Search Results (45)

Blepharospasm (BSP) is characterized by excessive orbicularis oculi muscle activity leading to abnormal blinking and involuntary eyelid closure. Botulinum neurotoxin (BoNT) injections are the main treatment for BSP, but they only partially and transiently relieve symptoms, leading to a waxing and waning therapeutic response. A patient-centered outcome (PCO) tool that measures BSP symptoms in a simple and efficient way could inform the development of better treatments. Using a stepwise modified Delphi approach, potential PCO items were first identified using the Dystonia Coalition Database with data from over 200 individuals with BSP who had provided responses to existing clinical assessment scales. These items were then analyzed for contribution to overall severity using a Random Forests approach, and redundant items were merged and revised in a series of iterative meetings with a specialist panel along with input from patient advocacy group representatives and focus groups. An online survey was conducted with 330 individuals with BSP to validate and verify the items’ relevance. Finally, the specialist panel provided content validity ratio, which was repeated until it showed good agreement for relevance and clarity of all items. In the end, an easy-to-use PCO tool designed for smartphones and tablets containing 17 items covering three symptom domains (motor, disability, and psychosocial/quality of life) was created. This novel PCO tool for BSP may be used to characterize the cyclical response that an individual patient experiences from BoNT treatments and provide a vital tool for future investigations of longer-acting BoNT preparations or adjunctive therapies. Full article

Background: Surface electromyography (sEMG) enables the non-invasive assessment of muscle activity and is widely used in orthodontics for evaluating masticatory muscles. However, little is known about the dynamic changes in facial expression muscles during orthodontic treatment. This study aimed to investigate alterations in facial muscle tone during the leveling and alignment phase in adult female patients undergoing fixed appliance therapy. Methods: The study included 30 female patients aged 20–31 years who underwent sEMG assessment at four time points: before treatment initiation (T0), at the start of appliance placement (T1), three months into treatment (T2), and six months into treatment (T3). Muscle activity was recorded during four standardized facial expressions: eye closure, nasal strain, broad smile, and lip protrusion. Electrodes were placed on the orbicularis oris, orbicularis oculi, zygomaticus major, and levator labii superioris alaeque nasi muscles. A total of 1440 measurements were analyzed using Friedman and Conover-Inman tests (α = 0.05). Results: Significant changes in muscle tone were observed during treatment. During lip protrusion, the orbicularis oris and zygomaticus major showed significant increases in peak and minimum activity (p < 0.01). Eye closure was associated with altered orbicularis oris activation bilaterally at T3 (p < 0.01). Nasal strain induced significant changes in zygomaticus and levator labii muscle tone, particularly on the right side (p < 0.05). No significant changes were noted during broad smiling. Conclusions: Orthodontic leveling and alignment influence the activity of selected facial expression muscles, demonstrating a dynamic neuromuscular adaptation during treatment. These findings highlight the importance of considering soft tissue responses in orthodontic biomechanics and suggest potential implications for facial esthetics and muscle function monitoring. Full article

Background and Objectives: The effects of face yoga, which continues to be popular as an anti-aging technique, on facial muscles in relation to aging represent an area of interest. The aim of this study was to investigate the effect of 8 weeks of intensive face yoga on facial muscles’ tonus, stiffness, and elasticity in middle-aged women. Materials and Methods: Twelve female participants with a mean age of 49.75 ± 3.76 were included in this pre-experimental clinical trial. Face yoga was applied to the participants for 8 weeks, 2 days a week face-to-face, and 5 days a week as a home program. At the beginning and the end of 8 weeks, the tonus, stiffness, and elasticity of the participants’ facial muscles were evaluated with the Myoton^®PRO device. Results: Following the face yoga program, the tonus and stiffness of the frontalis (p = 0.008, p = 0.002), corrugator supercilii (p = 0.008, p = 0.019), orbicularis oculi (p = 0.023, p = 0.034), and orbicularis oris (p = 0.007, p = 0.015) muscles decreased significantly, while the tonus and stiffness of the buccinator (p = 0.008, p = 0.002) and digastric (p = 0.008, p = 0.023) muscles increased. Elasticity values increased in all evaluated facial muscles (p = 0.045, p = 0.045, p = 0.034, p = 0.023, p = 0.028, p = 0.005, respectively). Conclusions: The results reveal that face yoga has different effects depending on the physiological structure and function of the muscles and positively affects connective tissue. Future studies should reproduce the results presented here to further our understanding of the effects of face yoga. Full article

