Fractures of the nose and other facial bones are a relatively common and potentially serious injury in soccer players, reports a Brazilian study in Plastic and Reconstructive Surgery — Global Open , the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).On the eve of the 2014 World Cup, a group of Brazilian plastic surgeons review their experience with soccer-related facial fractures requiring surgery. Dr. Dov Charles Goldenberg, MD, PhD, of University of So Paulo and colleagues write, “Due to exposure and the lack of protection for the face, the occasional maxillofacial trauma sustained during soccer games often entails serious facial injuries requiring hospital admissions and invasive procedures.”Soccer Players at Risk of Nasal and Other Facial FracturesThe researchers assembled data on 45 patients undergoing surgical treatment for soccer-related facial fractures at two large university hospital centers in So Paulo between 2000 and 2013. The 45 soccer injuries accounted for two percent of surgically treated facial fractures during that time. Forty-four of the patients were male; the average age was 28 years. All of the injured players were amateurs.The nose and upper jaw (maxilla) accounted for 35 percent of fractures and the cheekbone (zygomatic bone) for another 35 percent. Most of the remaining fractures were of the lower jaw (mandible) and eye socket (orbit). Eighty-seven percent of the injuries were caused by collision with another player; the rest occurred when the player was struck by the ball.Nasal fractures were treated by repositioning (reducing) the fractured bones to their proper place and splinting until they healed. Other types of facial fractures required open surgery and internal fixation (plates, screws) to reposition the bones. The patients remained in the hospital for about five days on average, and were told they could return to play after six to eight weeks of healing.Emphasis on Awareness and Examination to Detect Soccer-Related FracturesThe results are consistent with previous studies of soccer-related facial injuries. …Read more
Researchers at The Ohio State University have found a way for computers to recognize 21 distinct facial expressions — even expressions for complex or seemingly contradictory emotions such as “happily disgusted” or “sadly angry.”In the current issue of the Proceedings of the National Academy of Sciences, they report that they were able to more than triple the number of documented facial expressions that researchers can now use for cognitive analysis.”We’ve gone beyond facial expressions for simple emotions like ‘happy’ or ‘sad.’ We found a strong consistency in how people move their facial muscles to express 21 categories of emotions,” said Aleix Martinez, a cognitive scientist and associate professor of electrical and computer engineering at Ohio State. “That is simply stunning. That tells us that these 21 emotions are expressed in the same way by nearly everyone, at least in our culture.”The resulting computational model will help map emotion in the brain with greater precision than ever before, and perhaps even aid the diagnosis and treatment of mental conditions such as autism and post-traumatic stress disorder (PTSD).Since at least the time of Aristotle, scholars have tried to understand how and why our faces betray our feelings — from happy to sad, and the whole range of emotions beyond. Today, the question has been taken up by cognitive scientists who want to link facial expressions to emotions in order to track the genes, chemicals, and neural pathways that govern emotion in the brain.Until now, cognitive scientists have confined their studies to six basic emotions — happy, sad, fearful, angry, surprised and disgusted — mostly because the facial expressions for them were thought to be self-evident, Martinez explained.But deciphering a person’s brain functioning with only six categories is like painting a portrait with only primary colors, Martinez said: it can provide an abstracted image of the person, but not a true-to-life one.What Martinez and his team have done is more than triple the color palette — with a suite of emotional categories that can be measured by the proposed computational model and applied in rigorous scientific study.”In cognitive science, we have this basic assumption that the brain is a computer. So we want to find the algorithm implemented in our brain that allows us to recognize emotion in facial expressions,” he said. “In the past, when we were trying to decode that algorithm using only those six basic emotion categories, we were having tremendous difficulty. Hopefully with the addition of more categories, we’ll now have a better way of decoding and analyzing the algorithm in the brain.”They photographed 230 volunteers — 130 female, 100 male, and mostly college students — making faces in response to verbal cues such as “you just got some great unexpected news” (“happily surprised”), or “you smell a bad odor” (“disgusted”). In the resulting 5,000 images, they painstakingly tagged prominent landmarks for facial muscles, such as the corners of the mouth or the outer edge of the eyebrow. They used the same method used by psychologist Paul Ekman, the scientific consultant for the television show “Lie to Me.” Ekman’s Facial Action Coding System, or FACS, is a standard tool in body language analysis.They searched the FACS data for similarities and differences in the expressions, and found 21 emotions — the six basic emotions, as well as emotions that exist as combinations of those emotions, such as “happily surprised” or “sadly angry.”The researchers referred to these combinations as “compound emotions.” While “happily surprised” can be thought of as an expression for receiving unexpected good news, “sadly angry” could be