Endoscopically assisted facial suspension for treatment of facial palsy

Static suspension remains an option for certain patients with facial paralysis. Endoscopically assisted facial suspension obviates the need for a counter-incision at the oral commissure to distally inset the fascia lata graft as described in the standard technique. The endoscopic technique is simple, allows secure placement of perioral fascial strips, and can be performed as an outpatient.     

Understanding the recognition of facial identity and facial expression

Faces convey a wealth of social signals. A dominant view in face-perception research has been that the recognition of facial identity and facial expression involves separable visual pathways at the functional and neural levels, and data from experimental, neuropsychological, functional imaging and cell-recording studies are commonly interpreted within this framework. However, the existing evidence supports this model less strongly than is often assumed. Alongside this two-pathway framework, other possible models of facial identity and expression recognition, including one that has emerged from principal component analysis techniques, should be considered.     

Effect of unilateral partial facial paralysis on periosteal growth at the muscle-bone interface of facial muscles and facial bones

In a previous study, the influence of the midfacial musculature upon growth and development of the maxilla and mandible was established macroscopically. Dry skull measurements revealed a reduced premaxillary, maxillary, mandibular, and anterior corpus length with a simultaneous increase in mandibular ramal height on the paralyzed side. It was demonstrated that these reduced premaxillary and maxillary lengths were among others the result of reduced nasofrontal growth, whereas the increased ramal height was accompanied by condylar growth alterations. This study investigated whether the growth alterations at the mandibular corpus region could be explained by altered periosteal growth at the muscle-bone interface of the zygomatico-auricular muscle and the mandibular corpus, caused by altered muscle activity acting upon the periosteal sleeve. Fifty-six 12-day-old New Zealand White rabbits were randomly assigned to either a control or an experimental group. In the experimental group, left-sided partial facial paralysis was induced surgically when the animals were 12 days old. To study the muscle-bone interface, seven follow-up time intervals were defined between 3.5 and 60 days following the surgery. At these time intervals, four randomly selected control animals and four randomly selected experimental animals were killed. The anterior mandibular corpus region with the muscle-bone interface of the left control hemimandible and the left and right experimental hemimandibles was processed for undecalcified tissue preparation. Quantitative analysis of the total bone area at the muscle-bone interface revealed no significant differences between the left control hemimandible and the left and right experimental hemimandibles. Also, qualitative study of the histologic sections showed no major changes in the appearance or development of the trabecular pattern between the groups. However, slight differences in the distribution pattern of osteoblasts and osteoclasts along the bony surface were found between the left control hemimandible and the left and right experimental hemimandibles, which seemed to explain the alterations in mandibular corpus shape between these groups. It was suggested that these changes in the distribution pattern of osteoblasts and osteoclasts were the result of changes in the loading distribution pattern acting upon the mandible, caused by an altered neuromuscular recruitment pattern of the remaining functionally intact, mandibularly attached muscles. The latter was probably the result of adaptive mandibular positioning in response to an altered occlusal relationship, which was induced by the abnormal maxillary growth as a result of the unilateral partial facial paralysis.     

Automated tracking of facial features in patients with facial neuromuscular dysfunction

Facial neuromuscular dysfunction severely impacts adaptive and expressive behavior and emotional health. Appropriate treatment is aided by quantitative and efficient assessment of facial motion impairment. We validated a newly developed method of quantifying facial motion, automated face analysis (AFA), by comparing it with an established manual marking method, the Maximal Static Response Assay (MSRA). In the AFA, motion of facial features is tracked automatically by computer vision without the need for placement of physical markers or restrictions of rigid head motion. Nine patients (seven women and two men) with a mean age of 39.3 years and various facial nerve disorders (five with Bell's palsy, three with trauma, and one with tumor resection) participated. The patients were videotaped while performing voluntary facial action tasks (brow raise, eye closure, and smile). For comparison with MSRA, physical markers were placed on facial landmarks. Image sequences were digitized into 640 x 480 x 24-bit pixel arrays at 30 frames per second (1 pixel congruent with0.3 mm). As defined for the MSRA, the coordinates of the center of each marker were manually recorded in the initial and final digitized frames, which correspond to repose and maximal response. For the AFA, these points were tracked automatically in the image sequence. Pearson correlation coefficients were used to evaluate consistency of measurement between manual (the MSRA) and automated (the AFA) tracking methods, and paired t tests were used to assess the mean difference between methods for feature tracking. Feature measures were highly consistent between methods, Pearson's r = 0.96 or higher, p < 0.001 for each of the action tasks. The mean differences between the methods were small; the mean error between methods was comparable to the error within the manual method (less than 1 pixel). The AFA demonstrated strong concurrent validity with the MSRA for pixel-wise displacement. Tracking was fully automated and provided motion vectors, which may be useful in guiding surgical and rehabilitative approaches to restoring facial function in patients with facial neuromuscular disorders.     

