First impressions from faces in the real world: Commentary on Sutherland and Young (2022)

The study of first impressions from faces now emphasizes the need to understand trait inferences made to naturalistic face images (British Journal of Psychology, 113, 2022, 1056). Face recognition algorithms based on deep convolutional neural networks simultaneously represent invariant, changeable and environmental variables in face images. Therefore, we suggest them as a comprehensive 'face space' model of first impressions of naturalistic faces. We also suggest that to understand trait inferences in the real world, a logical next step is to consider trait inferences made to whole people (faces and bodies). On the role of cultural contributions to trait perception, we think it is important for the field to begin to consider the way in which trait inferences motivate (or not) behaviour in independent and interdependent cultures.

The Society for Craniofacial Genetics and Developmental Biology 45th Annual Meeting

The Society for Craniofacial Genetics and Developmental Biology (SCGDB) held its 45th Annual Meeting at the Sanford Consortium for Regenerative Medicine at the University of California, San Diego on October 20th-21st, 2022. The meeting included presentation of the SCGDB Distinguished Scientists in Craniofacial Research Awards to Drs. Ralph Marcucio and Loydie Jerome-Majewska and four scientific sessions that highlighted new discoveries in signaling in craniofacial development, genomics of craniofacial development, human genetics of craniofacial development and translational and regenerative approaches in craniofacial biology. The meeting also included workshops on analysis of single cell RNA sequencing datasets and using human sequencing data from the Gabriella Miller Kids First Pediatric Research Program. There were 110 faculty and trainees in attendance that represent a diverse group of researchers from all career stages in the fields of developmental biology and genetics. The meeting, which also included outdoor poster presentations, provided opportunities for participant interactions and discussions, thus strengthening the SCGDB community.

Re-cognizing the new self: The neurocognitive plasticity of self-processing following facial transplantation

The face is a defining feature of our individuality, crucial for our social interactions. But what happens when the face connected to the self is radically altered or replaced? We address the plasticity of self-face recognition in the context of facial transplantation. While the acquisition of a new face following facial transplantation is a medical fact, the experience of a new identity is an unexplored psychological outcome. We traced the changes in self-face recognition before and after facial transplantation to understand if and how the transplanted face gradually comes to be perceived and recognized as the recipient's own new face. Neurobehavioral evidence documents a strong representation of the pre-injury appearance pre-operatively, while following the transplantation, the recipient incorporates the new face into his self-identity. The acquisition of this new facial identity is supported by neural activity in medial frontal regions that are considered to integrate psychological and perceptual aspects of the self.

[Facial biotype in relation to the shape of the upper dental arch of individuals from the city of corrientes. a cross-sectional study]

This research sought to define a facial anthropometric pattern that characterizes individuals from the City of Corrientes.

Objectives

Obtain the facial morphometry of individuals of both sexes and determine its prevalence. To determine the most frequent types of maxillary arches in the sample. To analyze the facial variation through the morphometric index in relation to the shape of the maxillary arch.

Materials and methods

This study was observational, descriptive, and cross-sectional. The facial morphometric modification was analyzed in relation to the shape of the upper dental arch, which was presented by a group of 50 patients of both sexes, born in the city of Corrientes, Argentina with an age range between 18 to 40 years, who voluntarily attended for his attention to the FOUNNE University Dental Hospital and the Rossi Candia SAPS dependent on the Municipality of the City of Corrientes. To establish the Facial Morphological Index (FMI), the Rakosi & Irmtrud measurement was implemented, using a digital caliper with a range of 150 mm. To determine the shape of the arches, plaster models obtained from each maxilla belonging to the sample are made and with the use of 3M brand templates, the arches are classified according to Williams. With the upper arch shape, correlations with facial biotypes have already been established. (p<0.05).

Results

The most frequent facial biotype was Mesoprosopo with 38% followed by Leptoprosopo 36% and Euryprosopo 26%. Regarding the arch shape, 46% of the patients studied presented a quadrangular arch shape, 40% Ovoid, and 14% Triangular. None of the variables studied was significantly correlated with the age of the patients. The values calculated for Chi-Square were not significant (p-values > 0.05).

Conclusions

The results obtained do not allow for establishing a specific facial anthropometric pattern in individuals from the City of Corrientes. Likewise, there is facial morphometrics regarding the shape of the upper dental arch.

