FACIAL NERVE (VII) DISORDERS

Facial Nerve Front , Search , Index , Links , Pathology , Molecules , Syndromes , Muscle , NMJ , Nerve , Spinal , Ataxia , Antibody & Biopsy , Patient Info FACIAL NERVE (VII) DISORDERS Anatomy Bell's palsy Differential diagnosis Facial nerve: Anatomy 2 roots Motor from facial nucleus Nervus intermedius Sensory afferents: Skin & taste (to nucleus tractus solitarius) Preganglionic parasympathetics (from superior salivatory nucleus) Branches Large petrosal: Lacrimation & salivation Nerve to stapedius muscle Chorda tympani: Taste Sensory auricular branch Sensation of posterior external auditory canal & inferior pinna of ear Some axons may arise from vagus (Arnold's nerve) Motor: Facial muscles Facial nerve: Anatomical Diagram External link Brainstem anatomy Nerve anatomy: USUHS ; Yale Facial nerve paralysis: Signs Facial asymmetry Eyebrow droop Loss of forehead &d nasolabial folds Drooping of corner of mouth Uncontrolled tearing Inability to close eye Lips cannot be held tightly together: Diificulty keeping food in mouth Facial muscle atrophy (Late) Facial Paresis: Left Bell's Palsy 8 Sir Charles Bell Epidemiology Lifetime prevalence: 6.4 to 20 per 1,000 Incidence: Increased with age Overall: 0.5 per year per 1,000 Age 20: 0.1 per year per 1,000 Age 80: 0.6 per year per 1,000 Male = Female Recurrence: 7% Side: Right in 63% Increased incidence: Diabetes; Pregnant females Pathogenesis Evidence for herpes simplex type 1 infection Clinical Features Onset Paralysis: Progresses to maximal defecit over 3 to 72 hours Pain (50%): Near mastoid process Excess tearing (33%) Other: Hyperacusis; Dysgeusia Signs Facial weakness All branches of nerve: Upper & Lower Unilateral: Bilateral in < 1% Degree: Partial (30%); Complete (70%) Stapedius dysfunction (33%): Hyperacusis Lacrimation: Mildly affected in some patients Taste: No clinically significant changes in most patients Sensory loss 7 Mild or None May be present on face or tongue: On side of paralysis Possibly related to involvement of greater superficial petrosal nerve Prognosis better Incomplete paralysis Early improvement Slow progression Younger age Normal salivary flow Normal taste Electrodiagnostic tests normal Nerve excitability Electrogustometry Course Facial Paresis: Right Widened palpebral fissure Improvement onset: 10 days to 2 months Plateau: 6 weeks to 9 months Residual signs Synkinesis Frequency: ~50%; May be reduced by corticosteroid treatment May be treated with botulinum Probably due to misregeneration of nerve Face weakness: 30% Contracture: 20% Crocodile tears: 6% Blepharospasm: May occur years after paralysis Treatment of Bell's palsy Statistical degrees of benefit from drug treatment Prednisone + Acyclovir > Prednisone > Acyclovir More benefit when treatment started within 3 days of onset No benefit from treatment starting more than 10 days after onset Corticosteroids Use within one week of onset Adults: Prednisone 80 mg qd x 5 days Children: Prednisone 1 mg/kg/day After initial dose: Taper off over 7 to 10 days Acyclovir 5 Use within 3 days of onset Adults 2,000 mg per day (400 mg 5x/day) for 7 days With varicella zoster 4,000 mg per day Children: 80 mg/kg per day for 5 days ? More effective in Ramsay-Hunt syndrome Alternative anti-viral: Valacyclovir Protect eye from exposure ? Facial exercise Laboratory CSF: Protein high in 30%; Cells in 10% Calorics: Often reduced on affected side CNS imaging (MRI with gadolinium) indicated when No improvement in facial paresis after 1 month Hearing loss Multiple cranial nerve deficits Signs of limb paresis or sensory loss VII disorders: Differential Diagnosis Unilateral VII weakness Idiopathic: Bell's palsy Sarcoid & other granulomatous disorders Infection Leprosy : Especially with paralysis of upper face Otitis media Lyme disease Herpes Zoster (Ramsay Hunt syndrome) Neoplasm & Masses Trauma Cardiofacial syndrome :Lower lip or complete facial palsy Familial CNS lesions Bilateral VII weakness Melkersson syndrome Möbius syndrome Guillain Barré Motor neuron disorders Myasthenia gravis Myopathies Leprosy An-α-lipoproteinemia (Tangier) Central VII lesions Pyramidal: Lower face paralysis with voluntary motion Emotional 2 : Face paralysis with emotion Anatomy: Dorsolateral pons lesion Disorders Superior cerebellar artery infarction Unilateral With Deafness, Horner's, or reduced Sweating Extrapyramidal disorders Bilateral Parkinsonism Hemifacial spasm Melkersson-Rosenthal syndrome l Chromosome 9p11; Dominant Clinical Onset 5 to 70 years Incomplete penetrance Recurrent facial palsy Unilateral or Bilateral May include loss of taste Edema: Facial, Lip & Eyelid; Non-pitting External link: Image Onset: < 16 years Lingua plicata (Scrotal tongue) Laboratory Eyelid pathology: Granulomatous lymphangitis Möbius & Congenital facial syndromes Möbius syndrome: General Features 4 General: Rhombencephalic maldevelopment Onset: Congenital Facial paresis Unilateral or Bilateral Upper > Lower Ophthalmoplegia Common Especially VI nerve: Inability to abduct past midline Patterns Bilateral: 90% Abducens nerve palsy, isolated: 9% Conjugate horizontal gaze paresis: 48% Duane retraction syndrome : 34% Congenital fibrosis of extraocular muscles : 9% Palate and pharynx dysfunction: 56% Dysarthria, nasal Poor feeding Chewing defects: Associated with malocclusion Normal masticatory muscle function Motor disability, general: 88% Poor coordination (83%) Hypotonia: Congenital Poland syndrome : Some patients Respiratory abnormalities: 19%; Early death Tongue weakness: Hypoglossal nerve involvement Hypoplasia Asymmetry Limited range of motion Malformations Hands: Deformities Legs: Hypoplasia Möbius & Congenital facial syndromes: Types Sporadic Associated with toxic exposure Attempted abortion using misoprostol: Odds ratio = 38 Cocaine MBS1 l Chromosome 13q12.2-q13; Dominant Clinical: See general features Congenital facial diplegia; ± Asymmetric Ophthalmoplegia, esp VI nerve Mental retardation ± Peripheral neuropathy Skeletal: Arthrogryposis ; Orofacial malformations; Rib defects Muscle aplasia Respiratory failure: Central; Associated with tegmental brainstem calcification Hypogonadotropic hypogonadism Pathology: Aplasia or hypoplasia of cranial nerves & nuclei Hereditary congenital facial paresis 1 (HCPF1) l Chromosome 3q21-q22; Dominant Nosology: MBS2 Clinical Facial weakness Asymmetric Unequal involvement of the 3 branches of the facial nerve No ophthalmoplegia Pathology Facial nucleus: Reduced numbers of neurons Facial nerve: Small Rhombencephalon & corticospinal tracts: Normal Hereditary congenital facial paresis 2 (HCPF2) l Chromosome 10q21.3-q22.1; Dominant 1 Nosology: MBS3 Genetics: Variable penetrance Clinical Facial weakness: Unilateral or Bilateral Hearing loss: Congenital deafness, or Progressive hearing loss with age Ophthalmoplegia Chromosome translocation l Chromosome 1q22 Genetics Mutation Reciprocal translocation between chromosomes 1 & 11: t(1;11)(p22;p13) Reciprocal translocation between chromosomes 1 & 2: t(1;2)(p22.3;q21.1) Mutation often on paternally derived chromosome Clinical Facial diplegia Ptosis Other cranial nerves involved in some patients: III, VI, VIII Facial deformities: Anteverted nostrils, Malformed and low-set ears Developmental delay: Mild Poland syndrome: 1 patient Congenital heart disease Atrial septal defects + Similar genetic changes in cardiofacial syndrome Carey-Fineman-Ziter syndrome l Recessive Facial Nerve Trauma & Tumors Trauma Petrous bone fracture Surgery: Middle ear; Mastoidectomy; Parotid gland Tumors & Masses 6 Tumor types Neuroma/Neurinoma/Schwannoma: Most common Meningioma Hemangioma: Produce