A Pilot Study to Assess the Sialendoscopy-Assisted Transfacial Approach in Parotid Gland Sialolithiasis.

INTRODUCTION: Twenty percent of the total lithiasis that affect a major salivary gland will be found in the parotid gland. An exclusive sialoendoscopic approach has achieved success rates close to 80%. In a significant percentage of these remaining cases, combined transfacial approaches assisted by sialendoscopy are presented as an option to be taken into account. PATIENTS AND METHODS: A prospective analysis of cases treated by combined transfacial approach assisted by sialendoscopy for lithiasis of the parotid gland and the impact of the facial nerve stimulator used during surgery. RESULTS: Five patients were included; all of them operated satisfactorily. In 4 of them, the approach proposed by McGurk and modified by Capaccio was used, and in 1 of them, the approach proposed by Nahlieli was used. We suffered a complication in just case due to the appearance of postoperative sialocele. CONCLUSION: According to our results and those previously published, the transfacial approach assisted by sialendoscopy can be considered a useful technique. Proper planning ensures an optimal result in the treatment of parotid gland lithiasis. The use of facial nerve stimulator guarantees extra security when working near to a branch of the facial nerve is suspected.

Advance in Functional Restoration of Injured Nerve with Low Level Laser and its Utilization in the Dental and Maxillofacial Region.

The inferior alveolar nerve and facial nerve are the two most important nerves in the dental and maxillofacial region. The injury to them is one of the major postoperative complications after alveolar surgery and orthognathic surgery. However, recovering the nerve function after injury takes a long time and the recovery effect tends to be unsatisfactory. In recent years, an intensively investigated technique, low level laser which has been applying in assisting the recovery of nerve function, has been gradually proved to be effective in clinically treating postoperative nerve injury. In this article we review in terms of the mechanisms involved in low level laser-assisted functional restoration of nerve injury and its clinical application in the recovery of nerve function in the dental and maxillofacial area as well.

Will Repeated Ablative Er:YAG Laser Treatment Sessions Cause Facial Skin Sensitivity? Results of a 12-Month, Prospective, Randomized Split-Face Study.

Whether multiple laser irradiations affect skin sensitivity is still elusive. We aimed to investigate if repeated ablative erbium:yttrium-aluminum-garnet (Er:YAG) laser therapy could cause or increase skin sensitivity in the treatment areas. Nineteen healthy females received three sessions of a randomized, split-face, Er:YAG laser treatment in a scanning ablative mode (MicroLaserPeel™), with a 6-mm spot size, 8-µm ablative depths, and 30% of pulse overlap first. The next round was conducted in the fractional mode (ProFractional™) at depths ranging from 100 to 150 µm, with one pass by at coverage of 11% in the coagulation mode. Objective biophysical parameters, including transepidermal water loss (TEWL), skin glossiness, epidermal and dermal thickness and density, sensory nerve current perception threshold (CPT), and local blood flow, were measured before and after treatment. Quantitative evaluation of the Er:YAG laser treatment's effect on skin sensitivity is presented. Seventeen volunteers completed a follow-up of 12 months. On days 1 and 3, skin TEWL and epidermal thickness increased, while glossiness decreased. On day 7, there was no significant difference in the skin barrier function between the treated and the control side. Similarly, there was no significant difference in CPT values or local microvascular blood flow between sides at any time point before or after treatment, except that the local microvascular blood flow on the treated side was higher on the first day post-treatment. Er:YAG laser treatment does not influence skin sensitivity in healthy subjects in a long-term follow-up.

Systemic administration of α-lipoic acid suppresses excitability of nociceptive wide-dynamic range neurons in rat spinal trigeminal nucleus caudalis.

Although a modulatory role has been reported for α-lipoic acid (LA) on T-type Ca2+ channels in the nervous system, the acute effects of LA in vivo, particularly on nociceptive transmission in the trigeminal system, remain to be determined. The aim of the present study was to investigate whether acute intravenous LA administration to rats attenuates the excitability of wide dynamic range (WDR) spinal trigeminal nucleus caudalis (SpVc) neurons in response to nociceptive and non-nociceptive mechanical stimulation in vivo. Extracellular single unit recordings were made from seventeen SpVc neurons in response to orofacial mechanical stimulation of pentobarbital-anesthetized rats. Responses to both non-noxious and noxious mechanical stimuli were analyzed in the present study. The mean firing frequency of SpVc WDR neurons in response to both non-noxious and noxious mechanical stimuli was significantly and dose-dependently inhibited by LA (1-100 mM, i.v.) and maximum inhibition of the discharge frequency of both non-noxious and noxious mechanical stimuli was seen within 5 min. These inhibitory effects lasted for approximately 10 min. These results suggest that acute intravenous LA administration suppresses trigeminal sensory transmission, including nociception, via possibly blocking T-type Ca2+ channels. LA may be used as a therapeutic agent for the treatment of trigeminal nociceptive pain.

Variability in facial-muscle innervation: A comparative study based on electrostimulation and anatomical dissection.

Facial-nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial-and-neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial-muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169-175, 2019. © 2018 Wiley Periodicals, Inc.

Cortical and Subcortical Projections from Granular Insular Cortex Receiving Orofacial Proprioception.

We have recently revealed that the proprioceptive signal from jaw-closing muscle spindles (JCMSs) is conveyed to the dorsal part of granular insular cortex rostroventrally adjacent to the rostralmost part of secondary somatosensory cortex (dGIrvs2) via the caudo-ventromedial edge (VPMcvm) of ventral posteromedial thalamic nucleus (VPM) in rats. However, it remains unclear to which cortical or subcortical structures the JCMS proprioceptive information is subsequently conveyed from the dGIrvs2. To test this issue, we injected an anterograde tracer, biotinylated dextranamine, into the electophysiologically identified dGIrvs2, and analyzed the resultant distribution profiles of labeled axon terminals in rats. Labeled terminals were distributed with an ipsilateral predominance. In the cerebral cortex, they were seen in the primary and secondary somatosensory cortices, lateral and medial agranular cortices and dorsolateral orbital cortex. In the basal ganglia, they were found in the caudate putamen, core part of accumbens nucleus, lateral globus pallidus, subthalamic nucleus, and substantia nigra pars compacta and pars reticulata. They were also observed in the central amygdaloid nucleus and extended amygdala (the interstitial nucleus of posterior limb of anterior commissure and the juxtacapsular part of lateral division of bed nucleus of stria terminalis). In the thalamus, they were seen in the reticular nucleus, ventromedial nucleus, core VPM, parvicellular part of ventral posterior nucleus, oval paracentral nucleus, medial and triangular parts of posterior nucleus, and zona incerta as well as the VPMcvm. These data suggest that the JCMS proprioceptive information through the dGIrvs2 is transmitted to the emotional 'limbic' regions as well as sensorimotor regions.

Differential innervation of tissues located at traditional acupuncture points in the rat forehead and face.

OBJECTIVES: To compare the neural pathways associated with the tissues located at different traditional acupuncture points in the rat forehead and face using the cholera toxin B subunit (CTB) neural tracing technique. METHODS: After injection of CTB into the tissues at GB14, ST2 and ST6 in the rat, the neural labelling associated with each acupuncture point was revealed by fluorescent immunohistochemistry of the nervous system, including the trigeminal ganglion (TRG), cervical dorsal root ganglia (DRG), spinal cord and brain. RESULTS: The CTB labelling included sensory neurons and their transganglionic axonal terminals, as well as motor neurons. The labelled sensory neurons associated with GB14, ST2 and ST6 were distributed in both the TRG and cervical DRG, and their centrally projected axons terminated in an orderly fashion at their corresponding targets in the spinal trigeminal nucleus and cervical spinal dorsal horn. In addition, labelled motor neurons were observed in the facial motor nucleus, trigeminal motor nucleus and cervical spinal ventral horn, in which facial motor neurons projected to the tissues located at all three acupuncture points. Trigeminal motor neurons innervated both ST2 and ST6, while spinal motor neurons only correlated with ST6. CONCLUSIONS: These results indicate that the tissues located at each of these three traditional acupuncture points in the rat forehead and face has its own sensory and motor connection with the nervous system in a region-specific pattern through distinct neural pathways. Understanding the neuroanatomical characteristics of acupuncture points from the peripheral nervous system to the central nervous system should help inform acupuncture point selection according to the demands of the clinical situation.

