Microneurovascular free muscle transfer with cross-over nerve grafts in facial reanimation

Microneurovascular free muscle transfer with cross-over nerve grafts in facial reanimation Loss of facial symmetry and mimetic function as seen in facial paralysis has an enormous impact on the psychosocial conditions of the patients. Patients with severe long-term facial paralysis are often reanimated with a two-stage procedure combining cross-facial nerve grafting, and 6 to 8 months later with microneurovascular (MNV) muscle transfer. In this thesis, we recorded the long-term results of MNV surgery in facial paralysis and observed the possible contributing factors to final functional and aesthetic outcome after this procedure. Twenty-seven out of forty patients operated on were interviewed, and the functional outcome was graded. Magnetic resonance imaging (MRI) of MNV muscle flaps was done, and nerve graft samples (n=37) were obtained in second stage of the operation and muscle biopsies (n=18) were taken during secondary operations.. The structure of MNV muscles and nerve grafts was evaluated using histological and immunohistochemical methods ( Ki-67, anti-myosin fast, S-100, NF-200, CD-31, p75NGFR, VEGF, Flt-1, Flk-1). Statistical analysis was performed. In our studies, we found that almost two-thirds of the patients achieved good result in facial reanimation. The longer the follow-up time after muscle transfer the weaker was the muscle function. A majority of the patients (78%) defined their quality of life improved after surgery. In MRI study, the free MNV flaps were significantly smaller than originally. A correlation was found between good functional outcome and normal muscle structure in MRI. In muscle biopsies, the mean muscle fiber diameter was diminished to 40% compared to control values. Proliferative activity of satellite cells was seen in 60% of the samples and it tended to decline with an increase of follow-up time. All samples showed intramuscular innervation. Severe muscle atrophy correlated with prolonged intraoperative ischaemia. The good long-term functional outcome correlated with dominance of fast fibers in muscle grafts. In nerve grafts, the mean number of viable axons amounted to 38% of that in control samples. The grafted nerves characterized by fibrosis and regenerated axons were thinner than in control samples although they were well vascularized. A longer time between cross facial nerve grafting and biopsy sampling correlated with a higher number of viable axons. P75Nerve Growth Factor Receptor (p75NGFR) was expressed in every nerve graft sample. The expression of p75NGFR was lower in older than in younger patients. A high expression of p75NGFR was often seen with better function of the transplanted muscle. In grafted nerve Vascular Endothelial Growth Factor (VEGF) and its receptors were expressed in nervous tissue. In conclusion, most of the patients achieved good result in facial reanimation and were satisfied with the functional outcome. The mimic function was poorer in patients with longer follow-up time. MRI can be used to evaluate the structure of the microneurovascular muscle flaps. Regeneration of the muscle flaps was still going on many years after the transplantation and reinnervation was seen in all muscle samples. Grafted nerves were characterized by fibrosis and fewer, thinner axons compared to control nerves although they were well vascularized. P75NGFR and VEGF were expressed in human nerve grafts with higher intensity than in control nerves which is described for the first time.