defects even with small size Cholesteatoma Parotid gland Metastasis Carcinomatous meningitis Paget: Osteopetrosis Tumor location Most common: Geniculate ganglion & Tympanic region Tumors along multiple segments of VII nerve common Rare: Middle cranial fossa Signs Facial weakness: 82% Course: Weakness progressive Usually > 1 year Range: Over 2 to 120 months Hearing loss: Some patients; Conductive, sensorineural or mixed Tumor visible by otoscopy Other: Some tumors found incidentally Diagnosis: MRI from brainstem to parotid Treatment Surgery Residual or increased facial paresis common: More deficit after 1 year of symptoms Best prognosis after removal of hemangioma Hemifacial Spasm Onset Adults Typically 5th or 6th decade Younger patients: Rule out brainstem disease, MS Location: Orbicularis oculi muscle More common in women Contraction pattern Synchronous contraction of facial nerve innervated muscles Paroxysmal Involuntary Duration: Up to 1 minute May persist during sleep Usually unilateral Weakness: Unusual Triggers: Aggravating factors Emotion Fatigue Causes Recovery from Bell's palsy Associated with synkinesis & contracture Dolichoectatic brainstem artery Frequency: 30% Mechanism: Pressure on VII root entry zone Vessels: PICA; AICA; Vertebral Brainstem disease Idiopathic Course: Usually permanent without treatment Electrophysiology Brief bursts of action potentials High frequency (150-400 Hz) Normal motor units Variable rhythm & amplitude Lateral spread response 3 Stimulation: Facial nerve branch Response: In muscles not normally innervated by branch Related to cross transmission of facial nerve fibers Location: Probably at site of compression Treatment Botulinum toxin Microvascular decompression of VII nerve Morbidity & Mortality 5% Anticonvulsants Bright 1831 Barker T2 image: Brainstem & Cerebellum MRA: AP view Dolichoectasia of vertebral arteries Deviation to right (Arrows) Patient syndrome: R hemifacial spasm Return to Cranial nerve disorders Go to Facial Paralysis (Baylor) References 1. Am. J. Hum. Genet., 1999;65:752-756 2. Neurology 2000;54:1217 3. Muscle Nerve 2002;25:845849 4. Neurology 2003;61:327333 5. Otol Neurotol 2003;24:948951 6. Otol Neurotol 2003;24:942947 7. J Neurol Neurosurg Psychiatry 2005;76:10171018 8. Cleve Clin J Med 2005;72:398-401 7/13/2005

Microdermabrasion Microdermabrasion is a

Microdermabrasion Cosemetic Dermatology Cosmetic Dermatology Services Microdermabrasion Laser Hair Removal Sclerotherapy Facial Vein Laser Treatment Chemical Peels Collagen Replacement Therapy BOTOX® Cosmetic Laser Skin Resurfacing Services Microdermabrasion Microdermabrasion is a skin rejuvenation method for the treatment of acne scarring, sun damage, age spots, blemishes, uneven pigmentation, enlarged pores, blackheads and stretch marks. Procedure: Microdermabrasion removes the surface layer of the skin, without the use of chemicals, lasers or acids. The procedure utilizes a device called a "non-crystal microdermabrader," which is a wand that attaches to the skin with suction and gently sands down surface layers of the skin. This process unblocks pores, removes and vacuums away dead skin cells, and stimulates circulation. Treatment Duration: Treatments take between 30 and 60 minutes. Anesthesia: Many patients describe a slight stinging sensation during treatment, but the discomfort is minimal and anesthesia is generally not necessary. After Care: Following treatment, the skin may appear slightly pinkish for approximately 24 to 48 hours. You will be advised on post-treatment care. It is important to keep the skin well moisturized and protected with sunscreen. To find out if you are a candidate for microdermabrasion, call our Patient Services Representative at (650) 330-5921 to schedule a consultation. Back to top About Our Sutter Health Network · Contact Us · Privacy Policy · Home

