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Anatomy of the Midface
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Stephen A. Goldstein, Evan Ransom
The zygomaticus minor muscle may complement the action of the zygomaticus major and levator labii. Interestingly, this muscle is frequently absent (13). In a dissection study, Pessa et al. describe seven patterns of midfacial musculature with the most common pattern being a single zygomaticus major with paired upper lip elevators (levator labii superioris and levator alae nasi) (11). When present, the zygomaticus minor originates medial to the zygomaticus major on the inferomedial aspect of the zygomatic bone and inserts at the lateral most upper lip. Contraction of this muscle raises the upper lip alone, as in a snarl or expression of contempt. The risorius muscle originates at the platysma and masseteric fascia and attaches to the complex of muscles at the angle of the mouth. Like the zygomaticus minor, this muscle is frequently absent (7). Contraction of the risorius results in lateral excursion of the oral commissure and produces a grinning expression or a toothless smile.
Myasthenia Gravis
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
This patient has very mild bilateral ptosis at rest which is accentuated on sustained upward gaze, with the development of diplopia in all quadrants on repeated testing of her eye movements. She displays a mild so-called 'myasthenic snarl' on being asked to show her teeth and, on counting serially, her speech becomes progressively slurred, nasal and of a reduced volume. There is no evidence of any cranial nerve palsies and in view of the signs elicited, the most likely diagnosis is that of myasthenia gravis.
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
In a straightforward Bell’s palsy, hearing distortion, due to paralysis of stapedius, and impaired taste, due to simultaneous involvement of the chorda tympani, do not always occur and in mild cases the lower half of the face may be more severely affected than the upper half, mimicking an upper motor neuron lesion, as discussed above.24 Seventy-five per cent of patients make a good recovery over three to six weeks with or without treatment. Twenty per cent make an acceptable but slow recovery complicated by the development of facial synkinesis. This is due to nerve sprouting with subsequent loss of fine control, which can turn a smile into a snarl and eye closure into a distorted grimace. Five per cent of cases make little or no recovery and may ultimately require plastic surgical repair. In some cases, aberrant regeneration may lead to lacrimation instead of salivation on eating, so-called crocodile tears.25 It is most important that patients with Bell’s palsy are not told that they have had a small stroke. Exclusion of underlying hypertension, diabetes, sarcoidosis and inflammatory arterial disease is important and more recently the recognition of Lyme disease in southern rural England suggests blood tests for Borrelia burgdorfii be added to the diagnostic work up in appropriate areas, typically where there is a large deer population.
White Teachers
Published in Studies in Gender and Sexuality, 2022
A nine-year-old’s exasperated harrumph at another child taking his Lego without asking was described in my hearing recently by a white teacher—who was very fond of him, too—as a “snarl.” A boy was described in a staff meeting as “dead behind the eyes.” “The other children are frightened of him.” No, they aren’t. You are. A risk assessment for a vulnerable teenage girl—a risk assessment upon which her placement and future depended—described her as “likely to display violent and aggressive behavior” because of a single incidence of property being thrown in a children’s home when she was a much younger child. Again, when I took issue with this at senior management level of the huge national children’s charity who were the service providers, I was told that I had poor boundaries and was getting “too emotionally involved,” although (thankfully in this case), a multi-agency fight secured the placement.
A testimonio of a queer Chicana researcher in education
Published in Journal of Lesbian Studies, 2020
What does it mean to live in fear of my own writing, of my stories? Of my history and my future? For this Chicana dyke it means that I question my thoughts, experiences, words, and the entire process of the paper. The intensity can feel like there is a chance I’ll get pushed off a very steep cliff without a soft landing for my thoughts. Instead, my thoughts crash down to earth, crumbling among the shadow beasts that snarl messages of failure, intrusion, and otherness, before I even begin.