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Plastic and Reconstructive Surgery Mar 2010Facial nerve explorations and microstimulation of distal nerve branches during facial reanimation procedures by the senior author (J.K.T.) have yielded various...
BACKGROUND
Facial nerve explorations and microstimulation of distal nerve branches during facial reanimation procedures by the senior author (J.K.T.) have yielded various observations. This prompted the authors to quantify the surgical findings with an anatomical study and a subsequent analysis of the electrophysiologic intraoperative data. The present report details the microanatomical observations.
METHODS
Ten fresh cadaveric hemiface dissections (five specimens) were performed. The facial nerve branches were traced distally under the operating microscope and mapped with India ink. A number of nerve branches exited the parotid at approximately 9 +/- 0.85 cm from the facial nerve trunk division, and their distribution was noted. Photographic documentation was obtained.
RESULTS
The mean number of nerve branches was 7.70 +/- 1.05 at the anterior parotid border and 13.80 +/- 1.81 distally. Differences in the number and configuration of nerve branches existed even between the two sides of the face. The frontal branch had a mean nerve number of 2.80 +/- 0.63; the zygomatic branch, 4.40 +/- 1.34, the buccal branch, 3.20 +/- 0.78; and the marginal mandibular branch, 2.30 +/- 0.48. In 70 percent of specimens, the buccal branches originated from both upper and lower nerve divisions and interconnected with the marginal mandibular branch in 50 percent of specimens. Distally, connectivity was found between buccal branches and the infraorbital nerve, the marginal mandibular branches, and the mental nerve. A constant lower zygomatic or zygomaticobuccal branch reached the procerus and corrugator supercilii muscles. A twig from the frontal branch reached the corrugator muscle in 60 percent of cases.
CONCLUSIONS
Diversity of facial nerve anatomy is recognized and documented. Specific anatomical relationships are clarified and demonstrated as a guiding map.
Topics: Dissection; Eyelids; Facial Nerve; Humans; Mandible; Microsurgery; Zygoma
PubMed: 20195114
DOI: 10.1097/PRS.0b013e3181ccdc78 -
Dermatologic Surgery : Official... Dec 2009Hyperdynamic activity of the corrugator supercilii and procerus muscles causes glabellar furrows. Recently, a novel radiofrequency device has become available that can...
BACKGROUND
Hyperdynamic activity of the corrugator supercilii and procerus muscles causes glabellar furrows. Recently, a novel radiofrequency device has become available that can effectively ablate the efferent nerves controlling corrugator and procerus contraction, producing clinical results that are similar to those of botulinum toxin.
OBJECTIVE
To assess the efficacy, longevity of effect, and side effects of the radiofrequency ablation device in the treatment of hyperdynamic glabellar furrows.
MATERIALS AND METHODS
Four probe entry points were used to access branches of the temporal and angular nerves. Seven and two ablations, respectively, were delivered to each temporal branch and angular nerve.
RESULTS
Twenty-nine patients underwent bilateral radiofrequency ablation of temporal branches of the facial nerve and the angular nerves. Abrogation of glabellar furrowing was achieved in 90% of patients. No major adverse events were observed. All patients developed mild to moderate swelling, and nine patients (31%) developed purpura in the treated areas. Sixty-nine percent of patients had effects that lasted 4 months or longer, 41% had effects that lasted 6 months or longer, and 10% had effects lasting longer than 12 months.
CONCLUSION
Radiofrequency ablation of efferent branches of the temporal and angular nerves effectively eliminates corrugator and procerus contraction and concomitant glabellar furrowing.
Topics: Adult; Aged; Catheter Ablation; Facial Nerve; Female; Forehead; Humans; Male; Middle Aged; Skin Aging
PubMed: 20002647
DOI: 10.1111/j.1524-4725.2009.01352.x -
Plastic and Reconstructive Surgery Nov 2009In April, the U.S. Food and Drug Administration approved a new U.S. formulation of botulinum neurotoxin type A (Dysport; Medicis Aesthetics, Inc., Scottsdale, Ariz.).... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of variable-dose treatment with a new U.S. Botulinum Toxin Type A (Dysport) for correction of moderate to severe glabellar lines: results from a phase III, randomized, double-blind, placebo-controlled study.