Facial tinea incognito: a clinical, dermoscopic and mycological study of 38 cases

BACKGROUND

Tinea incognito (TI) is a dermatophytic infection of the skin that is modified by steroid use. As a result, it shows atypical clinical presentations that can lead to misdiagnosis. TI occurring on the face is most frequently misdiagnosed as cutaneous fungal infection, however, very limited information is available on facial TI.

OBJECTIVES

This study aimed to characterize the clinical, dermoscopic and mycological features of facial TI.

MATERIALS & METHODS

We retrospectively evaluated 38 patients with mycologically proven facial TI at a single institution in Korea between July, 2014 and July, 2021.

RESULTS

The patients had a mean age of 59.6 ± 20.4 years and showed a slight female predominance (male-to-female ratio of 1:1.38). The most common clinical presentation was an eczema-like pattern (47.4%), followed by rosacea-like (15.8%), psoriasis-like (10.5%), lupus erythematosus-like (10.5%), cellulitis-like (7.9%), and folliculitis-like (7.9%) patterns. The mean duration from disease onset to diagnostic confirmation was 3.4 months. Overall, 78.9% of the patients had accompanying chronic systemic diseases, and 57.9% had concurrent tinea infections at other skin sites, mainly the feet and toenails. On dermoscopy, scales and dilated vascular patterns (arborizing vessels and telangiectasia) were commonly observed on glabrous skin, with follicular patterns, such as black dots, broken hairs, and empty follicles. The characteristic trichoscopic features were comma, corkscrew, Morse code-like, and translucent hairs.

CONCLUSION

The clinical characteristics and distinct dermoscopic features described in this article may aid in the differential diagnosis of facial TI while reducing diagnostic delays and unnecessary treatments.

Face, Content, and Construct Validity Evaluation of Simulation Models in General Surgery Laparoscopic Training and Education: A Systematic Review

BACKGROUND

Laparoscopic technical surgical skills (LTS) are considered a fundamental competence for General Surgery residents. Several simulation tools (ST) have been explored to develop LTS. Although a plethora of systematic reviews evaluate the translation of LTS developed in simulation to real surgery, there is a lack of evidence that clarifies effectiveness of different validated ST in acquisition of LTS in surgical residents. The aim of this systematic review (SR) is to summarize published evidence on ST validation used for surgery education and training.

METHODS

A protocol was published in PROSPERO. A SR was carried out following PRISMA guidelines. Complete published articles in English or Spanish that validate either content or construct, plus another form of validation of ST to acquire LTS in general surgery were included. Articles that used only one validation or did not validate an ST were excluded.

RESULTS

1052 publications were initially identified across all searched databases. Title review identified 204 studies eligible for full text screening. 10 studies were included for final review. Two studies assessed both face and content, 4 face and construct, and 4 face, content and construct validity. None of the studies presented comparable outcomes due to metrics variation and scores used for the validation strategies.

CONCLUSIONS

This study assessed validated laparoscopic simulation models, particularly in content and construct validity. Articles reported an increased use of simulation models in laparoscopic training with positive feedback from trainees, but few studies reported validation of training model. Validation strategies are not standardized, limiting comparability between them.

A comparison of skin grafts versus local flaps for facial skin cancer from the patient perspective: protocol for a feasibility study

BRIEF ABSTRACT

This is a protocol to assess feasibility of conducting a prospective cohort study comparing local flaps versus skin grafts for surgical excision of skin cancer from the face.

INTRODUCTION

Skin cancer is the most common malignancy worldwide and the face is one of the most common locations of occurrence. Surgical excision is the most popular treatment for small lesions of the face. Defects can be reconstructed using local flaps or skin grafts. There is a paucity of literature evaluating outcomes after skin cancer surgery from the patient's perspective using valid measurement tools. The purpose of this study is to assess the feasibility of conducting a prospective observational cohort study. The primary outcomes include recruitment rates, eligibility rate, compliance of intervention and rate of completion of the primary outcome (FACE-Q scales) at 3 months. Secondary outcomes include examining patient characteristic and FACE-Q score differences between local flaps to skin grafts and adverse events.

METHODS AND ANALYSIS

This study is a prospective cohort study consisting of an anticipated 30 patients aged ≥18 years. The study population will consist of a consecutive sample of non-melanoma facial skin cancer patients undergoing a skin graft or local flap. Patients will be followed and evaluated with the FACE-Q questionnaire at 2 weeks, 3 months, 6 months and 1 year post-operation. The following criteria will determine success: patients who meet eligibility criteria >70%; recruitment rate >70%; compliance with intervention >90%; rate of completion of full-scale prospective study primary outcome (FACE-Q at 3 months) >80%; retention rate at 6-month follow-up visit >70%.

DISCUSSION

The findings of this study will be used to guide the sample size calculation for a future, large-scale prospective study.Trial registration: ClinicalTrials.gov (NCT04842279).

Viscoelastic Properties of Human Facial Skin and Comparisons with Facial Prosthetic Elastomers

Prosthesis discomfort and a lack of skin-like quality is a source of patient dissatisfaction with facial prostheses. To engineer skin-like replacements, knowledge of the differences between facial skin properties and those for prosthetic materials is essential. This project measured six viscoelastic properties (percent laxity, stiffness, elastic deformation, creep, absorbed energy, and percent elasticity) at six facial locations with a suction device in a human adult population equally stratified for age, sex, and race. The same properties were measured for eight facial prosthetic elastomers currently available for clinical usage. The results showed that the prosthetic materials were 1.8 to 6.4 times higher in stiffness, 2 to 4 times lower in absorbed energy, and 2.75 to 9 times lower in viscous creep than facial skin (p < 0.001). Clustering analyses determined that facial skin properties fell into three groups-those associated with body of ear, cheek, and remaining locations. This provides baseline information for designing future replacements for missing facial tissues.

The role of oxytocin in modulating self-other distinction in human brain: a pharmacological fMRI study

Self-other distinction is crucial for human interaction. Although with conflicting results, studies have found that oxytocin (OT) sharpens the self-other perceptual boundary. However, little is known about the effect of OT on self-other perception, especially its neural basis. Moreover, it is unclear whether OT influences self-other discrimination when the other is a child or an adult. This double-blind, placebo-controlled study investigated the effect of OT on self-face perception at the behavioral and neural levels. For the stimuli, we morphed participants' faces and child or adult strangers' faces, resulting in 4 conditions. After treatment with either OT or placebo, participants reported whether a stimulus resembled themselves while being scanned using functional magnetic resonance imaging (fMRI). Behavioral results showed that people judged adult-morphed faces better than child-morphed faces. Moreover, fMRI results showed that the OT group exhibited increased activity in visual areas and the inferior frontal gyrus for self-faces. This difference was more pronounced in the adult-face condition. In multivariate fMRI and region of interest analyses, better performance in the OT group indicated that OT increased self-other distinction, especially for adult faces and in the left hemisphere. Our study shows a significant effect of OT on self-referential processes, proving the potential effect of OT on a left hemisphere self-network.

Recurrent PIK3CA H1047R-Mutated Congenital Infiltrative Facial Lipomatosis: A Case Report and Review of Literature

Congenital infiltrating lipomatosis of the face (CILF) is a rare, congenital, nonhereditary facial overgrowth due to post-zygomatic activating mutations in PIK3CA gene. It is unilateral and involves hypertrophy of both the soft and hard tissue structures on the affected side of the face. This commonly results in early eruption of the teeth, hypertrophy of the facial bones, macroglossia, and proliferation of the parotid gland. Less than 80 cases of CILF have been reported in the literature so far. Treatment modalities include liposuction and surgical excision. However, since the hallmark of CILF is mutation in the PIK3CA gene, PI3K inhibitors may play a therapeutic role in CILF. We report a case of an 8-year-old boy with recurrent CILF of the scalp and nose, with PIK3CA H1047R mutation. We discuss the differential diagnoses, clinical outcomes, and management of this rare entity.