Human facial beauty

It is hypothesized that human faces judged to be attractive by people possess two features—averageness and symmetry—that promoted adaptive mate selection in human evolutionary history by way of production of offspring with parasite resistance. Facial composites made by combining individual faces are judged to be attractive, and more attractive than the majority of individual faces. The composites possess both symmetry and averageness of features. Facial averageness may reflect high individual protein heterozygosity and thus an array of proteins to which parasites must adapt. Heterozygosity may be an important defense of long-lived hosts against parasites when it occurs in portions of the genome that do not code for the essential features of complex adaptations. In this case heterozygosity can create a hostile microenvironment for parasites without disrupting adaptation. Facial bilateral symmetry is hypothesized to affect positive beauty judgments because symmetry is a certification of overall phenotypic quality and developmental health, which may be importantly influenced by parasites. Certain secondary sexual traits are influenced by testosterone, a hormone that reduces immunocompetence. Symmetry and size of the secondary sexual traits of the face (e.g., cheek bones) are expected to correlate positively and advertise immunocompetence honestly and therefore to affect positive beauty judgments. Facial attractiveness is predicted to correlate with attractive, nonfacial secondary sexual traits; other predictions from the view that parasite-driven selection led to the evolution of psychological adaptations of human beauty perception are discussed. The view that human physical attractiveness and judgments about human physical attractiveness evolved in the context of parasite-driven selection leads to the hypothesis that both adults and children have a species-typical adaptation to the problem of identifying and favoring healthy individuals and avoiding parasite-susceptible individuals. It is proposed that this adaptation guides human decisions about nepotism and reciprocity in relation to physical attractiveness.     

Molecular control of facial morphology

We present a developmental perspective on the concept of phylotypic and phenotypic stages of craniofacial development. Within orders of avians and mammals, a phylotypic period exists when the morphology of the facial prominences is minimally divergent. We postulate that species-specific facial variations arise as a result of subtle shifts in the timing and the duration of molecular pathway activity (e.g., heterochrony), and present evidence demonstrating a critical role for Wnt and FGF signaling in this process. The same molecular pathways that shape the vertebrate face are also implicated in craniofacial deformities, indicating that comparisons between and among animal species may represent a novel method for the identification of human craniofacial disease genes.     

The MPI facial expression database--a validated database of emotional and conversational facial expressions

The ability to communicate is one of the core aspects of human life. For this, we use not only verbal but also nonverbal signals of remarkable complexity. Among the latter, facial expressions belong to the most important information channels. Despite the large variety of facial expressions we use in daily life, research on facial expressions has so far mostly focused on the emotional aspect. Consequently, most databases of facial expressions available to the research community also include only emotional expressions, neglecting the largely unexplored aspect of conversational expressions. To fill this gap, we present the MPI facial expression database, which contains a large variety of natural emotional and conversational expressions. The database contains 55 different facial expressions performed by 19 German participants. Expressions were elicited with the help of a method-acting protocol, which guarantees both well-defined and natural facial expressions. The method-acting protocol was based on every-day scenarios, which are used to define the necessary context information for each expression. All facial expressions are available in three repetitions, in two intensities, as well as from three different camera angles. A detailed frame annotation is provided, from which a dynamic and a static version of the database have been created. In addition to describing the database in detail, we also present the results of an experiment with two conditions that serve to validate the context scenarios as well as the naturalness and recognizability of the video sequences. Our results provide clear evidence that conversational expressions can be recognized surprisingly well from visual information alone. The MPI facial expression database will enable researchers from different research fields (including the perceptual and cognitive sciences, but also affective computing, as well as computer vision) to investigate the processing of a wider range of natural facial expressions.     

