Facial Reanimation Utilizing Combined Orthodromic Temporalis Muscle Flap and End-to-Side Cross-Face Nerve Grafts

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

Inflammation and cancer: role of Annexin A1 and FPR2/ALX in proliferation and metastasis in human laryngeal squamous cell carcinoma

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

How do laryngeal and respiratory functions contribute to differentiate actors/actresses and untrained voices?

Purpose. The present study aimed to compare actors/actresses's voices and vocally trained subjects through aerodynamic and electroglottographic (EGG) analyses. We hypothesized that glottal and breathing functions would reflect technical and physiological differences between vocally trained and untrained subjects.Methods. Forty participants with normal voices participated in this study (20 professional theater actors and 20 untrained participants). In each group, 10 male and 10 female subjects were assessed. All participants underwent aerodynamic and EGG assessment of voice. From the Phonatory Aerodynamic System, three protocols were used: comfortable sustained phonation with EGG, voice efficiency with EGG, and running speech. Contact quotient was calculated from EGG. All phonatory tasks were produced at three different loudness levels. Mean sound pressure level and fundamental frequency were also assessed. Univariate, multivariate, and correlation statistical analyses were performed.Results. Main differences between vocally trained and untrained participants were found in the following variables: mean sound pressure level, phonatory airflow, subglottic pressure, inspiratory airflow duration, inspiratory airflow, and inspiratory volume. These variables were greater for trained participants. Mean pitch was found to be lower for trained voices.Conclusions. The glottal source seemed to have a weak contribution when differentiating the training status in speaking voice. More prominent changes between vocally trained and untrained participants are demonstrated in respiratory-related variables. These findings may be related to better management of breathing function (better breath support).

Mesenchymal stem cells engrafted in a fibrin scaffold stimulate Schwann cell reactivity and axonal regeneration following sciatic nerve tubulization

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of low-level laser therapy (LLLT) on peripheral nerve regeneration using fibrin glue derived from snake venom

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)