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The Laryngoscope Mar 2013To assess the survival of full-thickness skin grafts and perichondrial cutaneous grafts when placed on subcutaneous soft tissue flaps used in nasal reconstruction.
OBJECTIVES/HYPOTHESIS
To assess the survival of full-thickness skin grafts and perichondrial cutaneous grafts when placed on subcutaneous soft tissue flaps used in nasal reconstruction.
STUDY DESIGN
Retrospective case series from a secondary-care cutaneous cancer practice.
METHODS
Twenty-eight patients with nasal defects secondary to basal cell carcinoma excision were included. Clinical information, including case notes and photography, was obtained and analyzed. Graft survival was assessed in relation to type of graft and subcutaneous soft tissue flap employed for the reconstruction.
RESULTS
Overall graft survival was 79%, with 89% and 74% for perichondrial cutaneous graft and full-thickness skin grafts, respectively. Anecdotally, procerus and nasalis flaps were found to yield higher graft survival than cheek fat flaps.
CONCLUSIONS
The combination of subcutaneous soft tissue flap and skin graft cover offers a valuable addition to the treatment algorithm for nasal reconstruction following cutaneous malignancy excision.
Topics: Aged; Algorithms; Carcinoma, Basal Cell; Facial Muscles; Female; Free Tissue Flaps; Graft Survival; Humans; Male; Mohs Surgery; Nose Neoplasms; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation
PubMed: 23319461
DOI: 10.1002/lary.23722 -
Clinics in Plastic Surgery Jan 2013This article presents a review of the contribution of the periorbital musculature and brow depressors to the overall brow aesthetics. Special focus is given to the role... (Review)
Review
This article presents a review of the contribution of the periorbital musculature and brow depressors to the overall brow aesthetics. Special focus is given to the role of transblepharoplasty brow lift as well as myotomy of the corrugator and procerus muscles. The authors' preferred surgical technique and patient results are reviewed in detail.
Topics: Blepharoplasty; Esthetics; Facial Muscles; Forehead; Hair; Humans; Oculomotor Muscles; Rhytidoplasty; Sex Factors; Skin Aging; Surgical Flaps
PubMed: 23186762
DOI: 10.1016/j.cps.2012.06.003 -
Journal of Cosmetic Dermatology Dec 2012IncobotulinumtoxinA and onabotulinumtoxinA are effective treatments for glabellar frown lines, and a dose of 20 U is recommended for both preparations. However, debate... (Comparative Study)
Comparative Study
BACKGROUND
IncobotulinumtoxinA and onabotulinumtoxinA are effective treatments for glabellar frown lines, and a dose of 20 U is recommended for both preparations. However, debate continues over using the same dosages of these products, although a 1:1 dose ratio has been proven in several head-to-head clinical trials in neurological and esthetic indications.
OBJECTIVES
To investigate whether a 50% higher dose of onabotulinumtoxinA was nonsuperior to incobotulinumtoxinA in the treatment of glabellar frown lines in the short and long term.
METHODS AND MATERIALS
Subjects aged 18-65 years with symmetrical moderate-to-severe glabellar frown lines (score: ≥2 on a validated Merz 5-point scale) at maximum frown were enrolled. Corrugator muscles on both sides were treated with two injections of either 4 U incobotulinumtoxinA or 6 U onabotulinumtoxinA (equivalent to 20 and 30 U, respectively, if corrugator muscles on both sides and the procerus are treated) allowing intra-individual comparison. Glabellar frown line severity was assessed from standardized photographs every 4 weeks for 4 months and, in a subset of subjects, for up to 6 months posttreatment. The primary efficacy endpoint was the percentage of subjects with an improvement of ≥1 point on the 5-point scale at week 4. Nonsuperiority was assessed by comparing the response rates of each product.
RESULTS
Nonsuperiority of a 50% higher dose of onabotulinumtoxinA to that of incobotulinumtoxinA was confirmed at 4 weeks, 4 months, and 6 months posttreatment.
CONCLUSION
There is generally no reason to increase the dose of either incobotulinumtoxinA or onabotulinumtoxinA above the 20 U recommended for glabellar frown lines.
Topics: Adult; Aged; Botulinum Toxins, Type A; Eyebrows; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Neuromuscular Agents; Skin Aging
PubMed: 23174049
DOI: 10.1111/jocd.12001 -
HNO Oct 2012Endoscopic surgical techniques have greatly increased in popularity with the advent of modern endoscopes. Endoscopic brow lifting has largely replaced older, more...
Endoscopic surgical techniques have greatly increased in popularity with the advent of modern endoscopes. Endoscopic brow lifting has largely replaced older, more invasive procedures. With this technique a skilled surgeon can identify and treat a ptotic eyebrow by addressing the relevant anatomy, including the frontalis, corrugator, procerus and orbicularis oculi muscles. The frontalis muscle can then be permanently fixed into a predesignated position using titanium screws and permanent sutures. This approach has allowed facial plastic surgeons to address the ptotic brow with decreased rates of edema, hematoma, hypesthesia, alopecia and scarring.
Topics: Dermatologic Surgical Procedures; Endoscopy; Eyebrows; Humans; Plastic Surgery Procedures
PubMed: 23052234
DOI: 10.1007/s00106-012-2576-0 -
Expert Review of Neurotherapeutics Sep 2012Depression has a number of significant symptoms such as depressed mood, lack of volition/energy, suicidal ideation, low concentration, sleep disturbance, anger, anxiety,...
Depression has a number of significant symptoms such as depressed mood, lack of volition/energy, suicidal ideation, low concentration, sleep disturbance, anger, anxiety, psychomotor retardation, fear and sadness. In addition, various facial expressions such as frowning and sadness can also be easily recognized in depressed patients. In fact, major muscles involved in the development of such negative emotion have been reported in depressed patients, for instance, corrugators and procerus muscles in the glabellar regions of the face. Electromyography studies have also reported that depressed patients had overactivity of such grief muscles during different affective imagery paradigms. Furthermore, subjective emotion has also been found to be affected by differential facial expression via an image feedback system. Interestingly, anecdotal open-label studies have shown that botulinum toxin may have a role in treatment of depression and a recent randomized-placebo controlled study has also confirmed the effect of botulinum toxin in reduction of depressive symptoms for the first time. This article will discuss the putative role of botulinum toxin in a treatment of depression in the context of the clinical significance, limitations and future research directions.
PubMed: 23039383
DOI: 10.1586/ern.12.92 -
Arquivos de Neuro-psiquiatria Aug 2012
Topics: Blepharospasm; Diagnosis, Differential; Dystonic Disorders; Facial Muscles; Humans; Male; Middle Aged; Tic Disorders
PubMed: 22899039
DOI: 10.1590/s0004-282x2012000800016 -
Aesthetic Surgery Journal Sep 2011The dynamic muscles of the glabellar region can be overactive, giving patients a "scowling" look and making them appear angry, worried, or stressed.
BACKGROUND
The dynamic muscles of the glabellar region can be overactive, giving patients a "scowling" look and making them appear angry, worried, or stressed.
OBJECTIVE
The authors describe percutaneous selective nerve ablation, a minimally-invasive procedure for treatment of glabellar frown lines, and report results from a series of patients treated with the technique.
METHODS
From November 2007 to December 2009, 27 patients (22 women and five men) underwent percutaneous selective nerve ablation to improve glabellar frown lines. Initially, the surface pathway of the nerve to the corrugator supercilii and procerus was checked with a peripheral nerve stimulator. For percutaneous localization, a 22-gauge monopolar electrode was introduced into the lateral brow and cheek skin without incision. Short electrical stimulation (0.3-0.5 mA) was delivered to identify the proper lesion sites. Synchronous contraction of corrugator supercilii was elicited and radiofrequency nerve ablation performed (85°C, 70 seconds). In all patients, the frontal branch of the facial nerve and angular nerve were treated bilaterally. The improvement was evaluated with the Wrinkle Assessment Scale.
RESULTS
Mean patient age was 54.5 years, and mean follow-up time was 18 months (range, 12-26 months). One patient had superficial second-degree burns to the brow skin, which healed with conservative treatment. Two patients had temporary paresthesia that completely resolved in a few weeks without sequelae. The Wrinkle Assessment Scale indicated a statistically significant improvement in the glabellar frown lines (preoperative vs postoperative mean, 3.7 vs 1.8; P < .05).
CONCLUSIONS
Although long-term studies are necessary to determine the ideal amount of energy delivery for maximum efficacy and time for treatment of glabellar frown lines, the study lends support for the safety and efficacy of percutaneous selective nerve ablation.
