Facial artery musculomucosal flap for reconstruction of skull base defects

Facial Artery Musculomucosal Flap in Skull Base Reconstruction Xie L. MD, Lavigne F. MD, Rahal A. MD, Moubayed SP MD, Ayad T. MD Introduction: Failure in skull base defects reconstruction can have serious consequences such as meningitis and pneumocephalus. The nasoseptal flap is usually the first choice but alternatives are necessary when this flap is not available. The facial artery musculomucosal (FAMM) flap has proven to be successful in head and neck reconstruction but it has never been reported in skull base reconstruction. Objective: To show that the FAMM flap can reach some key areas of the skull base and be considered as a new alternative in skull base defects reconstruction. Methods: We conducted a cadaveric study with harvest of modified FAMM flaps, endoscopic skull base dissection and maxillectomies in 13 specimens. Measures were taken for each harvested FAMM flap. Results: The approximate mean area for reconstruction from the combination of the distal FAMM and the extension flaps is 15.90 cm2. The flaps successfully covered the simulated defects of the frontal sinus, the ethmoid areas, the planum sphenoidale, and the sella turcica. Conclusion: The FAMM flap can be considered as a new alternative in the reconstruction of skull base defects. Modifications add extra length to the traditional FAMM flap and can contribute to a tighter seal of the defect as opposed to the FAMM flap alone.

Effets du port continu de coquilles correctrices Invisalign® sur l’articulation temporo-mandibulaire et les muscles du complexe facial.

INTRODUCTION : L’articulation temporo-mandibulaire (ATM) est un système articulaire excessivement complexe. L'étiologie des désordres temporo-mandibulaires (DTM) est encore incertaine et le lien de cause à effet des traitements orthodontiques en tant que facteur de risque est une question qui a longuement été discutée. Cette étude clinique prospective vise à évaluer les effets à long terme du port continu de coquilles correctrices Invisalign® sur l’ATM et les muscles du complexe facial. MATÉRIELS ET MÉTHODES : L'étude incluait 43 adolescents et adultes âgés entre 13 et 51 ans (25 femmes et 18 hommes). Deux d'entre eux ont été exclus en raison de mauvaise coopération causant l’arrêt du traitement orthodontique. Les effets dans le temps des coquilles sur l'ATM et les muscles du complexe facial ont été évalués en utilisant l’examen du Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Le nombre de contractions musculaires durant le sommeil a été mesuré objectivement par enregistrements électromyographiques (EMG) et la fréquence de grincement et de serrement des dents à l’éveil a été rapportée subjectivement par les patients à l’aide de questionnaires. Des mesures répétées ont été effectuées aux temps suivants: avant le début du traitement pour les données contrôles (T1), deux semaines (T2), et six mois (T3) après le début du traitement. Les données numériques ont été analysées par l’analyse de variance (ANOVA) en mesures répétées et la méthode de Brunner-Langer, alors que les données nominales ont été évaluées par le test de Cochran-Mantel-Haenszel. Les résultats ont été considérés significatifs si p < 0.05. RÉSULTATS ET DISCUSSION : Le nombre de contractions musculaires par heure (index) durant le sommeil et leur durée moyenne n’ont pas été statistiquement différents entre les trois nuits d’enregistrement EMG (Brunner Langer, p > 0.005). Cependant, 67 % des participants ont rapporté avoir eu du grincement ou du serrement des dents la nuit au T2 et 64 % au T3 comparativement à 39 % au T1, ce qui était une augmentation significative (Cochran-Mantel-Haenszel, p = 0.0112). Quarante-quatre pour cent des patients ont signalé du grincement ou du serrement des dents pendant le jour au T1, tandis qu'un pourcentage nettement plus élevé de 66 % en a rapporté au T2 et 61 % au T3 (Cochran-Mantel-Haenszel, p = 0.0294). Au T1, 12 % des sujets ont indiqué qu'ils se sont réveillés avec une douleur musculaire, comparativement à 29 % au T2, ce qui était une augmentation significative (Cochran-Mantel-Haenszel, p = 0.0347). Au T2, il y avait une réduction significative des mouvements maximaux de la mandibule dans toutes les directions (ANOVA en mesures répétées, p < 0,05). De plus, il y a eu une augmentation significative du nombre de sites douloureux et de l'intensité de la douleur à la palpation de l'ATM et des muscles faciaux avec l'évaluation du RDC/TMD au T2 en comparaison aux T1 et T3 (Brunner Langer, p < 0,05). CONCLUSION : La présente étude n’a révélé aucun effet des coquilles sur l’activité oro-faciale durant le sommeil au fil du temps mesurée objectivement à l’aide des enregistrements EMG, mais une augmentation significative de la fréquence du grincement et du serrement des dents rapportée subjectivement par les patients au moyen des questionnaires aux T2 et T3. Au T2, il y avait une augmentation significative des symptômes de l'ATM et des muscles du complexe oro-facial, mais ces symptômes sont retournés au niveau initial avec le temps.

