Three-Dimensional quantification of the symmetry of normal facial movement

Objective: This study examined the right to left symmetry of the displacement of three-dimensional movement of the human face. Methods: Displacement data on 42 subjects was collected and analyzed with the Expert Vision Motion Analysis System. Right and left three-dimensional facial displacements were quantified. Results: Significantly greater left than right three-dimensional displacement across the whole face was measured. The three-dimensional displacement difference ranged from 0.48 mm to 2.28 mm between the right and left sides of the face. The 2-cm inferior pupil markers during the nose wrinkle expression had significantly greater left than right displacement. Conclusion: The ranges of displacement differences, along with the mean three-dimensional displacement measures, must be accounted for in the creation of a baseline of the range of normal facial movement

Three dimensional quantification of ‘still’ point during normal facial movement

This study investigated the 3-dimensional displacement of points on the face that were thought to be still during facial movement. These points are currently used to measure displacement of moving facial regions during assessment of normal facial movement and treatment interventions following facial nerve paralysis. It is, however, unknown if these places are #still# points. The Expert Vision Motion Analysis System was used to collect and analyze data on 42 normal subjects during facial movement. No point on the face was found to be still during facial expression. However, several points were present with very small movements for each individual expression. These were termed #reference# points. These small movements may be the result of system noise, physiological tremor, skin movement, or head-holder movement during facial expressions. Future studies of the displacement of the markers during facial movement in both normal subjects and patients with facial nerve paralysis may take into account the contribution of the #reference# point displacements to the overall facial movement

Quantification of three-dimensional displacement of normal facial movement

This study was undertaken to quantify 3-dimensional (3-D) facial movement in normal subjects, and to identify the individual axes in which this movement occurred. Displacement data on 42 subjects were collected and analyzed with the Expert Vision Motion Analysis System. The 3-D displacement was calculated by vectorially subtracting maximum marker movement from previously identified reference marker points. The 3-D range of normal facial movement was quantified, with the greatest displacement occurring during maximum smile. When the individual axes were examined, we found that most movement occurred in the vertical axes for the majority of expressions, followed by the anterior-posterior axis. These results may create an objective baseline from which disorders of the facial nerve, and hence, medical, surgical, and physiotherapy treatment interventions, can be analyzed in the future

Facial schwannoma : results of a large case series and review

Objectives and hypothesis: To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm. Study design: Retrospective case review combined with review of current literature. Materials and methods: A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented. Results: There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients. Discussion: The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level. Conclusion: Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.12 page(s

Bell's palsy: aetiology, clinical features and multidisciplinary care

Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus–axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy