin morphology, without immune response, with an excellent tolerability and is a promising scaffold for cells and biomaterial for soft tissue augmentation.

Reduced facial expressiveness in Parkinson's disease: A pure motor disorder?

BACKGROUND AND AIMS: Impaired emotional facial expressiveness is an important feature in Parkinson's disease (PD). Although there is evidence of a possible relationship between reduced facial expressiveness and altered emotion recognition or imagery in PD, it is unknown whether other aspects of the emotional processing, such as subjective emotional experience (alexithymia), might influence hypomimia in this condition. In this study wee aimed to investigate possible relationship between reduced facial expressiveness and altered emotion processing (including facial recognition and alexithymia) in patients with PD. METHODS: Forty PD patients and seventeen healthy controls were evaluated. Facial expressiveness was rated on video recordings, according to the UPDRS-III item 19 and using an ad hoc scale assessing static and dynamic facial expression and posed emotions. Six blind raters evaluated the patients' videos. Emotion facial recognition was tested using the Ekman Test; alexithymia was assessed using Toronto Alexithymia Scale (TAS-20). RESULTS: PD patients had a significantly reduced static and dynamic facial expressiveness and a deficit in posing happiness and surprise. They performed significantly worse than healthy controls in recognizing surprise (p=0.03). The Ekman total score positively correlated with the global expressiveness (R^2=0.39, p=0.01) and with the expressiveness of disgust (R^2=0.32, p=0.01). The occurrence of alexithymia was not different between PD patients and HC; however, a significant negative correlation between the expressiveness of disgust was found for a subscore of TAS (R^2=-.447, p=0.007). CONCLUSIONS: Reduced facial expressiveness in PD may be in part related to difficulties with emotional recognition in a context of an unimpaired subjective emotional experience.

Intense pulsed light, near infrared pulsed light, and fractional laser combination therapy for skin rejuvenation in Asian subjects: a prospective multi-center study in China.

Ablative skin rejuvenation therapies have limitations for Asian people, including post-inflammatory hyperpigmentation and long down time. Non-ablative lasers are safer but have limited efficacy. This study is to investigate the safety and efficacy of a combination therapy consisting of intense pulsed light (IPL), near infrared (NIR) light, and fractional erbium YAG (Er:YAG) laser for skin rejuvenation in Asian people. This study recruited 113 subjects from six sites in China. Subjects were randomly assigned to a full-face group, who received combination therapy, and split-face groups, in which one half of the face received combination therapy and the other half received IPL monotherapy. Each subject received five treatment sessions during a period of 90 days. Subjects were followed up at 1 and 3 months post last treatment. Three months after last treatment, the full-face group (n = 57) had a global improvement rate of 29 % and 29 % for wrinkles, 32 % for skin texture, 33 % for pigment spots, 28 % for pore size, respectively. For patients in the split-face groups (n = 54), monotherapy side had a global improvement rate of 23 % and 20 % for wrinkles, 27 % for skin texture, 25 % for pigment spots, 25 % for pore size, respectively. Both combination therapy and monotherapy resulted in significant improvements at the follow-up visits compared to baseline (P < 0.001). Combination therapy showed significantly greater improvements compared to monotherapy at two follow-up visits (P < 0.05). Combination therapy is a safe and more effective strategy than IPL monotherapy for skin rejuvenation in Asian people.

[Study on "Hegu (LI 4) regulates face and mouth" based on palmomental reflex].

OBJECTIVE: To explore the correlation between hand and face-mouth, so as to provide nerve reflex basis for the theory "Hegu (LI 4) regulates face and mouth". METHODS: Seven hundred and sixty-three participants who met the inclusive criteria were divided into different age groups. The skin around participants' thenar eminence was gently scraped to be observed whether there was an involuntary movement around the face or mouth, which was palmomental reflex. The results of palmomental reflex were recorded. RESULTS: The total occurrence rate of palmomental reflex was 46.26%. For those who were 0 to 1 years old, the palmomental reflex was all positive; for those who were 21 to 36 years old, the positive rate was 20.45%, which was the lowest; for those who were 65 to 85 years old, more than half of them were positive. The majority of those who were 0 to 2 years old were bilateral positive palmomental reflex, while the majority of those who were 65 to 85 years old were unilateral positive palmomental reflex. CONCLUSION: There is a certain connection between hand and face-mouth. The occurrence rate of palmomental reflex changes from high to low over age increasing, and then changes from low to high with the aging, presenting a "high-low-high" U-shaped curve, which is possible related to the growth and recession of nervous system.

