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Takahashi S, Ishizuka S, Kitamura K, Yang T, Abe SI, Murakami G, Rodríguez-Vázquez JF. Growth patterns of facial muscles at the angle of the mouth: A histological study using midterm and near-term human fetuses. J Anat 2024; 245:535-550. [PMID: 38953435 DOI: 10.1111/joa.14101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
At the angle of the mouth, spoke-like muscle bundles converge at the "modiolus," which is believed to appear in utero. The aim of this study was to investigate the growth of the modiolus histologically. We studied frontal histological sections of the face from 12 midterm and six near-term fetuses. At midterm, a convergence of the levator anguli oris (LAOM) and depressor anguli oris (DAOM) was frequently present, and another convergence of the LAOM with the platysma (PM) or orbicularis oris (OOM) was also often evident. At near-term, muscle fiber merging or interdigitation was classified into nine combinations, five of which were frequently seen: LAOM-PM, LAOM-DAOM, zygomaticus major (ZMM)-orbicularis oris (OOM), buccinator (BM)-LAOM, and BM-PM. These combinations existed at slightly different depths and/or sites, thus allowing the angle of the mouth to receive multiple muscles. Notably, tissues interposed between the muscle fibers were limited to a thin epimysium at each crossing or interdigitation. Therefore, the LAOM, DAOM, OOM, BM, and PM appear to form a basic configuration at birth, but the development and growth were much delayed than the classical description. The modiolus is not a specific fibromuscular structure but simply represents a cluster of muscle convergence sites. Even at meeting between an elevator and depressor, a specific fibrous structure seems unlikely to connect the epimysium for the muscle convergence. Instead, the central nervous system appears to regulate the activity of related muscles to minimize tension or friction stress at the meeting site.
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Affiliation(s)
- Sakiko Takahashi
- Department of Anatomy, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Satoshi Ishizuka
- Department of Pharmacology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Kei Kitamura
- Department of Histology and Developmental Biology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Tianyi Yang
- Department of Anatomy, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Shin-Ichi Abe
- Department of Anatomy, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Gen Murakami
- Department of Anatomy, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
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Funk PF, Levit B, Bar-Haim C, Ben-Dov D, Volk GF, Grassme R, Anders C, Guntinas-Lichius O, Hanein Y. Wireless high-resolution surface facial electromyography mask for discrimination of standardized facial expressions in healthy adults. Sci Rep 2024; 14:19317. [PMID: 39164429 PMCID: PMC11336214 DOI: 10.1038/s41598-024-70205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
Wired high resolution surface electromyography (sEMG) using gelled electrodes is a standard method for psycho-physiological, neurological and medical research. Despite its widespread use electrode placement is elaborative, time-consuming, and the overall experimental setting is prone to mechanical artifacts and thus offers little flexibility. Wireless and easy-to-apply technologies would facilitate more accessible examination in a realistic setting. To address this, a novel smart skin technology consisting of wireless dry 16-electrodes was tested. The soft electrode arrays were attached to the right hemiface of 37 healthy adult participants (60% female; 20 to 57 years). The participants performed three runs of a standard set of different facial expression exercises. Linear mixed-effects models utilizing the sEMG amplitudes as outcome measure were used to evaluate differences between the facial movement tasks and runs (separately for every task). The smart electrodes showed specific activation patterns for each of the exercises. 82% of the exercises could be differentiated from each other with very high precision when using the average muscle action of all electrodes. The effects were consistent during the 3 runs. Thus, it appears that wireless high-resolution sEMG analysis with smart skin technology successfully discriminates standard facial expressions in research and clinical settings.
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Affiliation(s)
- Paul F Funk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Bara Levit
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Chen Bar-Haim
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Dvir Ben-Dov
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Roland Grassme
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department of Prevention, Biomechanics, German Social Accident Insurance Institution for the Foodstuffs and Catering Industry, Erfurt, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.
