A new method for correcting a gummy smile

Myectomy and partial resection of the levator labii superioris promises a far better and direct approach to the problem of upper gum exposure during smiling. This procedure attempts to eliminate the cause of the deformity. The resected muscles are of the striated muscle group and are composed of single muscle fibers running the entire length of the trunk. Adequate resection of these muscles will thoroughly eliminate the regeneration of muscle, and thus a permanent correction is achieved. The resulting smile is very attractive and pleasing to both patient and surgeon.     

Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose

To achieve permanent results for the correction of a drooping nasal tip, it is important to understand the mechanism responsible for the caudal rotation of the tip when a person speaks or smiles. This mechanism can be considered to depend on a "functional unity" formed by three components: (1) the cartilaginous framework (alar cartilages and accessories acting as a single structure); (2) muscular motors (m. levator labii superioris alaeque nasi and depressor septi nasi); and (3) gliding areas (apertura piriformis, the valvular mechanism between the upper lateral cartilages and alar cartilages, the lax tissue of the nasal dorsum, and the membranous septum). We describe a new anatomical and functional concept responsible for the plunging of the nasal tip. When a person smiles, the functional unit is activated by a combination of two forces acting simultaneously in opposite directions that rotate the tip caudally and elevate the nasal base. The levator moves the alar base upward and the depressor pulls the tip caudally. To correct the drooping tip, the transcartilaginous incision is extended laterally, and the lateral portion of the alar arch is dissected free from the skin and the mucosa, thus exposing the accessory cartilages. The arch is then severed at the level of the accessories to allow the cephalad rotation of the domes. The muscle insertions are dissected free from the accessories and a section of the muscle and, if necessary, the accessory cartilages, is removed. From January of 1991 onward, 312 patients have had this ancillary procedure performed in addition to the basic rhinoplasty technique.     

On the muscles of expression in the geladaTheropithecus gelada (Rüppell) (primates,Cercopithecidae)

Musculature innervated by the N. facialis inTheropithecus gelada (Rüppell) is patterned on broad lines in agreement with related genera of catarrhine monkeys, but presents some specializations and divergences in detail. Noteworthy is the extension to the labial margins superficially of the combined levator labii superioris and zygomaticus in the upper and the pars mandibularis of trachelo-platysma in the lower lip. A specialization of the medial fibres of levator labii superioris forms a sling-like structure within the upper lip and serves to implement the lip-flip gesture characteristic of the genus. Its antagonist is the orbicularis oris. Special features of all other facialis muscles are considered.Abbreviations ABD Anterior belly of digastricus - AE Arteria facialis - ALS Arteria labialis superior - ANL Arteria lateralis nasi - AP Auricularis posterior - APA Arteria auricularis posterior - AS Arteria auricularis superior - A.Se. Arteria septi nasi - A.Sy. Arteria symphysialis - BP Buccal pouch - LAO Depressor anguli oris - FTA Fronto-temporo-auricularis - GLI Glandulae labialis inferiores - GLS Glandulae labialis superioris - LAO Levator anguli oris - LG Artery to labial glands - LLAN Levator labii superioris alaeque nasi - LLS Levator labii superioris - M Masseter - MM Musculus mentalis - NP Notoplatysma - O Occipitalis - OO Orbicularis oris - O.Oc Orbicularis oculi - P Procerus - SH Sterno-hyoideus - TP Trachelo-platysma - VL Vena labialis communis - VP Venous plexus of dorsum nasi - ZM Zygomaticus minor - Zy Zygomaticus     

提上睑肌缩短术与额肌瓣悬吊术对不同程度先天性上睑下垂的疗效观察

目的:对比提上睑肌缩短术和额肌瓣悬吊术对不同程度先天性上睑下垂患者的疗效,为临床上选取合适的术式提供依据。方法:选取2014年8月至2015年12月我院收治的64例先天性上睑下垂患者为研究对象,按随机数字表法分为A组和B组各32例。A组行提上睑肌缩短术,B组行额肌瓣悬吊术。术后定期回访3-12个月,评价两种术式的临床疗效、并发症发生率及术后满意率。结果:A组总有效率为68.75%,低于B组的84.38%,差异有统计学意义(P0.05),A组轻度患者的总有效率高于B组,中、重度患者的总有效率低于B组,差异有统计学意义(P0.05)。A组并发症发生率为15.63%,低于B组的31.25%,差异有统计学意义(P0.05)。A组的术后满意率为37.50%,低于B组的78.13%,差异有统计学意义(P0.05),且A组轻度患者术后满意率高于B组,中、重度患者术后满意率低于B组,差异有统计学意义(P0.05)。结论:提上睑肌缩短术对轻度先天性上睑下垂患者疗效较好,额肌瓣悬吊术对中、重度先天性上睑下垂患者疗效较好,临床应根据患者病情程度选择合适的治疗术式。     

