Comprehensive Glabellar Anatomy for the Cosmetic Surgeon

2005 ◽  
Vol 22 (1) ◽  
pp. 7-24 ◽  
Author(s):  
Cat N. Burkat ◽  
Mark J. Lucarelli ◽  
Bradley N. Lemke
Keyword(s):  
Facial Nerve ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Vascular Supply ◽  
Sensory Nerves ◽  
Small Artery ◽  
Main Trunk ◽  
Corrugator Supercilii ◽  
Fresh Frozen ◽  
Corrugator Supercilii Muscle

Introduction: The purpose of this study was to clarify controversies in motor innervation to the glabellar muscles in order to create a comprehensive guide of anatomic relationships within the glabella for the cosmetic surgeon performing surgery or injections in this aesthetic region. Methods: Microdissection was performed on 28 sides of 14 preserved cadaver heads and 10 sides of 5 fresh-frozen cadaver heads. Dissection proceeded anterograde from the main trunk of the facial nerve to its terminal branches in the glabellar muscles. Measurements were made with calipers to record the locations of the motor nerve entry into the corresponding muscle and the locations of the sensory nerves, vessels, and orbital landmarks. Results: The temporal branch of the facial nerve did not terminate after supplying the posterolateral transverse corrugator muscle but continued medially to innervate the oblique head of the corrugator muscle, entering 4 mm inferior to the superior edge (range 2–6.5 mm). This pattern was identified in 26 of 38 dissections (68.4%). In 74% of specimens, a small artery coursed with the nerve toward the corrugator muscle that should be anticipated to avoid bleeding. In 4 specimens (10.5%), the temporal facial nerve supplied a branch to the depressor supercilii, which continued to enter the posterior surface of the procerus muscle. In the remaining specimens, the small terminal branches were lost after entering the oblique corrugator muscle. The supratrochlear nerve exited between, rather than lateral to, the 2 heads of the corrugator supercilii muscle near the muscle origin before dividing into 2–3 branches and measured 17 mm from midline. A sensory branch entered the procerus muscle 5 mm inferior to the motor nerve entering the muscle. The supraorbital notch and foramen was 26 mm from midline. Prominent angular vessels were located between the heads of the corrugator supercilii muscle and between the heads of the depressor supercilii muscle. Conclusions: With a thorough understanding of the anatomic relationships of the muscles to their associated innervation and vascular supply, complications such as prolonged paresthesia or dysesthesia from sensory nerve injury, eyebrow asymmetry from motor nerve damage, traumatic neuromas, and visual loss from vascular emboli from cosmetic injections may be avoided.

Very Early Neurophysiological Study in Guillain-Barre Syndrome

2018 ◽  
Vol 80 (1-2) ◽  
pp. 100-105 ◽  
Author(s):  
Jiaoting Jin ◽  
Fangfang Hu ◽  
Xing Qin ◽  
Xuan Liu ◽  
Min Li ◽  
...  
Keyword(s):  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Tibial Nerve ◽  
Early Stage ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Sensory Nerves ◽  
Motor Nerve Conduction ◽  
Abnormal Rate ◽  
Motor Nerves

Purpose: The diagnosis of Guillain-Barre syndrome (GBS) in the very early stage may be challenging. Our aim was to report the neurophysiological abnormalities in GBS within 4 days of clinical onset. We expected that GBS will be diagnosed by the assistance of neurophysiological study in the very early stage. Methods: We prospectively recruited patients with a diagnosis of GBS discharged from First Affiliated Hospital of Xi’an Jiaotong University and Xi Jing Hospital. Patients were classified into 3 groups according to the onset of symptoms to electromyography examination interval (OEI). The neurophysiological findings were carried out using standard procedures. All patients were examined by the same experienced neurophysiologist. Results: There were not significant group differences in abnormal rate, distal motor latency (DML), motor nerve conduction velocity (MNCV), F response (FR), compound muscle action potential (CMAP), conduction block (CB), sensory nerve action potential (SNAP), and sensory nerve conduction velocity among OEI ≤4 days, 4< OEI ≤10 days, and OEI > 10 days groups. Motor nerves were more affected than sensory nerves in neurophysiological presentation in very early stage patients. The difference of motor nerves and sensory nerves was statistically significant in lower limbs, but was not in upper limbs. In motor nerve conduction studies, the abnormal rate of DML, MNCV, FR, CB was more common seen in ulnar and peroneal nerve than median and tibial nerve, the abnormal rate of CMAP was the same in ulnar, median, peroneal and tibial nerve. In sensory nerve conduction studies, the abnormal rate of ulnar nerve and median nerve was higher than the superficial peroneal nerve and sural nerve. The OEI was not correlated with the SNAP decrease rate of median (r = 0.10, p = 0.23) and ulnar (r = 0.26, p = 0.06) but was statistically correlated with sural SNAP decrease rate (r = 0.29, p = 0.04). The sural-sparing pattern phenomenon was the most commonly discovered phenomenon in very early stage patients (OEI ≤4 days), followed by patients with 4< OEI ≤10 days, ultimately found in patients with OEI > 10 days. Conclusions: We suggest performing neurophysiological examination as soon as possible for suspected GBS patients, particularly focusing on multi-spots inspection of ulnar and peroneal nerves, and paying close attention to sural-sparing patterns.

