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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
There are no standard protocols for successful cheek treatment. Every patient should be carefully evaluated by visual observation and hand palpation. Facial muscle movements can help to locate the muscle insertion points and delineate the underlying structures. Pinching the facial soft tissue and pressing upon the bone should help the injectors determine the bony shape and thickness of soft tissues in different regions.
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The masseters are muscles of the cheek and lower jaw and are the primary muscles of mastication. They are important cosmetically as it is possible to make the face appear slimmer by administering botulinum toxin to the masseters. This treatment has, however, fallen out of favour due to the significant risk of localised (and permanent) osteoporosis of the mandible with subsequent fractures. They arise from the zygomatic and maxillary processes of the zygoma and insert on the coronoid process and lateral aspect of the mandibular ramus. Their arterial blood supply comes from the masseteric artery, which itself is a branch of the external carotid artery and passes over the mandibular notch, which is located between the coronoid process of the mandible and the temporomandibular joint. Unlike many other facial muscles, the masseters receive their nervous innervation from the trigeminal nerve or, more precisely, the V3 segment or mandibular nerve. See Figure 3.23.
Anatomical Considerations to Improve Aesthetic Treatments Using Neuromodulators
Published in Yates Yen-Yu Chao, Optimizing Aesthetic Toxin Results, 2022
Nicholas Moellhoff, Sebastian Cotofana
Neurotoxins cause muscle paralysis by inhibiting the release of acetylcholine at the neuromuscular junction (Small 2014). Several factors impact the effect of neurotoxin injections, including dosage, volume, depth of injection, and anatomic region, as well as the anatomic fascial layers penetrated (Swift et al. 2022). The anatomy of the facial muscles is highly variable between individuals. Aesthetic outcomes are therefore dependent on precise patient evaluation prior to injection. Both dynamic contraction patterns and muscle fiber orientation, as well as static facial lines, should be assessed to determine the most suitable injection points. While adverse events are not observed frequently, and their duration is limited by the effectiveness of the toxin, they can cause dissatisfaction and can disturb the treated patient (Ahsanuddin et al. 2021). Adverse events are often the consequence of affecting muscles which were not the primary target of injection. In-depth understanding of the underlying musculature with its movement axes is therefore crucial to predict outcomes and to avoid collateral damage.
Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis
Published in Acta Oto-Laryngologica, 2023
Junhui Jeong, Jeon Mi Lee, Jin Kim
We used a computer-based numerical scoring system to evaluate the facial functions. To develop the system, we evaluated the anatomical elements of facial muscles by adding weighted values in a specific manner based on the vectors of facial muscle movements. We incorporated easily recognizable facial points using a modern camera-based interface technology. The designated points were selected with reference to an anatomical vector of facial muscles. The system measured the contraction ranges at major locations of the paralyzed and synkinetic muscles (Figure 2). The proportions of facial movements on the affected side, compared with the normal side at rest and while saying ‘e,’ were averaged and presented as percentages. Based on the percentages, primary and secondary facial movement scores were assigned for the paralyzed and synkinetic muscles, respectively. Then, the final facial movement scores were obtained by subtracting the secondary facial movement scores from primary facial movement scores. The evaluations were performed before and after 1 year of treatment by one senior author who was the most experienced. There was no inter-rater or intra-rater variability in this system.
Treatment considerations in myasthenia gravis for the pregnant patient
Published in Expert Review of Neurotherapeutics, 2023
Myasthenia gravis (MG) is an autoimmune disease where antibodies against the acetylcholine receptor (AChR) in the postsynaptic membrane at the neuromuscular junction cause the typical muscle weakness [1,2]. More rarely, pathogenic antibodies are instead directed against muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4) antigens functionally linked to AChR in the membrane. The muscle weakness can be generalized or localized. It occurs most frequently in extraocular muscles with diplopia and ptosis as troublesome symptoms. Weakness in swallowing and speech muscles as well as in facial muscles is common. Neck, shoulder, and arm muscles have frequently some weakness, whereas leg muscles are rarely affected [3]. Respiratory muscle weakness represents the major threat of MG, and myasthenic crisis with the need of ventilatory support can occur, especially during respiratory infections. Fluctuations during the day and over time are typical for MG. Repetitive and prolonged muscle use increases or precipitates the weakness.
Therapists’ perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study
Published in Physiotherapy Theory and Practice, 2022
Martinus M. van Veen, Britt W.T ten Hoope, Tessa E. Bruins, Roy E. Stewart, Paul M.N. Werker, Pieter U. Dijkstra
Facial palsy is a peripheral nerve injury characterized by the inability to contract the facial muscles, resulting in (partial) loss of facial expression. Approximately half of all facial palsies are idiopathic, commonly referred to as Bell’s palsy (incidence of 20–30/100,000 individuals per year) (Myers et al., 1991); the other half are due to a wide variety of causes such as iatrogenic or traumatic injuries, head and neck neoplasms, otologic diseases, and congenital birth defects (Hohman and Hadlock, 2014). Facial palsy patients experience various functional and psychosocial difficulties related to their inability to voluntarily contract the facial muscles. Myriad treatment options are available, including surgical, pharmacological, and physical therapeutic measures, all aimed at improving facial function and psychological wellbeing (Kleiss, 2015; Luijmes et al., 2017). Ultimately, treating facial palsy is a multidisciplinary team effort, in which the facial palsy rehabilitation therapist plays an essential role (Butler and Grobbelaar, 2017; Hohman and Hadlock, 2014; Van Landingham, Diels, and Lucarelli, 2018).