- Center for Rare Diseases, Jena University Hospital, Jena, Germany.
| | - Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- X-Trodes, Herzliya, Israel
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Kim JH, Murakami G, Rodríguez-Vázquez JF, Sekiya R, Yang T, Abe SI. Insertions of the striated muscles in the skin and mucosa: a histological study of fetuses and cadavers. Anat Cell Biol 2024; 57:278-287. [PMID: 38720632 PMCID: PMC11184418 DOI: 10.5115/acb.24.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/11/2024] [Accepted: 04/06/2024] [Indexed: 06/14/2024] Open
Abstract
Striated muscle insertions into the skin and mucosa are present in the head, neck, and pelvic floor. We reexamined the histology of these tissues to elucidate their role in transmission of the force. We examined histological sections of 25 human fetuses (gestational ages of ~11-19 weeks and ~26-40 weeks) and 6 cadavers of elderly individuals. Facial muscle insertion or terminal almost always formed as an interdigitation with another muscle or as a circular arrangement in which muscle fiber insertions were sandwiched and mechanically supported by other muscle fibers (like an in-series muscle). Our examination of the face revealed some limited exceptions in which muscle fibers that approached the dermis were always in the nasalis and mentalis muscles, and often in the levator labii superioris alaeque nasi muscle. The buccinator muscle was consistently inserted into the basement membrane of the oral mucosa. Parts of the uvulae muscle in the soft palate and of the intrinsic vertical muscle of the tongue were likely to direct toward the mucosa. In contrast, the pelvic floor did not contain striated muscle fibers that were directed toward the skin or mucosa. Although 'cutaneous muscle' is a common term, the actual insertion of a muscle into the skin or mucosa seemed to be very rare. Instead, superficial muscle insertion often consisted of interdigitated muscle bundles that had different functional vectors. In this case, the terminal of one muscle bundle was sandwiched and fixed mechanically by other bundles.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
| | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Aska Hospital, Iwamizawa, Japan
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | | | - Ryo Sekiya
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Tianyi Yang
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Sin-ichi Abe
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
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Levit B, Funk PF, Hanein Y. Soft electrodes for simultaneous bio-potential and bio-impedance study of the face. Biomed Phys Eng Express 2024; 10:025036. [PMID: 38350124 DOI: 10.1088/2057-1976/ad28cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/13/2024] [Indexed: 02/15/2024]
Abstract
The human body's vascular system is a finely regulated network: blood vessels can change in shape (i.e. constrict, or dilate), their elastic response may shift and they may undergo temporary and partial blockages due to pressure applied by skeletal muscles in their immediate vicinity. Simultaneous measurement of muscle activation and the corresponding changes in vessel diameter, in particular at anatomical regions such as the face, is challenging, and how muscle activation constricts blood vessels has been experimentally largely overlooked. Here we report on a new electronic skin technology for facial investigations to address this challenge. The technology consists of screen-printed dry carbon electrodes on soft polyurethane substrate. Two dry electrode arrays were placed on the face: One array for bio-potential measurements to capture muscle activity and a second array for bio-impedance. For the bio-potential signals, independent component analysis (ICA) was used to differentiate different muscle activations. Four-contact bio-impedance measurements were used to extract changes (related to artery volume change), as well as beats per minute (BPM). We performed concurrent bio-potential and bio-impedance measurements in the face. From the simultaneous measurements we successfully captured fluctuations in the superficial temporal artery diameter in response to facial muscle activity, which ultimately changes blood flow. The observed changes in the face, following muscle activation, were consistent with measurements in the forearm and were found to be notably more intricate. Both at the arm and the face, a clear increase in the baseline impedance was recorded during muscle activation (artery narrowing), while the impedance changes signifying the pulse had a clear repetitive trend only at the forearm. These results reveal the direct connection between muscle activation and the blood vessels in their vicinity and start to unveil the complex mechanisms through which facial muscles might modulate blood flow and possibly affect human physiology.