Symmetry, sexual dimorphism in facial proportions and male facial attractiveness

Facial symmetry has been proposed as a marker of developmental stability that may be important in human mate choice. Several studies have demonstrated positive relationships between facial symmetry and attractiveness. It was recently proposed that symmetry is not a primary cue to facial attractiveness, as symmetrical faces remain attractive even when presented as half faces (with no cues to symmetry). Facial sexual dimorphisms ('masculinity') have been suggested as a possible cue that may covary with symmetry in men following data on trait size/symmetry relationships in other species. Here, we use real and computer graphic male faces in order to demonstrate that (i) symmetric faces are more attractive, but not reliably more masculine than less symmetric faces and (ii) that symmetric faces possess characteristics that are attractive independent of symmetry, but that these characteristics remain at present undefined.     

Acquisition of conditioned facial reflexes in the cat: cortical control of different facial movements

The motor cortex plays a role in determining which of three different facial movements is acquired in Pavlovian conditioning experiments. Three separate facial reflexes can be distinguished by recording electromyographic activity from the orbicularis oculi (eye blink) and levator orii (nose twitch) muscles. One in a pure eye blink; a second is a nose twitch; the third is a compound eye blink and nose twitch. Which of these movements is elicited by a click (conditioned stimulus) following associative conditioning is reflected by the pattern of unit activity elicited by the click at the motor cortex. Activity is enhanced, after conditioning, in those units that project polysynaptically to the specific muscles performing the learned movement. This enhancement of activity is, in turn, relatable to an enhanced electrical excitability of the involved neurons. Analogous changes in the excitability of neurons of the motor cortex to applied currents can be produced by local application of cholinergic agents. Iontophoresis of acetylcholine, aceclidine (a cholinomimetic drug), or intracellularly applied cyclic GMP produces changes in single neuron membrane resistance that increase neuronal excitability. The units of the motor cortex that respond preferentially to these agents and to the click conditioned stimuli with short latencies have been identified as pyramidal cells of layer V. The axons of these neurons form the pyramidal tract, a pathway characterized as serving voluntary movement. It appears that this system supports rapid transmission and processing of auditory-motor information used to perform learned movements adaptively, selectively, and discriminatively.     

Unusual facial hemangioma.

An unusual hemangioma of the face, found in a 7-year-old girl in the masticator space and consisting of multiple lobes, is reported. Direct angiography was effective in clarifying the space occupied by the tumor. It was removed through a combined approach, using both temporal and oral incisions, with almost no bleeding.     

Allometry of facial mobility in anthropoid primates: implications for the evolution of facial expression

Body size may be an important factor influencing the evolution of facial expression in anthropoid primates due to allometric constraints on the perception of facial movements. Given this hypothesis, I tested the prediction that observed facial mobility is positively correlated with body size in a comparative sample of nonhuman anthropoids. Facial mobility, or the variety of facial movements a species can produce, was estimated using a novel application of the Facial Action Coding System (FACS). I used FACS to estimate facial mobility in 12 nonhuman anthropoid species, based on video recordings of facial activity in zoo animals. Body mass data were taken from the literature. I used phylogenetic generalized least squares (PGLS) to perform a multiple regression analysis with facial mobility as the dependent variable and two independent variables: log body mass and dummy-coded infraorder. Together, body mass and infraorder explain 92% of the variance in facial mobility. However, the partial effect of body mass is much stronger than for infraorder. The results of my study suggest that allometry is an important constraint on the evolution of facial mobility, which may limit the complexity of facial expression in smaller species. More work is needed to clarify the perceptual bases of this allometric pattern.     

Exacerbation of facial motoneuron loss after facial nerve axotomy in CCR3-deficient mice

We have previously demonstrated a neuroprotective mechanism of FMN (facial motoneuron) survival after facial nerve axotomy that is dependent on CD4⁺ Th2 cell interaction with peripheral antigen-presenting cells, as well as CNS (central nervous system)-resident microglia. PACAP (pituitary adenylate cyclase-activating polypeptide) is expressed by injured FMN and increases Th2-associated chemokine expression in cultured murine microglia. Collectively, these results suggest a model involving CD4⁺ Th2 cell migration to the facial motor nucleus after injury via microglial expression of Th2-associated chemokines. However, to respond to Th2-associated chemokines, Th2 cells must express the appropriate Th2-associated chemokine receptors. In the present study, we tested the hypothesis that Th2-associated chemokine receptors increase in the facial motor nucleus after facial nerve axotomy at timepoints consistent with significant T-cell infiltration. Microarray analysis of Th2-associated chemokine receptors was followed up with real-time PCR for CCR3, which indicated that facial nerve injury increases CCR3 mRNA levels in mouse facial motor nucleus. Unexpectedly, quantitative- and co-immunofluorescence revealed increased CCR3 expression localizing to FMN in the facial motor nucleus after facial nerve axotomy. Compared with WT (wild-type), a significant decrease in FMN survival 4 weeks after axotomy was observed in CCR3^−/− mice. Additionally, compared with WT, a significant decrease in FMN survival 4 weeks after axotomy was observed in Rag2^−/− (recombination activating gene-2-deficient) mice adoptively transferred CD4⁺ T-cells isolated from CCR3^−/− mice, but not in CCR3^−/− mice adoptively transferred CD4⁺ T-cells derived from WT mice. These results provide a basis for further investigation into the co-operation between CD4⁺ T-cell- and CCR3-mediated neuroprotection after FMN injury.     