The Westermarck effect revisited: a psychophysiological study of sibling incest aversion in young female adults

Research on human inbreeding avoidance has uncovered at least two central cues to the detection of siblings: witnessing an infant being taken care of by one's mother (i.e. maternal perinatal association) and growing up in close proximity to a child (the so-called Westermarck effect). Both cues have been supported by fieldwork in populations under specific cultural conditions, and by survey research mainly in student populations. Both types of research have relied often on self-reporting. Unfortunately, this method is frequently colored by ceiling effects and notions of social desirability. In order to circumvent this problem, we explored a complementary method for investigating incest aversion that involved measuring psychophysiological responses during an imagery task. As such, we analyzed data on 63 heterosexual female students who viewed pictures of sexual and non-sexual activities while imagining performing these activities with either their partner or their brother. In female subjects with only (one or more) older brothers—a proxy for lacking maternal perinatal association with an opposite-sex sibling—the duration of coresidence with brother(s) predicted activity in the mm. levator labii superioris and alaeque nasi, facial muscles that are highly active when a subject expresses facial disgust. The strength of these responses was also predicted by the frequency of having bathed and shared a bedroom with a brother in early childhood; two activities that may serve as additional cues for relatedness as it can be expected that they are typically performed with genetically related children. As a result, the psychophysiological approach not only complements the use of self-reports in recent research on incest aversion, but also has the potential to fine-tune well-established cues for sibling detection, or to uncover additional ones.     

Neuromuscular spindles of the extrinsic ocular musculature of the moufflon

Proprioceptive innervation of moufflon extrinsic ocular musculature and m. levator palpebrae superioris was studied. Muscle spindles and Golgi tendon organs were found. The first ones are usually between 1st and 2nd order muscle fascicles. The muscle spindles are highly represented in the extrinsic ocular muscles, but less numerous in m. levator palpebrae superioris. Their number varies according to muscles and individuals. In the same subject, also the ratio between the number of the muscle spindles found in m. rectus dorsalis and that of m. levator palpebrae superioris was examined. Besides, the histological structure of the intrafusal fascicles was investigated. Particular attention was devoted to the nerve supply of the muscle spindle. By means of impregnating methods, sensory and motor endings were identified. Primary and secondary sensory endings only in a few cases showed their usual pattern: motor fibres can end in form of plates or trails. Golgi tendon organs were observed between the tendon and the muscular tissue and are always less numerous.     

Predilection sites of Trichinella spiralis larvae in naturally infected horses.

A total of 120 muscle tissues from three horses naturally infected with Trichinella spiralis were examined. The head was the most infected site. In particular, the muscles harbouring the highest number of larvae were: musculus buccinator (12, 411 and 1183 larvae g-1), the tongue (11, 615 and 1749 larvae g-1), m. levator labii maxillaris (17,582 and 1676 larvae g-1), and the masseter (4.9, 289 and 821 larvae g-1). Compared with the diaphragm, the number of larvae per gram was from 3.5 to 6.8 times higher in the tongue, from 3.5 to 6.5 higher in m. levator labii maxillaris, and from 2.5 to 4.6 higher in m. buccinator. Of the examined muscles, the diaphragm had from the 6th to the 15th highest level of infection (3.1, 166 and 256 larvae g-1). Published data from experimentally infected horses confirm these results, suggesting that efforts to detect predilection sites should focus on the head muscles.     