Background/Objective: The orbicularis oculi muscle (OOM) is crucial for eyelid function and ocular protection. Surface electromyography (sEMG) is a useful tool for assessing OOM activity, but interpretation remains limited due to a lack of standardized reference values. This study investigates the influence of gender, laterality, and age on OOM activity using sEMG. Methods: In total, 84 healthy adult participants (44 females and 40 males) underwent sEMG measurements for both eyes during gentle (GEC) and maximal (MVC) voluntary eyelid closure. Results: The average age was 62.5 years (ranging from 27 to 86; SD = 13.79) for males, and 63.12 years (ranging from 27 to 87; SD = 13.8) for females. The mean Root Mean Square (RMS) MVC values were 157.80 ± 56.43 for men and 146.45 ± 56.48 for women. The mean RMS GEC values were 7.42 ± 2.94 for men and 8.35 ± 4.86 for female. No significant gender-based differences were found (p-value = 0.195 and 0.138, respectively). No significant differences between sides were found: The mean RMS MVC values were 152.24 ± 57.73 for left eyes and 151.47 ± 55.74 for right eyes (p-value = 0.93). The mean RMS GEC values were 8.29 ± 5.04 for left eyes and 7.53 ± 2.79 for right eyes (p-value = 0.227). The age of participants correlated negatively with maximal amplitude, mean amplitude, RMS and the difference between RMS and RMS baseline in MVC (p-value < 0.001). Conclusions: While OOM function remains consistent across gender and between eyes, aging contributes to a decline in OOM performance. Age-adjusted reference values may be beneficial in clinical and research applications assessing facial muscle function. Full article

Background and Objectives: The objective was to assess ocular biometric measurements in relation to age and gender among patients scheduled for cataract surgery, utilizing an optical biometry device. Materials and Methods: The optical biometric parameters evaluated included axial length (AL), central corneal thickness (CCT), anterior chamber depth (AD), lens thickness (LT), horizontal corneal diameter (WTW), and keratometry values in the flat (K1) and steep (K2) meridians. Astigmatism (AST) was also measured as the difference between these keratometry values. Results: A total of 14,183 optical biometric measurements were included in the study. The average age of the participants was determined to be 56 (3–110) years. The average AL was 23.57 ± 1.45 mm, the average AD was 2.76 ± 0.42 mm, the average CCT was 518.13 ± 37.81 μm, the average WTW distance was 11.88 ± 0.59 mm, and the average LT was 4.19 ± 0.51 mm. The keratometry measurements were recorded as K1 = 43.39 ± 1.96 diopters (D), K2 = 44.51 ± 2.31 D, and AST = 1.12 ± 1.15 D. The average values for male eyes in terms of the AL, AD, WTW, and LT measurements were significantly higher than those for female eyes (p = 0.001). The average K1 and K2 values were flatter in males than in females, while the AST value was found to be higher in females (p = 0.001). As age progressed, the mean AL decreased, the CCT decreased, the AD narrowed, the WTW distance decreased, the LT increased, and the keratometric values K1, K2, and AST decreased until the age of 60, after which they increased again. Conclusions: Research indicates that the measurements of the bulbus oculi are generally larger in males than in females. Furthermore, each of the optical biometric measurements is interrelated. Over time, these measurements may change. Full article