Telling facial metrics: facial width is associated with testosterone levels in men

High facial width-to-height ratio (fWHR) has been associated with a cluster of behavioural traits in men, including aggression and status-striving. This association between face structure and behaviour may be caused by testosterone. Here we investigated the relationship of both baseline and reactive testosterone levels to fWHR. In addition, we investigated the link between testosterone and three well-characterised sexually dimorphic facial metrics. Testosterone was measured in one sample of males (n = 185) before and after a speed-dating event. An additional sample provided only baseline testosterone measures (n = 92). fWHR was positively associated with testosterone reactions to potential mate exposure and marginally associated with baseline testosterone in Sample 1. We found a positive association with baseline testosterone and fWHR in Sample 2. In addition, face-width-to-lower-height ratio was positively associated with testosterone in both samples, suggesting that, in particular, facial width (scaled by two measures of facial height) is associated with testosterone. Importantly, our results also indicate that there is no association between adult testosterone and the sexual dimorphism of face shape. Thus, while our findings question the status of sexual dimorphism as a proxy measure of testosterone, they do provide evidence that testosterone is linked to fWHR and might underlie the relationship between fWHR and behaviour.     

Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis

Injury to the frontal or other facial nerve branches can result in an asymmetry that can be very distressful to both patient and surgeon. This is especially true following cosmetic procedures such as rhytidectomy. We propose a means to create temporary symmetry while awaiting the possible return of nerve function. Botulinum neurotoxin causes a muscle paralysis lasting for approximately 3 months, and it is well established as the preferred treatment for blepharospasm. A case is presented in which botulinum toxin type A was injected into the opposite functioning frontalis muscle of a patient with unilateral frontal nerve paralysis. The patient experienced satisfactory relief of the asymmetry caused by onesided forehead wrinkling and brow elevation. Botulinum toxin therapy should be considered for both temporary and permanent facial asymmetries due to facial nerve paralysis as well as spasm.     

A classification of facial wrinkles.

An increasing number of injectable filler materials for facial wrinkles and folds points to the need for objective measurements of their effectiveness. Patient satisfaction is the goal, but proof of the value of a particular product requires objective measurement. A wrinkle assessment scale was developed as a simple tool for use by plastic surgeons, dermatologists, and aesthetic surgeons who want to assess the changes resulting from injecting filler materials in their patients. By correlating the grade of the wrinkle in the reference photographs with the wrinkle in a patient's face, a classification of 0 to 5 is assigned. Reliability of the scale was assessed by "live" judgment of 76 wrinkles by nine observers. The same rating was given to 92.7 percent of all wrinkles. In a second trial, photographs from 130 wrinkles were presented to eight observers who rated 89.4 percent of all wrinkles equally. A significant correlation of 87 percent was found between subjective ratings and objective wrinkle depth measured by profilometry on 40 silicone impressions. Manufacturers, monitors of clinical trials, health authorities, and most important, patients will benefit from objective data on current and new injectable materials.     

Endotemporal branching of the facial nerve

Out of 400 specimens of temporal bone the authors found two cases of branching of the facial nerve in the mastoid course, i.e., 0.5%. Knowledge of this anomaly has a certain practical value in surgical intervention of the middle ear.     