The SOOF lift: its role in correcting midfacial and lower facial asymmetry in patients with partial facial palsy

Subperiosteal face lifting has gained wide acceptance in aesthetic surgical practice. It may also have a role to play in patients with partial facial palsy. These patients demonstrate poor static position of the mouth but maintain some degree of facial movement. This study examined the role of subperiosteal facial suspension as an alternative treatment modality in this patient group. In this series, five patients with varying degrees of partial facial palsy underwent subperiosteal face lifting, including sub-orbicularis oculi fat elevation via a temporal, lower lid, and buccal approach, thereby mobilizing and elevating and suspending the zygomaticus major and levator labii superioris muscles on the facial skeleton. An attempt was made to categorize the patients according to overall House-Brackmann score. It was not possible to precisely classify the patients by this method, although the approximate scores were two patients scoring 3, two patients scoring 4, and one patient scoring 5. To overcome inconsistencies with this method, the degree of static and dynamic asymmetry of the mouth and also the excursion of the mouth were graded separately. Four patients with mild to moderate dynamic and static asymmetry (House-Brackmann score of approximately 3 and 4) who maintained excellent or good excursion of the mouth achieved excellent or good results. One patient with poor excursion and severe partial facial palsy (House-Brackmann score of 5) was improved but remained markedly asymmetric (follow-up, 4 months to 1 year). Subperiosteal face lifting is a useful therapeutic modality for management of selected patients with mild partial facial palsy. These patients demonstrate asymmetric static position but maintain some degree of muscle excursion. Patients with severe facial palsies with poor muscle excursion continue to require muscle transfer or sling procedures. The authors hope that long-term follow-up will confirm the sustained effect of midfacial suspension in this selected patient group.     

Smiles when sharing

One of the proposed functions of human smiling is to advertise cooperative dispositions and thereby increase the likelihood that a social partner would invest resources in a relationship. In particular, smiles involving an emotional component would be honest signals of altruistic dispositions because they are not easy to produce voluntarily. In this study, 60 people were covertly filmed while interacting with a friend in two conditions: control and sharing. Smiles were classified into Duchenne (spontaneous) and non-Duchenne smiles. Participants also completed a series of questionnaires, including the Altruism Scale and a self-report questionnaire of emotional state. Interestingly, Duchenne smiles were displayed at higher rates in the sharing situation as opposed to the control situation, whereas non-Duchenne smiles were unaffected by the type of interaction. Furthermore, Duchenne smiles in the sharing interaction were positively affected by a measure of altruism. Self-reported emotional states did not vary between conditions and were poorly related to smiling. This study shows that the Duchenne smile is relevant to situations that involve the sharing of material resources because it would reliably advertise altruistic intentions. The Duchenne smile could therefore be an important signal in the formation and maintenance of cooperative relationships.     

Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket

Rejuvenation of the lower eyelid complex is based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. When a deep groove is present along the orbital rim in the area of the tear trough deformity, it is advantageous, rather than removing orbital fat, to reposition the fat over the orbital rim through the opened arcus marginalis onto the superior face of the maxilla. Orbital fat repositioning can be accomplished through a transconjunctival approach. The arcus marginalis is exposed and incised, and a subperiosteal pocket is created over the superior face of the maxilla. The subperiosteal pocket shape and location are customized based on the desired location of the orbital fat pedicle; often the origins of the levator superioris labialis and the levator alae nasi muscles are partially dissected. Medial and central fat pedicles are created and rotated over the orbital rim into the subperiosteal pocket. A 6-0 polypropylene externalized sutured is used to fixate the fat pedicle in position. The suture can be removed after 3 to 5 days. Twenty-four patients were followed clinically after orbital fat repositioning, with follow-up ranging from 6 to 30 months. Although the fat pedicle undergoes some variable resorption, the viability of the graft, the texture and contour of the repositioned fat after a healing period of 1 to 2 months, and the excellent patient acceptance are indicative of the viability of orbital fat repositioning.     

The first smile: spontaneous smiles in newborn Japanese macaques (<Emphasis Type="Italic">Macaca fuscata</Emphasis>)

Spontaneous smiles are facial movements that are characterized by lip corner raises that occur during irregular sleep or drowsiness without known external or internal causes. They are shown by human infants and infant chimpanzees. These smiles are considered to be the developmental origin of smiling and laughter. There are some case studies showing that spontaneous smiles occur in Japanese macaques. The goals of this study were to investigate whether newborn Japanese macaques show a considerable number of spontaneous smiles thus to examine the mechanism of them. Seven newborn Japanese macaques were observed in a room for an average of 44 min, and incidental sleeping situations were monitored twice. All seven participants showed spontaneous smiles at least once during the observation. They showed 8.29 spontaneous smiles in average (SD = 10.89; 58 smiles in total), all found in the state of REM sleep. Thirty-nine of the 58 smiles were produced on the left side of the mouth. These characteristics were similar to those of spontaneous smiles in human infants. This is the first evidence that macaques as well as hominoids show a considerable number of spontaneous smiles. These phenomena may facilitate the development of the zygomaticus major muscle, which is implicated in smiling-like facial expressions.     