Background/Objectives: Blepharospasm (BSP) is a focal dystonia characterized by involuntary, bilateral spasms of the orbicularis oculi muscle. While botulinum toxin (BoNT) is the standard treatment, cognitive tasks such as reading and writing may exert transient modulatory effects on spontaneous blinking and dystonic spasms. This study investigates the potential of cognitive training, including reading and writing tasks, as a complementary therapeutic approach to BoNT in BSP patients. Methods: A total of 16 BSP patients were randomly assigned to two groups: Group A (n = 6) received cognitive training alongside BoNT, while Group B (n = 10) received only BoNT. Cognitive training included structured reading and writing exercises over three months. Blink rate (BR) and dystonic spasms were assessed at baseline (T0), one month (T1), and three months (T2) post-treatment. Results: Both groups exhibited a significant reduction in BR at T1 (p = 0.001), but Group A exhibited a greater improvement in BR (45.4%) compared to that of Group B (12.6%, p = 0.04). Reading and writing tasks were the most effective in reducing BR and dystonic spasms (p < 0.001). No significant correlation was found between the clinical and demographic features (p > 0.05). Conclusions: Cognitive training significantly enhances the therapeutic effects of BoNT on BR in BSP patients, suggesting its potential as a non-invasive complementary intervention. These preliminary findings warrant further investigation using larger cohorts and employing neurophysiological assessments. Full article

Study design: literature review. Introduction: Irreversible facial paralysis is a chronic condition characterized by an absence of mimetic muscle tone and function. This disruption of facial expressions not only has functional, but also psychological and social consequences. In facial dynamic reanimation, techniques are proposed partly recovering facial reanimation and function. To date, a vast amount of literature is available on dynamic reanimation techniques. However, no review has yet been published that delineates in detail the musculature and techniques used for dynamic reanimation in irreversible facial paralysis. Objective: the aim of the present paper is to offer a complete overview of possible techniques. Methods: A chapter division is made between the lower, mid-, and upper face. Each chapter is subdivided between local transposition, free muscle flaps, and for the upper face, implantable devices. Results: The literature discussing reanimation of the lower face is limited. In midfacial reanimation, temporalis transposition and gracilis free flap transfer are popular. In upper facial reanimation, no consensus on muscle choice is available, and information is limited too. Suggested techniques include orbicularis oculi transpositioning, temporalis transpositioning, and platysma free muscle transfer. Conclusions: This paper discusses the current techniques for dynamic facial reanimation. Yet, studies comparing different techniques are lacking, setting ground for future research. This paper highlights the importance of a personalized approach in selecting a fitting reconstruction method. Full article

Infraorbital groove and hollowness are common aging-related anatomical changes in the periorbital region, leading to a sunken and tired appearance. These conditions are caused by the progressive loss of volume in the deep fat pads, including the sub-orbicularis oculi fat (SOOF) and malar fat, along with skin thinning and decreased elasticity. Filler injections, particularly hyaluronic acid-based fillers, are the preferred treatment to restore volume and smooth the under-eye area. Proper diagnosis, understanding of anatomical variations, and accurate injection techniques are essential to avoid complications and achieve natural, esthetically pleasing outcomes. Treatments should consider the patient’s unique anatomy and potential adjunctive procedures to ensure balanced and harmonious facial rejuvenation. Full article

