Cranial Nerve Palsy

This, prospective, observational study has two goals which are to determine outcomes of (1) facial impairment and disfigurement, and (2) self-perceptions of facial appearance and well-being in patients who undergo facial reanimation surgery to address unilateral, mid-facial paralysis: one of the most frequent forms of paralysis. These goals are represented by the three Specific Aims as previously stated. The study participants will be patients unilateral with facial paralysis who are slated for facial muscle reconstruction surgery using a free gracilis muscle transfer with one of four innervations: (1) Trigeminal nerve (nV), (2) cross-face nerve graft (nVII), (3) dual using both the trigeminal nerve and a cross-face nerve graft, and (4) midfacial modification. All patients will be recruited from a single treatment Center, the Facial Nerve Center (FNC) at MEEI. Dr. Tessa Hadlock will be the attending for all the patients and will perform the surgeries. The age range for the patients will be 18 to 68 years. The patients will attend TUSDM, where Dr. Trotman maintains her Facial Animation laboratory, for all testing and data collection. All patients will be followed longitudinally and tested at three separate visits: At baseline immediately before surgery, then at five and 18 months after surgery. The 18 month post-surgery testing time is important to track changes related to the regenerative process.13 The specific data to be obtained from each subject will include 3D static facial photographs, video data of different facial animations, 3D objective facial movements/animations, and patient-centered questionnaires to assess condition-specific and general QOL. Dr. Hadlock, the operating surgeon, will be masked to the patients' pre-surgery and outcome data-this study does not involve an Intervention. Patients who are potentially eligible for participation in the study will be identified and recruited based on the selection criteria. Enrolled patients with facial paralysis will continue to receive all other services routinely provided during treatment. The total number of subjects needed to complete study goal is 96 (n=24 per group). Up to 125 subjects will be screened in order to enroll and complete 96 subjects. All patients will be recruited from the Facial Nerve Center at Massachusetts Eye and Ear Infirmary. All patients will be followed longitudinally and tested at three separate visits: prior to surgery at MEEI (baseline visit), then at 5 and 18 months after surgery. The longitudinal testing times concur with their recall visits during treatment and are important to track changes. There will be 3 study visits, each include the following procedures: * The psychosocial tests will occur first (estimated 20 minutes): We will use three psychosocial scales/questionnaires for this patient population to gauge patients' perceptions of the impact of their paralysis and their recovery. The questionnaires will be completed by the patients at baseline, and 18 months after surgery. Moreover, we also will compare patient perceptions to the patient-related responses with clinical scoring made by the surgeons using the eFACE,6 Face-Gram/Emotrics12 software, and the 3D dynamic measures. * 3D dynamic (objective) facial movement data will be collected next (estimated time 1 hour): The gold standard for tracking facial soft tissue movement (a Motion Analysis TM system) to measure the facial movements of each patient according to the methods and analyses of Trotman and co-workers. The system tracks retro-reflective markers secured to specific facial soft tissue landmarks during facial animations. Ten replications of each of 12 animations will be obtained to include brow raise, gentle eye closure, tight eye closure, "ee" sound, "oo" sound, gentle smile, maximum smile, grimace, lip purse, check puff, mouth opening, and natural smile. Non-landmark based data also will be collected using a 3dMDdynamic Face System™. * Static 3D photographic data (estimated time 15 minutes): 3D static facial images/photographs will be recorded for each patient using 3dMD Face System. The system has four digital cameras to be used for the geometry reconstruction and two color digital cameras for the texture overlay. The system uses a combination of white light for the texture cameras and a random pattern projector for the geometry cameras. The system has a field of view of 220 by 300 millimeters with a stated accuracy rating of 500 microns, and captures both 3-D surface data (x, y, z coordinates) and high resolution (\~ 2 megapixels) 2D image texture data (color overlay). The patient will be seated comfortably in front of the camera and the camera adjusted to focus on the face. In order to capture the subject in natural head position, the patient will focus on his or her own image in a mirror placed at an appropriate distance. Two repetitions of each position will be captured. The raw data from each of the 24 images per patient then will be exported and stored for further analysis. * Video data of the different facial animations (estimated time 15 minutes): A standardized set of simultaneous frontal, and right and left video images of patients will be recorded during each of the series of facial animations/movements. Three video cameras positioned at right angles to each other will record images of each patient. These images will be displayed on a split-screen color television and recorded using a standard video-recorder. The images for patients will be compiled and saved for viewing.

