• Physical Therapy Korea
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• v.9 no.3
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• pp.101-111
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• 2002

The purpose of this study was to determine EMG biofeedback training effect on the muscle activities in 3 unilateral facial palsy patients along with multiple baseline design across subjects. The auditory feedback about facial muscles (orbicularis oris, orbicularis oculi, frontalis) was provided with each patient during facial exercise training. Electromyographic (EMG) activity during maximal voluntary contraction and maximal compound muscle action potential (CMAP) amplitude elected by supramaximal electrical stimulation on facial nerve of facial muscles were measured pre- and post- EMG biofeedback training to evaluate motor learning. EMG activity during maximal voluntary contraction was increased after EMG biofeedback training and CMAP amplitude elected by supramaximal electrical stimulation was not changed in all subjects. The results indicate that EMG biofeedback training is useful method to improve motor learning of facial excercise training in unilateral facial palsy patients.

• Journal of Yeungnam Medical Science
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• v.17 no.2
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• pp.129-136
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• 2000

Background and Purpose: This study was undertaken to compare the sensitivity of the Repetitive Nerve Stimulation Test (RNST) between the upper and lower extremity muscles in myasthenia gravis(MG) patients. Material and Methods: The study population consisted of 20 normal persons(control group) and 10 MG patients(MG group). Using Stalberg's method. RNST was systemically performed in orbicularis oculi muscle. upper extremity muscles(flexor carpi ulnaris. abductor digiti quinti), and lower extremity muscles(tibialis anterior. extensor digitorum brevis. vastus medialis). Results: There were statistical differences of decremental response($mean{\pm}SD$) in orbicularis oculi and upper extremity muscles between the control and MG groups(p<0.05 or p<0.01). However, there was no statistical difference of decremental response($mean{\pm}SD$) to RNST in lower extremity muscles between the control and MG groups. There were highersensitivity in orbicularis oculi and upper extremity muscles than lower extremity muscles. Although positive reponse were detected in the lower extremity muscles, the positive response rates of lower extremity muscles were lower than o.oculi and upper extremity muscles. Conclusions: When the response rates of RNST in facial and upper extremity muscles are normal, may not be required RNST in lower extremity muscles.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.171-177
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• 2020

Background Infrabrow blepharoplasty has become a common surgical method used to rejuvenate aged upper eyelids in Asians. In this paper, we describe the parallel excision method for infrabrow blepharoplasty as a useful alternative to the conventional elliptical excision method. The authors' experience over a 3-year period is presented and reviewed. Methods A retrospective review of parallel excision infrabrow blepharoplasty cases at our hospital between 2014 and 2017 was performed. Three oculoplastic surgeons compared preoperative and postoperative photographs using the Strasser grading system. Results From the medical records of 123 patients, a total of 93 patients with moderate-to-severe bilateral dermatochalasis were selected as subjects. The exclusion criterion was levator function less than 8 mm. The total mean follow-up period was 2 years (range, 0.5-3.5 years). The mean skin excision height and width were 9.75 mm (range, 5-16 mm) and 58.51 mm (range, 42-75 mm), respectively. All patients who underwent surgery recovered without major complications, and all patients had high levels of satisfaction and improvements in their visual field. In the Strasser evaluation performed by the oculoplastic surgeons, most patients were found to have excellent results. Conclusions The parallel excision method for infrabrow blepharoplasty is a safe and effective technique that yields more natural- and youthful-looking eyelids than the conventional elliptical excision method. In our method, more effective manipulation of the orbicularis oculi muscle led to a reduction in frontalis compensation, resolution of sunken eyelids, and correction of lateral hooding.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.277-286
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• 2001

Background: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. Materials and Methods: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. Results: The significant electrodecremental response of RNST were noted in orbicularis oculi(58.9%), nasalis (51.3%), flexor carpi ulnaris(42%), anconeus(41%) and abductor digiti quinti muscles(27%). Among the 3 muscles of upper extremity(abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles(p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. Conclusion: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.576-583
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• 2014

Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.304-310
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• 2005

Bulging of the lower eyelid & tear trough groove is regarded as a sign of aging. In the past, the surgical excision of the fat pad has been the mainstray of the management of lower palpebral bag in cosmetic blepharoplasty, Recently, fat pad sliding method has been introduced to make more attractive lower eyelids. We used the fat pad for covering the hollowness of the lower eye lid. And we use redundant fat pad for filling & augmentation of the lower eye lid by reflexion. Redraping of the orbicularis arc, with its accompanying midfacial fat repositioning, anatomically restores the cheek and lower lid to make more youthful contour. By redraping and fixing the orbicularis arc on the medial surface of the orbital rim, it becomes a more attractive midface and may prevent of ectropion. From August, 2002 to July, 2004 in correction of lower palpebral bulge & tear trough groove, these two technique were performed in 42 consecutive individuals (84 lower eyelid) for two-year period. Follow up ranged from 3 to 15 months. (an average of 9 months) Palpebral bulge & tear trough groove were corrected and obtained a youthful midface. Complication was rare. The advantages of these techniques are that: prevent in of secondary palpebral bulge and irregularity of lower eyelid by using of reflexed fat fad; prevent in of ectropion. Thus an attractive midface is obtained by redraping of orbicularis arc.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.115-118
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• 2021