Peripheral facial palsy : Grading, Etiology, and Melkersson-Rosenthal Syndrome

The objective of this study was to assess the utility of two subjective facial grading systems, to evaluate the etiologic role of human herpesviruses in peripheral facial palsy (FP), and to explore characteristics of Melkersson-Rosenthal syndrome (MRS). Intrarater repeatability and interrater agreement were assessed for Sunnybrook (SFGS) and House-Brackmann facial grading systems (H-B FGS). Eight video-recorded FP patients were graded in two sittings by 26 doctors. Repeatability for SFGS was from good to excellent and agreement between doctors from moderate to excellent by intraclass correlation coefficient and coefficient of repeatability. For H-B FGS, repeatability was from fair to good and agreement from poor to fair by agreement percentage and kappa coefficients. Because SFGS was at least as good in repeatability as H-B FGS and showed more reliable results in agreement between doctors, we encourage the use of SFGS over H-B FGS. Etiologic role of human herpesviruses in peripheral FP was studied by searching DNA of herpes simplex virus (HSV) -1 and -2, varicella-zoster virus (VZV), human herpesvirus (HHV) -6A, -6B, and -7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) by PCR/microarray methods in cerebrospinal fluid (CSF) of 33 peripheral FP patients and 36 controls. Three patients and five controls had HHV-6 or -7 DNA in CSF. No DNA of HSV-1 or -2, VZV, EBV, or CMV was found. Detecting HHV-7 and dual HHV-6A and -6B DNA in CSF of FP patients is intriguing, but does not allow etiologic conclusions as such. These DNA findings in association with FP and the other diseases that they accompanied require further exploration. MRS is classically defined as a triad of recurrent labial or oro-facial edema, recurrent peripheral FP, and plicated tongue. All three signs are present in the minority of patients. Edema-dominated forms are more common in the literature, while MRS with FP has received little attention. The etiology and true incidence of MRS are unknown. Characteristics of MRS were evaluated at the Departments of Otorhinolaryngology and Dermatology focusing on patients with FP. There were 35 MRS patients, 20 with FP and they were mailed a questionnaire (17 answered) and were clinically examined (14 patients). At the Department of Otorhinolaryngology, every MRS patient had FP and half had the triad form of MRS. Two patients, whose tissue biopsies were taken during an acute edema episode, revealed nonnecrotizing granulomatous findings typical for MRS, the other without persisting edema and with symptoms for less than a year. A peripheral blood DNA was searched for gene mutations leading to UNC-93B protein deficiency predisposing to HSV-1 infections; no gene mutations were found. Edema in most MRS FP patients did not dominate the clinical picture, and no progression of the disease was observed, contrary to existing knowledge. At the Department of Dermatology, two patients had triad MRS and 15 had monosymptomatic granulomatous cheilitis with frequent or persistent edema and typical MRS tissue histology. The clinical picture of MRS varied according to the department where the patient was treated. More studies from otorhinolaryngology departments and on patients with FP would clarify the actual incidence and clinical picture of the syndrome.

Mesh Processing for Computerized Facial Anthropometry

Understanding of the shape and size of different features of the human body from scanned data is necessary for automated design and evaluation of product ergonomics. In this paper, a computational framework is presented for automatic detection and recognition of important facial feature regions, from scanned head and shoulder polyhedral models. A noise tolerant methodology is proposed using discrete curvature computations, band-pass filtering, and morphological operations for isolation of the primary feature regions of the face, namely, the eyes, nose, and mouth. Spatial disposition of the critical points of these isolated feature regions is analyzed for the recognition of these critical points as the standard landmarks associated with the primary facial features. A number of clinically identified landmarks lie on the facial midline. An efficient algorithm for detection and processing of the midline, using a point sampling technique, is also presented. The results obtained using data of more than 20 subjects are verified through visualization and physical measurements. A color based and triangle skewness based schemes for isolation of geometrically nonprominent features and ear region are also presented. [DOI: 10.1115/1.3330420]

The role of polar and facial amphipathic character in determining lipopolysaccharide-binding properties in synthetic cationic peptides

Two series of peptides, designated K and NK were synthesized and tested for lipid A binding and neutralizing properties. K-2, which has an 11-residue amphiphilic core, and a branched N-terminus bearing two branched lysinyl residues does not bind lipid A, while NK2, also with an 11-residue amphiphilic core comprised entirely of non-ionizable residues, and a similarly branched, cationic N-terminus, binds lipid A very weakly. Both peptides do not inhibit lipopolysaccharide (LPS) activity in the Limulus assay, nor do they inhibit LPS-induced TNF-alpha and NO production in 5774 cells. These results are entirely unlike a homologous peptide with an exclusively hydrophobic core whose LPS-binding and neutralizing properties are very similar to that of polymyxin B [David SA, Awasthi SK, Wiese A et al. Characterization of the interactions of a polycationic, amphiphilic, terminally branched oligopeptide with lipid A and lipopolysaccharide from the deep rough mutant of Salmonella minnesota. J Endotoxin Res 1996; 3: 369-379]. These data suggest that a clear segregation of charged and apolar domains is crucial in molecules designed for purposes of LPS sequestration and that head-tail (polar) orientation of the cationic/hydrophobic regions is preferable to molecules with mixed or facial cationic/amphipathic character.

