Face ; physiopathology ; Humans ; Mouth ; physiopathology ; Pain ; Pain Threshold ; Somatoform Disorders

Kabuki syndrome is characterized by long palpebral fissures, large ears, a depressed nasal tip, and skeletal anomalies associated with postnatal dwarfism and mental retardation. There have been few prior detailed descriptions of strabismus or stereopsis in these patients. We report a patient with Kabuki syndrome who showed small-angle strabismus and poor stereopsis. This case illustrates the need for patients with a diagnosis of Kabuki syndrome to have an ophthalmologic evaluation. Strabismus associated with Kabuki syndrome may have a small angle that can be easily overlooked.
Abnormalities, Multiple/physiopathology ; Child ; Face/abnormalities/physiopathology ; Female ; Hematologic Diseases/complications/physiopathology ; Humans ; Strabismus/*etiology/physiopathology ; Vestibular Diseases/complications/physiopathology ; *Vision, Binocular ; *Visual Acuity

Harlequin syndrome is characterized by unilateral hyperhidrosis and flushing, which are predominantly induced by heat or exercise. Usually, the sympathetic deficits confine to the face. Rarely, the autonomic deficits involve the arm or the parasympathetic neurons in the ciliary ganglia. We report a 43-yr-old woman who presented with facial flushing and sweating in the right side, which were mainly induced by exercise. The facial flushing accompanied relative coldness in the right arm. Valsalva maneuver, cold pressure and 0.125% pilocarpine test, and computed tomography of the chest were normal. The crossed sympathetic deficit in the left face and right arm suggested that the lesions were multifocal. The sympathetic impairment in our patient may lie on a spectrum of pre- and postganglionic autonomic dysfunction, which was observed in Holmes-Adie, Ross, and Guillain-Barre syndrome.
Adult ; Arm/innervation/*physiopathology ; Autonomic Nervous System Diseases/*physiopathology ; Face/innervation/*physiopathology ; Female ; Flushing/*physiopathology ; Humans ; Research Support, Non-U.S. Gov't ; Sweating/*physiology ; Syndrome

OBJECTIVE: To explore changes of facial sensory function after intracranial surgery in the treatment of idiopathic trigeminal neuralgia (TN) and their possible reasons. METHOD: Fifty-six patients of TN receiving trigeminal microvascular decompression (MVD) or nerve combing or coagulation surgery by post-sigmoid approach from 2006 to 2008 were observed. Their sensory score of pain, temperature and tactile were recorded before and 1 week after surgery. These scores as well as status of neurovascular conflict in trigeminal sensory root were analyzed and potential reasons were discussed. RESULT: Nineteen (33.9%) cases had normal facial sense after surgery and 37 (66.1%) cases had a decreased sensation. Sensory scores of each divisions 1 week after surgery were significantly lower than those before surgery (P < 0.05). The tactile and temperature sensory score of the first division had not significant difference before and after surgery (P > 0.05 respectively), while the pain sensory had obvious difference (P < 0.01). In the third division the descend score of pain and temperature in the lateral portion was lower than that of the medial portion (P < 0.05), but tactile score had not differences. In all 56 patients, 45 had neurovascular conflict and 26 of them had a decreased facial sense. While in 11 cases without responsible vessel, their facial sense were all abnormal. In the abnormal sensory group, the ratio of conflict vessel presenting at caudal, middle and rostral end of sensory root is 42.3%, 26.9% and 30.8% respectively. In normal sensory group, 63.2% cases had rostral conflict vessel and only 5.3% had caudal conflict vessel. CONCLUSION Intracranial surgery of trigeminal nerve results different changes of superficial sensation on the different portion of the face. In addition to direct injury, stretching of the sensory root (especially at root entry zoon) is an important possible responsibility of postoperative sensory hypesthesia.
Adult ; Aged ; Decompression, Surgical ; Face ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Period ; Sensation ; Trigeminal Nerve ; physiopathology ; surgery ; Trigeminal Neuralgia ; physiopathology ; surgery

OBJECTIVETo explore the correlation between hand and face-mouth, so as to provide nerve reflex basis for the theory "Hegu (LI 4) regulates face and mouth".

METHODSSeven hundred and sixty-three participants who met the inclusive criteria were divided into different age groups. The skin around participants' thenar eminence was gently scraped to be observed whether there was an involuntary movement around the face or mouth, which was palmomental reflex. The results of palmomental reflex were recorded.