THE MUSCULAR HYDROSTAT OF THE FLORIDA MANATEE (TRICHECHUS MANATUS LATIROSTRIS): A FUNCTIONAL MORPHOLOGICAL MODEL OF PERIORAL BRISTLE USE

Facial musculature was examined in the Florida manatee, Tricbecbus manatus latirostris , in order to develop a functional model of perioral bristle use. Muscles identified include the M. levator nasolabialis, M. buccinatorius, M. maxillonasolabialis, M. centralis nasi, M. lateralis nasi, M. spbincter colli profundus pars oris, M. orbicularis oris, M. mandibularis, and M. mentalis. A new muscle, M. centralis nasi , has been named and is an integral part of perioral bristle movement. The snout of the Florida manatee is capable of performing complex movements. The prehensile ability of Florida manatees can be explained in the context of a muscular hydrostat as defined by Kier and Smith (1985). Eversion of certain bristles in the upper lip occurs by shortening longitudinal, transverse, and semicircular muscles in combination with volume displacement due to compensatory changes in the shape of the snout. Midline sweeping of these bristles is accomplished by the contraction of M. centralis nasi. Eversion of bristles on the lower jaw is a result of shortening of M. mentalis. Contraction of M. orbicularis oris pushes vegetation into the oral cavity. All observed movement patterns and uses of perioral bristles can be explained by variation of these sequences within the context of muscular hydrostat function.     

Positive Feeling,Negative Meaning: Visualizing the Mental Representations of In-Group and Out-Group Smiles

Even though smiles are seen as universal facial expressions, research shows that there exist various kinds of smiles (i.e., affiliative smiles, dominant smiles). Accordingly, we suggest that there also exist various mental representations of smiles. Which representation is employed in cognition may depend on social factors, such as the smiling person’s group membership: Since in-group members are typically seen as more benevolent than out-group members, in-group smiles should be associated with more benevolent social meaning than those conveyed by out-group members. We visualized in-group and out-group smiles with reverse correlation image classification. These visualizations indicated that mental representations of in-group smiles indeed express more benevolent social meaning than those of out-group smiles. The affective meaning of these visualized smiles was not influenced by group membership. Importantly, the effect occurred even though participants were not instructed to attend to the nature of the smile, pointing to an automatic association between group membership and intention.     

Infants Time Their Smiles to Make Their Moms Smile

One of the earliest forms of interaction between mothers and infants is smiling games. While the temporal dynamics of these games have been extensively studied, they are still not well understood. Why do mothers and infants time their smiles the way they do? To answer this question we applied methods from control theory, an approach frequently used in robotics, to analyze and synthesize goal-oriented behavior. The results of our analysis show that by the time infants reach 4 months of age both mothers and infants time their smiles in a purposeful, goal-oriented manner. In our study, mothers consistently attempted to maximize the time spent in mutual smiling, while infants tried to maximize mother-only smile time. To validate this finding, we ported the smile timing strategy used by infants to a sophisticated child-like robot that automatically perceived and produced smiles while interacting with adults. As predicted, this strategy proved successful at maximizing adult-only smile time. The results indicate that by 4 months of age infants interact with their mothers in a goal-oriented manner, utilizing a sophisticated understanding of timing in social interactions. Our work suggests that control theory is a promising technique for both analyzing complex interactive behavior and providing new insights into the development of social communication.     

Properties and use of botulinum toxin and other microbial neurotoxins in medicine.