Emotional processing of infants displays in eating disorders.

AIM: The aim of this study is to examine emotional processing of infant displays in people with Eating Disorders (EDs). BACKGROUND: Social and emotional factors are implicated as causal and maintaining factors in EDs. Difficulties in emotional regulation have been mainly studied in relation to adult interactions, with less interest given to interactions with infants. METHOD: A sample of 138 women were recruited, of which 49 suffered from Anorexia Nervosa (AN), 16 from Bulimia Nervosa (BN), and 73 were healthy controls (HCs). Attentional responses to happy and sad infant faces were tested with the visual probe detection task. Emotional identification of, and reactivity to, infant displays were measured using self-report measures. Facial expressions to video clips depicting sad, happy and frustrated infants were also recorded. RESULTS: No significant differences between groups were observed in the attentional response to infant photographs. However, there was a trend for patients to disengage from happy faces. People with EDs also reported lower positive ratings of happy infant displays and greater subjective negative reactions to sad infants. Finally, patients showed a significantly lower production of facial expressions, especially in response to the happy infant video clip. Insecure attachment was negatively correlated with positive facial expressions displayed in response to the happy infant and positively correlated with the intensity of negative emotions experienced in response to the sad infant video clip. CONCLUSION: People with EDs do not have marked abnormalities in their attentional processing of infant emotional faces. However, they do have a reduction in facial affect particularly in response to happy infants. Also, they report greater negative reactions to sadness, and rate positive emotions less intensively than HCs. This pattern of emotional responsivity suggests abnormalities in social reward sensitivity and might indicate new treatment targets.

Acupuncture-induced changes in functional connectivity of the primary somatosensory cortex varied with pathological stages of Bell's palsy.

Bell's palsy is the most common cause of acute facial nerve paralysis. In China, Bell's palsy is frequently treated with acupuncture. However, its efficacy and underlying mechanism are still controversial. In this study, we used functional MRI to investigate the effect of acupuncture on the functional connectivity of the brain in Bell's palsy patients and healthy individuals. The patients were further grouped according to disease duration and facial motor performance. The results of resting-state functional MRI connectivity show that acupuncture induces significant connectivity changes in the primary somatosensory region of both early and late recovery groups, but no significant changes in either the healthy control group or the recovered group. In the recovery group, the changes also varied with regions and disease duration. Therefore, we propose that the effect of acupuncture stimulation may depend on the functional connectivity status of patients with Bell's palsy.

Emotional processing of personally familiar faces in the vegetative state.

BACKGROUND: The Vegetative State (VS) is a severe disorder of consciousness in which patients are awake but display no signs of awareness. Yet, recent functional magnetic resonance imaging (fMRI) studies have demonstrated evidence for covert awareness in VS patients by recording specific brain activations during a cognitive task. However, the possible existence of incommunicable subjective emotional experiences in VS patients remains largely unexplored. This study aimed to probe the question of whether VS patients retain a brain ability to selectively process external stimuli according to their emotional value and look for evidence of covert emotional awareness in patients. METHODS AND FINDINGS: In order to explore these questions we employed the emotive impact of observing personally familiar faces, known to provoke specific perceptual as well as emotional brain activations. Four VS patients and thirteen healthy controls first underwent an fMRI scan while viewing pictures of non-familiar faces, personally familiar faces and pictures of themselves. In a subsequent imagery task participants were asked to actively imagine one of their parent's faces. Analyses focused on face and familiarity selective regional brain activations and inter-regional functional connectivity. Similar to controls, all patients displayed face selective brain responses with further limbic and cortical activations elicited by familiar faces. In patients as well as controls, Connectivity was observed between emotional, visual and face specific areas, suggesting aware emotional perception. This connectivity was strongest in the two patients who later recovered. Notably, these two patients also displayed selective amygdala activation during familiar face imagery, with one further exhibiting face selective activations, indistinguishable from healthy controls. CONCLUSIONS: Taken together, these results show that selective emotional processing can be elicited in VS patients both by external emotionally salient stimuli and by internal cognitive processes, suggesting the ability for covert emotional awareness of self and the environment in VS patients.

Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy.

OBJECTIVE: To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients. PATIENTS AND METHOD: Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Student's t-tests. RESULTS: There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals. CONCLUSION: This particular type of LLLT is effective at relieving pain but does not provide physical improvement.