Age differences and brain maturation provide insight into heterogeneous results in autism spectrum disorder

Studies comparing individuals with autism spectrum disorder (ASD) to typically developing (TD) individuals have yielded inconsistent results. These inconsistencies reflect, in part, atypical trajectories of development in children and young adults with ASD compared to TD peers. These different trajectories alter group differences between children with and without ASD as they age. This paper first summarizes the disparate trajectories evident in our studies and, upon further investigation, laboratories using the same recruiting source. These studies indicated that cognition improves into adulthood typically, and is associated with the maturation of striatal, frontal, and temporal lobes, but these age-related improvements did not emerge in the young adults with ASD. This pattern - of improvement into adulthood in the TD group but not in the group with ASD - occurred in both social and non-social tasks. However, the difference between TD and ASD trajectories was most robust on a social task, face recognition. While tempting to ascribe this uneven deficit to the social differences in ASD, it may also reflect the prolonged typical development of social cognitive tasks such as face recognition into adulthood. This paper then reviews the evidence on age-related and developmental changes from other studies on ASD. The broader literature also suggests that individuals with ASD do not exhibit the typical improvements during adolescence on skills important for navigating the transition to adulthood. These skills include execution function, social cognition and communication, and emotional recognition and self-awareness. Relatedly, neuroimaging studies indicate arrested or atypical brain maturation in striatal, frontal, and temporal regions during adolescence in ASD. This review not only highlights the importance of a developmental framework and explicit consideration of age and/or stage when studying ASD, but also the potential importance of adolescence on outcomes in ASD.

Does wearing a surgical mask influence face touching by healthcare workers? A retrospective cohort study

OBJECTIVE

At the start of the COVID-19 pandemic, healthcare workers (HCW) in our ED were advised against and actively discouraged from wearing masks when not seeing respiratory patients, as mask wearing was thought to increase the risk of droplet transmission by face touching. The primary objective of the present study was to determine whether HCW using face masks were more or less likely to touch their faces than those not wearing masks.

METHODS

We analysed six randomly selected hours of closed circuit television footage from our staff base. Face touches were recorded electronically by trained researchers. Generalised linear mixed models were used to compare the frequency and duration of face touches with and without face masks, controlling for individual clusters, adjusting for time of footage, duration on screen and staff role.

RESULTS

Data were collected from 187 HCW. Masks were worn in 231 (36%) of 642 screen sessions. Wearing a mask did not significantly change the odds of face touching (odds ratio 0.55, 95% confidence interval [CI] 0.30-1.01, P = 0.055) or duration of face touch (mean difference -1.45 s, 95% CI -8.84, 5.99, P = 0.71). For mucosal areas, a significant reduction in the odds of face touching was observed for mask wearers (odds ratio 0.21, 95% CI 0.11-0.43, P < 0.001) and on the frequency of mucosal touches (rate ratio 0.45, 95% CI 0.29-0.69, P < 0.001).

CONCLUSIONS

Mask wearing did not change face touching or the duration of face touches. However, significantly fewer mucosal touches were observed when wearing a mask, which may help to reduce nosocomial droplet transmission of viruses.

Vellus hair condition is related to dermal elasticity and facial sagging severity

BACKGROUND

Sagging of facial skin is a critical factor associated with an aged appearance. However, the mechanism of sagging has not been fully elucidated. The facial skin contains vellus hair (fine hair), but the contribution of vellus hair to skin condition and facial aging has yet to be studied.

AIM

We aimed to clarify the influence of vellus hair on the physical properties and sagging severity of facial skin by establishing an evaluation system for vellus hair condition.

METHOD

Photographs were taken to assess the vellus hair condition in the cheek area in 30 middle-aged female volunteers. Skin elasticity was measured with a cutometer and sagging severity was evaluated by using previously established photograph-based grading criteria.

RESULTS

Facial skin vellus hairs were divided into three types: fine, thick, and normal thickness. Based on this observation, we established a 6-grade photograph-based grading system based on the dominant type of vellus hair in the target area and used it to evaluate vellus hair condition at the cheek. We found that vellus hair condition is significantly positively related to skin elasticity parameters Ua/Uf (representing overall elasticity including creep and creep recovery), Ur/Ue (representing net elasticity without viscoelastic creep), and Ur/Uf (ratio of elastic recovery to total deformation). Further, vellus hair condition was significantly negatively correlated to sagging severity.

CONCLUSION

Our results suggest that vellus hair condition positively contributes to the skin's physical properties, and consequently deterioration of the vellus hair condition promotes an aged facial appearance.

Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans

BACKGROUND

Facial wrinkles and sagging are the most visible signs of aging and can cause profound distress. Microneedle fractional radiofrequency (MFR) is a minimally invasive procedure, which utilizes both microneedling and radiofrequency energy to rejuvenate the skin.

OBJECTIVE

To describe the safety and efficacy of a temperature-controlled MFR device on facial fine lines and laxity.