Topics: Adult; Aged; Catheter Ablation; Cosmetic Techniques; Electric Stimulation; Facial Muscles; Facial Nerve; Female; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 21908806
DOI: 10.1177/1090820X11416807 -
Eliminating frown lines with an endoscopic forehead lift procedure (corrugator muscle disinsertion).Aesthetic Plastic Surgery Aug 2011In certain cases of endoscopic forehead lift without muscle resection, patients were incidentally noted to develop weakness or loss of their ability to frown during the...
BACKGROUND
In certain cases of endoscopic forehead lift without muscle resection, patients were incidentally noted to develop weakness or loss of their ability to frown during the postoperative period despite intact musculature. This finding suggested the possibility of decreasing frown strength using the disinsertion of the relevant muscles. This finding persuaded the authors to try to eliminate or decrease the sensory problems resulting from open or endoscopic frowning muscle resection by disinserting these muscles. We therefore sought to determine the efficacy of a brow/forehead lift that involved disinsertion rather than muscle resection.
METHODS
From September 2004 through December 2006, 22 endoscopic forehead lifts (20 females and 2 males) were performed using the conventional corrugator muscle resection technique (group 1). From January 2007 through October 2009, 43 patients (38 females and 5 males) underwent endoscopic forehead lift with a muscle-preserving technique (group 2). In both groups, small scalp incisions were made, and an endoscope was used to elevate the brows and forehead to perform glabellar and forehead muscle resection in group 1 and disinsertion of the frowning muscles in group 2. The skin of the forehead was then reanchored to a more superior location using sutures attached to deep temporal fascia as well as outer table screws and skin staples.
RESULTS
Aesthetically pleasing eyebrow and forehead with reduced power in the frowning muscles were achieved in the majority of patients in both groups. A significant decrease in the depth of vertical and horizontal glabellar creases was obtained in these patients. In group 1, 19 of 22 patients completely lost the ability to frown and 3 patients (13.6%) suffered permanent sensory loss. In group 2, 33 of 43 patients lost their ability to frown but only 2 cases (4.5%) developed minimal unilateral forehead partial sensory deficit after a 12-month follow-up period.
CONCLUSION
Disinsertion of the corrugator supercilli, procerus, or orbicularis oculi muscles can decrease contractility with less chance of damaging nearby or intermingled sensory nerves than offered by resection.
Topics: Adult; Endoscopy; Female; Forehead; Humans; Male; Middle Aged; Muscle, Skeletal; Rhytidoplasty; Skin Aging
PubMed: 21298513
DOI: 10.1007/s00266-010-9649-9 -
Journal of the Neurological Sciences Nov 2010'Procerus sign' has been described as vertical wrinkles in the glabella region and bridge of the nose of patients with Progressive Supranuclear Palsy. The action of...
'Procerus sign' has been described as vertical wrinkles in the glabella region and bridge of the nose of patients with Progressive Supranuclear Palsy. The action of Corrugator and Orbicularis Oculi produce the vertical wrinkling. The relevance of this sign in early clinical diagnosis has been established and this sign has gained importance in literature and has been quoted as a useful sign in texts following the original description. We prospectively performed a cross sectional analysis of the facial appearance in subsequent Parkinsonism patients and found statistically significant presence of this sign in PSP compared to other Parkinsonian disorders. We recommend that this should be called "vertical wrinkling of the forehead" to avoid confusion and emphasize the dystonic nature of this condition rather than contraction of a single muscle as indicated by 'Procerus sign'.
Topics: Aged; Blinking; Cross-Sectional Studies; Face; Facial Expression; Facial Muscles; Female; Forehead; Humans; Male; Middle Aged; Parkinsonian Disorders; Prospective Studies; Supranuclear Palsy, Progressive
PubMed: 20810128
DOI: 10.1016/j.jns.2010.08.010 -
Zhonghua Zheng Xing Wai Ke Za Zhi =... May 2010To study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.
OBJECTIVE
To study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.
METHODS
10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 x operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus.
RESULTS
(1) AN was classified into I, II, III type according to its formation pattern. Type I (20%, 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type II (20%, 4/20 sides), the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type III (60%, 12/20 sides), the AN had two branches in the "Four Muscle Gap". (2) The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. (3) The branch of AN enters the depressor supercilii or procerus 2.19 to 4.28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6.89 to 9.38 mm below the medial canthus ligament.
CONCLUSIONS
The approach of denervation surgery for AN should be performed medial to the support ligation, between 2.19 mm above the medial canthus and 6.89 mm below the medial canthus.
Topics: Adult; Cadaver; Denervation; Facial Muscles; Facial Nerve; Female; Humans; Male
PubMed: 20737954
DOI: No ID Found