Botulinum toxin in association with other rejuvenation methods

Botulinum toxin is an import agent in facial rejuvenation, and the use of botulinum toxin in combination with other methods helps preserve and maintain a long‐term result. This paper briefly reviews the use of botulinum toxin in associate with dermal fillers, laser resurfacing and other surgical rejuvenation modalities.     

OnabotulinumtoxinA treatment of moderate to severe glabellar lines in Chinese subjects after laser therapy: A prospective,open-label,noncomparative study

Introduction: This study evaluated safety and efficacy of onabotulinumtoxinA for moderate to severe glabellar lines (GL) following laser therapy in Chinese subjects. Materials and Methods: Subjects (n = 173) were followed for 120 days following a single onabotulinumtoxinA (20 U) treatment for GL after recent laser therapy. Subjects completed validated patient-reported outcomes, including Facial Lines Outcome 11-item (FLO-11) Questionnaire and Facial Lines Satisfaction Questionnaire (FLSQ). Physicians and subjects assessed GL severity at maximum frown and at rest using the Facial Wrinkle Scale with Asian Photonumeric Guide (FWS-A). Results: Mean total FLO-11 scores increased from 47.7 (baseline) to 75.9 (day 120) (p < 0.0001), with mean improvement of at least two grades for most items maintained to day 120. Most subjects were mostly or very satisfied, per the FLSQ. Percentages of subjects with at least one-grade improvement in FWS-A (responders) at maximum frown per subjects and physicians were 93.1% and 97.1%, respectively, at day 30, and 72.3% and 81.5% at day 120 (all, p < 0.0001). More than 70% were FWS-A responders at day 120. All adverse events were mild or moderate; none were related to onabotulinumtoxinA. Conclusions: A single onabotulinumtoxinA (20 U) treatment following laser therapy was safe and effective in correcting GL for up to 120 days.     

手术入路的选择在面神经保护中的作用

头皮冠状和耳屏切口因其切口位置隐蔽、面部不留瘢痕、术野显露充分,已成为颌面外科治疗面中部骨折、眶上缘骨折、眶外侧缘骨折、颧骨颧弓骨折的常用方法。2006—03—2012—06期间我院采用头皮冠状和耳屏切口进路结合微型钛板坚强内固定治疗68例颌面部骨折患者,现就如何防止该术式的常见并发症——面神经损伤的方法探讨如下。     

Principles and biomechanics of muscle tendon unit transfer: Application in temporalis muscle tendon transposition for smile improvement in facial paralysis

Muscle tendon unit (MTU) transfer is a common procedure performed to restore hand function after peripheral nerve or spinal cord injury. The principles of MTU transfer established for hand surgery can be adopted to optimize the dynamic excursion of the temporalis tendon transfer procedure for facial reanimation. Additionally, the force generating ability of a transferred MTU depends on the ideal length‐tension relationship of the donor muscle. There are unclear guideline for selecting the ideal tension at which a transferred MTU will generate maximum force and excursion and current practice often leads to overstretch and suboptimal actin myosin interaction. The use of intraoperative electrical stimulation is an option for determining the ideal tension to optimize excursion of transferred temporalis tendon units in simile restoration. Understanding the biomechanics and principles of MTU and applying it to the temporalis tendon transfer procedure is necessary to improve its use in facial reanimation.     