La reconnaissance émotionnelle faciale : validation préliminaire de stimuli virtuels dynamiques et comparaison avec les Pictures of Facial Affect (POFA)

Bien que des photographies d’expressions émotionnelles faciales soient couramment utilisées pour étudier le traitement des informations affectives, les ensembles de stimuli actuels comportent différentes limites méthodologiques. Dans la perspective d’améliorer la validité écologique des travaux sur la reconnaissance émotionnelle faciale (REF), l’étude propose un nouvel ensemble de stimuli dynamiques constitué de personnages virtuels exprimant les six émotions fondamentales à différentes intensités. La validation préliminaire des stimuli a été effectuée en les comparant aux stimuli du POFA. Dans l’étude 1, le contenu émotionnel de 84 avatars statiques et de 48 photographies du POFA a été évalué par 150 étudiants. Dans l’étude 2, la REF a été évaluée chez 134 étudiants à l’aide d’avatars dynamiques. L’habileté à reconnaître les émotions est similaire à celle rapportée dans la littérature scientifique ainsi qu’au POFA. Les résultats permettent de conclure que les avatars constituent un ensemble valide de stimuli pour étudier la REF, offrant une contribution significative dans le domaine de la recherche émotionnelle. L’usage d’avatars étant de plus en plus courant à des fins d’intervention et de recherche, les stimuli ouvrent aussi la voie à diverses applications, entre autres pour l’étude des comportements violents. D’autres travaux devront être réalisés afin de poursuivre leur validation.

The role of the amygdala in facial emotional expression during a discrimination task. 'El papel de la am??gdala en una tarea de discriminaci??n de expresiones emocionales'

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Evaluación a largo plazo en mujeres tratadas con laser para depilación facial en uniláser medica

El vello facial no deseado es un problema común en las mujeres, los tratamientos láser han mostrado efectividad para su manejo. Objetivo: Evaluar los resultados de la depilación láser en cara de las pacientes tratadas a largo plazo (20 sesiones o más ) luego de un seguimiento de 6 meses durante los años 1997 y 2012. Metodología: 55 mujeres que con tipo de piel II a V recibieron 20 o más sesiones de láser con seguimiento mayor a 6 meses posterior al la última sesión. Resultados: la edad promedio fue (32 ± 9,3 años), el 18,2 % presentaban SOP o Hiperandrogenismo el número de sesiones en cara fue de (30,84 ± 12,132), un promedio de disparos de (6,330 ± 7,804), los Kilojulios acumulados tuvieron un promedio de (126,5 ± 161,4) la fluencia promedio fue (18,5 ± 3,2 Julios/cm2), el láser de Alexandrita fue utilizado en el 98% de las pacientes. Se encontró cambios significativos entre el conteo inicial y el final de vello facial (484,9 ± 568.9 (med=300) vs. 103,33± 138,63 (med=60), p<0.001, Test de Wilcoxon). El 32.7% mostraron reducción > 90% (5,5% reducción del 100%). Conclusión : El tratamiento con de depilación con láser mostro una reducción significativa del vello facial, en mujeres mayores de 14 años con un tratamiento a largo plazo (20 sesiones o más), con una tasa de reducción mayor del 90% en 32.7% de las pacientes y un promedio de reducción del grupo de 79,36 ±15,51 %, similar a lo reportado en los diferentes estudios (77%).