Spatiotemporal integration of looming visual and tactile stimuli near the face.

Real-world objects approaching or passing by an observer often generate visual, auditory, and tactile signals with different onsets and durations. Prompt detection and avoidance of an impending threat depend on precise binding of looming signals across modalities. Here we constructed a multisensory apparatus to study the spatiotemporal integration of looming visual and tactile stimuli near the face. In a psychophysical experiment, subjects assessed the subjective synchrony between a looming ball and an air puff delivered to the same side of the face with a varying temporal offset. Multisensory stimuli with similar onset times were perceived as completely out of sync and assessed with the lowest subjective synchrony index (SSI). Across subjects, the SSI peaked at an offset between 800 and 1,000 ms, where the multisensory stimuli were perceived as optimally in sync. In an fMRI experiment, tactile, visual, tactile-visual out-of-sync (TVoS), and tactile-visual in-sync (TViS) stimuli were delivered to either side of the face in randomized events. Group-average statistical responses to different stimuli were compared within each surface-based region of interest (sROI) outlined on the cortical surface. Most sROIs showed a preference for contralateral stimuli and higher responses to multisensory than unisensory stimuli. In several bilateral sROIs, particularly the human MT+ complex and V6A, responses to spatially aligned multisensory stimuli (TVoS) were further enhanced when the stimuli were in-sync (TViS), as expressed by TVoS < TViS. This study demonstrates the perceptual and neural mechanisms of multisensory integration near the face, which has potential applications in the development of multisensory entertainment systems and media.

High variability of facial muscle innervation by facial nerve branches: A prospective electrostimulation study.

OBJECTIVES/HYPOTHESIS: To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions. STUDY DESIGN: Single-center prospective clinical study. METHODS: Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators. RESULTS: A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region. CONCLUSIONS: FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1288-1295, 2017.

fMRI Cortical Correlates of Spontaneous Eye Blinks in the Nonhuman Primate.

Eyeblinks are defined as a rapid closing and opening of the eyelid. Three types of blinks are defined: spontaneous, reflexive, and voluntary. Here, we focus on the cortical correlates of spontaneous blinks, using functional magnetic resonance imaging (fMRI) in the nonhuman primate. Our observations reveal an ensemble of cortical regions processing the somatosensory, proprioceptive, peripheral visual, and possibly nociceptive consequences of blinks. These observations indicate that spontaneous blinks have consequences on the brain beyond the visual cortex, possibly contaminating fMRI protocols that generate in the participants heterogeneous blink behaviors. This is especially the case when these protocols induce (nonunusual) eye fatigue and corneal dryness due to demanding fixation requirements, as is the case here. Importantly, no blink related activations were observed in the prefrontal and parietal blinks motor command areas nor in the prefrontal, parietal, and medial temporal blink suppression areas. This indicates that the absence of activation in these areas is not a signature of the absence of blink contamination in the data. While these observations increase our understanding of the neural bases of spontaneous blinks, they also strongly call for new criteria to identify whether fMRI recordings are contaminated by a heterogeneous blink behavior or not.

Essential regional nerve blocks for the dermatologist: part 1.

The aim of this two-part series is to provide an up-to-date review of essential regional nerve blocks for dermatological practice. In Part 1, we give a concise overview of local anaesthetics and their potential complications, as well as the relevant anatomy and cutaneous innervation of the face and scalp. This culminates in a step-by-step practical guide to performing each nerve block.

Topiramate in the treatment of migraine: a kainate (glutamate) receptor antagonist within the trigeminothalamic pathway.