Facial macrosomatognosia and pain in a case of Wallenberg's syndrome: selective effects of vestibular and transcutaneous stimulations.

Macro- and micro-somatognosia refer to rare disorders of the cerebral representation of the body whereby patients perceive body parts as disproportionately large or small. Here we report the experimental study of a patient who, following a left lateral medullary stroke (Wallenberg's syndrome, including vestibular deficits) complained of a persistent somatosensory illusory sensation of swelling, confined to the left side of his face (i.e., left macrosomatognosia). This hemifacial somatosensory distortion was associated with a left facial anesthesia, and a neuropathic pain affecting the three branches of the left trigeminal nerve. In this study, we first document quantitatively the patient's somatosensory illusion by using a somatosensory-to-visual matching task in which the patient modified the picture of his own face to fit his left-sided somatosensory misperception. The patient's performance revealed that macrosomatognosia was confined to the second branch of the left trigeminal nerve. Perception of the size of visual objects was comparatively preserved. Second, we investigated the effects of two peripheral stimulations, which may affect the spatial component of somatosensory deficits (caloric vestibular stimulation, CVS; transcutaneous electrical nervous stimulation, TENS) and pain (TENS). Left CVS abolished the facial somatosensory illusion, for about 30min, but had no effect on the left facial pain. Conversely, left TENS substantially reduced the neuropathic pain during stimulation, but had no effect on macrosomatognosia, indicating a double dissociation between the two disorders. These results reveal that facial macrosomatognosia may be regarded as a high-order deficit of somatosensory perception of the shape and volume of the face, which fits the definition of 'hyperschematia' (i.e., when the body takes up too much room) originally proposed by Bonnier (1905). Our data also indicate that CVS may favor the restoration of the conscious representation of the shape and size of the face. Overall, these findings lend support to the view that afferent inputs from the vestibular system can affect in a specific fashion the activity of cerebral structures involved in the building up and updating of the topological description of body parts.

Frontonasal dysplasia: clinical evaluation on audiological and brainstem electrophysiological profiles.

UNLABELLED: Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. No systematic studies describing hearing in this condition were found. AIM: To evaluate hearing sensitivity and sound stimulus conduction from cochlea to brainstem in patients with clinical signs of FND. METHODS: 21 patients with isolated or syndromic FND were submitted to a clinical (otological/vestibular antecedents and otoscopy) and instrumental (pure tone and speech audiometry, tympanometry and brainstem auditory evoked response) hearing evaluation. DESIGN: A clinical, cross-sectional observational prospective study. RESULTS: Hearing thresholds were normal in 15 (70%) patients, abnormal in 5 (25%), mostly with conductive hearing loss; one patient did not cooperate with testing. The tympanometric curve was type A in 30 (72%) ears, type C in 5 (12%), type As in 4 (9%) and type B in 3 (7%). The auditory brainstem response (ABR) showed no abnormalities. CONCLUSION: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in this study. Mild conductive hearing loss found in some is probably related to cleft palate. Further evaluation of hearing pathways at higher levels is recommended.

Frontonasal dysplasia: clinical evaluation on audiological and brainstem electrophysiological profiles / Displasia frontonasal: avaliação clínica e eletrofisiológica da audição

Frontonasal dysplasia (FND) is a rare malformative complex affecting the frontal portion of the face, the eyes and the nose; it may occur singly or associated with other clinical signs. No systematic studies describing hearing in this condition were found. AIM: To evaluate hearing sensitivity and sound stimulus conduction from cochlea to brainstem in patients with clinical signs of FND. METHODS: 21 patients with isolated or syndromic FND were submitted to a clinical (otological/vestibular antecedents and otoscopy) and instrumental (pure tone and speech audiometry, tympanometry and brainstem auditory evoked response) hearing evaluation. DESIGN: A clinical, cross-sectional observational prospective study. RESULTS: Hearing thresholds were normal in 15 (70 percent) patients, abnormal in 5 (25 percent), mostly with conductive hearing loss; one patient did not cooperate with testing. The tympanometric curve was type A in 30 (72 percent) ears, type C in 5 (12 percent), type As in 4 (9 percent) and type B in 3 (7 percent). The auditory brainstem response (ABR) showed no abnormalities. CONCLUSION: Patients with FND showed no abnormalities in the auditory system from cochlea to brainstem in this study. Mild conductive hearing loss found in some is probably related to cleft palate. Further evaluation of hearing pathways at higher levels is recommended.