Impacto de la auto - percepción de imagen corporal en sujetos con VIH y lipoatrofia facial.

La lipoatrofia facial es uno de los efectos secundarios que con más frecuencia se presenta y afecta la calidad de vida del paciente con VIH que recibe tratamiento antiretroviral. Metodología: Estudio observacional de corte transversal que involucró 126 sujetos, a quienes se aplicó una encuesta semi-estructurada para determinar cómo percibe el paciente que la lipoatrofia facial lo afecta en áreas afectiva, social, laboral y ocupacional; evaluar la percepción de la imagen corporal; caracterizar sociodemográficamente; determinar la prevalencia de lipoatrofia facial y establecer si hay diferencias de percepción de la imagen corporal según la caracterización sociodemográfica. Resultados: La Prevalencia de lipoatrofia facial fue del 57.1%. El grado de satisfacción en cuanto a apariencia física tuvo un promedio de 5.01±2.69. El 88.7% y 80.3% de los pacientes evaluados sintieron tristeza y frustración con su apariencia respectivamente. El 53.5% y el 42.9% informaron menos oportunidades laborales y educativas. La orientación sexual reportada con mayor frecuencia fue homosexualidad. No hubo diferencias estadísticamente significativas entre el grado de satisfacción de apariencia con aspectos sociodemográficos excepto en pacientes que recibieron apoyo psicológico. Conclusión: Primer estudio en el país que evalúa el impacto de la lipoatrofia facial en pacientes con VIH y tratamiento antiretroviral. Aunque la presencia de lipoatrofia facial sobre la cotidianidad no es estadísticamente significativa, si resulta trascendental pues existen porcentajes importantes de emociones y alteraciones psicológicas que afectan directamente a estos sujetos en las áreas afectiva, social, laboral y ocupacional. Se hace necesaria la realización de más estudios que permitan obtener mayor de evidencia.

Recognition of static and dynamic facial expressions: Influences of sex, type and intensity of emotion

Ecological validity of static and intense facial expressions in emotional recognition has been questioned. Recent studies have recommended the use of facial stimuli more compatible to the natural conditions of social interaction, which involves motion and variations in emotional intensity. In this study, we compared the recognition of static and dynamic facial expressions of happiness, fear, anger and sadness, presented in four emotional intensities (25 %, 50 %, 75 % and 100 %). Twenty volunteers (9 women and 11 men), aged between 19 and 31 years, took part in the study. The experiment consisted of two sessions in which participants had to identify the emotion of static (photographs) and dynamic (videos) displays of facial expressions on the computer screen. The mean accuracy was submitted to an Anova for repeated measures of model: 2 sexes x [2 conditions x 4 expressions x 4 intensities]. We observed an advantage for the recognition of dynamic expressions of happiness and fear compared to the static stimuli (p < .05). Analysis of interactions showed that expressions with intensity of 25 % were better recognized in the dynamic condition (p < .05). The addition of motion contributes to improve recognition especially in male participants (p < .05). We concluded that the effect of the motion varies as a function of the type of emotion, intensity of the expression and sex of the participant. These results support the hypothesis that dynamic stimuli have more ecological validity and are more appropriate to the research with emotions.

Gender differences among undergraduates in the recognition of emotional facial expressions

The perceptive accuracy of university students was compared between men and women, from sciences and humanities courses, to recognize emotional facial expressions. emotional expressions have had increased interest in several areas involved with human interaction, reflecting the importance of perceptive skills in human expression of emotions for the effectiveness of communication. Two tests were taken: one was a quick exposure (0.5 s) of 12 faces with an emotional expression, followed by a neutral face. subjects had to tell if happiness, sadness, anger, fear, disgust or surprise was flashed, and each emotion was shown twice, at random. on the second test 15 faces with the combination of two emotional expressions were shown without a time limit, and the subject had to name one of the emotions of the previous list. in this study, women perceived sad expressions better while men realized more happy faces. there was no significant difference in other emotions detection like anger, fear, surprise, disgust. Students of humanities and sciences areas of both sexes, when compared, had similar capacities to perceive emotional expressions