PATIENTS AND METHODS

A retrospective chart & histology review was performed on individuals who received bipolar MFR for facial rejuvenation. A total of 15 Koreans with a median age of 46 years were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the participants' satisfaction scores. Histologic changes before, immediately after MFR and at 4 months follow-up was examined. Complications were also recorded.

RESULTS

Partially denatured collagen fibers and dermal shrinkage was observed immediately after MFR whereas an increase in elastin and collagen was noted at 4 months follow-up. 86.7% of recipients considered the results satisfactory. Consensus ratings by two independent dermatologists on the objective outcomes at 4-month follow-up were very much improved (53.3%), much improved (26.7%) and improved (20%). Treatment was well tolerated and did not cause any significant long-lasting discomfort.

CONCLUSION

Temperature-controlled bipolar MFR is a minimally invasive treatment option to consider for facial fine lines and laxity via neo-collagenesis and neo-elastogenesis. The procedure was safe and clinically effective.

Bacterial exposure risk to the endoscopist's face while performing endoscopy

Objectives

Gastrointestinal endoscopy increases the risk of bacterial exposure to endoscopists. However, before 2019, most endoscopists did not pay attention to microorganism transmission from patients. This study aimed to investigate the incidence of bacterial exposure to endoscopists' faces during gastrointestinal endoscopic procedures using the bacterial culture method.

Methods

This was a single-centered, retrospective study including endoscopists who performed various gastrointestinal endoscopy procedures at the Division of Endoscopy, Hirosaki University Hospital between August 31 and October 6, 2020. Endoscopists wore surgical masks and affixed pre-sterilized films over them. Following the gastrointestinal endoscopic procedures, attached microbes were collected from the endoscopists' surface films using sterilized swabs. Collected microorganisms were cultured on tryptic soy agar and 5% sheep blood agar, and the incidence of bacterial exposure was determined by bacterial culture positivity. Cultured bacteria were identified by gram staining and 16S rRNA gene sequencing.

Results

Bacterial culture positivity was 12.6%, and it was significantly higher in therapeutic than in diagnostic endoscopy. Notably, therapeutic endoscopy increased bacterial culture positivity in colonoscopy, but not in esophagogastroduodenoscopy. Staphylococci, including Staphylococcus epidermidis and Staphylococcus capitis, were the most commonly found bacteria in samples identified through 16S rRNA gene sequencing.

Conclusions

The risk of bacterial exposure to the endoscopist's face was increased in colonoscopy treatment procedures. Therefore, endoscopists should be aware of the significant risk of microbial infection from scattering fluid that comes from the endoscopy's working channel.

Comparison of Two Paradigms Based on Stimulation with Images in a Spelling Brain-Computer Interface

A P300-based speller can be used to control a home automation system via brain activity. Evaluation of the visual stimuli used in a P300-based speller is a common topic in the field of brain-computer interfaces (BCIs). The aim of the present work is to compare, using the usability approach, two types of stimuli that have provided high performance in previous studies. Twelve participants controlled a BCI under two conditions, which varied in terms of the type of stimulus employed: a red famous face surrounded by a white rectangle (RFW) and a range of neutral pictures (NPs). The usability approach included variables related to effectiveness (accuracy and information transfer rate), efficiency (stress and fatigue), and satisfaction (pleasantness and System Usability Scale and Affect Grid questionnaires). The results indicated that there were no significant differences in effectiveness, but the system that used NPs was reported as significantly more pleasant. Hence, since satisfaction variables should also be considered in systems that potential users are likely to employ regularly, the use of different NPs may be a more suitable option than the use of a single RFW for the development of a home automation system based on a visual P300-based speller.

Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques

Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.

Face-specific negative bias of aesthetic perception in depression: Behavioral and EEG evidence

INTRODUCTION

Symptoms of depression are associated with the dysfunction of neural systems such as the emotion, reward system, and the default mode network. These systems were suggested by the model of neuroaesthetics as key contributions to aesthetic experience, leading to the prediction of atypical aesthetic orientation in depression. Here we investigated the aesthetic characteristics of depression and the corresponding neural underpinnings.

METHODS

Fifty-two (25 depression patients, 27 healthy controls) participants were asked to make aesthetic judgments on faces and landscapes in an electroencephalographic (EEG) experiment.

