面神经炎病人神经电生理检查和面肌运动评分的相关性

目的：探讨神经电生理检查和面肌运动功能评分在面神经炎诊断和面肌功能评估中的相关性。方法：选取符合入选标准的面神经炎病人37例,在发病第7、28天分别予以神经电生理检查和面肌运动功能评分。神经电生理检查选用瞬目反射和面神经电图;面肌运动功能评分采用House Brackmann分级量表（HB）评分和Nottingham面神经分级量表评分（选用VMG指数）,比较不同评分标准对面神经炎评估的异同,并应用Pearson相关分析法探讨不同评分标准之间的相关性。结果：与神经电图评分法相比较,瞬目反射评分法和HB评分法更为一致。Pearson相关性分析结果显示VMG指数与HB评分法相关性最强（r=-0．925）,神经电图评分法和HB评分法相关性相对较差。结论：针对面神经炎病人的评估应将面神经运动功能评估和神经电生理学评估结合起来,才能达到最好的客观性和准确性。HB评分、VMG指数联合以瞬目反射为最优指标的神经电生理检测是较为理想、科学的面神经炎的诊断和评估方法,可以较为可信地应用到临床诊治和科学研究工作中。     

听骨链完好者面神经膝节神经节扩大减压术

面神经减压术在面瘫治疗中的价值多持肯定态度。但对听力基本正常，由于面神经连路段远端，膝状神经节及水平段被听骨链遮挡，中耳进路难以彻底显露减压，经颅手术又有颅内并发症的可能。本在应用解剖学研究的基础上，采取经上鼓室前隐窝进路，解决了不损伤听骨链而进行膝状神经节及迷路段远端的减压问题。2例患经该入路手术后，面瘫恢复或好转，听力无改变。     

The face of Smith-Magenis syndrome: a subjective and objective study

We report a study of 55 subjects with Smith-Magenis syndrome, aged 9 months to 35 years. Each person has been evaluated with an assessment of "gestalt" and detailed facial measurement, using previously published methodology, with compilation of Z score pattern profiles. The facial phenotype of SMS is quite distinctive, even in the young child. The overall face shape is broad and square. The brows are heavy, with excessive lateral extension of the eyebrows. The eyes slant upwards and appear close set and deep set. The nose has a depressed root and, in the young child, a scooped bridge. With time, the bridge becomes more ski jump shaped. The height of the nose is markedly reduced while the nasal base is broad and the tip of the nose is full. The shape of the mouth and upper lip are most distinctive. The mouth is wide with full upper and lower lips. The central portion of the upper lip is fleshy and everted with bulky philtral pillars, producing a tented appearance that, in profile, is striking. With age, mandibular growth is greater than average and exceeds that of the maxilla. This leads to increased jaw width and protrusion and marked midface hypoplasia. Craniofacial pattern analysis supports these subjective impressions. After mid-childhood, mandibular dimensions consistently exceed their maxillary counterparts. Craniofacial widths are greater than corresponding depths and heights. Nasal height is reduced while nasal width is increased. There is mild brachycephaly. The most marked age related changes are increased width of the nose and lower face (mandibular width) with reduction in nasal height and midfacial depth.     

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures

The facial nerve is responsible for any facial expression channeling human emotions. Facial paralysis causes asymmetry, lagophthalmus, oral incontinence, and social limitations. Facial dynamics may be re‐established with cross‐face‐nerve‐grafts (CFNG). Our aim was to reappraise the zygomaticobuccal branch system relevant for facial reanimation surgery with respect to anastomoses and crossings. Dissection was performed on 106 facial halves of 53 fresh frozen cadavers. Study endpoints were quantity and relative thickness of branches, correlation to “Zuker's point”, interconnection patterns and crossings. Level I and level II branches were classified as relevant for CFNG. Anastomoses and fusion patterns were assessed in both levels. The zygomatic branch showed 2.98 ± 0.86 (range 2–5) twigs at level II and the buccal branch 3.45 ± 0.96 (range 2–5), respectively. In the zygomatic system a single dominant branch was present in 50%, two co‐dominant branches in 9% and three in 1%. In 66% of cases a single dominant buccal twig, two co‐dominant in 12.6%, and three in 1% of cases were detected. The most inferior zygomatic branch was the most dominant branch (P = 0.003). Using Zuker's point, a facial nerve branch was found within 5 mm in all facial halves. Fusions were detected in 80% of specimens. Two different types of fusion patterns could be identified. Undercrossing of branches was found in 24% at levels I and II. Our study describes facial nerve branch systems relevant for facial reanimation surgery in a three‐dimensional relationship of branches to each other. Clin. Anat. 32:480–488, 2019. © 2019 Wiley Periodicals, Inc.     