Cochlear implant and delayed facial palsy

Abstract

Delayed facial nerve palsy following cochlear implant surgery is less documented though it poses diagnostic and therapeutic challenges. Apart from the functional, aesthetic and emotional concerns, it can raise important medico legal issues. The objectives of this study were: to report a case of delayed facial palsy following cochlear implant surgery in a patient who had positive viral antibody markers pre operatively; and to review the literature on delayed onset facial paralysis following viral reactivation and its relation to cochlear implant surgery. An extensive literature review was done using internet and medical search engines and library facilities. Important articles on the topic were identified and summarised. Data on delayed facial palsy following cochlear implant surgery were collected, constructed in a coherent way and details discussed. Postulated mechanisms of delayed facial palsy include neural oedema, vasospasm and viral reactivation. Of these, reactivation of previous herpes simplex virus infection has special significance, as many of these patients are positive for viral antibody markers. Manipulation of sensory branches of the facial nerve and chorda tympani can be a mechanism in such cases. Correlation of clinical presentation and pre operative positive viral antibody markers with positive polymerase chain reaction can be strongly suggestive of viral reactivation. It is concluded that patients with positive viral antibody markers are more susceptible to facial palsy from viral reactivation. Corticosteroids, antiviral agents and physiotherapy can be useful in producing a quicker and complete recovery. An experienced cochlear implant surgery team and pre operative radiological evaluations are mandatory to decrease the chances of direct facial nerve trauma. Proper irrigation lowers the risk of neural oedema. Copyright © 2009 John Wiley & Sons, Ltd.     

Challenges in genetic counseling because of intra‐familial phenotypic variation of oral‐facial‐digital syndrome type 1

Oral‐facial‐digital syndrome type 1 (OFD1; MIM 311200) is characterized by multiple anomalies of the oral cavity, face and digits. We report a family with OFD1, where two female siblings and their mother shared the same mutation of the responsible gene (OFD1) c.1193_1196delAATC. Phenotypic variability was observed among them; the mother showed minimal features of OFD1, whereas her two daughters showed partial features and the full spectrum of OFD1, respectively. Thus, OFD1 was suspected only after a health check‐up during pregnancy of the second patient showing fetal brain anomaly and maternal polycystic kidney. For these reasons, there was a delay in the recognition of OFD1 in this family. Patients with OFD1 show phenotypic variability, which poses challenges for genetic counseling.     

Motor unit number index (MUNIX) in the orbicularis oculi muscle of healthy subjects

Introduction: The motor unit number index (MUNIX) refers to an electrophysiological method that measures the number of motor units in the surface electromyographic interference pattern (SIP) recorded during graded muscle contractions. MUNIX studies of limb muscles have been conducted, but MUNIX studies of bulbo‐facial muscles have not been reported. Methods: We assessed bilateral orbicularis oculi muscles using MUNIX, and the reference values and reproducibility of MUNIX and motor unit size index (MUSIX) were investigated in healthy subjects. Results: In this study, MUNIX was applied successfully to the orbicularis oculi muscles and showed good reproducibility. The correlation coefficients for MUNIX and MUSIX were 0.803 and 0.592, respectively, and the coefficients of variation were 20.9% and 8.5%, respectively. Conclusions: The MUNIX procedure for the orbicularis oculi muscle would be a useful tool for evaluating bulbar symptoms, especially in amyotrophic lateral sclerosis. Muscle Nerve 51 : 197–200, 2015     

孙世道治疗皮肤病经验举隅

总结孙世道教授辨治皮肤病临床经验。重在病证合参,内外兼治;除邪务尽,顾护气阴。并举验案2则。     

Everolimus: an mTOR inhibitor for the treatment of tuberous sclerosis

Tuberous sclerosis complex (TSC) is a devastating disease affecting virtually all organ systems of the body and is characterized by multiple hamartomas and neurodevelopmental disorders. The majority of patients with TSC have mutations in TSC1 or TSC2, resulting in constitutive activation of mTOR. Because the pathogenesis of the disease is mTOR hyperactivity, mTOR inhibitors have the potential to treat the underlying cause in TSC patients. Everolimus is the first mTOR inhibitor approved in the USA for the treatment of patients with subependymal giant-cell astrocytomas (SEGAs) associated with TSC. Evidence supports and ongoing studies are evaluating the role of mTOR inhibitors in the treatment of a wide spectrum of disease manifestations, including reduction in tumor volume (SEGAs, renal angiomyolipoma) and improvement in epilepsy, lung function and skin manifestations, including facial angiofibromas. In time, the use of mTOR inhibitors in patients with TSC will likely be very well established.