3D shape extraction of human face in presence of facial hair: A profilometric approach

The increasing use of 3D modeling of Human Face in Face Recognition systems, User Interfaces, Graphics, Gaming and the like has made it an area of active study. Majority of the 3D sensors rely on color coded light projection for 3D estimation. Such systems fail to generate any response in regions covered by Facial Hair (like beard, mustache), and hence generate holes in the model which have to be filled manually later on. We propose the use of wavelet transform based analysis to extract the 3D model of Human Faces from a sinusoidal white light fringe projected image. Our method requires only a single image as input. The method is robust to texture variations on the face due to space-frequency localization property of the wavelet transform. It can generate models to pixel level refinement as the phase is estimated for each pixel by a continuous wavelet transform. In cases of sparse Facial Hair, the shape distortions due to hairs can be filtered out, yielding an estimate for the underlying face. We use a low-pass filtering approach to estimate the face texture from the same image. We demonstrate the method on several Human Faces both with and without Facial Hairs. Unseen views of the face are generated by texture mapping on different rotations of the obtained 3D structure. To the best of our knowledge, this is the first attempt to estimate 3D for Human Faces in presence of Facial hair structures like beard and mustache without generating holes in those areas.

pi.-Facial selectivities in cycloadditions to norbornyl- and norbornenyl-fused p-benzoquinones

The stereochemistry of the Diels-Alder cycloaddition of several dienes to the facially perturbed dienophiles 2,3-norbornenobenzoquinone (3) and 2,3-norbornanobenzoquinone (4) has been examined. Unambiguous structural proof for the adducts formed has been obtained from complementary 'H and I3C NMR spectral data and in two cases through X-ray crystal structure determination. While 1,3-~yclopentadiene1, ,3-~yclohexadienea, nd cyclooctatetraene exhibit preference for addition to 3 from the bottom side, the stereochemical outcome is reversed in their response to 4.1,3-DiphenyIisobenzofuran and 1,2,3,4-tetrachloro-5,5-dimethoxycyclopentadieenneg aged 3 from the top side with marked selectivity, which is further enhanced in their reaction with 4. The observed stereoselectivities seem to be essentially controlled by steric interactons at the transition state. Model calculations provide support for this interpretation.

A simple computational model for predicting .pi.-facial selectivity in reductions of sterically unbiased ketones. Relative importance of electrostatic and orbital interactions

Various factore controlling the preferred facial selectivity in the reductions of a number of sterically unbiased ketones have been evaluated using a semiempirical MO procedure. MNDO optimized geometries do not reveal any significant ground-state distortions which can be correlated with the observed face selectivities. Electrostatic effecta due to an approaching reagent were modeled by placing a test negative charge at a fixed distance from the carbonyl carbon on each of the two faces. A second series of calculations was carried out using the hydride ion as a test nucleophile. The latter calculations effectively include orbital interactions involving the u and u* orbitals of the newly formed bond in the reaction. The computed energy differences with the charge model are generally much larger compared to those with the hydride ion. However, both models lead to predictions which are qualitatively consistent with the experimentally determined facial preferences for most of the systems. Thus, electrostatic interactions between the nucleophile and the substrate seem to effectively determine the face selectivities in these molecules. However, there are a few exceptions in which orbital interactions are found to contribute significantly and occasionally reverse the preference dictated by electrostatic effecta. The remarkable succew of the hydride model calculations, in spite of retaining the unperturbed geometries of the substrates, points to the unimportance of torsional effeds and orbital distortions associated with the pyramidalized carbonyl unit in the transition state in most of the substrates considered. Additional experimental results are reported which provide useful calibration for the present computational approach.