The feedback-enabled magnetic device primarily comprises 2 matched pairs of one near-infrared light-emitting diode and one photodiode sensor, a magnetic actuator, an iron sheet (for affixing to the paralytic upper eyelid), and a biosignal acquisition module along with a power supply unit providing a wired connection with optical sensors and a magnetic actuator. Before the study, the differences between the affected and unaffected palpebral fissure heights were directly measured using a ruler. During the test after using the device, the distance of the paralytic eyelid lift was documented and the corrected distance (gain) of the paralytic upper eyelid was calculated. The efficacy and safety of the device were assessed. The efficacy was evaluated according to the symmetrical blinks and gain of paralytic eyelid lifts. Subjective sensation and complications were assessed by visual field obstruction, blurred vision, foreign body sensation over the cornea, burning or hot sensation over facial skin, and erythema or pruritus over the eyelid. After the completion of the study procedure, the eyelid skin integrity, subjective sensation and discomfort were examined. Outcomes in the management of blepharoptosis of diverse etiologies using a feedback-enabled magnetic device will be demonstrated. Differences in outcomes between patients managed using the device and those who underwent surgery will be presented.

The transient diplopias (TD) is defined by a short diplopia. Their etiology may be ophthalmological, neurological non-ischemic or of ischemic origin. The difficulty is to recognize an ischemic mechanism which imposes emergency cares. A clinical score could help the clinician to recognize the etiology of the TD .

This is a Phase III Study to evaluate the efficacy and safety of STN1013800 Ophthalmic Solution in Chinese Patients with Acquired Blepharoptosis. At present, there are no medicines for the treatment of acquired blepharoptosis in China. Therefore, to evaluate the efficacy and safety of 0.1% STN1013800 ophthalmic solution, Vehicle (Placebo) are designed. For the screening period, 3-7 days were set to confirm the subjects and judge their qualification. Dosage and administration were based on prior clinical trial results approved at 0.1% once daily for 42 days treatment.

To accomplish the goal of understanding the source of individual variability in eye movement patterns, each participant will complete three separate tasks. The first task will require participants to find a target and eye movements will be measured to assess individual differences in fixation duration and other types of eye movement behavior. A second task will evaluate attentional functioning over the visual field by requiring participants to detect briefly-presented targets using their peripheral vision. Finally, a third task will assess inhibitory functioning by having participants attempt to stop eye movements after they have been programmed.

This is a prospective, randomized, controlled clinical trial designed to compare the efficacy, functional outcomes, aesthetic results, and patient-reported satisfaction associated with two surgical techniques for correcting primary aponeurotic ptosis: anterior white line advancement and posterior white line advancement. Participants will be randomized 1:1 into two parallel groups. In the anterior approach, access to the levator aponeurosis is achieved via a skin crease incision, and advancement is performed using sutures placed on the white line to reattach it to the anterior surface of the tarsus. In the posterior approach, access is gained through a conjunctival incision above the superior tarsal border, followed by dissection to expose the white line and suture advancement to the anterior tarsus, without a skin incision. Functional eyelid position will be assessed through MRD1 measurements, symmetry evaluation, and contour analysis. Contour will be quantified objectively using ImageJ software with Bézier curve fitting, and subjectively through independent masked evaluations based on pre-defined criteria. Patient-reported outcomes will be assessed using the validated FACE-Q Aesthetics questionnaire, including scales for appearance satisfaction, psychosocial function, early recovery, and satisfaction with the surgical outcome and decision. Tear film stability and ocular surface parameters will be assessed using TBUT, Schirmer test (without anesthesia), and the Ocular Surface Disease Index (OSDI). Standardized digital photographs will be taken at each follow-up visit to ensure consistent evaluation of eyelid contour and aesthetic results. All images and clinical data will be securely stored with restricted access for authorized investigators only. Follow-up visits are scheduled for Day 7, Month 2, and Month 6 postoperatively. No masking will be applied due to the nature of the surgical techniques; however, outcome assessors for eyelid contour and patient-reported measures will remain blinded to group assignment. This study aims to generate high-quality comparative data to guide clinical decision-making in the surgical management of aponeurotic ptosis, with an emphasis on both anatomical and patient-centered outcomes.

Analgesia nociception index (ANI 0-100) and patient-reported numeric rating scale (NRS 0-10) were trained on a convolutional neural network (CNN) model by linking the patients' facial expression with the score. By applying the predicted pain score by the AI model to evaluate pain, it is intended to measure the intensity of pain in an automatic, fast, and objective way for appropriate pain management.