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Affiliation(s)
- Bara Levit
- School of Physics, Tel Aviv University, Tel Aviv, Israel
| | - Paul F Funk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
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Guntinas-Lichius O, Trentzsch V, Mueller N, Heinrich M, Kuttenreich AM, Dobel C, Volk GF, Graßme R, Anders C. High-resolution surface electromyographic activities of facial muscles during the six basic emotional expressions in healthy adults: a prospective observational study. Sci Rep 2023; 13:19214. [PMID: 37932337 PMCID: PMC10628297 DOI: 10.1038/s41598-023-45779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
High-resolution facial surface electromyography (HR-sEMG) is suited to discriminate between different facial movements. Whether HR-sEMG also allows a discrimination among the six basic emotions of facial expression is unclear. 36 healthy participants (53% female, 18-67 years) were included for four sessions. Electromyograms were recorded from both sides of the face using a muscle-position oriented electrode application (Fridlund scheme) and by a landmark-oriented, muscle unrelated symmetrical electrode arrangement (Kuramoto scheme) simultaneously on the face. In each session, participants expressed the six basic emotions in response to standardized facial images expressing the corresponding emotions. This was repeated once on the same day. Both sessions were repeated two weeks later to assess repetition effects. HR-sEMG characteristics showed systematic regional distribution patterns of emotional muscle activation for both schemes with very low interindividual variability. Statistical discrimination between the different HR-sEMG patterns was good for both schemes for most but not all basic emotions (ranging from p > 0.05 to mostly p < 0.001) when using HR-sEMG of the entire face. When using information only from the lower face, the Kuramoto scheme allowed a more reliable discrimination of all six emotions (all p < 0.001). A landmark-oriented HR-sEMG recording allows specific discrimination of facial muscle activity patterns during basic emotional expressions.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.
- Center for Rare Diseases, Jena University Hospital, Jena, Germany.
| | - Vanessa Trentzsch
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nadiya Mueller
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Martin Heinrich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Roland Graßme
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department of Prevention, Biomechanics, German Social Accident Insurance Institution for the Foodstuffs and Catering Industry, Erfurt, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Trentzsch V, Mueller N, Heinrich M, Kuttenreich AM, Guntinas-Lichius O, Volk GF, Anders C. Test-retest reliability of high-resolution surface electromyographic activities of facial muscles during facial expressions in healthy adults: A prospective observational study. Front Hum Neurosci 2023; 17:1126336. [PMID: 36992792 PMCID: PMC10040741 DOI: 10.3389/fnhum.2023.1126336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
ObjectivesSurface electromyography (sEMG) is a standard method for psycho-physiological research to evaluate emotional expressions or in a clinical setting to analyze facial muscle function. High-resolution sEMG shows the best results to discriminate between different facial expressions. Nevertheless, the test-retest reliability of high-resolution facial sEMG is not analyzed in detail yet, as good reliability is a necessary prerequisite for its repeated clinical application.MethodsThirty-six healthy adult participants (53% female, 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). In one session, participants performed three trials of a standard set of different facial expression tasks. On one day, two sessions were performed. The two sessions were repeated two weeks later. Intraclass correlation coefficient (ICC) and coefficient of variation statistics were used to analyze the intra-session, intra-day, and between-day reliability.ResultsFridlund scheme, mean ICCs per electrode position: Intra-session: excellent (0.935–0.994), intra-day: moderate to good (0.674–0.881), between-day: poor to moderate (0.095–0.730). Mean ICC’s per facial expression: Intra-session: excellent (0.933–0.991), intra-day: good to moderate (0.674–0.903), between-day: poor to moderate (0.385–0.679). Kuramoto scheme, mean ICC’s per electrode position: Intra-session: excellent (0.957–0.970), intra-day: good (0.751–0.908), between-day: moderate (0.643–0.742). Mean ICC’s per facial expression: Intra-session: excellent (0.927–0.991), intra-day: good to excellent (0.762–0.973), between-day: poor to good (0.235–0.868). The intra-session reliability of both schemes were equal. Compared to the Fridlund scheme, the ICCs for intra-day and between-day reliability were always better for the Kuramoto scheme.ConclusionFor repeated facial sEMG measurements of facial expressions, we recommend the Kuramoto scheme.