the face we make when someone we care about makes us angry.The model was able to determine the degree to which the basic emotions and compound emotions were characterized by a particular expression.For example, the expression for happy is nearly universal: 99 percent of the time, study participants expressed happiness by drawing up the cheeks and stretching the mouth in a smile. Surprise was also easily detected: 92 percent of the time, surprised participants opened their eyes wide and dropped their mouth open.”Happily surprised” turned out to be a compound of the expressions for “happy” and “surprised.” About 93 percent of the time, the participants expressed it the same way: with the wide-open eyes of surprise and the raised cheeks of happiness — and a mouth that was a hybrid of the two — both open and stretched into a smile.The computer model also gives researchers a tool to understand seemingly contradictory emotions. …Read more
Aug. 30, 2013 — A new study finds that sleep deprivation affects facial features such as the eyes, mouth and skin, and these features function as cues of sleep loss to other people.Results show that the faces of sleep-deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes and darker circles under the eyes. Sleep deprivation also was associated with paler skin, more wrinkles or fine lines, and more droopy corners of the mouth. People also looked sadder when sleep-deprived than after normal sleep, and sadness was related to looking fatigued.”Since faces contain a lot of information on which humans base their interactions with each other, how fatigued a person appears may affect how others behave toward them,” said Tina Sundelin, MSc, lead author and doctoral student in the department of psychology at Stockholm University in Stockholm, Sweden. “This is relevant not only for private social interactions, but also official ones such as with health care professionals and in public safety.”The study, which appears in the September issue of the journal Sleep, was conducted at the Karolinska Institute in Stockholm, Sweden. Ten subjects were photographed on two separate occasions: after eight hours of normal sleep and after 31 hours of sleep deprivation. The photographs were taken in the laboratory at 2:30 p.m. on both occasions. Forty participants rated the 20 facial photographs with respect to 10 facial cues, fatigue and sadness.According to the authors, face perception involves a specialized neuronal network and is one of the most developed visual perceptual skills in humans. Facial appearance can affect judgments of attributes such as trustworthiness, aggressiveness and competence.Read more
Aug. 27, 2013 — Botox is best known as a cosmetic treatment for frown lines, but the drug also effectively treats the after effects of Bell’s palsy and other serious facial nerve problems.Bell’s palsy results from damage to the facial nerve that controls muscles on one side of the face. Ear-nose-throat surgeon Dr. Matthew Kircher of Loyola University Medical Center is giving patients Botox injections to treat facial nerve disorders that sometimes occur after Bell’s palsy, including unwanted facial movements known as synkinesis.Botox injections work by weakening or paralyzing certain muscles or by temporarily blocking the nerve input into the muscles.Facial synkinesis is the involuntary movement of one set of muscles when the patient tries to move another set of muscles. For example, when the patient blinks, the mouth smiles or grimaces.Botox can improve the symmetry of the face and reduce muscle contractures and spasms. Botox also is effective for platysmal banding — verticle lines that develop in the neck as a result of muscle contractions.Kircher said he starts out conservatively, treating patients with dilute doses. After seeing how well the patient does, Kircher adjusts the dose if necessary.Botox is not a cure. The drug wears off after three or four months, so patients need repeat injections.”While we can never make the face perfect, we have found Botox to be extremely effective,” Kircher said. “It can make a huge difference in patients’ lives.”Kircher is an assistant professor in the Department of Otolaryngology of Loyola University Chicago Stritch School of Medicine.Read more
Mar. 23, 2011 — Patients with facial paralysis who underwent surgical treatment for a condition that leaves them unable to completely close their eyes reported improvement in comfort around the eyes and overall quality of life, according to a report in the March issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
The inability to close the eye can be a devastating result of facial paralysis. “The resulting loss of corneal protection can lead to exposure keratitis [inflammation of the cornea], corneal ulceration, and potentially permanently vision loss,” the authors write as background information in the article. “Eyelid weight placement, lower eyelid suspension, and brow ptosis [drooping or sagging of the eyelid] correction are frequently performed to protect the eye.”
Douglas K. Henstrom, M.D., of Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, and colleagues measured and reported the change in quality of life (QOL) after surgical periocular treatment. The researchers used the Facial Clinimetric Evaluation (FaCE) scale — a patient-based system that measures impairment and disability in facial paralysis and represents a valuable adjunct to traditional physician-graded scales for evaluating QOL issues in patients affected by facial paralysis.
From March 2009 to May 2010, 49 patients with paralytic inability to completely close the eye were treated at the Facial Nerve Center at Massachusetts Eye and Ear Infirmary, Boston. Thirty-seven of the patients completed preoperative and postoperative FaCE surveys.