Crystalline botulinum toxin type A was licensed in December 1989 by the Food and Drug Administration for treatment of certain spasmodic muscle disorders following 10 or more years of experimental treatment on human volunteers. Botulinum toxin exerts its action on a muscle indirectly by blocking the release of the neurotransmitter acetylcholine at the nerve ending, resulting in reduced muscle activity or paralysis. The injection of only nanogram quantities (1 ng = 30 mouse 50% lethal doses [U]) of the toxin into a spastic muscle is required to bring about the desired muscle control. The type A toxin produced in anaerobic culture and purified in crystalline form has a specific toxicity in mice of 3 x 10(7) U/mg. The crystalline toxin is a high-molecular-weight protein of 900,000 Mr and is composed of two molecules of neurotoxin (ca. 150,000 Mr) noncovalently bound to nontoxic proteins that play an important role in the stability of the toxic unit and its effective toxicity. Because the toxin is administered by injection directly into neuromuscular tissue, the methods of culturing and purification are vital. Its chemical, physical, and biological properties as applied to its use in medicine are described. Dilution and drying of the toxin for dispensing causes some detoxification, and the mouse assay is the only means of evaluation for human treatment. Other microbial neurotoxins may have uses in medicine; these include serotypes of botulinum toxins and tetanus toxin. Certain neurotoxins produced by dinoflagellates, including saxitoxin and tetrodotoxin, cause muscle paralysis through their effect on the action potential at the voltage-gated sodium channel. Saxitoxin used with anaesthetics lengthens the effect of the anaesthetic and may enhance the effectiveness of other medical drugs. Combining toxins with drugs could increase their effectiveness in treatment of human disease.     

Facial EMG responses to odors in solitude and with an audience

Two experiments were undertaken to examine whether facial responsesto odors correlate with the hedonic odor evaluation. Experiment1 examined whether subjects (n = 20) spontaneously generatedfacial movements associated with odor evaluation when they aretested in private. To measure facial responses, EMG was recordedover six muscle regions (M. corrugator supercilii, M. procerus,M. nasalis, M. levator, M. orbicularis oculi and M. zygomaticusmajor) using surface electrodes. In experiment 2 the experimentalgroup (n = 10) smelled the odors while they were visually inspectedby the experimenter sitting in front of the test subjects. Thecontrol group (n = 10) performed the same experimental conditionas those subjects participating in experiment 1. Facial EMGover four mimetic muscle regions (M. nasalis, M. levator, M.zygomaticus major, M. orbicularis oculi) was measured whilesubjects smelled different odors. The main findings of thisstudy may be summarized as follows: (i) there was no correlationbetween valence rating and facial EMG responses; (ii) pleasantodors did Dot evoke smiles when subjects smelled the odors inprivate; (iii) in solitude, highly concentrated malodors evokedfacial EMG reactions of those mimetic muscles which are mainlyinvolved in generating a facial display of disgust; (iv) thosesubjects confronted with an audience showed stronger facialreactions over the periocular and cheek region (indicative ofa smile) during the smelling of pleasant odors than those wbosmelled these odors in private; (v) those subjects confrontedwith an audience showed stronger facial reactions over the M.nasalis region (indicative of a display of disgust) during thesmelling of malodors than those who smelled the malodors inprivate. These results were taken as evidence for a more socialcommunicative function of facial displays and strongly mitigatesthe reflexive-hedonic interpretation of facial displays to odorsas supposed by Steiner.     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。     

The "levator septi nasi muscle" and its clinical significance

It is strange that all textbooks of anatomy describe the depressor septi nasi muscle singly, without an antagonist. Incidentally, in 1986, a small rod of soft tissue was found between the medial crura of the two alar cartilages during a rhinoplastic operation with the external approach technique of Anderson and Ries. From 1990 through 1995, anatomic dissections of the nasolabial region under 3.5x loupe magnification were performed on 14 Chinese formalin-preserved cadavers, one fresh Chinese cadaver, and one fresh American white female cadaver. The small soft-tissue rod was found in every one of the dissected cadavers, and it was seen to be a pair of muscles. Each one of these paired small muscles arose from the aponeurosis on the dorsum of the nose and inserted into the muscular substance of the upper lip at the base of the columella and to the anterior spine of the maxilla. Histologic examinations of these muscles stained with hematoxylin and eosin and Masson trichrome showed that they were striated muscles. According to its origin and insertion, this newly found muscle was called the "levator septi nasi." Its clinical significance in cleft lip deformity and its relations to the orbicularis oris muscle, the dermocartilaginous ligament of Pitanguy, and the nasal superficial musculoaponeurotic system of Letourneau and Daniel are all discussed.     

Botulinum toxin A in clinical medicine

The results of the treatment with botulinum toxin A injection of 234 patients with blepharospasm and 73 with hemifacial spasm were reviewed. Visual function improved in the majority of patients with blepharospasm, and the improvement was sustained for up to 40 sets of injections. Mid and lower facial movements were also reduced in a minority of patients. However, a sub-group with pre-tarsal blepharospasm or persistent levator inhibition after treatment had a poor response. An average 75% reduction in abnormal movements was seen in cases of hemifacial spasm. Side effects of the treatment were usually mild and short lived.