Identi???cation of degrees of anxiety in children with three- and ???ve-face facial scales

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Facial feature extraction and selection by Gabor wavelets and boosting

In this paper, we present a feature selection approach based on Gabor wavelet feature and boosting for face verification. By convolution with a group of Gabor wavelets, the original images are transformed into vectors of Gabor wavelet features. Then for individual person, a small set of significant features are selected by the boosting algorithm from a large set of Gabor wavelet features. The experiment results have shown that the approach successfully selects meaningful and explainable features for face verification. The experiments also suggest that for the common characteristics such as eyes, noses, mouths may not be as important as some unique characteristic when training set is small. When training set is large, the unique characteristics and the common characteristics are both important.

Intact imitation of emotional facial actions in autism spectrum conditions.

It has been proposed that there is a core impairment in autism spectrum conditions (ASC) to the mirror neuron system (MNS): If observed actions cannot be mapped onto the motor commands required for performance, higher order sociocognitive functions that involve understanding another person's perspective, such as theory of mind, may be impaired. However, evidence of MNS impairment in ASC is mixed. The present study used an 'automatic imitation' paradigm to assess MNS functioning in adults with ASC and matched controls, when observing emotional facial actions. Participants performed a pre-specified angry or surprised facial action in response to observed angry or surprised facial actions, and the speed of their action was measured with motion tracking equipment. Both the ASC and control groups demonstrated automatic imitation of the facial actions, such that responding was faster when they acted with the same emotional expression that they had observed. There was no difference between the two groups in the magnitude of the effect. These findings suggest that previous apparent demonstrations of impairments to the MNS in ASC may be driven by a lack of visual attention to the stimuli or motor sequencing impairments, and therefore that there is, in fact, no MNS impairment in ASC. We discuss these findings with reference to the literature on MNS functioning and imitation in ASC, as well as theories of the role of the MNS in sociocognitive functioning in typical development.

Theory of mind and attentional bias to facial emotional expressions: A preliminary study

Theory of mind ability has been associated with performance in interpersonal interactions and has been found to influence aspects such as emotion recognition, social competence, and social anxiety. Being able to attribute mental states to others requires attention to subtle communication cues such as facial emotional expressions. Decoding and interpreting emotions expressed by the face, especially those with negative valence, are essential skills to successful social interaction. The current study explored the association between theory of mind skills and attentional bias to facial emotional expressions. According to the study hypothesis, individuals with poor theory of mind skills showed preferential attention to negative faces over both non-negative faces and neutral objects. Tentative explanations for the findings are offered emphasizing the potential adaptive role of vigilance for threat as a way of allocating a limited capacity to interpret others’ mental states to obtain as much information as possible about potential danger in the social environment.

Interpretation of infant facial expression in the context of maternal postnatal depression

Postnatal maternal depression is associated with difficulties in maternal responsiveness. As most signals arising from the infant come from facial expressions one possible explanation for these difficulties is that mothers with postnatal depression are differentially affected by particular infant facial expressions. Thus, this study investigates the effects of postnatal depression on mothers’ perceptions of infant facial expressions. Participants (15 controls, 15 depressed and 15 anxious mothers) were asked to rate a number of infant facial expressions, ranging from very positive to very negative. Each face was shown twice, for a short and for a longer period of time in random order. Results revealed that mothers used more extreme ratings when shown the infant faces (i.e. more negative or more positive) for a longer period of time. Mothers suffering from postnatal depression were more likely to rate negative infant faces shown for a longer period more negatively than controls. The differences were specific to depression rather than an effect of general postnatal psychopathology—as no differences were observed between anxious mothers and controls. There were no other significant differences in maternal ratings of infant faces showed for short periods or for positive or neutral valence faces of either length. The findings that mothers with postnatal depression rate negative infant faces more negatively indicate that appraisal bias might underlie some of the difficulties that these mothers have in responding to their own infants signals.