BACKGROUND
In April, the U.S. Food and Drug Administration approved a new U.S. formulation of botulinum neurotoxin type A (Dysport; Medicis Aesthetics, Inc., Scottsdale, Ariz.). This formulation has demonstrated inhibition of glabellar lines at a 50-unit dose. Standard clinical practice is to adjust the dose based on muscle mass.
METHODS
Patients stratified by race/ethnicity were randomized to receive a single treatment of Dysport administered in various doses or placebo. Dysport was administered in a total volume of 0.4 to 0.6 ml for women (50, 60, or 70 units) and 0.5 to 0.7 ml for men (60, 70, or 80 units), based on procerus/corrugator muscle mass. Efficacy was assessed by a blinded evaluator and patient self-evaluation on days 14, 30, 60, 90, 120, and 150 after treatment.
RESULTS
At day 30, 85 percent and 87 percent of Dysport-treated patients were responders as assessed by blinded evaluator and patient self-evaluation, respectively, compared with 3 percent and 5 percent of placebo-treated patients, respectively (p < 0.001). Median duration of effect was 109 days for Dysport versus 0 days for placebo (blinded evaluator) and 107 days for Dysport versus 0 days for placebo (patient self-evaluation). Response and duration of action were slightly higher in African American patients. The majority of treatment-emergent adverse events were mild or moderate in severity.
CONCLUSION
A single treatment with Dysport, with the dose based on gender and muscle mass, is well tolerated and provides a greater and longer-lasting improvement in glabellar lines compared with placebo.
Topics: Adult; Black or African American; Botulinum Toxins, Type A; Double-Blind Method; Drug Administration Schedule; Facial Muscles; Female; Forehead; Humans; Injections, Intramuscular; Male; Middle Aged; Neuromuscular Agents; Patient Satisfaction; Severity of Illness Index; Time Factors; Treatment Outcome; United States
PubMed: 19584772
DOI: 10.1097/PRS.0b013e3181b5641b -
Journal of Cosmetic Dermatology Jun 2009Ptosis is an important side effect of frown correction by botulinum toxin type A (BTX-A). The most likely reason of eyelid ptosis is the diffusion of the toxin to...
BACKGROUND
Ptosis is an important side effect of frown correction by botulinum toxin type A (BTX-A). The most likely reason of eyelid ptosis is the diffusion of the toxin to levator palpebrae superioris muscle through orbital septum while the toxin is injected into the corrugator muscle.
OBJECTIVES
In this pilot study, to prevent ptosis, we evaluated the efficacy of BTX-A injection at superior middle aspect of the corrugator muscle instead of the common injection site located above the medial eyebrow head.
METHODS
Fifteen patients were selected from those referred to our clinic with history of eyelid ptosis due to previous BTX-A (dysport; Ipsen) injection. They received three injections of BTX-A; 10 U into the procerus muscle and 20 U into the superior middle aspect of each corrugator muscle, instead of injecting into the belly of the corrugator muscles.
RESULTS
We observed excellent, good and moderate responses in 66.66%, 13.33% and 20% of our patients 2 weeks post-injection respectively. The outcomes were improved to excellent in the latter two groups by injecting 5 U of BTX-A (dysport; Ipsen) into the contractible corrugator in patients with good and 5 U in each corrugator (total of 10 U) in patients with moderate responses.
CONCLUSION
Employing this method a very satisfactory outcome was obtained while no ptosis was observed. Therefore, we recommend this safe technique for treating patients with a history of eyelid ptosis.
Topics: Adult; Blepharoptosis; Botulinum Toxins, Type A; Cosmetic Techniques; Dermatologic Agents; Female; Forehead; Humans; Injections, Intramuscular; Middle Aged; Oculomotor Muscles; Patient Satisfaction; Pilot Projects; Skin Aging; Treatment Outcome
PubMed: 19527332
DOI: 10.1111/j.1473-2165.2009.00433.x -
The Journal of Craniofacial Surgery Mar 2009A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal...
A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.