Day-night differences in effects of cosmetic treatments on facial skin. Effects on facial skin appearance

Two groups of 24 healthy caucasian women, similar with regard to age classes (from 19 to 55) as well as fair and dark complexion of skin and hair, volunteered to use during a 14-day span a conventional facial cream (active placebo: AP) and thereafter, during a 21-day span Noctosome (Noctos). The latter is a new generation of liposome made with non-ionic lipids leading to microspheres which include glycopeptides in the aqueous compartment of the vesicle, alpha-tocopherol ester in the membrane-like structure and sphingo-ceramides at the surface of the microspheres. The aim of the study was to test the beneficial effects of Noctos (vsAP) with respectively morning (7-9-hr) and evening (21-23-hr) applications as facial ointments. Observed differences were validated using several statistical tests: ANOVA, cosinor, etc. Subjects were socially synchronized with a diurnal activity from 7 hr to 23 hr and a nocturnal rest. Each day, at fixed clock hours (7, 10, 20 and 23 hr), each subject used visual analogue scales to self-rate a set of variables characterizing facial aspects. Brilliance of complexion and texture of skin exhibited a circadian rhythm (peak time at 10 hr), both with AP and Noctos. The latter produces a beneficial effect with regard to reference values (AP). The evening application of Noctos is more efficient than the morning one. However, the magnitude of this beneficial effect is related both to age (greater for the age class 25-35 years than for younger and older subjects) and to skin complexion (greater for fair than dark complexioned subjects). Major beneficial effects of Noctos in the evening hours are related neither to fatigue nor to mood of the women since the respective circadian rhythms of these variables appear to vary independently from those of facial skin characteristics.     

Vascularized rib for facial reconstruction

The reconstruction of maxillectomy defects is a complex problem encountered in plastic surgery. Defects can range in size and complexity from small defects requiring only soft tissue to complete maxillectomies requiring large tissue bulk, bone, and one or more skin paddles. The most difficult defects involve the skull base and orbit. The reconstructive surgeon is faced with the challenge of isolating the nasopharynx from the dura and globe while simultaneously restoring the bony framework of the maxilla and orbit to support the soft tissue of the cheek. The authors present a series of six reconstructions using a rectus abdominis muscle flap with associated vascularized rib for reconstruction of complex maxillectomy defects. This flap provides large soft-tissue bulk as well as bony support and a long vascular pedicle. A skin island can be taken with the flap, and the donor-site morbidity is comparable to that seen with a vertical rectus abdominis myocutaneous flap. Six flaps were used in five patients over a 20-month period. All patients had stable support of the orbit at follow-up with adequate soft-tissue coverage, and there were no incidences of visual changes.     

Primary neoplasms of the facial nerve

A series of 30 primary facial nerve tumors is reviewed. Most of them were benign (n = 26); there were four malignant tumors. Neoplasms originating within the temporal bone were found to have preoperative facial paralysis in 84 percent of cases; the extracranial tumors had a 35 percent incidence of preoperative facial paralysis. All tumors in this series were treated surgically--by means of a middle fossa or transmastoid approach for the intratemporal group of tumors; the extracranial tumors were removed by the technique of parotid tumor surgery with complete facial nerve dissection. All the patients with preoperative facial weakness required facial nerve transection. Facial paralysis was rehabilitated with nerve grafts, hypoglossal crossover, or muscle transfers. Because "normal" facial expression is still not attainable following repair of complete facial nerve transection, an early diagnosis, hopefully prior to total neurotmesis, is essential. All patients with unexplained facial weakness, especially that which is progressive and persistent, should have the entire course of the facial nerve investigated for the possibility of treatable etiology.     

Higher-level mechanisms detect facial symmetry

The role of symmetry detection in early visual processing and the sensitivity of biological visual systems to symmetry across a wide range of organisms suggest that symmetry can be detected by low-level visual mechanisms. However, computational and functional considerations suggest that higher-level mechanisms may also play a role in facial symmetry detection. We tested this hypothesis by examining whether symmetry detection is better for faces than comparable patterns, which share low-level properties with faces. Symmetry detection was better for upright faces than for inverted faces (experiment 1) and contrast-reversed faces (experiment 2), implicating high-level mechanisms in facial symmetry detection. In addition, facial symmetry detection was sensitive to spatial scale, unlike low-level symmetry detection mechanisms (experiment 3), and showed greater sensitivity to a 45 degrees deviation from vertical than is found for other aspects of face perception (experiment 4). These results implicate specialized, higher-level mechanisms in the detection of facial symmetry. This specialization may reflect perceptual learning resulting from extensive experience detecting symmetry in faces or evolutionary selection pressures associated with the important role of facial symmetry in mate choice and 'mind-reading' or both.