Body Butter Lotions Creams

The Body Shop: Sesame Body Butter, sesame, body butter, body, butter, cream, lotion, moisturizer, flavor, cream flavor | | My Account | Login | Favorites | View Cart Body Butter Lotions Creams Other Moisturizers Hand Care Foot Care Massage Spa Scrubs Sun Care Accessories Gift Ideas Strawberry Bath Shower Soap Scrubs Accessories Gift Ideas Cleansers Toners Moisturizers Scrubs and Masks Treatments Lips Eye Care Make-up Removers Sun Care Accessories Palettes Lips Eyes Face Make-Up Tools Oils Aroma Jars Candles & Accessories Gift Ideas Eau de Toilette Perfume Oils Body Sprays Lotions Shower Bath Lifestyle Fragrances Invent Your Scent Gift Ideas Scent-Me Collection Shampoo Conditioner Treatment Styling Products Brushes Essential Oils Massage Lotions Bath & Shower Home Fragrance Bergamot Lavender Ylang-Ylang Mandarin Gift Ideas Shaving & Face Hair & Body Fragrance Accessories Massage Gift Ideas Bath Hair Brushes Hand & Foot Massage Skin Accessories Make-Up Tools Bags & Cases Support a Cause Books Gift Ideas Sign up to receive discounts and special offers. Creams Best Sellers Coconut Body Butter Hemp Hand Protector Peppermint Intensive Foot Rescue Passion Fruit Lip Butter Cocoa Butter Body Scrub Sesame Body Butter Made with organic sesame oil, one of the richest natural moisturizers around. Especially good on very dry skin. View Larger See More Details Sesame Body Butter 78136 Add to My Favorites List $16.00 Quantity We also recommend... Sesame Foaming Bath More Details Key Ingredients All Ingredients Instructions Tip Zone Sesame oil Moisturizes and helps to soften the skin. Provides vital income for small-scale farmers. Cocoa Butter Is an excellent moisturizer that melts at body temperature, leaving the skin feeling soft and silky smooth. Enables the development of community projects such as schools and village wells, in addition to providing small scale farmers with income to support their families. Shea butter Moisturizes and helps soften the skin. Also provides a rural community of women with regular work and income. Community Trade Information Our Community Traded sesame oil is sourced from a co-operative of small-scale in a remote area of Nicaragua. We've been buying this great, easily absorbed oil from them since 1993. With every product you buy, you help provide these farmers with vital income. View More For centuries the women of Ghana have used cocoa butter to moisturize and cool their skin in the African heat. Since 1995, The Body Shop has been buying cocoa beans from the Kuapa Kokoo company in Ghana, a fair trade co-operative with over 30,000 small-scale farmers. The money made by the co-operative enables the development of community projects such as schools and village wells in addition to providing the farmers with income to support their families. View More Shea butter is one of nature's great moisturizers. Ghanaian women have used it for centuries to protect their skin from the dry Saharan winds. So who better to buy ours from than the Tungteiya Shea Butter Association, Northern Ghana. An association of around 400 women from 10 villages, we ensure a fair price for their product. Since trading with The Body Shop the women have been able to dramatically change their lives with water pipes and wells saving hours of water collecting, better housing, medical care, food, and self esteem. Importantly, they are also able to give their children, particularly their daughters, the chance to go to school. View More Corporate Site | News | Employment Opportunities | The Body Shop Canada | The Body Shop UK | Terms & Conditions | Privacy Policy | About Us Affiliate Program | Store Locator | Site Map | Help | Contact Us Body Butter & Body Scrubs | Creams | Body Butter © 2005 The Body Shop International plc. All Rights Reserved.