This prospective clinical trial aims to evaluate the accuracy and efficacy of patient-specific plates (PSPs) created through virtual surgical planning (VSP) for the correction of maxillary cant in patients with facial asymmetry. Facial asymmetry, particularly in the upper third of the face, often presents with occlusal canting that poses both aesthetic and functional challenges. Traditional orthognathic techniques, such as LeFort I osteotomy with standard fixation hardware, often rely heavily on surgeon experience, potentially compromising consistency and precision. Virtual Surgical Planning and 3D-Printed PSPs introduce a paradigm shift by enabling surgeons to simulate the osteotomy and repositioning process in a digital environment. This planning facilitates the design and fabrication of custom titanium plates and cutting guides precisely tailored to the patient's skeletal anatomy. This trial investigates whether these individualized devices can achieve closer adherence to the preoperative virtual plan, thus improving surgical accuracy and outcomes. A sample of eight clinical cases will be included, all diagnosed with maxillary cant and facial asymmetry and meeting defined inclusion/exclusion criteria. The intervention involves a multi-step process: CT Imaging and Data Acquisition: High-resolution scans of each patient's craniofacial skeleton are obtained in DICOM format. 3D Modeling and Segmentation: Specialized software (Mimics, ProPlan, 3-Matic) is used to segment anatomical structures and perform virtual surgical planning. Design of PSPs and Surgical Guides: Custom plates and cutting guides are generated based on the planned osteotomy and repositioning. 3D Printing and Manufacturing: Plates are fabricated from titanium using milling techniques, while guides are printed with biocompatible resin. Surgical Execution: The LeFort I osteotomy, combined with BSSO when indicated, is performed using the guides to ensure precise bone cuts and the PSPs for fixation in the planned position. The primary outcome is the degree of congruence between preoperative virtual plans and postoperative outcomes, assessed through 3D superimposition of CT images at multiple timepoints (1 week, 1 month, 3 months, and 6 months). Secondary outcomes include aesthetic evaluation and patient satisfaction. Postoperative care involves standardized antibiotic, analgesic, and steroid regimens, with structured follow-up. Accuracy is quantified in millimeters using reproducible anatomical landmarks. Data will be analyzed using appropriate parametric or nonparametric tests, depending on distribution. This study addresses a critical gap in the literature by focusing specifically on the role of PSPs in correcting maxillary cant-a feature of asymmetry often overlooked in prior research. The results are expected to contribute evidence-based insights into improving surgical precision, enhancing patient-specific outcomes, and possibly minimizing intraoperative time and postoperative complications.

Patients belonging to the UOC Ophthalmology, the UOS Diagnosis and Treatment of Ocular Motility Disorders and the Pediatric Ophthalmology Outpatient Clinic, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome who meet the inclusion criteria will be recruited. Patients will be divided into two groups according to the nature of strabismus (congenital or acquired). All patients, regardless of the nature of strabismus, will undergo a complete ophthalmologic and orthoptic examination and balance examination before strabismus surgery (baseline, T0), at 30 days after surgery (T1), at 90 days after surgery (T2), and at 180 days after surgery (T3). All patients will undergo clinical evaluation and assessment of balance and fall risk at all assessment timepoints

Behavioral disorders in adolescents are defined by a set of behaviors (such as aggressiveness, agitation, clastic crisis, running away and endangerment) whose common characteristic is the predominance of action over mentalization and opposition to normal socialization processes. These disorders are associated with significant morbidity and high mortality linked to a high rate suicide or attempted suicide. Behavioral disorders in adolescence are linked to defects of mentalization (i.e. the psychic process by which the adolescent imagines and interprets his behaviors and to alterations in emotional regulation capacities. This emotional dysregulation has several components, including motor and physiological components. Moreover, this dysregulation is constructed in a dynamic process linked to the environment, including the adolescent's relationship with parents. To date, the psychopathological processes underlying behavioral disorders in the teenager are unknown, which prevents from offering appropriate psychological care. Thus, it seems essential to characterize adolescents behavior, by integrating both mentalizing capacities, the physiological parameters of their emotional regulation and the interactive patterns with their parents. This approach allow to overcome the difficulty of adolescents to use words to express what they feel and thus to understand their psychic functioning and the strategies, which they put in place to regulate their emotions. This study is a monocentric cross-sectional descriptive observational study. Objectives of this study is to describe the mentalization profiles of adolescents with mental disorders behavior and to evaluate: * Oculomotor parameters of emotional regulation * Physiological parameters of emotional regulation (Electrodermal Activity, RED) * Self-assessed mentalizing abilities (RFQ-Y scale) * Emotional regulation (DERS scale) * The emotional and behavioral functioning of adolescents (YSR scale) * Attachment characteristics of adolescents (ARSQ scale) * The interactions of the adolescent with his parent (GPACS scale) * Parental reflexive capacities (RFQ scale). This research was developed to support a comprehensive understanding of adolescent processes with the integration of bio-neuro-social parameters. The aim of this study is to establish mentalization profiles of the clinical population of adolescents with behavioral disorders and their neurophysiological correlates of emotional regulation. These first data are essential for a better understanding of this clinical population and a starting point for future research; particularly to develop therapies based on mentalization in this population and to evaluate their effectiveness.