Background: Ectropion is a common eyelid problem and is defined as eversion of the eyelid margin and typically involves the lower eyelid. The main acquired causes of ectropion include involutional, cicatricial, paralytic, and mechanical. A severe manifestation of ectropion is tarsal ectropion, where much of the tarsal conjunctiva is visible, often with keratinization of the conjunctiva. causes. Common techniques for ectropion repair include horizontal tightening of the lid with lateral tarsal strip or Bick procedure, lateral tarsorraphy, inverting sutures and the sub-orbicularis oculi fat lift. However, all surgical techniques are prone to ectropion recurrence. We review the techniques for ectropion repair and describe a novel adjunctive technique called the superotemporal skin transposition (STS), which is well suited for patients with recurrent or tarsal ectropion. Methods: The STS is combined with a lateral tarsal strip or Bick procedure. For the STS, all of the anterior lamellae of the lateral lower lid is retained. The posterior lamellae is sutured to the lateral orbital tubercle. A triangular bed of skin is excised superotemporally, and the lower lid anterior lamellae is transposed and secured with multiple sutures. The STS can be combined with inverting sutures, or skin graft for cicatricial cases. Results: We used the STS with Bick procedure and optional inverting sutures on 23 patients, 4 of whom required bilateral ectropion repair. At 1–6 month followup all patients achieved satisfactory outcomes with a well-positioned eyelid and improved symptoms. The STS had more lateral cutaneous scarring than with a Bick procedure alone, but patients did not find this objectionable. No reoperations were required. Conclusion: The STS is a straightforward and useful adjunct for patients with severe, recurrent or tarsal ectropion. Further studies are needed to determine the long-term efficacy of this technique. Full article

Background: Age-related changes to the orbicularis oculi muscle include impaired eyelid function, such as lagophthalmos, alterations in tear film dynamics, and aesthetic changes like wrinkles, festoons, and the descent of soft tissue. To date, the structural and functional changes that would comprehensively increase our understanding of orbicularis aging have not been analyzed. This study aims to investigate functional outcomes using surface electromyography and correlate them with ultrastructural changes in orbicularis during aging. Methods: This study enrolled 26 patients aged 37 to 78 years with a clinical diagnosis of dermatochalasis. Patients were divided into two age groups (<60 years; ≥60 years). Ultrastructural and electromyographical examinations were performed, and the electromyographical signals were correlated with the ultrastructural damage in the orbicularis. Results: This study revealed significantly lower values of average voluntary contraction and RMS of the surface electromyography signals in the older age group compared to the younger age group (p = 0.029 and p = 0.045, respectively). There was no statistically significant association between age and muscle damage (χ²(2) = 2.86, p > 0.05). There was no correlation between average voluntary contraction and the degree of ultrastructural damage in both groups (Spearman’s coefficient equaled 0.06923 and 0.64366, respectively). Conclusions: sEMG measurements are valuable for monitoring age-related functional changes in the orbicularis. Aging diminishes the functional capacity of the orbicularis, as evidenced by reduced contraction strength. This study, the first to compare ultrastructural and electromyographical changes in the orbicularis among dermatochalasis patients of different ages, finds that ultrastructural damage to muscle fibers is not directly responsible for the contraction strength decline. Full article

Botulinum neurotoxin type-A (BoNT/A), which blocks quantal acetylcholine (ACh) release at the neuromuscular junction (NMJ), has demonstrated its efficacy in the symptomatic treatment of blepharospasm. In 3.89% of patients treated for blepharospasm at Tenon Hospital, BoNT/A was no longer effective in relieving the patient’s symptoms, and a partial upper myectomy of the Orbicularis oculi muscle was performed. We used surgical waste samples from 14 patients treated with repeated injections of either abobotulinumtoxinA (Dysport^®) or incobotulinumtoxinA (Xeomin^®). These muscle fragments were compared to others from 4 normal subjects, naïve of BoNT/A. The morphological study was performed blinded to the BoNT/A treatment and between treated and control samples. Neuromuscular specimens analyzed by confocal laser scanning microscopy, using fluorescent staining and immune-labeling of presynaptic proteins, revealed that the pattern of innervation (e.g., polyneuronal and convergent innervation), the muscle nicotinic ACh receptors (nAChRs), and the NMJs exhibited marked differences in BoNT/A-treated muscles (regardless of the toxin clinically used), with respect to controls. BoNT/A-treated junctions exhibited profuse polyneuronal innervation in which 2–6 axons innervated 74.84% of single muscle fibers, while 99.47% of control junctions were mono-innervated. Another new finding was the stable convergent innervation, in which several motor axons end onto the same endplate. Morphological signs of synapse elimination included the presence of retraction bulbs in axons and nerve terminals and a reduced extension of postsynaptic nAChRs. These outcomes suggest that synapse elimination is altered and raise questions on the origin and factors contributing to the plasticity changes observed and the functioning of NMJs. Full article