肌电图监测在听神经瘤手术中面神经保护及其功能预后

目的探讨肌电图在听神经瘤切除手术中对面神经的保护作用及术后对面神经功能预后的评价。方法56例听神经瘤患者,其中男性24例,女性32例,年龄10～68岁,平均年龄48-3岁。使用美国Nicoli公司Endeavor-CR 16通道术中监护仪,对患者的面神经监测资料进行归纳、分析和整理。面神经监测主要采取两种方式：自发连续肌电图（onlian EMG）和间断电刺激诱发肌电图（triggered EMG）。结果onlian EMG结合triggered EMG可以准确定位面神经。肿瘤切除后在面神经出脑干端进行电刺激,刺激量为0．1～4．0mA,相应的术后面神经功能保留优良率高。超过10mA术后面神经功能很难恢复。面神经解剖保留率为87．5％（49／56）。结论听神经瘤切除术中肌电图监测可以精确判断面神经的走向,提高面神经的解剖和功能保留率。     

Subnormal short-latency facial mimicry responses to dynamic emotional facial expressions in male adolescents with disruptive behavior disorders and callous-unemotional traits

Using still pictures of emotional facial expressions as experimental stimuli, reduced amygdala responses or impaired recognition of basic emotions were repeatedly found in people with psychopathic traits. The amygdala also plays an important role in short-latency facial mimicry responses. Since dynamic emotional facial expressions may have higher ecological validity than still pictures, we compared short-latency facial mimicry responses to dynamic and static emotional expressions between adolescents with psychopathic traits and normal controls. Facial EMG responses to videos or still pictures of emotional expressions (happiness, anger, sadness, fear) were measured. Responses to 500-ms dynamic expressions in videos, as well as the subsequent 1500-ms phase of maximal (i.e., static) expression, were compared between male adolescents with disruptive behavior disorders and high (n = 14) or low (n = 17) callous-unemotional (CU) traits, and normal control subjects (n = 32). Responses to still pictures were also compared between groups. EMG responses to dynamic expressions were generally significantly smaller in the high-CU group than in the other two groups, which generally did not differ. These group differences gradually emerged during the 500-ms stimulus presentation period but in general they were already seen a few hundred milliseconds after stimulus onset. Group differences were absent during the 1500-ms phase of maximal expression and during exposure to still pictures. Subnormal short-latency mimicry responses to dynamic emotional facial expressions in the high-CU group might have negative consequences for understanding emotional facial expressions of others during daily life when human facial interactions are primarily dynamic.     

76例头面部烧伤的护理体会

目的：探讨促进头面部烧伤患者尽快康复的护理方案。方法对我院2013年5月~2014年5月收治的76例头面部烧伤患者根据不同的时期给予针对性的护理方案并给予心理护理与康复护理。结果在76例头面部烧伤的患者中,有71例患者一期愈合,5例患者植皮后二期愈合,无患者出现并发症,均康复出院。结论正确的护理方案,能够促进头面部烧伤的愈合,并减少后遗症的发生。     

Microsurgical anatomy of the facial nerve trunk

Dissection and manipulation of the facial nerve (FN) trunk between its exit from the cranial base through the stylomastoid foramen (SMF) and its bifurcation is a critical step in various otologic, plastic and neurosurgical procedures. This study demonstrates the anatomical relationships and variability of the FN trunk with emphasis on some important morphometric data, particularly with relevance to hypoglossal-facial nerve anastomosis (HFA). Bilateral microsurgical dissection was performed on twenty-three human cadavers fixed with formalin. The whole trunk of the FN was exposed, its diameter at the SMF and its length were measured, its branches were observed and the site of its bifurcation was determined. Anastomotic connections with other nerves and blood supply of the trunk were studied. The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.66 +/- 0.55 mm. Two branches consistently originated from the trunk: the posterior auricular nerve and the nerve to the digastric muscle. Less consistent were the communicating branch with the glossopharyngeal nerve and the nerve to the stylohyoid muscle. The bifurcation of the FN occurred before its penetration into the parotid gland in 15% of cases and within the gland in 85%. The length of the FN trunk was 16.44 +/- 3.2 mm. Anastomoses between the FN and other nerves were observed in one-third of the dissections. The blood supply to the FN trunk was provided by the stylomastoid artery that was identified in 91% of cases. Understanding the microsurgical anatomy of the FN trunk is essential for performing any surgical procedure in the relevant region. Surgical implications of this study are presented with emphasis on HFA surgery.     