scholarly journals TrkA inhibitor promotes motor functional regeneration of recurrent laryngeal nerve by suppression of sensory nerve regeneration

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hiroshi Suzuki ◽  
Koji Araki ◽  
Toshiyasu Matsui ◽  
Yuya Tanaka ◽  
Kosuke Uno ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Regeneration ◽  
Vocal Fold ◽  
Compound Muscle Action Potential ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Laryngeal Nerve ◽  
Sensory Nerves ◽  
Nucleus Ambiguus ◽  
Functional Regeneration

Abstract Recurrent laryngeal nerve (RLN) injury, in which hoarseness and dysphagia arise as a result of impaired vocal fold movement, is a serious complication. Misdirected regeneration is an issue for functional regeneration. In this study, we demonstrated the effect of TrkA inhibitors, which blocks the NGF-TrkA pathway that acts on the sensory/automatic nerves thus preventing misdirected regeneration among motor and sensory nerves, and thereby promoting the regeneration of motor neurons to achieve functional recovery. RLN axotomy rat models were used in this study, in which cut ends of the nerve were bridged with polyglycolic acid-collagen tube with and without TrkA inhibitor (TrkAi) infiltration. Our study revealed significant improvement in motor nerve fiber regeneration and function, in assessment of vocal fold movement, myelinated nerve regeneration, compound muscle action potential, and prevention of laryngeal muscle atrophy. Retrograde labeling demonstrated fewer labeled neurons in the vagus ganglion, which confirmed reduced misdirected regeneration among motor and sensory fibers, and a change in distribution of the labeled neurons in the nucleus ambiguus. Our study demonstrated that TrkAi have a strong potential for clinical application in the treatment of RLN injury.

scholarly journals Application of Microspectral Imaging in Motor and Sensory Nerve Classification

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Du Xu
Keyword(s):  
Feature Extraction ◽  
Light Source ◽  
Motor Nerve ◽  
Incident Light ◽  
Sensory Nerve ◽  
Sensory Nerves ◽  
Correction Algorithm ◽  
Fast Speed ◽  
Motor Nerves ◽  
Better Than

Objective. It aimed to explore the application of the microscopic hyperspectral technique in motor and sensory nerve classification. Methods. The self-developed microscopic hyperspectral acquisition system was applied to collect the data of anterior and posterior spinal cord sections of white rabbits. The joint correction algorithm was employed to preprocess the collected data, such as noise reduction. On the basis of pure linear light source index, a new pixel purification algorithm based on cross contrast was proposed to extract more regions of interest, which was used for feature extraction of motor and sensory nerves. Besides, the ML algorithm was employed to classify motor and sensory nerves based on feature extraction results. Results. The joint correction algorithm was adopted to preprocess the data collected by the microscopic hyperspectral technique, so as to eliminate the influence of the incident light source and the system and improve the classification accuracy. The axon and myelin spectrum curves of the two kinds of nerves in the stained specimens had the same trend, but the values of all kinds of spectrum of sensory nerves were higher than those of motor nerves. However, the myelin sheath spectrum curves of motor nerves in the unstained specimens were greatly different from the curves of sensory nerves. The axon spectrum curves had the same trend, but the axon spectrum values of sensory nerves were higher than those of motor nerves. The ML algorithm had high accuracy and fast speed in motor and sensory nerve classification, and the classification effect of stained specimens was better than that of unstained specimens. Conclusion. The microscopic hyperspectral technique had high feasibility in sensory and motor nerve classification and was worthy of further research and promotion.

scholarly journals Effect of Ranirestat on Sensory and Motor Nerve Function in Japanese Patients with Diabetic Polyneuropathy: A Randomized Double-Blind Placebo-Controlled Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Jo Satoh ◽  
Nobuo Kohara ◽  
Kenji Sekiguchi ◽  
Yasuyuki Yamaguchi
Keyword(s):  
Clinical Symptoms ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Diabetic Polyneuropathy ◽  
Japanese Patients ◽  
Sensory Nerves ◽  
Controlled Study ◽  
Double Blind ◽  
Safety Parameters ◽  
Clinically Significant

