A new evaluation of heat distribution on facial skin surface by infrared thermography.

OBJECTIVE: The aim of this study was to identify the facial areas defined by thermal gradient, in individuals compatible with the pattern of normality, and to quantify and describe them anatomically. METHODS: The sample consisted of 161 volunteers, of both genders, aged between 26 and 84 years (63 ± 15 years). RESULTS: The results demonstrated that the thermal gradient areas suggested for the study were present in at least 95% of the thermograms evaluated and that there is significant difference in temperature between the genders, racial group and variables "odontalgia", "dental prothesis" and "history of migraine" (p < 0.05). Moreover, there was no statistically significant difference in the absolute temperatures between ages, and right and left sides of the face, in individuals compatible with the pattern of normality (ΔT = 0.11°C). CONCLUSIONS: The authors concluded that according to the suggested areas of thermal gradients, these were present in at least 95% of all the thermograms evaluated, and the areas of high intensity found in the face were medial palpebral commissure, labial commissure, temporal, supratrochlear and external acoustic meatus, whereas the points of low intensity were inferior labial, lateral palpebral commissure and nasolabial.

Lagophthalmos.

Lagophthalmos is the incomplete or defective closure of the eyelids. The inability to blink and effectively close the eyes leads to corneal exposure and excessive evaporation of the tear film. The main cause of lagophthalmos is facial nerve paralysis (paralytic lagophthalmos), but it also occurs after trauma or surgery (cicatricial lagophthalmos) or during sleep (nocturnal lagophthalmos). The main cause for paralytic lagophthalmos is Bell's palsy but it may be secondary to trauma, infections, tumors, and many other conditions. The main purpose when treating lagophthalmos is to prevent exposure keratitis and reestablish eyelid function. It is equally important for the patient to regain a cosmetically acceptable appearance. Clinical treatment includes lubricant drops and ointments. Surgical procedures include dynamic and static techniques. The decision about the most appropriate method for reconstruction depends on the location, extent, degree and duration of paralysis, etiology, patient's age, health, and expectations. The indications and technical steps of the most used static procedures are described in this review.

Reference jitter values for concentric needle electrodes in voluntarily activated extensor digitorum communis and orbicularis oculi muscles.

The aim of this study was to estimate normal jitter in voluntarily activated extensor digitorum communis (EDC) and orbicularis oculi (OOc) muscles using a disposable concentric needle electrode (CNE). The EDC of 67 normal subjects (22 males and 45 females, mean age 35.5 +/- 10.2 years) and the OOc of 50 normal subjects (13 males and 37 females, mean age 37.9 +/- 9.6 years) were studied. Jitter values were expressed as the mean consecutive difference (MCD) of 20 potential pairs. The mean MCD for EDC was 23.6 +/- 3.1 micros (upper 95% confidence limit [CL]: 29.7 micros). The mean MCD of all potential pairs (n = 1340) was 23.5 +/- 7.3 micros (95% CL: 38.2 micros). The mean MCD for the 18th highest value was 31.4 +/- 4.9 micros (95% CL: 41.2 micros). The mean MCD for OOc was 24.7 +/- 3.1 micros (95% CL: 31.0 micros). The mean MCD of all potential pairs (n = 1000) was 24.7 +/- 7.1 micros (95% CL: 39.0 micros). The mean MCD for the 18th highest value was 32.7 +/- 4.1 micros (95% CL: 40.9 micros). Our reported CNE jitter values obtained during voluntary activation represent the largest series currently available. The suggested practical limit in the EDC for mean MCD was 30 mus and for outliers was 42 micros, and in the OOc for mean MCD was 31 micros and 41 micros for outliers. The present study confirms that CNE can be used to assess jitter values, although certain precautions must be taken.

Predictive factors in infraorbital sensitivity disturbances following zygomaticomaxillary fractures.

The aim of this study was to define if the alterations in sensory modalities could be a predictive factor in the prognostic recovery of the ION. Ten patients that had suffered facial trauma, associated with sensitivity alterations of the ION were evaluated prospectively. Touch detection thresholds (TD) were measured using Von Frey's filaments aesthesiometer. A warm/cold discrimination (W/C) was also done to the patients, on the same areas. The patients were examined in both sides of the face, using the non-traumatized side as control. The tests were done before surgery and several times postoperatively. For statistical analysis of the results, the two-sample t test was used. A significant difference (P < 0.0001) in the mean tactile recovery time between the areas without thermal sensitivity before surgery and those with normal thermal sensitivity before surgery was observed. Therefore, we propose that during the preoperative examination, the surgeon examines the thermal discrimination in order to establish prognosis and approximate recovery times.

[Marcus Gunn Phenomenon: differential diagnosis of palpebral ptoses in children]. / Fenômeno de Marcus Gunn: diagnóstico diferencial das ptoses palpebrais na criança.

OBJECTIVE: The aim of this paper is to review existing literature on the subject and to report on and discuss a case of Marcus Gunn Phenomenon. DESCRIPTION: A five year-old female, otherwise a healthy patient, while still a few months old, was seen by a pediatrician who detected a disorder of the right eye, initially believed to be strabismus, at a follow-up childcare consultation. Several ophthalmologists failed to establish a precise diagnosis. After a pediatric ophthalmologist had examined the child at four years of age, a diagnosis of Marcus Gunn Phenomenon, otherwise known as jaw-winking phenomenon, was confirmed. Apart from this anomaly, physical, ophthalmological, and neurological examinations were normal. Since ptosis was mild and no association with strabismus, amblyopia or other conditions was established, no surgical procedures were necessary. COMMENTS: This report is an alert to pediatricians regarding the presence of this largely unknown phenomenon, making it possible for pediatricians to identify the phenomenon, refer the patient to an ophthalmologist, and establish differential diagnosis from other, more severe forms of ptosis, requiring more aggressive treatment.

Fenômeno de Marcus Gunn: diagnóstico diferencial das ptoses palpebrais na criança / Marcus Gunn Phenomenon: differential diagnosis of palpebral ptoses in children

OBJETIVO: Este trabalho teve por objetivo fazer uma revisão bibliográfica, relatar e discutir o caso clínico de um paciente com fenômeno de Marcus Gunn. DESCRIÇAO: Criança de 5 anos de idade, sexo feminino, hígida. Nos primeiros meses de vida, em consulta de puericultura, foi detectada alteração no olho direito, que, a princípio, parecia tratar-se de estrabismo. Após consultas com vários oftalmologistas, não se alcançou um diagnóstico preciso. Já aos 4 anos de idade, após exame realizado por oftalmologista pediátrico, confirmou-se o diagnóstico do fenômeno de Marcus Gunn. O restante do exame físico, incluindo exame neurológico, estava normal. Por se tratar de ptose palpebral leve, sem outras patologias associadas, optou-se por uma conduta conservadora. COMENTARIOS: Este relato visa alertar os pediatras com relação ao fenômeno de Marcus Gunn, que ainda é pouco conhecido. A partir deste conhecimento, o pediatra poderá identificar o fenômeno, possibilitando o encaminhamento precoce para a abordagem de complicações ou condições associadas, além de diagnóstico diferencial com outros tipos de ptose palpebral.

Blepharoclonus and parkinsonism associated with aqueductal stenosis.

A 28-year-old man with a history of congenital hydrocephalus due to aqueductal stenosis shunted at 45 days of age is presented. At age 4 years the valve had to be removed because of septicemia. Twenty-three years later he developed parkinsonian signs and abnormal, involuntary rhythmic contractions of the eyelids. The latter were elicited on gentle eye closure. Parkinsonism promptly improved after ventriculoperitoneal shunting, but blepharoclonus persisted unchanged.