Background: Due to the high incidence of malignant tumors of the lower eyelids and the widespread use of surgery for their treatment, the reconstruction of tissues in this area is a frequent task for surgeons. Methods for restoring full-thickness lower eyelid defects are often invasive, pose a significant risk of complications, and do not provide optimal results. Methods: The authors developed a simple technique for the reconstruction of full-wall defects of the lower eyelids. It is a V-Y-type musculocutaneous island flap from the lower eyelid, with the orbicularis oculi muscle folded in the upper part and partially left for spontaneous healing, called by the authors a “floating island flap”. Between 2012 and 2023, 39 patients were operated on using this method. Results: Surgical procedures performed under local anesthesia were well tolerated by the patients. The healing process was quick and well accepted. Complications were rare. The most common were: eye irritation and temporary swelling of the flap. In 37 patients, proper protection of the eyeball and good esthetic results were achieved; only in two cases was the cosmetic result assessed as poor. Corneal defects occurred in two cases and healed after conservative treatment. In no cases was reoperation necessary. Conclusions: The developed method is simple and effective. It can be widely used in the reconstruction of full-thickness defects of the lower eyelids. Full article

Background: The superficial musculoaponeurotic system (SMAS) is crucial for the structural integrity and dynamics of facial expressions and is a particularly important consideration during facelift surgeries. This study investigated the anatomical structure and continuity of the SMAS at the site where the zygomaticus major (Zmj) originates, which is where the SMAS extends from the lateral to the anterior aspects of the face. Knowledge of these aspects is crucial for understanding the mechanics of facial movements and also the aging process. Methods: Dissections of 66 specimens and histological analyses were used to explore the intricate relationships and attachments between the SMAS and facial muscles. Results: The findings indicated that at the Zmj origin site, the SMAS—connected to the inferior margin of the orbicularis oculi—covered the superficial surface of the Zmj fibers. As it tracked downward, the SMAS was observed to split into two layers lateral to the Zmj fibers, enveloping them both superficially and deeply. Additionally, as the SMAS continued forward, it ceased to be distinctly visible in the buccal area. Conclusions: These results provide a deeper understanding of the complex layering and interconnectivity of the SMAS, which supports facial dynamics and structural integrity. This information could be particularly useful in surgical and aesthetic procedures in the midfacial area. Full article

The use of choroidal vascularization to diagnose and follow-up ocular and systemic pathologies has been consolidated in recent research. Unfortunately, the choroidal parameters can be different depending on the lighting settings of optical coherence tomography (OCT) images. The purpose of this study was to examine whether the brightness of OCT images could influence the measurements of choroidal parameters obtained by processing and analyzing scientific images with the ImageJ program. In this observational, prospective, non-randomized study, 148 eyes of 74 patients with a mean age of 30.7 ± 8.5 years (ranging from 23 to 61 years) were assessed. All patients underwent a complete ophthalmological examination including slit lamp, fundus oculi, ocular biometry, corneal tomography and spectral domain (SD) OCT evaluations of the foveal region in the enhanced depth imaging (EDI) mode. OCT images at two different brightness levels were obtained. The total choroidal area (TCA), choroidal vascularity index (CVI), stromal choroidal area (SCA) and luminal choroidal area (LCA) at both lower and higher brightness levels were measured. To avoid the bias of operator-dependent error, the lower and higher brightness TCAs were obtained using two methods: the manual tracking mode and fixed area. At the two different brightness levels, LCA, SCA and CVI measurements showed statistically significant changes (p < 0.05), whereas the TCA differences were not statistically significant (p > 0.05). According to the results of this study, highlighting that brightness could affect LCA, SCA and CVI parameters, care should be taken during OCT image acquisition. Full article

Background: Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. Methods: Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. Results: In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5–3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman’s model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman’s rho: 0.8268, p < 0.0001). Conclusions: We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG. Full article