RESULTSThe total occurrence rate of palmomental reflex was 46.26%. For those who were 0 to 1 years old, the palmomental reflex was all positive; for those who were 21 to 36 years old, the positive rate was 20.45%, which was the lowest; for those who were 65 to 85 years old, more than half of them were positive. The majority of those who were 0 to 2 years old were bilateral positive palmomental reflex, while the majority of those who were 65 to 85 years old were unilateral positive palmomental reflex.

CONCLUSIONThere is a certain connection between hand and face-mouth. The occurrence rate of palmomental reflex changes from high to low over age increasing, and then changes from low to high with the aging, presenting a "high-low-high" U-shaped curve, which is possible related to the growth and recession of nervous system.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Face ; physiopathology ; Female ; Hand ; physiopathology ; Humans ; Infant ; Male ; Middle Aged ; Mouth ; physiopathology ; Reflex ; Young Adult

OBJECTIVETo evaluate and analysis facial somatosensory changes of patients with chronic masticatory muscle pain (MMP) quantitatively.

METHODSThe seven parameters of standardized quantitative sensory testing (QST) protocol were used to test the pain sites, contralateral sites of masticatory muscles of 20 chronic MMP patients and the same sites of right masticatory muscles of 20 matched healthy controls. QST thresholds were compared within groups using paired t test and between groups using unpaired t test.

RESULTSCompared to the controls, all seven parameters of bilateral sides of patients had changed. Mainly cold detection thresholds [(-1.2±0.5) and (-1.7±0.9) °C] and cold pain thresholds [(27.6±2.3) and (27.0±2.0) °C] of pain and contralateral sides increased significantly, while warm detection thresholds [(2.0±1.1) and (2.1±1.2) °C], heat pain thresholds [(37.9±3.2) and (39.7±3.9) °C], and mechanical pain thresholds [(49.3±34.1) and (111.8±86.3) mN] of pain and contralateral sides decreased significantly (P<0.05). Mechanical detection thresholds of pain sites [(1.8±1.4) mN] significantly increased (P=0.01).

CONCLUSIONSChronic MMP patients were detected thermal hyperesthesia, thermal hyperalgesia, and mechanical hyperalgesia. Mechanical hypoesthesia was found at the pain sites of masticatory muscles. Chronic MMP might influence the central modulation of trigeminal nerve system.

Case-Control Studies ; Chronic Pain ; physiopathology ; Cold Temperature ; Face ; Hot Temperature ; Humans ; Hyperalgesia ; diagnosis ; physiopathology ; Hypesthesia ; diagnosis ; physiopathology ; Masticatory Muscles ; physiopathology ; Myalgia ; physiopathology ; Pain Measurement ; methods ; Pain Threshold ; physiology

OBJECTIVETo probe into the effective acupuncture technique for deviation of the mouth in intractable facial palsy.

METHODSOne hundred and one cases of intractable facial palsy were randomly divided into an observation group (48 cases) and a control group (53 cases). Cuanzhu (BL 2), Sibai (ST 2), Jiache (ST 6) and Qianzheng (Extra) on the affected side were punctured in two groups. Additionally, three acupoints of the mouth were supplemented, named Dicang (ST 4), Kouheliao (LI 19) and Jiachengjiang (Extra) were added, and the sticking needle and traction method was adopted on them in observation group. the routine needling technique was applied in control group. The treatment was given once a day and 10-day treatment made one session. The changes in facial nerve function index (FNFI) were observed in 2 sessions of treatment.

RESULTSAfter treatment, FNFI in two groups increased significantly (both P < 0.01), but the improvement in observation group was better than that in control group (P < 0.01). In observation group, the basic recovery rate of FNFI was 87.5% (42/48), which was higher than that (67.9%, 36/53) in control group (P < 0.05).

CONCLUSIONThe sticking needle and traction method o three points is the quite effective approach in the treatment of deviation of the mouth in intractable facial palsy.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Face ; innervation ; Facial Nerve ; physiopathology ; Facial Paralysis ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Mouth ; Traction ; Young Adult

OBJECTIVETo investigate the relationship between serum sex hormone levels, liver function, and pathogenic mechanisms related to cutaneous lesions involving the facial skin in male patients with liver cirrhosis.

METHODSFifty male cirrhotic patients with facial skin lesions, including spider angiomas, angiotelectasis and special type rash, (mean age: 48.1 +/- 12.2 years) were randomly selected for study and enrolled as the case group. Thirty cirrhotic male patients without facial skin lesions (mean age: 44.5 +/- 11.7 years) were enrolled as the control group. Serum levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), prolactin (PRL), estradiol (E2), progesterone (PRGE), and testosterone (T) were detected and compared between cases and controls by the t-test. All patients were sub-categorized according to severity of cirrhosis (Child-Pugh classification) and comparisons between cases and controls were carried out by single factor analysis of variance. Logistic regression modeling was used to evaluate whether the presence of skin lesions is related to changes in markers of liver impairment, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), serum albumin (Alb), prothrombin time (PT-SEC), creatinine (CREA), platelet count (PLT), and alcoholism.