Acne Creams/Gels Teens Teen

Top Picks - Top Natural Acne Creams/Gels  You are here: About > Teens > Teen Advice > Puberty & Body Image > Acne Treatments > Top Picks - Top Natural Acne Creams/Gels Teens Teen Advice Essentials QUIZ: Ready for sex? QUIZ: Are you in love? QUIZ: Will your love last? QUIZ: Kissing I.Q. Teen Advice How Tos Topics Quizzes Teen Life FAQs/Q&A's Fact Sheets for Teens Crisis Lines & Advice Girl Stuff Guy Stuff Sex & Abstinence Suicide & Depression Teen Pregnancy Love and Dating Violence & Bullying Drugs & Alchohol Puberty & Body Image Birth Control & STDs Top Picks & Reviews Buyer's Guide Before You Buy Top Picks Product Reviews Forums Help FREE Newsletter Sign Up Now for the Teen Advice newsletter! See Online Courses   Search Teen Advice Guide Picks - Top 5 Natural Acne Creams/Gels Every teen needs a good daily/frequent use acne fighting gel or cream. Not only do these products fight existing blemishes but theyhelp reduce the frequency of future breakouts. When used as directed, these products can make a big difference to the overallappearance of your skin. Whether you prefer a medicated product or an all natural one, there is something out there for you. Check outour 5 favorite all natural acne cream/gels. 1) PhytoMe Acne Gel The non-drying formula soothes the skin without causing further irritation. PhytoMe Acne Gel can handle the most stubborn breakouts and the analgesic properties of the Arnica fight acne related pain. When used regularly, PhytoMe Acne Gel can unclog pores and significantly reduce the instances of breakouts. Effectively deals with pustules, whiteheads and blackheads. Read Review Manufacturer's Site 2) Pure Pores Blackhead Remover & Pore Minimizer Gel From JOEY New York, natural beauty products. This miracle daily use gel will remove blackheads, shrink large pores and absorb excess oil... and it will do it all in 60 seconds!The gentle, all-natural formula is non-drying and contains a specially balanced blend of fruit acids and organic botanicals. Get clear, clean skin fast, with the science of nature. Read Review -- 3) Acnesil A non-drying, completely natural acne remedy. Acnesil works by promoting a healthy moisture balance in your skin while destroying the bacteria that causes of the acne. It attacks the acne causing bacteria on your face leaving the essential moisturebalance untouched. Made from a 10% Melaleuca Alternifolia (tea tree oil) solution blended with other proven natural acne fighting ingredients. Read Review -- Manufacturer's Site 4) Zia Natural Skincare Balancing Elixir A therapeutic blend of essential oils and phytonutrients that treat skin problems at their source. Can be used twice daily and is greatunder make-up or moisturizers. For best results, follow the instructions on the package. The natural ingredients get to work restoring a balanceto your face, combatting existing acne and eliminating future breakouts. Read Review -- 6) Desert Essence Blemish Stick A Tea Tree Oil touch-stick blended with other known natural acne fighters.Just dab it on to troubled spots during the day (before make-up) and evening (before bed). The all-natural ingredients go towork immediately, killing bacteria and restoring sin's pH balance. This all natural product is 100% vegetarian and doesnot test on animals. Read Review -- Related Guide Picks Related Resources • Top Overall Acne Fighting Products • Top Medicated Acne Creams/Gels • Top Medicated Acne Cleansers • Top Medicated Acne Scrubs • Top Medicated Acne Masks • Top Medicated Overnight Treatments Top Natural Acne Creams/Gels --• Top Natural Acne Cleansers • Top Natural Acne Scrubs • Top Natural Acne Masks • Top Natural Overnight Treatments • Top Acne Fighting Essential Oils • Before You Buy Acne Products • 10 Things You Oughta Know About Zits • Essential Oils for Teens • Dealing with Puberty Important product disclaimer information about this About site. From Mike Hardcastle , Your Guide to Teen Advice . FREE Newsletter. Sign Up Now! Advertisement Most Popular Is it Love? A teen advice quiz that can help you decide. tee... Are You Ready to Have Sex? A 45 Question Quiz - Give us 20 m... Are you a good kisser? A quick and easy quiz to help you det... Will your love last? A quick and easy True or False quiz to ... Is it lust or love? 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Microdermabrasion Device Firms Receive