BACKGROUND: The development of new agents for the preventive treatment of migraine is the greatest unmet need in the therapeutics of primary headaches. Topiramate, an anticonvulsant drug, is an effective anti-migraine preventive whose mechanism of action is not fully elucidated. Since glutamate plays a major role in migraine pathophysiology, the potential action of topiramate through glutamatergic mechanisms is of considerable interest. METHODS: Recordings of neurons in the trigeminocervical complex (TCC) and the ventroposteromedial thalamic nucleus (VPM) of anesthetized rats were made using electrophysiological techniques. The effects of intravenous or microiontophorezed topiramate on trigeminovascular activation of second- and third-order neurons in the trigeminothalamic pathway were characterized. The potential interactions of topiramate with the ionotropic glutamate receptors were studied using microiontophoresis. RESULTS: Both intravenous and microiontophorized topiramate significantly inhibited trigeminovascular activity in the TCC and VPM. In both nuclei microiontophoretic application of topiramate significantly attenuated kainate receptor-evoked firing but had no effect on N-methyl-d-aspartic acid or α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptor activation. CONCLUSION: The data demonstrate for the first time that topiramate modulates trigeminovascular transmission within the trigeminothalamic pathway with the kainate receptor being a potential target. Understanding the mechanism of action of topiramate may help in the design of new medications for migraine prevention, with the data pointing to glutamate-kainate receptors as a fruitful target to pursue.

Surface facial electromyography, skin conductance, and self-reported emotional responses to light- and season-relevant stimuli in seasonal affective disorder.

BACKGROUND: Learned associations between depressive behavior and environmental stimuli signaling low light availability and winter season may play a role in seasonal affective disorder (SAD). The purpose of this study was to determine whether light and season environmental cues elicit emotional responses that are distinct in individuals with SAD. METHODS: Twenty-four currently depressed SAD participants were compared to 24 demographically-matched controls with no depression history on emotional responses to outdoor scenes captured under two light intensity (i.e., clear, sunny vs. overcast sky) and three season (i.e., summer with green leaves, fall with autumn foliage, and winter with bare trees) conditions. Emotion measures included surface facial electromyography (EMG) activity in the corrugator supercilii and zygomaticus major muscle regions, skin conductance, and self-reported mood state on the Profile of Mood States Depression-Dejection Subscale. RESULTS: Light intensity was a more salient cue than season in determining emotional reactions among SAD participants. Relative to controls, SAD participants displayed more corrugator activity, more frequent significant skin conductance responses (SCR), greater SCR magnitude, and more self-reported depressed mood in response to overcast stimuli and less corrugator activity, lower SCR magnitude, and less self-reported depressed mood in response to sunny stimuli. LIMITATIONS: Study limitations include the single, as opposed to repeated, assessment and the lack of a nonseasonal depression group. CONCLUSIONS: These findings suggest that extreme emotional reactivity to light-relevant stimuli may be a correlate of winter depression; and future work should examine its potential onset or maintenance significance.

Acupuncture modulates facial warm sensory thresholds.

AIMS: To assess the effects of four- and six-point acupuncture on facial sensory detection thresholds to thermal and electrical stimuli. METHODS: Ten healthy volunteers underwent four-point acupuncture at ST6 and LI4 bilaterally for 15 minutes. A further 10 subjects underwent six-point acupuncture by adding needling at ST2 bilaterally. Sensory testing to thermal and electrical stimuli applied to mental and infraorbital nerve dermatomes was performed at baseline, 10 minutes, 1 hour, and 1 day after needling. RESULTS: In the mental and infraorbital nerve dermatomes, six-point acupuncture significantly increased warm threshold by a peak mean of 1.1°C to 1.4°C (repeated measures ANOVA P = .001) and this effect was significant at all time points relative to baseline (P < .05). No significant effects were observed by the four-point acupuncture on warm thresholds, and neither four- nor six-point acupuncture significantly altered electrical detection thresholds. CONCLUSION: A dose effect, related to the number of points employed, may be present when employing acupuncture.

[Facial nerve function index evaluation on deviation of the mouth in intractable facial palsy treated with sticking needle and traction method on three points of the mouth].

OBJECTIVE: To probe into the effective acupuncture technique for deviation of the mouth in intractable facial palsy. METHODS: One hundred and one cases of intractable facial palsy were randomly divided into an observation group (48 cases) and a control group (53 cases). Cuanzhu (BL 2), Sibai (ST 2), Jiache (ST 6) and Qianzheng (Extra) on the affected side were punctured in two groups. Additionally, three acupoints of the mouth were supplemented, named Dicang (ST 4), Kouheliao (LI 19) and Jiachengjiang (Extra) were added, and the sticking needle and traction method was adopted on them in observation group. the routine needling technique was applied in control group. The treatment was given once a day and 10-day treatment made one session. The changes in facial nerve function index (FNFI) were observed in 2 sessions of treatment. RESULTS: After treatment, FNFI in two groups increased significantly (both P < 0.01), but the improvement in observation group was better than that in control group (P < 0.01). In observation group, the basic recovery rate of FNFI was 87.5% (42/48), which was higher than that (67.9%, 36/53) in control group (P < 0.05). CONCLUSION: The sticking needle and traction method o three points is the quite effective approach in the treatment of deviation of the mouth in intractable facial palsy.

[Study on needling depth and direction from different acupoints to sphenopalatine ganglion].

OBJECTIVE: To observe and survey the location of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) on the surface, and the needling depth and direction from the 3 points to sphenopalatine ganglion. METHODS: Fifteen corpses (30 sides) of adult male were fixed by 10% formalin. The lateral areas of face were dissected from the surface to the deep on the 3 acupoints: the electric drill with the kirschner wire punctured towards the sphenopalatine ganglion and extended to the contralateral areas according to different directions of puncturing sphenopalatine ganglion from the 3 acupoints. The corresponding puncturing points of the 3 acupoints were measured by the coordinate location method. RESULTS: (1) Surface location: the distance between Quanliao (SI 18) and "Die'e" was 21 mm and the distance between Xiaguan (ST 7) and "Die'e" was 17 mm; (2) Inserting depth of each point to sphenopalatine ganglion: the depths of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) were 49.9 mm, 46.9 mm and 46.6 mm, respectively; (3) The coordinate location of the corresponding puncturing points: the puncturing direction of Xiaguan (ST 7) was anterointernal upper corresponding to the area of connecting center between contralateral Taiyang (EX-HN 5) and Tongziliao (GB 1), the distance between the corresponding inserting point of Xiaguan (ST 7) and Sizhukong (TE 23) was 17.6 mm; the puncturing direction of "Die'e" point was posterointernal upper, and the horizontal distance from the corresponding puncture point to the zygomatic arch was 33 mm and the vertical distance from the corresponding puncture point to the eyes' outer canthus was 42 mm; the puncturing direction of Quanliao (SI 18) was posteriointernal upper and the distance between the corresponding inserting point and the area of contralateral parietal tuber, the distance between the corresponding inserting point of Quanliao (SI 18) and the connecting line of bilateral external acoustic pore was 28 mm, the distance between the corresponding inserting point of Quan-liao (SI 18) and the medial line of the head was 62 mm. CONCLUSION: Understanding the surface location, inserting depths and the general puncturing directions of the 3 points can provide basis for puncturing the sphenopalatine ganglion in clinical practice.

The trigeminal trophic syndrome: an unusual cause of face pain, dysaesthesias, anaesthesia and skin/soft tissue lesions.

The trigeminal trophic syndrome is an unusual consequence of trigeminal nerve injury that results in facial anaesthesia, dysaesthesia and skin ulceration. Limited knowledge is available. The aim of this study was to increase the knowledge of this syndrome by performing a retrospective medical record review and case series report. Fourteen cases were identified. The female:male ratio was 6:1. Mean age of onset was 45 years (range 6-82). The cause was iatrogenic in most. Latent period to onset ranged from days to almost one decade. The majority (n = 12) had bothersome dysaesthesias. Most (n = 9) self-manipulated the face; a third (n = 5) did not. Most ulcers affected the second trigeminal division, mainly in the infraorbital nerve distribution. Neuropathic and/or neuralgic facial pain occurred in 50% (n = 7). Pain intensity was severe in most (n = 6). Gabapentin gave relief in two. To conclude, trigeminal trophic syndrome follows injury to the trigeminal nerve or its nuclei. For unclear reasons, most ulcerations follow infraorbital nerve distribution. Self-manipulation may contribute to ulcer development rather than being required. Gabapentin may help pain.