Topics: Aged; Aged, 80 and over; Carcinoma, Basal Cell; Cheek; Eyelid Neoplasms; Eyelids; Facial Muscles; Facial Neoplasms; Female; Follow-Up Studies; Graft Survival; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Ophthalmic Artery; Plastic Surgery Procedures; Skin Neoplasms; Skin Pigmentation; Skin Transplantation; Subcutaneous Tissue; Surgical Flaps; Tissue and Organ Harvesting; Wound Healing
PubMed: 19305249
DOI: 10.1097/SCS.0b013e3180f611c8 -
Dermatologic Surgery : Official... Mar 2009Histologic differences (e.g., dermal thickness, collagen fibers) between Caucasian and other racial and ethnic groups may affect wrinkle formation and influence... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Histologic differences (e.g., dermal thickness, collagen fibers) between Caucasian and other racial and ethnic groups may affect wrinkle formation and influence responses to treatment with botulinum toxin type A (BoNT-A).
OBJECTIVE
To evaluate the degree and duration of efficacy of 20 and 30 U of BoNT-A for the treatment of glabellar lines in African-American women with skin types V and VI.
MATERIALS & METHODS
Women aged 18 to 65 with a glabellar rhytid score of 2 or more at maximum frown on an investigator-rated 4-point facial wrinkle scale (FWS; 0=none, 3=severe) were eligible for this study. Patients were randomly assigned to receive 20 U or 30 U of BoNT-A in the glabellar region. Evaluations were conducted at baseline and days 30, 60, 90, and 120 postinjection. The investigator and patient graded the severity of wrinkles at maximum frown and repose on the same 4-point FWS. BoNT-A was administered at the assigned dose, divided between five equal intramuscular injections into the procerus muscle, each corrugator muscle, and a site above the midpupillary line on each side.
RESULTS
The percentage of responders at maximum frown did not differ significantly between the two groups. Although not statistically significant, the effect lasted somewhat longer in the subjects receiving the 30 U dose. No differences were evident between groups at repose through day 120. Adverse events were mild and transient and did not differ between the groups.
CONCLUSION
These results indicate that doses of 20 and 30 U of BoNT-A demonstrate efficacy and safety in African-American women with skin types V and VI.
Topics: Adolescent; Adult; Black or African American; Aged; Botulinum Toxins, Type A; Cosmetic Techniques; Dose-Response Relationship, Drug; Double-Blind Method; Forehead; Humans; Middle Aged; Neuromuscular Agents; Patient Satisfaction; Skin Aging; Young Adult
PubMed: 19250310
DOI: 10.1111/j.1524-4725.2009.01063.x -
Eye (London, England) Jul 2009Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management...
PURPOSE
Severe cases of blepharospasm resistant to botulinum toxin represent a challenging clinical problem. Over the last 10 years, we have adopted a staged surgical management of these cases with an initial upper lid orbicularis myectomy (combined with myectomy of procerus and corrugator supercilius as appropriate) and then 4-6 months later a brow suspension with autologous fascia lata. The aim of this study was to assess the outcome of this staged surgical approach.
MATERIALS AND METHODS
A questionnaire was sent to all patients who had undergone the procedure and the clinical records reviewed.
RESULTS
Fourteen patients had undergone the procedure of which 13 were alive. They were sent a questionnaire and 10 of them responded. All had both procedures. Eight of the 10 reported great benefit from the surgery, one some benefit, and one was worse off. All patients still required botulinum toxin injections after the surgery.
CONCLUSIONS
Majority, but not all, of the patients in our series greatly benefitted from this staged surgical approach.
Topics: Aged; Blepharospasm; Eyelids; Fascia Lata; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oculomotor Muscles; Patient Satisfaction; Surveys and Questionnaires; Transplantation, Autologous
PubMed: 18927593
DOI: 10.1038/eye.2008.314 -
Journal of the American Academy of... Jun 2008The facial feedback hypothesis suggests that muscular manipulations which result in more positive facial expressions may lead to more positive emotional states in... (Review)
Review
The facial feedback hypothesis suggests that muscular manipulations which result in more positive facial expressions may lead to more positive emotional states in affected individuals. In this essay, we hypothesize that the injection of botulinum toxin for upper face dynamic creases might induce positive emotional states by reducing the ability to frown and create other negative facial expressions. The use of botulinum toxin to pharmacologically alter upper face muscular expressiveness may curtail the appearance of negative emotions, most notably anger, but also fear and sadness. This occurs via the relaxation of the corrugator supercilii and the procerus, which are responsible for brow furrowing, and to a lesser extent, because of the relaxation of the frontalis. Concurrently, botulinum toxin may dampen some positive expressions like the true smile, which requires activity of the orbicularis oculi, a muscle also relaxed after toxin injections. On balance, the evidence suggests that botulinum toxin injections for upper face dynamic creases may reduce negative facial expressions more than they reduce positive facial expressions. Based on the facial feedback hypothesis, this net change in facial expression may potentially have the secondary effect of reducing the internal experience of negative emotions, thus making patients feel less angry, sad, and fearful.