RESULTSIn the cases with spider veins, LH level was significantly elevated (t = 2.01) and T level was significantly decreased (t = -2.20) (both, P less than 0.05 vs. controls). In the cases with telangiectasia, the LH level (t = 3.76, E2 (t = 2.08) and E2/T ratio (t = 2.98) were significantly elevated and T level was significantly decreased (t = -3.77) (all, P less than 0.05 vs. controls). In the cases with special type rash, FSH level was significantly elevated (t = 2.03) and T level was significantly decreased (t = -2.01) (both, P less than 0.05 vs. controls). In the case group, E2 levels decreased as severity of liver damage increased, while in the control group, E2 levels increased as severity of liver damage increased; however, the difference in average E2 values of the two groups did not reach statistical significance (P more than 0.05). In both cases and controls, the T levels were decreased as the severity of liver damage increased (F = 3.70, P less than 0.05). Multivariate logistic regression analysis showed that increased incidence of facial skin lesions is associated with alcoholism (odds ratio (OR) = 4.46, 95% confidence interval (CI) = 1.45-13.7, P less than 0.05) and elevated serum levels of AST (OR = 11.87, 95% CI = 1.24-113.1, P less than 0.05).

CONCLUSIONAlcoholism, impaired liver function, and perturbed levels of circulating sex hormones are associated with cirrhosis-related facial lesions and may play important roles in the pathogenesis of cutaneous lesions in patients with cirrhosis.

Adult ; Alcoholism ; physiopathology ; Case-Control Studies ; Face ; pathology ; Gonadal Steroid Hormones ; blood ; Humans ; Liver Cirrhosis ; blood ; pathology ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Skin ; pathology

OBJECTIVETo manifest the specificity of acupoints objectively through observing the relationship of both Guangming (GB 37) and Hegu (LI 4) with the some areas of face.

METHODSThe patients with peripheral facial paralysis were divided into the Guangming (GB 37) group and Hegu (LI 4) group, and punctured respectively. Before and after treatment, the distribution and change of facial temperatures were measured with infrared thermography and the data on each area was comparatively analyzed.

RESULTSAfter punctured at Guangming (GB 37), the temperature went up in the areas around the eyes of both health and affected sides, especially on the affected side, which was significantly different from the other facial areas (all P<0.05). After punctured at Hegu (IA 4), the temperature obviously went up in the area around the mouth, which was significantly different from other areas of face, such as the areas of Yintag and health eye. The temperature in the area around the affected eye was significantly higher than that of the area around the health eye.

CONCLUSIONThere is some close coordination between Guangming (GB 37) and eye area, as well as between Hegu (LI 4) and mouth area, suggesting the specificity of acupoints.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Face ; physiopathology ; Facial Paralysis ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Skin Temperature ; Thermography

OBJECTIVETo compare electrical sensory threshold (EST) and electrical pain threshold (EPT) of bilateral masseters, temporal muscles and finger region of chronic masticatory muscle pain (MMP) patients and the controls, and to analyze the mechanism of pain threshold change.

METHODSTwelve patients with MMP and 12 matched controls participated in this study. EST and EPT of bilateral masseters, bilateral temporal muscles, and left middle finger were recorded and compared within group and between groups.

RESULTSCompared to the controls, the EPTs of patients significantly decreased [left masseter (5.9 +/- 1.1) mA,right masseter (5.7 +/- 1.0) mA, left temporal muscle (5.3 +/- 1.4) mA, right temporal muscle (5.5 +/- 1.7) mA,finger (5.2 +/- 1.0) mA] (P < 0.001). There was no significant difference in EST between patients and the controls. No relationship was found among VAS, ESP, and EPT.

CONCLUSIONSDecreased pain thresholds of masseters, temporal muscles and fingers in MMP indicated that peripheral sensitization was induced in MMP patients. Decreased pain threshold in patients meant that MMP might influence the central modulation of nervous system.

Adult ; Case-Control Studies ; Chronic Disease ; Electric Stimulation ; Face ; Facial Pain ; physiopathology ; Female ; Fingers ; Humans ; Male ; Masticatory Muscles ; physiopathology ; Middle Aged ; Pain Measurement ; Pain Threshold ; Young Adult