We conducted a 26-week oral-administration study of ranirestat (an aldose reductase inhibitor) at a once-daily dose of 20 mg to evaluate its efficacy and safety in Japanese patients with diabetic polyneuropathy (DPN). The primary endpoint was summed change in sensory nerve conduction velocity (NCV) for the bilateral sural and proximal median sensory nerves. The sensory NCV was significantly (P=0.006) improved by ranirestat. On clinical symptoms evaluated with the use of modified Toronto Clinical Neuropathy Score (mTCNS), obvious efficacy was not found in total score. However, improvement in the sensory test domain of the mTCNS was significant (P=0.037) in a subgroup of patients diagnosed with neuropathy according to the TCNS severity classification. No clinically significant effects on safety parameters including hepatic and renal functions were observed. Our results indicate that ranirestat is effective on DPN (JapicCTI-121994).

scholarly journals PENGUJIAN EFEKTIVITAS CAPSICUM SEBAGAI SUMBER CAPSAICIN KO-ANESTESI PADA ANESTESI LOKAL

2015 ◽  
Vol 38 (2) ◽  
pp. 73
Author(s):  
Aldian Mulyanto Lokaria ◽  
Muhammad Ridwan ◽  
Muhamad Febry ◽  
Fadil Oenzil
Keyword(s):  
Local Anesthesia ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Nerve Cells ◽  
Sensory Nerves ◽  
Test Design ◽  
Specific Work ◽  
Sprague Dawley ◽  
Post Test ◽  
Motor Effects

AbstrakAnestesi lokal bekerja dengan memblok sel saraf sensorik rasa sakit (nosiseptor) dan sel saraf lain, sehingga diperlukan Capsaicin pada cabai sebagai ko-anestesi agar obat anestesi lokal bekerja spesifik pada nosiseptor. Beragam varietas cabai menuntut adanya penelitian untuk mengetahui jenis cabai yang tepat sebagai sumber Capsaicin ko-anestesi, hubungan dengan peningkaan kadar Capsaicin, dan pengaruh terhadap waktu kerja obat anestesi. Penelitian ini merupakan penelitian eksperimental dengan desain pre and post test design. Penelitian dilakukan di Laboratorium Biota Sumatera Universitas Andalas dan di Laboratorium Hewan Fakultas Kedokteran Unand selama 3 bulan. Sampel penelitian ini adalah tikus (Rattus novergicus) jantan dari galur Sprague Dawley dengan berat 250-350 gram, sebanyak 24 ekor dibagi 8 kelompok. Tiap kelompok mendapatkan perlakuan berupa pemberian Capsaicin dari jenis cabai dengan kadar yang berbeda. Hasil penelitian terdapat perbedaan waktu munculnya efek sensorik (p 0,020) dan motorik (p 0,001) antar kelompok perlakuan. Kelompok C.frutescens 5% tercepat dalam menghentikan bloking saraf motorik (3,33 menit), sedangkan kelompok C.frutescens 10% terbaik dalam mempengaruhi lama bloking saraf sensorik (53,67 menit). Dimana peningkatan kadar berbanding lurus dengan hasil anestesi dan jenis cabai dengan kadar yang berbeda juga mempengaruhi lama waktu kerja obat anestesi.Abstract Local anesthesia works by blocking pain sensory nerve cells (nociceptors) and other nerve cells, it's need capsaicin in chili as co-anesthesia so that local anesthesia specific work on nociceptors only. The diversity of chili, demand more research to determine the most appropriate type of chili as a source of capsaicin co-anesthesia. This is a pre and post test design experimental research. Which each groups is given of Capsaicin from different chili types and concentration. There are difference time in emergence of sensory effects (p 0.020) and motor effects (p 0.001) between groups. Group of C.frutescens 5% is the fastest group in stopping of the motor nerve blocking (3.33 minutes), while group of C.frutescens 10% is best group in influencing long-blocking sensory nerves (53.67 minutes). Thus the increased concentration is linear correlation to the results of anesthesia and the types of chili with different concentration affect the work time of anesthesia.