Intramuscular hemangioma is a rare vascular benign proliferation that can occur within any muscle, particularly in the trunk and extremities. In the head and neck region, the masseter muscle is most commonly involved, followed by the periorbital and sternocleidomastoid muscles. Diagnosing intramuscular hemangioma is challenging because there are no characteristic symptoms; instead, magnetic resonance imaging is the best imaging modality to diagnose these lesions. Complete surgical resection is the treatment of choice, although the local recurrence rate is high. Herein, we report a rare case of intramuscular hemangioma located in the zygomaticus minor muscle, which is related to smiling and usually runs along the orbicularis oculi muscle. Distinguishing or separating these two muscles is challenging. However, based on the muscle vector of the midface and radiological findings, the two muscles were successfully separated. The zygomaticus minor was cut very slightly to approach to the lesion and the muscle fibers were split to excise it. A follow-up examination revealed no nerve damage or muscle dysfunction at 4 weeks postoperatively. This rare case may serve as a reference for managing intramuscular hemangioma in the head and neck region.

• Archives of Craniofacial Surgery
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• v.19 no.4
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• pp.296-299
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• 2018

Xanthelasma palpebrarum is the most common cutaneous xanthoma found on the medial side of the eyelid. The typical lesion is usually a flat and yellowish plaque on the skin. However, we report on a unique case of intramuscular xanthoma found during blepharoplasty for the correction of ptosis. A 53-year-old male patient visited our department with a complaint of a ptotic eyelid. He was concerned about the cosmetic appearance and the uncomfortable feeling while opening his eyes, and wanted these problems to be solved. A yellowish plaque of about $0.3{\times}0.3cm$ in size was found in the orbicularis oculi muscle during the surgery. The lesion was excised and xanthelasma was confirmed with biopsy. We have found this specific case of xanthelasma palpebrarum in the only muscle. Therefore, a careful approach to clinical and histologic examination and imaging is required for patients with these lesions.

• The Journal of Internal Korean Medicine
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• v.45 no.3
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• pp.429-443
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• 2024

Background: The study reports the effect of Korean medicine treatment on a patient with left facial palsy caused by Wegener's granulomatosis. Case information: The patient was receiving steroid treatment for facial palsy and was hospitalized for 21 days. He received acupuncture, electroacupuncture, bee venom pharmacopuncture, and moxibustion treatment along with Ssanghwa-tang and Cheongansohabwon herbal medicine treatment. During hospitalization, the Sunnybrook facial grading scale, House-Brackmann scale and length of time for the eye to completely close were evaluated at 11/16, 11/21, 11/27, 12/1, and 12/6. Post treatment, the degree of the movement in the left eyelid was improved, it took less time for the eye to close completely, the movement of the forehead wrinkle muscles improved, but that of the facial muscles under the eyes and left orbicularis oculi muscle showed little improvement. Conclusion: Korean medicine treatment for facial palsy caused by Wegener's Granulomatosis helps restore mobility of the forehead and orbicularis oculi muscles.

• The Journal of Korean Medicine
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• v.36 no.4
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• pp.69-73
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• 2015

Objectives: This study was carried out to analyse the skin of the Hand lesser yang in human. Methods: The Hand lesser yang meridian was labeled with latex in the body surface of the cadaver, subsequently dissecting a body among superficial fascia and muscular layer in order to observe internal structures. Results: This study has come to the conclusion that a depth of the skin has encompassed a common integument and a immediately below superficial fascia, and this study established the skin boundary with adjacent structures such as relative muscle, tendon as compass. The skin area of the Hand lesser yang in human is as follows: The skin close to the ulnar root angle of 4th finger nail, above between 4th and 5th metacarpal bone, between extensor digit. minimi tendon(t.) and extensor digit. t., extensor digit. m(muscle). at 2, 4, 7 cun above dorsal carpal striation, triceps brachii m. t., deltoid m., trapezius m., just around the ear, upper orbicularis oculi m. Conclusions: The skin area of the Hand lesser yang from anatomical viewpoint seems to be the skin area outside the superficial fascia or the muscle involved in the pathway of the Hand lesser yang meridian, the collateral meridian, the meridian muscle, with the condition that we consider adjacent skins.