“Overall QOL, measured by the FaCE instrument, significantly improved following static periocular treatment,” the authors report. “Mean FaCE scores increased from 44.1 to 52.7.”
“Patients also reported a significant decrease in the amount of time their eye felt dry, irritated, or scratchy,” the authors write.
Two patients experienced localized cellulitis (a bacterial infection of the skin and tissues beneath the skin) in reaction to the eyelid weight. There was one eyelid weight extrusion.
“In the overall treatment paradigm for patients with facial paralysis, treating the eye using this modality is simple, and not only improves corneal protection but also yields a significant subjective benefit,” the authors conclude.Read more
May 17, 2011 — Transferring a segment of muscle from the thigh appears to help restore the ability to smile in children with facial paralysis just as it does in adults, according to a report in the May issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. The article is part of a theme issue focusing on facial plastic surgery in the pediatric population.
Facial paralysis often disrupts the ability to smile. In pediatric patients, this can be especially problematic, according to background information in the article. Surgery to repair the affected area may generate failure rates as high as 30 percent. But not acting can also harm children, the authors write: “The inability to express oneself via facial movement can have serious social consequences because it is the dominant nonverbal expression of happiness and contentment. The additional functional and esthetic issues associated with facial paralysis can be devastating to a child’s development, or to their recovery following treatment for a central nervous system (CNS) tumor resulting in facial paralysis.”
Tessa A. Hadlock, M.D., and colleagues from the Massachusetts Eye and Ear Infirmary, Boston , evaluated pediatric patients undergoing free gracilis transfer (an operation in which part of the gracilis muscle in the thigh is transplanted into facial muscles). They compared 17 children with facial paralysis who had a total of 19 surgeries to 17 adults who also had 19 of the same surgeries. The authors explain that they wanted to determine failure rates in children, discover how much smiles and quality of life (QOL) improved after the operation, and examine whether these patients’ experiences differed from those of adults. “These data were sought under the hypothesis that establishing a QOL benefit would help clinicians and families make more insightful decisions regarding surgery.”
The main measure of smile improvement was the extent of commissure excursion (movement of the corners of the mouth). The average change in pediatric patients was 8.8 mm, which is similar to the change that adults experienced. The researchers determined that the surgery failed in two of the pediatric patients (11%) versus in four of the adults (21 percent). Thirteen children completed both a pre-operative and a post-operative QOL measure, the Facial Clinimetric Evaluation (FaCE); the results show a statistically significant QOL improvement after the free gracilis transfer.
“In conclusion,” the authors write, “free gracilis for smile reanimation in children carries an acceptable failure rate, significantly improves smiling, and seems to improve QOL with respect to facial function.” They add, “Early facial reanimation provides the advantage of permitting children to express themselves nonverbally through smiling and may in fact lead to fewer negative social consequences as they interact with peers.”Read more
Feb. 25, 2013 — Patients with Bell palsy who received acupuncture that achieves de qi, a type of intense stimulation, had improved facial muscle recovery, reduced disability and better quality of life, according to a randomized controlled trial published in CMAJ (Canadian Medical Association Journal).
Bell palsy is sudden onset of facial paralysis that is usually temporary, resolving within weeks or months, although it can sometimes be permanent.
Acupuncture is used to treat a variety of conditions and is gaining acceptance worldwide. De qi is a combination of sensations stimulated by manipulation of acupuncture needles — soreness, tingling, coolness, warmth and others radiating at the insertion points — but has not been validated by randomized controlled trials.
“There is a long-held belief in the traditional theory and clinical practice of acupuncture that the intensity of the stimulus must reach a threshold to elicit de qi, which plays a pivotal role in achieving the best therapeutic effects,” writes Dr. Wei Wang, Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Wuhan, Hubei, China, with coauthors.
In a randomized controlled trial with 338 patients, Chinese researchers sought to understand the efficacy of acupuncture with weak stimulation or strong (de qi) stimulation. The trial, conducted at 11 tertiary hospitals in China, involved 15 experienced acupuncturists who administered acupuncture to the de qi group (167 people), which received intense stimulation, and the control group (171 people), which received needles but no stimulation. Patients’ facial expressions, a marker of facial-nerve function, were rated on a 6-point scale and videotaped to ensure consistent findings across hospital sites.
Six months after randomization, facial-nerve function, disability and quality of life were better in patients in the de qi group than in the control group.
“We found evidence that acupuncture with de qi improved facial muscle recovery, disability and quality of life among patients with Bell palsy. Stronger intensity of de qi was associated with better therapeutic effects.”
“De qi and its related techniques should be properly appreciated in acupuncture practice and research, and should be considered for inclusion in clinical guidelines for acupuncture,” the authors conclude.Read more