Search Results (412)

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors. Full article

Background: Congenital muscular torticollis (CMT) is usually managed conservatively during infancy, whereas surgical treatment is considered for persistent deformity in older children. However, evidence remains limited regarding the outcomes of distal resection combined with proximal release of the sternocleidomastoid muscle in children presenting beyond infancy. This study aimed to evaluate the functional and cosmetic outcomes of this combined approach in patients aged 3 years and older. Methods: This retrospective single-surgeon series included 37 patients with CMT aged 3 to 14 years who underwent distal resection combined with proximal release of the sternocleidomastoid muscle between 2002 and 2024. Preoperative and postoperative assessments were performed using the clinical outcome framework originally described by Lee et al., goniometric measurement of cervical rotation and lateral flexion, and clinical evaluation of head tilt, facial asymmetry, scar appearance, lateral band formation, and sternocleidomastoid V-column contour. Patients were also analyzed according to age at surgery, as 3–10 years and 11–14 years. Results: The mean age at surgery was 4.7 years, and the mean follow-up duration was 3.4 years. Significant postoperative improvement was observed in all major functional outcomes. Mean cervical rotation improved from 54.2 ± 8.6° to 87.9 ± 3.4°, and mean lateral flexion improved from 24.1 ± 6.8° to 44.5 ± 3.2° (both p < 0.001). Preoperative functional assessment scores averaged 6.8 ± 1.4, whereas postoperative total outcome scores averaged 14.2 ± 0.9. At final follow-up, no patient had residual head tilt. Mild residual facial asymmetry persisted in 3 patients (8.1%). Overall, postoperative outcomes were rated as excellent in 33 patients (89.2%) and good in 4 patients (10.8%). A slight partial loss of the sternocleidomastoid V-column contour was observed in 34 patients (91.9%), although this finding was not documented as a major cosmetic concern in the available clinical records. Hypertrophic scarring developed in 1 patient (2.7%). No lateral band formation, recurrence, revision surgery, infection, or hematoma was observed. Conclusions: Distal resection combined with proximal release provided favorable functional and cosmetic outcomes in children older than 3 years with CMT. The technique was associated with marked improvement in cervical motion, correction of head tilt, low complication rates, and a high proportion of excellent or good results. Full article

Botulinum neurotoxin (BoNT) treatment outcomes are commonly assessed through visual evaluation of facial wrinkle patterns, a process that remains inherently subjective despite structured grading systems. This study evaluated whether contemporary multimodal artificial intelligence (AI) systems can identify facial changes associated with BoNT treatment, using region-specific wrinkle patterns as surrogate markers of underlying muscle activity. A dataset of 46 facial images (23 pre-treatment, 23 post-treatment) was analyzed using four multimodal models, each assessed across five independent runs. Models were tasked with classifying treatment state from single images, detecting wrinkle presence in the forehead, glabella, and periorbital regions, and generating exploratory severity scores and age estimates. Two models achieved 100% accuracy in distinguishing pre- from post-treatment images in this dataset, while region-specific wrinkle detection was variable and frequently did not exceed majority-class baselines. Inter-run reliability varied substantially across models. Exploratory wrinkle severity scores showed directional differences between treatment states, whereas apparent age estimates demonstrated minimal systematic variation. These findings suggest that global facial changes associated with BoNT treatment appear to be detectable in model outputs, but region-specific assessment remains limited, underscoring the need for cautious interpretation and further validation. Full article

This study proposes a morphological convolutional neural network (MCNN) architecture that integrates morphological operations with CNN layers for facial expression recognition (FER). Conventional CNN-based FER models primarily rely on appearance features and may be sensitive to illumination and demographic variations. This work investigates whether morphological structural representations provide complementary information to convolutional features. A multi-source and multi-ethnic FER dataset was constructed by combining CK+, JAFFE, KDEF, TFEID, and a newly collected Indonesian Facial Expression dataset, resulting in 3684 images from 326 subjects across seven expression classes. Subject-independent data splitting with 10-fold cross-validation was applied to ensure reliable evaluation. Experimental results show that the proposed MCNN1 model achieves an average accuracy of 88.16%, while the best MCNN2 variant achieves 88.7%, demonstrating competitive performance compared to MobileNetV2 (88.27%), VGG19 (87.58%), and the morphological baseline MNN (50.73%). The proposed model also demonstrates improved computational efficiency, achieving lower inference latency (21%) and reduced GPU memory usage (64%) compared to baseline models. These results indicate that integrating morphological representations into convolutional architectures provides a modest but consistent improvement in FER performance while enhancing generalization and efficiency under heterogeneous data conditions. Full article