Ground state geometric distortions Image distal substituent effects in determining the β-facial selectivity in 7-norbornenones

The X-ray structure of Image and MNDO optimized geometries of related 7-norbornenone derivatives show a clear tilt of the carbonyl bridge away from the C=C double bond. The preferred reduction from the more hindered face of the diester reveals the electron/electrostatic origin of π - facial selectivity in these systems. X-ray structure and MNDO calculations reveal the dominance of electronic effects in determining the π-facial selectivity in 4a.

Facial Coordination in BIS[BIS(Benzimidazol-2-Ylmethyl)Amine]Copper(II) Perchlorate Dihydrate - Synthesis, Structure, Spectra and Redox Behavior

The 1:1 and 1:2 cooper(II) complexes with the tridentate compound bis(benzimidazol-2-ylmethyl)amine (L(1)) and its benzimidazole (L(2)) and amine (L(3)) N-methyl-substituted derivatives have been prepared and their spectroscopic properties studied. While the 1:1 complexes are of the type CuLX(2) nH(2)O (X = C/O-4(-), NO3-, Cl- or Br-), the 1:2 complexes are of the type CuL(2) (ClO4)(2) nH(2)O (L = L(1) or L(3), n = 0-4). In all these complexes L acts as a tridentate ligand with the amine nitrogen and both the benzimidazole nitrogens co-ordinating to Cu-II. The complex [CuL(2)(1)][ClO4](2) 2H(2)O crystallises in the monoclinic space group P2(1)/c with a = 9.828(2), b = 9.546(2) and c = 19.906(2) Angstrom and beta = 95.71(1)degrees, for Z = 2. The R value is 0.0635 for 2180 significant reflections. The copper(II) ion has an elongated octahedral geometry with four equatorial benzimidazole and two long-distance axial amine N donors. The Cu-N-bzim and Cu-N-amine distances are 2.011(4) and 2.597(6) Angstrom respectively. Factors favouring facial co-ordination to tridentate ligands are discussed. The 1:1 complexes involve meridonal co-ordination of the ligands, with square-based geometry as revealed by ligand-field and EPR spectral properties. The NMe substitution as in CuL(3)(ClO4)(2) confers low V ($) over tilde$$(max) and high E(1/2) for the cu(II)-Cu-I couple. Most of the 1:1 complexes are less reversible but exhibit E(1/2) values more positive than those of the corresponding 1:2 complexes.

Automatic Recognition of Facial Features and Landmarking of Digital Human Head

Ergonomic design of products demands accurate human dimensions-anthropometric data. Manual measurement over live subjects, has several limitations like long time, required presence of subjects for every new measurement, physical contact etc. Hence the data currently available is limited and anthropometric data related to facial features is difficult to obtain. In this paper, we discuss a methodology to automatically detect facial features and landmarks from scanned human head models. Segmentation of face into meaningful patches corresponding to facial features is achieved by Watershed algorithms and Mathematical Morphology tools. Many Important physiognomical landmarks are identified heuristically.

Facial selectivities in the nucleophilic additions of 2,3-unsaturated 3-arylsulfinyl pyranosides

2,3-Unsaturated 3-arylsulfinyl pyranosides undergo nucleophilic additions at C-2, with facial selectivities depending on the nucleophile and the substituent on sulfinyl sulfur. The reactions of such sugar vinyl sulfoxides lead to the addition of nucleophile preferring an axial orientation at C-2, with concomitant formation of an allylic bond at C-3 to C-4. This trend in the addition pattern is observed for primary amine, carbon and sulfur nucleophiles, whereas secondary amines prefer an equatorial addition at C-2. The effect of p-tolylthio-versus (p-isopropylphenyl)thio vinyl sulfoxide is that the equatorial nucleophilic addition is preferred even more with the latter vinyl sulfoxide. (C) 2013 Published by Elsevier Ltd.