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Affiliation(s)
- Vanessa Trentzsch
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Nadiya Mueller
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Martin Heinrich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
- *Correspondence: Orlando Guntinas-Lichius, ; orcid.org/0000-0001-9671-0784
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Mai HN, Win TT, Tong MS, Lee CH, Lee KB, Kim SY, Lee HW, Lee DH. Three-dimensional morphometric analysis of facial units in virtual smiling facial images with different smile expressions. J Adv Prosthodont 2023; 15:1-10. [PMID: 36908751 PMCID: PMC9992697 DOI: 10.4047/jap.2023.15.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/06/2022] [Accepted: 01/31/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE Accuracy of image matching between resting and smiling facial models is affected by the stability of the reference surfaces. This study aimed to investigate the morphometric variations in subdivided facial units during resting, posed and spontaneous smiling. MATERIALS AND METHODS The posed and spontaneous smiling faces of 33 adults were digitized and registered to the resting faces. The morphological changes of subdivided facial units at the forehead (upper and lower central, upper and lower lateral, and temple), nasal (dorsum, tip, lateral wall, and alar lobules), and chin (central and lateral) regions were assessed by measuring the 3D mesh deviations between the smiling and resting facial models. The one-way analysis of variance, Duncan post hoc tests, and Student's t-test were used to determine the differences among the groups (α = .05). RESULTS The smallest morphometric changes were observed at the upper and central forehead and nasal dorsum; meanwhile, the largest deviation was found at the nasal alar lobules in both the posed and spontaneous smiles (P < .001). The spontaneous smile generally resulted in larger facial unit changes than the posed smile, and significant difference was observed at the alar lobules, central chin, and lateral chin units (P < .001). CONCLUSION The upper and central forehead and nasal dorsum are reliable areas for image matching between resting and smiling 3D facial images. The central chin area can be considered an additional reference area for posed smiles; however, special cautions should be taken when selecting this area as references for spontaneous smiles.
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Affiliation(s)
- Hang-Nga Mai
- Institute for Translational Research in Dentistry, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.,Dental School of Hanoi University of business and technology, Hanoi, Vietnam
| | - Thaw Thaw Win
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Minh Son Tong
- School of Dentistry, Hanoi Medical University, Hanoi, Vietnam
| | - Cheong-Hee Lee
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Kyu-Bok Lee
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - So-Yeun Kim
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Woo Lee
- Department of Oral and Maxillofacial Surgery, Uijeongbu Eulji Medical Center, Eulji University School of Dentistry, Uijeongbu, Republic of Korea
| | - Du-Hyeong Lee
- Institute for Translational Research in Dentistry, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.,Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Mueller N, Trentzsch V, Grassme R, Guntinas-Lichius O, Volk GF, Anders C. High-resolution surface electromyographic activities of facial muscles during mimic movements in healthy adults: A prospective observational study. Front Hum Neurosci 2022; 16:1029415. [PMID: 36579128 PMCID: PMC9790991 DOI: 10.3389/fnhum.2022.1029415] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Nadiya Mueller
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Vanessa Trentzsch
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Roland Grassme
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Prevention, Biomechanics, German Social Accident Insurance Institution for the Foodstuffs and Catering Industry, Erfurt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany,*Correspondence: Orlando Guntinas-Lichius,
| | - Gerd Fabian Volk
- Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Kehrer A, Ruewe M, Platz Batista da Silva N, Lonic D, Heidekrueger PI, Knoedler S, Jung EM, Prantl L, Knoedler L. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics (Basel) 2022; 12:diagnostics12071650. [PMID: 35885554 PMCID: PMC9322000 DOI: 10.3390/diagnostics12071650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed.
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Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
- Correspondence: ; Tel.: +49-941-944-6763
| | - Marc Ruewe
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | | | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Paul Immanuel Heidekrueger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (N.P.B.d.S.); (E.M.J.)
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
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Kurz A, Volk GF, Arnold D, Schneider-Stickler B, Mayr W, Guntinas-Lichius O. Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis. Front Neurol 2022; 13:869900. [PMID: 35444611 PMCID: PMC9013944 DOI: 10.3389/fneur.2022.869900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.
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Affiliation(s)
- Annabella Kurz
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
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