Efficacy and safety of thread embedding acupuncture for facial expression muscles atrophy after peripheral facial paralysis: study protocol for a randomized controlled trial

Background Facial expression muscles atrophy is one kind of sequelae after peripheral facial paralysis. It causes critical problems in facial appearance of patient as well as social and psychological problems. This study aims to evaluate the efficacy and safety of Thread-embedding acupuncture (TEA) for the management of facial expression muscles atrophy after peripheral facial paralysis. Methods This is a patient-assessor blinded, randomized, sham-controlled trial. A total of fifty-six eligible patients will be randomly divided into TEA (n=28) and sham TEA (STEA) (n=28) groups. Both groups will receive TEA or STEA treatment at the frontal muscle and the depressor anguli oris muscle, at one predefined points once a week for eight weeks. Additionally, both groups will receive traditional acupuncture treatment at ten acupoints (GB20, LI4, LR3, GB12, ST7, SI18, LI20, BL2, SJ23, ST4) twice a week for eight weeks as a concurrent treatment. B-mode ultrasonography will be used to assess the changes in facial expression muscle thickness ratio of the affected/healthy side at baseline and at 10 weeks after screening, as the primary outcome. House-Brackmann Grade and lip mobility score will be measured and analyzed at baseline and 4, 8, 10, and 12 weeks after screening, as secondary outcomes. Discussion The study will compare TEA with sham TEA to explore the feasibility for TEA in improving facial expression muscles atrophy after peripheral facial paralysis. Trial registration Chinese Clinical Trial Registry, ChiCTR1900027170. Registered on 3 November 2019, http://www.chictr.org.cn/edit.aspx?pid=45173&htm=4

Mask wearing increases eye involvement during smiling: a facial EMG study

The use of face masks has become ubiquitous. Although mask wearing is a convenient way to reduce the spread of disease, it is important to know how the mask affects our communication via facial expression. For example, when we are wearing the mask and meet a friend, are our facial expressions different compared to when we are not? We investigated the effect of face mask wearing on facial expression, including the area around the eyes. We measured surface electromyography from zygomaticus major, orbicularis oculi, and depressor anguli oris muscles, when people smiled and talked with or without a mask. Only the actions of the orbicularis oculi were facilitated by wearing the mask. We thus concluded that mask wearing may increase the recruitment of the eyes during smiling. In other words, we can express joy and happiness even when wearing a face mask.

Depressor Anguli Oris Myectomy versus Transfer to Depressor Labii Inferioris for Facial Symmetry in Synkinetic Facial Paralysis

Background Postparalytic synkinesis presents with a combination of hypo- and hypertonic muscles, leading to facial asynchrony with animation and at rest. One ubiquitous finding is a hypertonic depressor anguli oris (DAO) muscle and a weak depressor labii inferioris (DLI) muscle. The goal of this study was to evaluate the utility of DAO myectomy with or without its transfer to the weakened DLI in improving critical components of the dynamic smile. Methods From 2018 to 2020, this single-center, prospective study included of postparetic facial synkinetic patients with evidence of DAO hypertonicity who underwent DAO myectomy with or without transfer to DLI. Objective facial measurements were used to compare the effectiveness of DAO to DLI transfer to pure DAO myectomy in improving asymmetry of the synkinetic hemiface. Results Twenty-one patients with unilateral postparetic facial synkinesis with DAO hypertonicity were included; 11 underwent DAO myectomy, while 10 underwent DAO to DLI transfer. Baseline demographics and facial measurements were similar between the groups. DAO myectomy resulted in increased modiolus resting position, closed-mouth smile modiolus angle and excursion, open-mouth smile modiolus angle, excursion, dental show, and decreased lower lip height deviation. DAO to DLI transfer demonstrated similar findings but lacked significant increase in excursion and resulted in worsened lower lip height deviation. Conclusion These findings illustrate the utility of DAO myectomy in improving imbalance in the synkinetic patient and necessitate further technical refinements for DAO transfers or a different approach for improving lower lip depression in this subgroup of patients.

Eyes Compensate Smile When Wearing Mask

The use of face masks has become ubiquitous. Although mask wearing is a convenient way to reduce the spread of disease, it is important to know how the mask affects our communication via facial expression. For example, when we are wearing the mask and meet a friend, are our facial expressions different compared to when we are not? We investigated the effect of face mask wearing on facial expression, including the area around the eyes. We measured surface electromyography from zygomaticus major, orbicularis oculi, and depressor anguli oris, when people smiled and talked with or without the mask. We found that only orbicularis oculi were facilitated by wearing the mask. We thus concluded that mask wearing increases the use of eye smiling as a form of communication. In other words, we can express joy and happiness even when wearing the mask using eye smiling.

Defining a Safe Corridor of Cervical Branch Preservation in Lateral Platysmaplasty Surgery During Facial Rejuvenation Surgery

Background During rhytidectomies, the cervical branch of the facial nerve (CBFN) can easily be encountered, and potentially injured, when releasing the cervical retaining ligaments in the lateral neck. This nerve has been shown to occasionally co-innervate the depressor anguli oris muscle, and damage to it can thus potentially compromise outcomes with a post-operative palsy. Objectives To examine the lateral cervical anatomy specific to the CBFN, to ascertain if the position of the nerve can be predicted, enhancing safety of the platysmal flap separation and dissection from this lateral zone of adhesion. Methods Eleven cadaveric hemifaces were dissected and the distance between the medial border of sternocleidomastoid (SCM), and the CBFN was measured at three key points: (1) ‘Superior’: the distance between SCM and the nerve at the level of the angle of the mandible in neutral. (2) ‘Narrowest’: the narrowest distance measurable between the ‘superior’ and ‘inferior’ points as the CBFN descends into the neck medial to the SCM. (3) ‘Inferior’: the distance at the most distal part of the cervical nerve identified before its final intramuscular course. Results The average distances (in mms) were: Superior = 12.1 (range: 10.1-15.4), Narrowest = 8.8 (range: 5.6-12.2) and Inferior = 10.9 (range: 7.9-16.7). Conclusions There is a narrow range between the nerve and the anterior border of SCM. We thus propose a safe corridor where lateral deep plane dissection can be performed to offer cervical retaining ligament release, with reduced risk of endangering the CBFN.

Case of oculo-auriculo-vertebral spectrum: rare clinical features

A 2-month-old boy presented to us with bilateral microtia, left lower motor neuron facial palsy, micrognathia, hemivertebra, bifid rib, bifid thumb and absent/hypoplastic right-sided depressor anguli oris. He had bilateral external auditory canal atresia, although response to loud sound was present. Brain stem evoked response audiometry (BERA) was advised at 3 months of age. Karyotype was normal. We diagnosed him as a case of oculo-auriculo-vertebral spectrum. Child was discharged on request by the family with the plan for bone-anchored hearing aid after BERA and plan for pinna and ear canal reconstruction at a later age but child did not come for any follow-up visit. On telephonic enquiry, it was found that he is thriving well but has developmental delay including speech delay. We conclude that children presenting with external ear abnormalities should be screened for multiple congenital anomalies so that a multidisciplinary approach to management can be planned.