面神经锥体段的解剖学及其临床意义

在80侧成人颞骨干标本上,对面神经锥体段的埋藏位置及深度,面神经与面神经隐窝、鼓室窦三者之间的关系及其变异类型进行了应用解剖学研究。提出了耳科后鼓室进手术路中对面神经锥体段的予测方法。经90例手术验证有实用价值。     

Facial expression recognition and emotional regulation in narcolepsy with cataplexy

Cataplexy is pathognomonic of narcolepsy with cataplexy, and defined by a transient loss of muscle tone triggered by strong emotions. Recent researches suggest abnormal amygdala function in narcolepsy with cataplexy. Emotion treatment and emotional regulation strategies are complex functions involving cortical and limbic structures, like the amygdala. As the amygdala has been shown to play a role in facial emotion recognition, we tested the hypothesis that patients with narcolepsy with cataplexy would have impaired recognition of facial emotional expressions compared with patients affected with central hypersomnia without cataplexy and healthy controls. We also aimed to determine whether cataplexy modulates emotional regulation strategies. Emotional intensity, arousal and valence ratings on Ekman faces displaying happiness, surprise, fear, anger, disgust, sadness and neutral expressions of 21 drug‐free patients with narcolepsy with cataplexy were compared with 23 drug‐free sex‐, age‐ and intellectual level‐matched adult patients with hypersomnia without cataplexy and 21 healthy controls. All participants underwent polysomnography recording and multiple sleep latency tests, and completed depression, anxiety and emotional regulation questionnaires. Performance of patients with narcolepsy with cataplexy did not differ from patients with hypersomnia without cataplexy or healthy controls on both intensity rating of each emotion on its prototypical label and mean ratings for valence and arousal. Moreover, patients with narcolepsy with cataplexy did not use different emotional regulation strategies. The level of depressive and anxious symptoms in narcolepsy with cataplexy did not differ from the other groups. Our results demonstrate that narcolepsy with cataplexy accurately perceives and discriminates facial emotions, and regulates emotions normally. The absence of alteration of perceived affective valence remains a major clinical interest in narcolepsy with cataplexy, and it supports the argument for optimal behaviour and social functioning in narcolepsy with cataplexy.     

面神经损伤的针刺效应与面神经核胆碱乙酰转移酶的关系

目的:揭示针刺促进损伤面神经再生修复的机制。方法:大耳白兔分为假手术组、模型组、西药组、传统针刺组、电针刺激组,每组又分为术后4个时间点,应用神经卡压法造成面神经损伤模型,观察各组家兔面神经核中胆碱乙酰转移酶(ChAT)的变化。结果:术后细胞核核仁偏位,术后2、3、4周时模型组胞体肿胀,截面积均明显大于假手术组、西药组、传统针刺组、电针刺激组,尼氏体明显减少,随治疗时间延长,西药组、传统针刺组、电针刺激组均有不同程度的尼氏体增多,其中电针刺激组增多较明显。电针刺激组ChAT于各时间点均明显好于其他对照组,西药组、传统针刺组、电针刺激组均有随治疗时间延长ChAT表达增多的趋势,且有显著性差异。结论:穴位针刺可提高家兔面神经核中ChAT的表达,并对损伤面神经修复有促进作用。     

针灸治疗周围面瘫的神经电生理变化

探索针灸治疗周围性面瘫的机理 ,用神经电生理的方法研究针灸对周围性面瘫的影响。对 31例周围性面瘫患者进行针灸后神经电生理的检测 ,观察治疗后的变化。结果 :31例患者针灸后临床有效率 10 0 %。所检神经电生理指标均有不同程度改变 ,经统计学处理有显著差异。结论 :周围性面瘫患者针灸前后做神经电生理测定 ,一方面可以了解神经损害程度 ,另一方面可以观察疗效并预测预后 ,给临床提供诊疗的依据。     

中国大学生虚拟仿真动态表情库的建立与评价

目的:建立一套标准化的中国大学生虚拟仿真动态表情库。方法:采集筛选40名大学生的6种不同动态表情共240段,对其进行标准化加工处理。在北京地区4所高校招募23名大学生,对动态表情的类型、愉悦度和唤醒度进行内部一致性信度、评分者信度检验。结果:建立了包含愤怒9段、厌恶1段、害怕1段、高兴38段、悲伤19段、惊讶39段的表情库,其动态表情的认同率均大于60%。愉悦度与唤醒度的Cronbach α系数分别为0.96、0.76;评分者信度显示被试在愉悦度与唤醒度(W=0.54、0.21,均P<0.001)上具有一致的评价。结论:本研究建立的中国大学生虚拟仿真动态表情库有较好的信度,可作为虚拟现实及情绪研究的实验材料。     

Sociality of facial expressions in immersive virtual environments: a facial EMG study

Immersive virtual environment technology is increasingly used by psychologists as a tool for researching social influence in realistic, yet experimentally controllable, settings. The present study demonstrates the validity and reliability of facial electromyography as a marker of affect in immersive virtual environments and further shows that the mere presence of virtual humans is enough to elicit sociality effects on facial expressiveness. Participants viewed pleasant and unpleasant images in a virtual room either alone or with two virtual humans present. The patterns of smiling and frowning activity elicited by positive and negative stimuli in the virtual environment were the same as those found in laboratory settings. Moreover, when viewing positive stimuli, smiling activity was greater when two agents were present than in the alone condition. The results provide new psychophysiological evidence for the potency of social agents in immersive virtual environments.     