FDA/CFSAN - Hair Removal and Microdermabrasion Device Firms Receive Warning Letter FDA Home Page | CFSAN Home | Search/Subject Index | Q & A | Help CFSAN/Office of Cosmetics and Colors Fact Sheet February 19, 2002; Revised November 16, 2004 Hair Removal and Microdermabrasion Device Firms Receive Warning Letters WarningLetters issued by FDA to the manufacturer of a hair removal system (available in HTML and PDF ) and the manufacturerof a microdermabrasion device (available in PDF ) illustrate an important legal distinction -- the difference between the legal definitions of cosmetics and medical devices. Although the devices cited in these Warning Letters are intended to affect a person's appearance,the fact that a product is used to diagnose or treat a medical condition or affect the structure orfunction of the body makes it a medical device, not a cosmetic, under the Federal Food, Drug, & Cosmetic Act (FD&C Act). The FD&C Act requires medical device manufacturers to obtain marketing clearance for their productsbefore offering them for sale [ FD&C Act, section501(f)(1) ]. The law does not require clearance or approval to market cosmetic products or ingredients.(An exception is color additives , which are covered separately in section 721 of the FD&C Act .) In addition,medical devices are subject to the Quality System Regulation (21 CFR part 820). Cosmetics are not subject to thisregulation. This is how the FD&C Act defines a device: The term ''device'' (except when used in paragraph (n) of thissection and in sections 301(i), 403(f), 502(c), and 602(c)) means aninstrument, apparatus, implement, machine, contrivance, implant, in vitroreagent, or other similar or related article, including any component, part,or accessory, which is - (1) recognized in the official National Formulary, orthe United States Pharmacopeia, or any supplement to them, (2) intended foruse in the diagnosis of disease or other conditions, or in the cure,mitigation, treatment, or prevention of disease, in man or other animals, or(3) intended to affect the structure or any function of the body of man orother animals, and which does not achieve its primary intended purposesthrough chemical action within or on the body of man or other animals andwhich is not dependent upon being metabolized for the achievement of itsprimary intended purposes. [FD&C Act, section 201 (h)] This is how the FD&C Act defines a cosmetic: The term ''cosmetic'' means (1) articles intended to be rubbed,poured, sprinkled, or sprayed on, introduced into, or otherwise applied to thehuman body or any part thereof for cleansing, beautifying, promotingattractiveness, or altering the appearance, and (2) articles intended for useas a component of any such articles; except that such term shall not includesoap. [FD&C Act, section 201(i)] For related information, see Is It a Cosmetic, a Drug, or Both? (or Is It Soap?) , Cosmeceuticals , Soap , Warning Letters , and Medical Devices . Warning Letter to Rejuvenu International Ltd. (available in HTML and PDF ). August 16, 2004 Warning Letter to Biorem s.r.l. (available in PDF ). December 14, 2001 Cosmetics CFSAN Home | CFSAN Search/Subject Index | CFSAN Disclaimers & Privacy Policy | CFSAN Accessibility/Help FDA Home Page | Search FDA Site | FDA A-Z Index | Contact FDA FDA/Center for Food Safety & Applied Nutrition Hypertext updated by bxm/cjm/dav November 16, 2004