RESULTS

Our results indicate that relative to the controls, the depression tended to give ugly judgments and refrained from giving beautiful judgments, which was observed only for faces but not for landscapes. We also found that the face-induced component N170 was more negative in the depression group than the control group for ugly and neutral faces. Moreover, the aesthetic evaluation of ugly faces was associated with decreased N200 negativity in the depression group than in the control group, while the evaluation of beautiful faces was associated with decreased brain synchronization at the theta band.

DISCUSSION

These results suggested a face-specific negative aesthetic bias in depression which can help to design and develop aesthetics-oriented schemes in assisting the clinical diagnosis and therapy of depression.

Development of upper visual field bias for faces in infants

The spatial location of the face and body seen in daily life influences human perception and recognition. This contextual effect of spatial locations suggests that daily experience affects how humans visually process the face and body. However, it remains unclear whether this effect is caused by experience, or innate neural pathways. To address this issue, we examined the development of visual field asymmetry for face processing, in which faces in the upper visual field were processed preferentially compared to the lower visual field. We found that a developmental change occurred between 6 and 7 months. Older infants aged 7-8 months showed bias toward faces in the upper visual field, similar to adults, but younger infants of 5-6 months showed no such visual field bias. Furthermore, older infants preferentially memorized faces in the upper visual field, rather than in the lower visual field. These results suggest that visual field asymmetry is acquired through development, and might be caused by the learning of spatial location in daily experience.

The Science Behind Nefertiti's Beauty: A Plastic Surgeon's Analysis

Introduction  The famous stucco limestone coated "Bust of Nefertiti" housed in the Neues Museum, Germany dated 1,345 BC is an icon of beauty. Sculpted around three millennia ago by Thutmose, the bust still emits a charm that leaves its audience spellbound. However, no one, to the best of author's knowledge, has analyzed this sculpture or its photographs objectively to determine if there is any scientific basis to its attractiveness. Materials and Methods  High-resolution photographs of the bust were anthropometrically analyzed in frontal and right lateral profile views using neoclassical canons and Farkas' studies. Results  The photographs of the bust exhibit many of the neoclassical canons and proportions of Farkas' studies exactly, while many of the remaining are very close to these measurements. A few measurements are out of range of what is considered acceptable these days; however, her overall appearance is pleasing. Conclusion  Despite passage of more than three millennia, the proportions and parameters defining beautiful faces have largely remained unchanged.

Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face

Objectives

To evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face.

Materials and methods

A multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted.

Results

Mean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI).

Conclusion

Image-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.

High-resolution surface electromyographic activities of facial muscles during mimic movements in healthy adults: A prospective observational study

Objectives

Surface electromyography (sEMG) is a standard tool in clinical routine and clinical or psychosocial experiments also including speech research and orthodontics to measure the activity of selected facial muscles to objectify facial movements during specific facial exercises or experiments with emotional expressions. Such muscle-specific approaches neglect that facial muscles act more as an interconnected network than as single facial muscles for specific movements. What is missing is an optimal sEMG setting allowing a synchronous measurement of the activity of all facial muscles as a whole.

Methods

A total of 36 healthy adult participants (53% women, 18-67 years) were included. Electromyograms were recorded from both sides of the face using an arrangement of electrodes oriented by the underlying topography of the facial muscles (Fridlund scheme) and simultaneously by a geometric and symmetrical arrangement on the face (Kuramoto scheme). The participants performed a standard set of different facial movement tasks. Linear mixed-effects models and adjustment for multiple comparisons were used to evaluate differences between the facial movement tasks, separately for both applied schemes. Data analysis utilized sEMG amplitudes and also their maximum-normalized values to account for amplitude differences between the different facial movements.

Results

Surface electromyography activation characteristics showed systematic regional distribution patterns of facial muscle activation for both schemes with very low interindividual variability. The statistical significance to discriminate between the different sEMG patterns was good for both schemes (significant comparisons for sEMG amplitudes: 87.3%, both schemes, normalized values: 90.9%, Fridlund scheme, 94.5% Kuramoto scheme), but the Kuramoto scheme performed considerably superior.

Conclusion

Facial movement tasks evoke specific patterns in the complex network of facial muscles rather than activating single muscles. A geometric and symmetrical sEMG recording from the entire face seems to allow more specific detection of facial muscle activity patterns during facial movement tasks. Such sEMG patterns should be explored in more clinical and psychological experiments in the future.