Glucagon-like peptide-1 (GLP-1) is an incretin hormone involved in glucose regulation. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used in the treatment of type 2 diabetes mellitus and obesity, as well as in cardiovascular risk reduction. Recent evidence suggests that GLP-1 receptors are expressed in cutaneous tissues; however, their role in skin homeostasis and aging remains insufficiently clarified. This review summarizes recent experimental and clinical studies examining the effects of GLP-1 receptor agonists on skin homeostasis, wound healing, regeneration, and aging processes. Experimental data indicate that GLP-1 RAs may promote wound healing through modulation of inflammatory pathways, enhancement of keratinocyte migration, improved microvascular perfusion, and support of fibroblast function. Antioxidant and cytoprotective mechanisms have also been described. Conversely, rapid weight loss associated with GLP-1 RA therapy has been linked to structural facial changes, including reduction in dermal white adipose tissue and decreased collagen synthesis, which may clinically resemble accelerated skin aging. Mechanistic findings suggest heterogeneous and pathway-dependent effects. Overall, the impact of GLP-1 receptor agonists on skin biology appears multifaceted, and further well-designed clinical studies are required to determine their precise dermatological implications. Full article

Remote photoplethysmography (rPPG) extracts physiological signals from facial videos by analyzing subtle skin color variations caused by blood flow. While this technology enables contactless health monitoring, it also raises privacy concerns because facial videos reveal both identity and sensitive biometric information. Existing privacy-preserving techniques, such as blurring or pixelation, degrade visual quality and are unsuitable for practical rPPG applications. This paper presents rePPG, a framework that inserts a desired rPPG signal into facial videos while preserving the original facial appearance. The proposed method disentangles facial appearance and physiological features, enabling replacement of the physiological signal without altering facial identity or visual quality. Skin segmentation restricts modifications to skin regions, and a cycle-consistency mechanism ensures that the injected rPPG signal can be reliably recovered from the generated video. Importantly, the extracted rPPG signals are evaluated against the injected target physiological signals rather than the subject’s original physiological state, ensuring that the evaluation measures signal rewriting accuracy. Experiments on the PURE and UBFC datasets show that rePPG successfully embeds target PPG signals, achieving 1.10 BPM MAE and 95.00% PTE6 on PURE while preserving visual quality (PSNR 24.61 dB, SSIM 0.638). Heart rate metrics are computed using a 5-second temporal window to ensure a consistent evaluation protocol. Full article

Introduction: Facial aging is characterized by progressive soft-tissue descent, affecting all anatomical layers—from bone structures to the skin envelope. Early manifestations include downward displacement of the midface soft tissues, deepening of the nasolacrimal and nasolabial folds, and the appearance of soft-tissue “puckering” in the lower third of the face. At this stage, patients typically seek aesthetic correction to restore youthful facial contours with minimal or no visible signs of surgical intervention. Methods: This study is an observational analysis of a prospectively maintained surgical database including 201 female patients who underwent TESL between 2006 and 2024. Patient demographic data, surgical technique specifics, and postoperative outcomes were collected. A total of 612 procedures were performed. The cohort was stratified into two age groups: 30–35 years (n = 72) and 36–45 years (n = 129). Results: No cases of facial nerve injury or neurological complications were observed. Complications included 13 cases of localized cicatricial alopecia (6.47%) and four postoperative hematomas (1.99%). Eleven patients (5.47%) required minor secondary revision to address preauricular skin pleating. The technique demonstrated consistent and favorable outcomes in restoring soft-tissue volume and positioning, eliminating early lower-face “puckering,” and improving the cervicomental and mandibular contours. Conclusions: For patients under 45 years of age presenting with early signs of facial soft-tissue ptosis, endoscopic subcutaneous midface elevation with vertical SMAS plication is a safe, effective, and minimally invasive approach to rejuvenating the mid and lower face. Full article

Personality recognition and emotion recognition, two core tasks within affective computing, are fundamentally constrained by data scarcity as collecting and annotating human behavioral data is expensive and restricted by privacy concerns. Under these limited data conditions, existing models tend to rely on superficial shortcut features such as background appearance, lighting conditions, or color variations, rather than behavior-relevant cues including facial expressions, posture, and motion dynamics. To address this issue, we propose Style-Abstraction-based Data Augmentation, a style transfer-based augmentation strategy that reduces dependency on low-level appearance information while preserving high-level semantic cues. Specifically, we employ cartoonization to generate stylized variants of training videos that retain expressive characteristics but remove stylistic bias. We validate our approach on three diverse personality benchmarks (First Impression v2, UDIVA v0.5, and KETI) and emotion benchmark(Emotion Dataset) using state-of-the-art models including ViViT (Video Vision Transformer), TimeSformer, and VST (Video Swin Transformer). Our experiments indicate that increasing the proportion of style-abstracted data in the training set can improve performance on the evaluated datasets. Notably, our method yields consistent gains across all benchmarks: a 0.0893 reduction in MSE on UDIVA v0.5 (with VST), a 0.0023 improvement in 1-MAE on KETI (with TimeSformer), and a 0.0051 improvement on First Impression v2 (with TimeSformer). Furthermore, extending style-abstraction-based data augmentation to a four-class categorical emotion recognition task demonstrates similar performance gains, achieving up to a 3.44% accuracy increase with the TimeSformer backbone. These findings verify that our style-abstraction-based data augmentation facilitates learning of behavior-relevant features by reducing reliance on superficial shortcuts. Overall, cartoonization-based style abstraction for data augmentation functions as both an effective augmentation strategy and a regularization mechanism, encouraging the model to learn more stable and generalizable representations for affective computing applications. Full article

Facial emotion recognition (FER) plays an important role in healthcare, human–computer interaction, and intelligent security systems. However, despite recent advances, many state-of-the-art FER methods depend on computationally intensive CNN or transformer backbones and large-scale annotated datasets while suffering noticeable performance degradation under cross-dataset evaluation because of domain shift. These limitations hinder practical usage in resource-constrained and real-world environments. To address this issue, we propose Cross-Adaptive Gated Fusion Network (CA-GFNet), a lightweight dual-stream FER framework that explicitly combines shallow structural features with deep semantic representations. The proposed architecture integrates domain-robust gradient-based descriptors with compact deep features extracted from a VGG-based backbone. After face detection and normalization, the structural stream captures fine-grained local appearance cues, whereas the semantic stream encodes high-level facial configurations. The two feature streams are projected into a shared latent space and adaptively fused using a gated fusion mechanism that learns sample-specific weights, allowing the model to prioritize the more reliable feature source under dataset shift. Extensive experiments on KDEF along with zero-shot cross-dataset evaluation on CK+ using a strict train-on-KDEF/test-on-CK+ protocol with subject-independent splits demonstrate the effectiveness of the proposed method. CA-GFNet achieves 99.30% accuracy on KDEF and 98.98% on CK+ while requiring significantly fewer parameters than conventional deep FER models. These results confirm that adaptive gated fusion of shallow and deep features can deliver both high recognition accuracy and strong cross-dataset robustness. Full article

Social categorization often occurs automatically, shaping whom we notice, remember, and group together. The present study examined how visual cues indicative of sex, race, and facial anomaly guide spontaneous categorization, testing the hypothesis that anomaly-based categorization is more malleable than categorization by race or sex. Using a within-subjects Who-Said-What (WSW) paradigm, participants viewed faces that varied by sex, race, and presence of a facial scar, each paired with self-descriptive statements. A surprise recall task required matching statements to faces. Categorization strength was computed from recall errors. Participants showed the strongest categorization by sex, weak categorization by race, and very weak categorization by facial anomaly. Regression analyses revealed that scar-based categorization was negatively associated with sex- and race-based categorization. When sex or race was strongly encoded, scar-based categorization was sharply diminished, and the cue appeared only under relatively weak and infrequent conditions. Thus, although visually salient, facial anomalies did not function as an independent or stable basis for social grouping. These findings demonstrate that the categorization system prioritizes evolutionarily primary cues such as sex, treats race as a comparatively weaker cue, and assigns facial anomalies to a minimal and malleable role. Overall, the results highlight the fragile, low-priority, and easily overshadowed nature of anomaly-based categorization in social memory. Importantly, the fragility of scar-based categorization suggests that negative evaluations of anomalous faces (anomalous-is-bad stereotyping) are not automatically translated into robust memories or categorical organization. Full article

Facial emotion recognition (FER) is an important component of human–computer interaction and healthcare-oriented affective computing. However, reliable deployment remains difficult in unconstrained settings due to appearance and geometric variability (e.g., pose, illumination, and occlusion), demographic imbalance, and dataset bias. In practice, two additional constraints frequently limit real-world FER systems: the computational overhead of heavy architectures and limited adaptability when data evolve over time, where sequential updates can cause catastrophic forgetting. To address these challenges, we propose the Incremental Attention-Enhanced Network (IAE-Net), a compact single-branch framework built on a DenseNet121 backbone and a cascaded refinement pipeline. The model incorporates Channel Attention (CA) to emphasize expression-relevant feature channels and suppress less informative responses, followed by a deformable attention module (DA) that reduces feature misalignment caused by non-rigid facial motion and pose shifts, thereby improving robustness under geometric variability. For continual deployment, IAE-Net supports class-incremental updates via weight transfer, exemplar replay, and knowledge distillation to improve retention during sequential learning. We evaluate IAE-Net on four widely used benchmarks, FER2013, FERPlus, KDEF, and AffectNet, covering both controlled and in-the-wild conditions under a unified training protocol. The proposed approach achieves accuracies of 79.15%, 92.03%, 99.48%, and 74.20% on FER2013, FERPlus, KDEF, and AffectNet, respectively, with balanced precision, recall, and F1-score trends. These results indicate that IAE-Net provides an efficient and extensible FER framework with potential utility in dynamic real-world and longitudinal healthcare-oriented applications. Full article

Background: The maxillary canine is the second-most frequently impacted tooth, affecting 1–3% of the population. It plays a crucial role in occlusion, facial esthetics, and arch development, making orthodontic traction the preferred approach over extraction or clinical monitoring without intervention. This systematic review aimed to identify the factors associated with the duration of orthodontic traction for impacted maxillary canines and to evaluate their influence. Methods: A systematic search was conducted in MEDLINE, Cochrane Library, Embase, Web of Science, and grey literature following PRISMA guidelines. Traction duration was defined as follows: (A) time from traction initiation to alignment; (B) time to cusp emergence; and (C) time to appliance removal. Risk of bias was assessed using RoB 2 and ROBINS-I v2. Results: Out of 1156 initial studies, 43 were included in qualitative analysis and 24 in quantitative analysis. The pooled mean treatment duration was 43.13 months (95% CI: 32.50–53.77; I² = 99.6%) for definition A, 44.81 months (95% CI: 23.28–66.34; I² = 99.8%) for definition B, and 87.48 months (95% CI: 69.80–106.07) for definition C. Alpha angle, vertical height, and sector were the most frequently reported factors, potentially influencing traction duration. Meta-regression showed a significant association between mean patient age and treatment duration for definition B (β = −8.168, 95% CI: −15.299 to −1.037; p = 0.025), whereas no significant associations were observed for definition A. Heterogeneity across studies was high, and most non-randomized studies showed moderate to serious risk of bias, while randomized trials presented some concerns. Conclusions: Patient- and treatment-related factors, including higher alpha angle, greater vertical height, and more midline positioning, appear to influence traction duration. Despite variability across studies, these findings provide valuable insights for clinical practice. Full article

