• Archives of Plastic Surgery
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• v.45 no.3
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• pp.222-228
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• 2018

Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0-1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.446-451
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• 2023

Background Elderly patients often have complications of blepharoptosis surgery that can result in the appearance or exacerbation of superficial punctate keratopathy (SPK). However, postoperative changes to SPK status have not been previously reported. We used subjective assessment of symptoms and measurement of SPK scale classification to investigate the safety and efficacy of blepharoptosis surgery in elderly patients. Methods Included in this prospective study were 22 patients (44 eyes) with bilateral blepharoptosis that underwent surgery. Patients comprised 8 males and 14 females with a mean (±standard deviation) age of 75.7 ± 8.2 years (range: 61-89). Blepharoptosis surgery consisted of transcutaneous levator advancement and blepharoplasty including resection of soft tissue (skin, subcutaneous tissue, and the orbicularis oculi muscle). Margin reflex distance-1 (MRD-1) measurement, a questionnaire survey of symptoms and SPK scale classification, was administered preoperatively and 3 months postoperatively for evaluation. Results The median MRD-1 was 1 mm preoperatively and 2.5 mm postoperatively, representing a significant postoperative improvement. SPK area and density scores were found to increase when the MRD-1 increase was more than 2.5 mm with surgery. All 10 items on the questionnaire tended have increased scores after surgery, and significant differences were observed in 7 items (poor visibility, ocular fatigue, heavy eyelid, foreign body sensation, difficulty in focusing, headaches, and stiff shoulders). Conclusion Blepharoptosis surgery was found to be a safe and effective way to maintain the increase in MRD-1 within 2.0 mm. Despite the benefits, surgeons must nonetheless be aware that blepharoptosis surgery is a delicate procedure in elderly people.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.77-84
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• 2024

Background: The facial artery is an important blood vessel responsible for supplying the anterior face. Understanding the branching patterns of the facial artery plays a crucial role in various medical specialties such as plastic surgery, dermatology, and oncology. This knowledge contributes to improving the success rate of facial reconstruction and aesthetic procedures. However, debate continues regarding the classification of facial artery branching patterns in the existing literature. Methods: We conducted a comprehensive anatomical study, in which we dissected 102 facial arteries from 52 embalmed and formaldehyde-fixed Vietnamese cadavers at the Anatomy Department, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. Results: Our investigation revealed eight distinct termination points and identified 35 combinations of branching patterns, including seven arterial branching patterns. These termination points included the inferior labial artery, superior labial artery, inferior alar artery, lateral nasal artery, angular artery typical, angular artery running along the lower border of the orbicularis oculi muscle, forehead branch, duplex, and short course (hypoplastic). Notably, the branching patterns of the facial artery displayed marked asymmetry between the left and right sides within the same cadaver. Conclusion: The considerable variation observed in the branching pattern and termination points of the facial artery makes it challenging to establish a definitive classification system for this vessel. Therefore, it is imperative to develop an anatomical map summarizing the major measurements and geometric features of the facial artery. Surgeons and medical professionals involved in facial surgery and procedures must consider the detailed anatomy and relative positioning of the facial artery to minimize the risk of unexpected complications.

• Journal of Electrodiagnosis and Neuromuscular Diseases
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• v.20 no.2
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• pp.84-90
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• 2018

Objective: To assess the correlation between surface electromyography (SEMG) and conventional EMG in patients with facial nerve palsy. Additionally, compare the discomfort and the time required by the patients in two methods. Method: 36 patients with facial palsy were given nerve conduction studies (NCS) via conventional EMG. Then, the peak root mean square (RMS) values were obtained from the SEMG. We also recorded visual analogue scale (VAS), House-Brackmann scale, and the time required for the examination. Results: Pearson's correlation coefficient between the amplitude loss ratio of the RMS values obtained by SEMG compared to the unaffected side (RSEMG) and the amplitude loss ratio of CMAP amplitudes compared to the unaffected side (RCMAP) was 0.567 at the frontalis, 0.456 at the orbicularis oculi, 0.393 at the nasalis, and 0.437 at the orbicularis oris. An increase in RSEMG is positively correlated with an increase in RCMAP. The mean VAS score with conventional EMG was $3.55{\pm}1.42$, whereas that experienced when using SEMG was $0.11{\pm}0.52$ and the mean time required for conventional EMG was $610{\pm}103.84$ seconds, while that required for SEMG was $420{\pm}86.32$ seconds. Conclusion: This study demonstrated a significant positive correlation between facial muscle activities as measured by SEMG and conventional EMG in patients with facial nerve palsy. SEMG has the benefits of being more comfortable and faster when diagnosing facial palsy.

• Journal of Oral Medicine and Pain
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• v.33 no.1
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• pp.85-95
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• 2008

The purpose of this study was to evaluate the effects of oral habits on the muscles of mastication and facial expression by means of two parameters: muscle stiffness and elasticity. 10 healthy, fully-dentate male subjects in their twenties were selected for this study; all had normal Class I occlusal relationships. Muscle stiffness and elasticity were measured with a tactile sensor(Venustron, Axiom Co., JAPAN) while subjects were asked to relax and perform various parafunctional activities such unilateral clenching(biting the bite force recorder with a force of 50kg on each subject's preferred side), jaw thrusting and lip bracing. The following muscles were examined: temporalis anterior(Ta), masseter(Mm), frontalis(Fr), inferior orbicularis oculi(OOci), zygomaticus major(Zm), superior and inferior orbularis oris(OOrs and OOri) and mentalis(Mn). Paired t-test, Correlation Coefficients, ANOVA and Multiple Comparison t-tests were used for statistical analysis. Unilateral clenching was highly correlated with bilateral stiffness and elasticity of all the muscles tested. Mm was affected by all three oral habits; Ta was affected by unilateral clenching(p<0.05); Zm was affected by unilateral clenching and OOrs, OOri and Mn were most affected by lip bracing(p<0.05). This study indicates that not only the masticatory muscles but also the muscles of facial expression, mainly circumoral muscles, can be significantly influenced by parafunctional activities such as unilateral clenching and lip bracing.