A displasia frontonasal (DFN) representa um complexo malformativo que afeta os olhos, o nariz e a região frontal da face. Estudos específicos com o objetivo de estudar a audição na DFN não foram encontrados na literatura. OBJETIVO: Avaliar o sistema auditivo em indivíduos com DFN quanto à acuidade e condução do estímulo sonoro até o tronco encefálico. MATERIAL E MÉTODO: 21 pacientes na faixa etária de 7 a 42 anos, sendo 14 do sexo feminino e 7 do sexo masculino, com DFN isolada ou sindrômica, foram submetidos à anamnese, meatoscopia, imitanciometria, audiometria tonal liminar e potenciais evocados auditivos de tronco encefálico (PEATE). FORMA DE ESTUDO: Estudo de série clínico prospectivo. RESULTADOS: Limiares audiométricos normais em 15 (70 por cento) indivíduos e alterados em 5 (25 por cento), sendo perda auditiva condutiva na maior parte. Na timpanometria, 30 orelhas (72 por cento) apresentaram curva tipo A, 5 (12 por cento) tipo C, 4 (9 por cento) tipo Ar e 3 (7 por cento) tipo B. Os valores das latências absolutas e interpicos do PEATE foram normais. CONCLUSÕES: Não foram encontradas alterações na via auditiva até o tronco encefálico. As alterações condutivas são provavelmente relacionadas às patologias de orelha média decorrentes da fissura de palato. Sugerimos a avaliação de níveis mais altos dentro do sistema auditivo.

[Study on the manifestation of facial infrared thermography induced by acupuncturing Guangming (GB 37) and Hegu (LI 4)].

OBJECTIVE: To manifest the specificity of acupoints objectively through observing the relationship of both Guangming (GB 37) and Hegu (LI 4) with the some areas of face. METHODS: The patients with peripheral facial paralysis were divided into the Guangming (GB 37) group and Hegu (LI 4) group, and punctured respectively. Before and after treatment, the distribution and change of facial temperatures were measured with infrared thermography and the data on each area was comparatively analyzed. RESULTS: After punctured at Guangming (GB 37), the temperature went up in the areas around the eyes of both health and affected sides, especially on the affected side, which was significantly different from the other facial areas (all P<0.05). After punctured at Hegu (IA 4), the temperature obviously went up in the area around the mouth, which was significantly different from other areas of face, such as the areas of Yintag and health eye. The temperature in the area around the affected eye was significantly higher than that of the area around the health eye. CONCLUSION: There is some close coordination between Guangming (GB 37) and eye area, as well as between Hegu (LI 4) and mouth area, suggesting the specificity of acupoints.

A method of selecting acupoints for acupuncture treatment of peripheral facial paralysis by thermography.

The purpose of this study is to select acupoints for acupuncture treatment of peripheral facial paralysis according to the temperature on the face of the patient detected by thermogram, to determine an objective acupoint selection method for acupuncture treatment. In the test group of 60 cases of facial paralysis, the infrared thermogram on the face was detected at the first visit, and then acupuncture was given at the acupoints on the affected side with a temperature difference of over 0.5 degrees C from the healthy side for one therapeutic course, and in each successive course the acupoints were re-determined according to the results of thermogram examination and were administrated till the end of the total therapeutic course, and 120 cases of the control group were treated with acupuncture at conventionally selected acupoints. The results showed that the cured and basically cured rate was 90.0% (54 cases) in the test group and 77.5% (93 cases) in the control group with a significant difference between the two groups (p < 0.05); and the total sessions of acupuncture were less and the course of treatment was shorter in the test group than those in the control group (both p < 0.001). The utilization rate of the acupoints selected by facial thermogram in the test group was in order of Dicang (ST 4, 92.3%), Yingxiang (LI 20, 90.6%), Taiyang (EX-HN 5, 85.5%), Yangbai (GB 14, 76.6%), Quanliao (SI 18, 72.3%), and so on. In conclusion, acupuncture at the acupoints selected by thermogram for treatment of facial paralysis in the cured rate, the therapeutic course and sessions of acupuncture is significantly superior to acupuncture at the conventionally selected acupoints, and the thermogram-aided acupoint selection method is beneficial to objectivity and modernization of acupoint selection for acupuncture and moxibustion treatments.