Peptides, particularly SA1-III decapeptide, play a key role in maintaining skin structure by inhibiting collagen degradation. The aim of this analysis was to investigate the combined effects of Definisse™ Revitalise Threads and Definisse [KP1]^® Redensifying Cream containing SA1-III for facial rejuvenation. Patients receiving Definisse™ Revitalise Threads were offered Definisse™ Redensifying Cream for one month. Outcomes—including efficacy, safety, and patient satisfaction—were assessed over six months using 3D imaging, clinical evaluation, and the FACE-Q™ questionnaire. Due to the sample size, data were summarised descriptively, with group comparisons using exact Mann–Whitney U tests and paired analyses using the Wilcoxon signed-rank test (p < 0.05). Nineteen individuals underwent treatment with Definisse™ Revitalise Threads (17 females and 2 males, aged 38–72 years); 10 patients used additional Definisse [KP1]^® Redensifying Cream while 9 did not. All patients reported significant improvements in skin satisfaction, cheek fullness, and perceived aging, based in FACE-Q^TM scores before and after treatment. Thread treatment visibly improved facial appearance, but the addition of the peptide-containing cream further enhanced skin quality. Indeed, greater improvements in skin satisfaction were reported by individuals using vs. not using Definisse [KP1]^® Redensifying Cream. No adverse events were reported, and the FACE-Q^TM Adverse Effects scale indicated only mild, transient effects. In this preliminary series with a six-month follow-up, the combination of Definisse Revitalise Threads and Definisse^® Redensifying Cream was well-tolerated and showed potential for enhancing facial rejuvenation. These preliminary findings suggest that peptide-based cosmeceuticals may complement aesthetic procedures and support skin health. These preliminary results will be used to generate hypotheses for larger studies with longer follow-up, which are needed to confirm these effects. Full article

Introduction: Occipital neuralgia [ON] is a primary headache disorder that contributes to a significant proportion of facial pain cases. Occipital neuralgia is an uncommon but disabling headache disorder with an estimated annual incidence of approximately 3.2 per 100,000 individuals. The pathophysiology of ON involves both sensitization of the greater occipital nerve and central mechanisms, including the sensitization of the trigeminocervical pain pathway. Objective: The aim of this study was to evaluate the effectiveness of occipital nerve stimulation (ONS) in patients with refractory occipital neuralgia after six months of treatment. Materials and Methods: StimO is a prospective, open-label, controlled, randomized, and parallel-group study comparing two groups: ONS (occipital nerve stimulation) and OMM (optimized medical management). Results: The percentage change in maximum pain between baseline (D0) and month 6 (M6) showed a significantly greater reduction (p = 0.04) in the ONS group compared to the OMM group. The EQ5D scores revealed that the ONS group had a better quality of life than the OMM group at month 1 (p = 0.01). Medication Quantification Scale (MQS) scores were significantly lower at M1, M3, and M6 [p = 0.03]. However, ONS did not significantly impact anxiety or depression, as assessed by the HAD scale [p > 0.05]. Conclusions: ONS appears to be safe and effective therapy, decreasing pain and medication use and improving quality of life at six months. Trial Registration: The study protocol is registered on ClinicalTrial.gov under the following registration number: NCT03475797 Full article

Callous–unemotional (CU) traits are characterised by reduced empathy, guilt, and emotional responsiveness, and are strongly linked to atypical socioemotional processing. Eye-tracking research provides a valuable window into these processes by capturing early developing patterns of attention to emotionally salient social cues, particularly facial expressions. This narrative review examines how alterations in gaze behaviour contribute to the emergence of CU traits across neurodevelopmental disorders (NDs), with a focus on autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder (CD). Across studies, elevated CU traits are associated with reduced fixations on the eye region, most consistently in response to fearful faces. ASD is associated with robust eye avoidance, ADHD with inhibitory and attentional control difficulties during face processing, and CD with atypical gaze allocation to negative emotional expressions such as fear and anger. These patterns appear amplified when CU traits co-occur with NDs. Competing explanatory accounts, including aberrant amygdala functioning, oculomotor disinhibition, and hostile attribution biases, each capture aspects of these patterns but fail to provide a unified explanation. Integrating developmental, neurobiological, and environmental perspectives, we propose that CU traits reflect a transdiagnostic developmental construct shaped by early attentional–emotional mechanisms, rather than a disorder-specific identity. Full article