Adaptive and Maladaptive Neural Plasticity Due to Facial Nerve Palsy

2016 ◽  
Vol 224 (2) ◽  
pp. 102-111 ◽  
Author(s):  
Carsten M. Klingner ◽  
Stefan Brodoehl ◽  
Gerd F. Volk ◽  
Orlando Guntinas-Lichius ◽  
Otto W. Witte
Keyword(s):  
Facial Nerve ◽  
Neural Plasticity ◽  
Cortical Plasticity ◽  
Brain Plasticity ◽  
Motor Nerve ◽  
Predictive Coding ◽  
Theoretical Framework ◽  
Cortical Reorganization ◽  
Nerve Lesion ◽  
Peripheral Facial Palsy

Abstract. This paper reviews adaptive and maladaptive mechanisms of cortical plasticity in patients suffering from peripheral facial palsy. As the peripheral facial nerve is a pure motor nerve, a facial nerve lesion is causing an exclusive deefferentation without deafferentation. We focus on the question of how the investigation of pure deefferentation adds to our current understanding of brain plasticity which derives from studies on learning and studies on brain lesions. The importance of efference and afference as drivers for cortical plasticity is discussed in addition to the crossmodal influence of different competitive sensory inputs. We make the attempt to integrate the experimental findings of the effects of pure deefferentation within the theoretical framework of cortical responses and predictive coding. We show that the available experimental data can be explained within this theoretical framework which also clarifies the necessity for maladaptive plasticity. Finally, we propose rehabilitation approaches for directing cortical reorganization in the appropriate direction and highlight some challenging questions that are yet unexplored in the field.

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

scholarly journals Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alessandro Gualdi ◽  
Janos Cambiaso-Daniel ◽  
Jonatann Gatti ◽  
Ziv M. Peled ◽  
Robert Hagan ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Migraine Headache ◽  
Botulinum Toxin Type A ◽  
Operative Procedure ◽  
Motor Innervation ◽  
Research Committee ◽  
Invasive Approach ◽  
Corrugator Supercilii ◽  
Corrugator Supercilii Muscle

Abstract Introduction Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM. Materials and methods Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC). Results Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 (p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 (p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure. Conclusions Our findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation. Trial registration The data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.

Abstract MP45: Deletion Of The Transient Receptor Vanilloid-1 (TRPV1) Channel In Rats Attenuates 2 Kidney 1 Clip Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Sean D Stocker ◽  
Leon J DeLalio
Keyword(s):  
Heart Rate ◽  
Renovascular Hypertension ◽  
Sensory Nerve ◽  
Experimental Models ◽  
Sensory Nerves ◽  
Male Rats ◽  
Wild Type ◽  
Renal Nerve ◽  
Trpv1 Channels ◽  
Arterial Blood

Renal denervation lowers arterial blood pressure (ABP) in both clinical populations and multiple experimental models of hypertension. This therapeutic effect is partly attributed to the removal of overactive renal sensory nerves that increase sympathetic efferent activity and ABP. Renal sensory nerves highly express TRPV1 channels, and administration of the TRPV1 agonist capsaicin increases renal sensory nerve activity. However, the extent by which TRPV1 channels directly contribute to renal nerve dependent models of hypertension has not been tested. To test this hypothesis, we generated a novel TRPV1 -/- rat using CRISPR/Cas9 and deletion of exon 3. Male and female TRPV1 -/- and wild-type littermates (8-12 weeks) were instrumented with telemetry. At 2 weeks later, renovascular hypertension via renal stenosis was produced by placement of a PTFE cuff (0.16 x 0.22 inches, 1mm long) around the right renal artery. Male TRPV1 -/- and wild-type rats had no differences in baseline mean ABP (99±2 vs 98±3 mmHg, respectively; n=7-9) or heart rate (390±7 vs 400±8 bpm, respectively). Renal stenosis significantly increased mean ABP in both groups; however, mean ABP was significantly lower at Day 28 in male TRPV1 -/- versus wild-type rats (125±8 vs 155±2 mmHg, respectively: P<0.01). Ganglionic blockade with chlorisondamine (2.5mg/kg, sc) at Day 28 produced a smaller fall in mean ABP of male TRPV1 -/- versus wild-type rats (-53±4 vs -86±3 mmHg, respectively; P<0.001). On the other hand, female TRPV1 -/- and wild-type rats had no differences in baseline mean ABP (102±2 vs 104±1 mmHg, respectively; n=6-9) or heart rate (419±8 vs 410±7 bpm, respectively). Renal stenosis significantly increased mean ABP in both groups; however, there were no differences at Day 28 between female TRPV1 -/- versus wild-type rats (117±8 vs 122±6 mmHg, respectively). Moreover, the increase in mean ABP was smaller in females versus males. The ganglionic blocker chlorisondamine produced similar depressor responses in female TRPV1 -/- versus wild-type rats (-64±7 vs -65±7 mmHg, respectively). These findings illustrate a sex difference in renovascular hypertension in rats, but importantly indicate that TRPV1 channels contribute to the established phase of renovascular hypertension in male rats.

Sign in / Sign up

Export Citation Format

Share Document