面静脉瓣膜及其临床意义

在30具尸体上,对60例面静脉的瓣膜进行了观察,发现75%的面静脉具有瓣膜。调查结果表明,一般解剖学教科书关于面静脉无瓣膜的提法是不正确的。     

Nasal Septal Deviation and Facial Skeletal Asymmetries

During ontogeny, the nasal septum exerts a morphogenetic influence on the surrounding facial skeleton. While the influence of the septum is well established in long snouted animal models, its role in human facial growth is less clear. If the septum is a facial growth center in humans, we would predict that deviated septal growth would be associated with facial skeletal asymmetries. Using computed tomographic (CT) scans of n = 55 adult subjects, the purpose of this study was to test whether there is a correlation between septal deviation and facial asymmetries using three‐dimensional (3D) geometric morphometric techniques. We calculated deviation as a percentage of septal volume relative to the volume of a modeled non‐deviated septum. We then recorded skeletal landmarks representing the nasal, palatal, and lateral facial regions. Landmark data were superimposed using Procrustes analysis. First, we examined the correlation between nasal septal deviation and the overall magnitude of asymmetry. Next, we assessed whether there was a relationship between nasal septal deviation and more localized aspects of asymmetry using multivariate regression analysis. Our results indicate that while there was no correlation between septal deviation and the overall magnitude of asymmetry, septal deviation was associated with asymmetry primarily in the nasal floor and the palatal region. Septal deviation was unassociated with asymmetries in the lateral facial skeleton. Though we did not test the causal relationship between nasal septal deviation and facial asymmetry, our results suggest that the nasal septum may have an influence on patterns of adult facial form. Anat Rec, 299:295–306, 2016. © 2016 Wiley Periodicals, Inc.     

Quantitative anatomical analysis of facial expression using a 3D motion capture system: Application to cosmetic surgery and facial recognition technology

The topography of the facial muscles differs between males and females and among individuals of the same gender. To explain the unique expressions that people can make, it is important to define the shapes of the muscle, their associations with the skin, and their relative functions. Three‐dimensional (3D) motion‐capture analysis, often used to study facial expression, was used in this study to identify characteristic skin movements in males and females when they made six representative basic expressions. The movements of 44 reflective markers (RMs) positioned on anatomical landmarks were measured. Their mean displacement was large in males [ranging from 14.31 mm (fear) to 41.15 mm (anger)], and 3.35–4.76 mm smaller in females [ranging from 9.55 mm (fear) to 37.80 mm (anger)]. The percentages of RMs involved in the ten highest mean maximum displacement values in making at least one expression were 47.6% in males and 61.9% in females. The movements of the RMs were larger in males than females but were more limited. Expanding our understanding of facial expression requires morphological studies of facial muscles and studies of related complex functionality. Conducting these together with quantitative analyses, as in the present study, will yield data valuable for medicine, dentistry, and engineering, for example, for surgical operations on facial regions, software for predicting changes in facial features and expressions after corrective surgery, and the development of face‐mimicking robots. Clin. Anat. 28:735–744, 2015. © 2015 Wiley Periodicals, Inc.     

The nerve supply of zygomaticus major: Variability and distinguishing zygomatic from buccal facial nerve branches

The zygomaticus major (ZM) is important for the human smile. There are conflicting data about whether the zygomatic or buccal branches of the facial nerve are responsible for its motor innervation. The literature provides no precise distinction of the transition zone between these two branch systems. In this study, a definition to distinguish the facial nerve branches at the level of the body of the zygoma is proposed. In the light of this definition, we conducted an anatomical study to determine how the source of innervation of the ZM was distributed. A total of 96 fresh‐frozen cadaveric facial halves were dissected under loupe magnification. A hemiparotidectomy was followed by antegrade microsurgical dissection. Any branch topographically lying superficial to the zygoma or touching it was classed as zygomatic, and any neighboring inferior branch was considered buccal. The arborization of the facial nerve was diffuse in all cases. In 64 out of 96 specimens (67%, 95% CI: 56% to 76%), zygomatic branches innervated the ZM. Buccal branches innervated ZM in the other 32 facial halves (33%, 95% CI: 24% to 44%). There were no differences in respect of sex or facial side. All facial halves displayed additional branches, which crossed the muscle on its inner surface without supplying it. In 31 specimens, a nerve branch ran superficial to ZM in its cranial third. According to our classification, the zygomaticus major is innervated by zygomatic branches in 67% of cases and by buccal branches in 33%. Clin. Anat. 31:560–565, 2018. © 2018 Wiley Periodicals, Inc.