Topics: Biofeedback, Psychology; Botulinum Toxins; Emotions; Facial Expression; Facial Muscles; Happiness; Humans
PubMed: 18485989
DOI: 10.1016/j.jaad.2007.10.649 -
Journal of the Chinese Medical... Dec 2007Botulinum toxin type A (BoNT-A) for the treatment of patients with various forms of migraine has been studied, but there is a paucity of data regarding the use of BoNT-A...
BACKGROUND
Botulinum toxin type A (BoNT-A) for the treatment of patients with various forms of migraine has been studied, but there is a paucity of data regarding the use of BoNT-A in Asian headache patients. Our study was designed to evaluate the efficacy of BoNT-A in the treatment of transformed migraine (TM) in a population of Taiwanese patients.
METHODS
We retrospectively analyzed 30 patients who underwent BoNT-A treatment for TM from July 2003 to May 2004. Of 30 patients, 14 had palpable muscle tenderness (or tender points) in the pericranial region and 16 did not. All patients received injections into the corrugator, procerus, frontalis, and temporalis muscles (a total of 30 U), while a subset of TM patients with tender points (6 of 14 patients) also received injections to additional muscles based on a follow-the-tenderness approach (mean dose, 45 U).
RESULTS
Twenty-seven of the 30 patients (90%) surveyed reported effective relief of their symptoms with BoNT-A treatment (at least a 50% reduction in the number of headache days or in headache intensity). The greatest reduction in headache days per month and headache intensity was found in TM patients with tender points who received a mean dose of 45 U compared to those who received fixed-site dosing of 30 U.
CONCLUSION
Our results suggest that BoNT-A may be an effective prophylactic treatment for TM in Taiwanese patients. Interestingly, similar efficacy was demonstrated in TM patients with tender points compared to those without tender points when an additional dose of BoNT-A was injected into the tender muscles in the former.
Topics: Adult; Aged; Botulinum Toxins, Type A; Female; Headache Disorders; Humans; Male; Middle Aged; Migraine Disorders; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 18194894
DOI: 10.1016/S1726-4901(08)70056-X -
Plastic and Reconstructive Surgery Oct 2007Patient satisfaction is a key measure of success when using botulinum toxin type A to treat glabellar rhytides. However, lack of a standardized method of assessing...
BACKGROUND
Patient satisfaction is a key measure of success when using botulinum toxin type A to treat glabellar rhytides. However, lack of a standardized method of assessing satisfaction has limited its evaluation.
METHODS
In this open-label study, 58 women with moderate or severe glabellar rhytides at maximum frown were treated with 20 units of botulinum toxin type A (divided injections in corrugator and procerus muscles). Patients' self-perceptions were assessed at baseline and the following were assessed at days 30 and 120: investigator- and patient-rated global assessment of change in glabellar line severity, patient self-perception of age, and patient satisfaction with the effects of treatment and the procedure itself (using the Facial Lines Treatment Satisfaction Questionnaire).
RESULTS
Overall, patients had a positive self-image at baseline. At day 30, the investigator reported that all patients had 50 percent or greater improvement in glabellar line severity. At days 30 and 120, 95 percent and 86 percent of patients, respectively, reported satisfaction with treatment overall and 82 percent or more reported satisfaction with various aspects of the effects of treatment (time to onset of action, improvement in facial lines and appearance, and appearing better and relaxed) and the procedure itself (absence of downtime and side effects). More than one-third of patients considered that they looked younger than they did before treatment (by a median of 5 years at both time points).
CONCLUSIONS
Botulinum toxin type A treatment of glabellar rhytides resulted in high levels of patient satisfaction, and more than one-third of patients thought they appeared younger than they did before treatment.
Topics: Adult; Body Image; Botulinum Toxins, Type A; Female; Humans; Middle Aged; Neuromuscular Agents; Patient Satisfaction; Prospective Studies; Self Concept; Skin Aging
PubMed: 17898617
DOI: 10.1097/01.prs.0000279377.86280.8d