BACKGROUND: The majority of conventional studies on skin aging have focused on static conditions. However, in daily life, the facial skin we encounter is constantly in motion due to conversational expressions and changes in facial expressions, causing the skin to alter its position and shape, resulting in a dynamic state. Consequently, it is hypothesized that characteristics of aging not apparent in static conditions may be present in the dynamic state of the skin. Therefore, this study investigates age-related changes in dynamic skin characteristics associated with facial expression alterations.
METHODS: A motion capture system measured the dynamic characteristics (delay and stretchiness of skin movement associated with expression) of the cheek skin in response to facial expressions among 86 Japanese women aged between 20 and 69 years.
RESULTS: The findings revealed an increase in the delay of cheek skin response to facial expressions (r = 0.24, p < 0.05) and a decrease in the stretchiness of the lower cheek area with age (r = 0.60, p < 0.01). An increasing variance in delay and stretchiness within the same age group was also observed with aging.
CONCLUSIONS: The findings of this study revealed that skin aging encompasses both static characteristics, such as spots, wrinkles, and sagging, traditionally studied in aging research, and dynamic aging characteristics of the skin that emerge in response to facial expression changes. These dynamic aging characteristics could pave the way for the development of new methodologies in skin aging analysis and potentially improve our understanding and treatment of aging impressions that are visually perceptible in daily life but remain unexplored.

BACKGROUND: Alveolar soft part sarcoma (ASPS) occurs most often in the deep muscles or fascia of the extremities in adults, with only 3.4% of these tumours originating from the head, face and neck. To date, only 17 cases of buccal ASPS have been reported, including the case presented here. Only one case of ASPS recurrence at the primary site, similar to our case, has been reported thus far. Immune checkpoint inhibitors (ICPis)-associated diabetes, with an estimated incidence of 0.43%, is usually seen in older cancer patients and has not been reported in younger people or in patients with ASPS.
METHODS: A 24-year-old male patient presented with a slowly progressing right cheek mass with a clinical history of approximately 28 months. Sonographic imaging revealed a hypoechoic mass, which was considered a benign tumour. However, a pathological diagnosis of ASPS was made after excision of the mass. Five days later, functional right cervical lymph node dissection was performed. No other adjuvant therapy was administered after surgery. In a periodic follow-up of the patient six months later, blood-rich tumour growth was noted at the primary site, and Positron emission tomography-computedtomography (PET-CT) ruled out distant metastasis in other areas. The patient was referred to the Ninth People\'s Hospital of Shanghai Jiaotong University. Due to the large extent of the mass, the patient received a combination of a Programmed Cell Death Ligand 1(PD-L1) inhibitor and a targeted drug. Unfortunately, the patient developed three episodes of severe diabetic ketoacidosis after the administration of the drugs. A confirmed diagnosis of ICPis-associated diabetes was confirmed. After the second operation, the postoperative pathological diagnosis was ASPS, and the margins were all negative. Therefore, we made a final clinical diagnosis of ASPS recurrence at the primary site. Currently in the follow-up, the patient is alive, has no distant metastases, and undergoes multiple imaging examinations every 3 months for the monitoring of their condition.
CONCLUSIONS: In analysing the characteristics of all previously reported cases of buccal ASPS, it was found that the clinical history ranged from 1 to 24 months, with a mean of approximately 3 to 9 months. Tumour recurrence at the primary site has been reported in only one patient with buccal ASPS, and the short-term recurrence in our patient may be related to the extraordinarily long 28-month history. ICPis-associated diabetes may be noted in young patients with rare tumours, and regular insulin level monitoring after use is necessary.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women of childbearing age and is the primary cause of anovulatory infertility, accounting for 70% to 80% of cases. Ovulation induction is the main treatment approach for infertile patients with PCOS. Commonly utilized medications for this purpose are clomiphene citrate (CC) and letrozole (LE). Clomiphene citrate administration results in an ovulation rate ranging from 60% to 85%, while the pregnancy rate is limited to 35% to 40%, and a further reduction is observed in live birth rates. Letrozole demonstrates a slightly higher pregnancy rate and live birth rate compared to clomiphene citrate, although challenges persist in terms of longer stimulation cycles, multiple pregnancies, and the risk of ovarian hyperstimulation syndrome (OHSS). Clinical reports indicate that acupuncture therapy shows promising efficacy in treating patients with PCOS-related infertility, despite a partially unclear understanding of its underlying mechanisms.
METHODS: In this study, one patient did not achieve pregnancy despite more than a year of ovulation induction using clomiphene citrate and letrozole. However, after 3 months of receiving cheek acupuncture therapy, she successfully conceived and gave birth to a liveborn baby. Another patient achieved natural conception and live birth after 2 months of exclusive cheek acupuncture therapy.
METHODS: PCOS.
METHODS: Cheek acupuncture therapy.
RESULTS: Both of them successfully conceived and gave birth to a liveborn baby.
CONCLUSIONS: These findings suggest that cheek acupuncture therapy can effectively stimulate follicle development and ovulation, potentially improving endometrial receptivity. According to holographic theory, there is a biologically holographic model within the cheek region that shares a homology with the human body structure. This model provides an explanation for the regulatory effects of cheek acupuncture point stimulation on the Hypothalamic-Pituitary-Ovarian axis (HPO), which subsequently influences follicle development and ovulation in patients. Consequently, when cheek acupuncture therapy is applied alone or in combination with ovulation induction medication, patients have the ability to achieve successful pregnancy and experience a smooth delivery.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm that can be mistaken for malignancies due to its unfamiliarity among clinicians and aggressive clinical appearance. We herein contributed by reporting an additional case of MNTI characterized by an extensive extraoral protrusion in a 2-month-old infant. The lesion involved the anterior maxilla, cheek, and infraorbital region, resulting the displacement of the nose to the contralateral side, and measuring approximately 10 cm in size. Surgical resection of the lesion was performed. After a 6-month follow-up, the patient has shown no evidence of recurrence. The rapid growth and aggressive behavior of MNTI emphasize the importance of an early diagnosis and prompt intervention in order to achieve favorable outcomes.

Loss of vision after topical injection of sclerosant is a rare and uncommon complication. We describe a case with vision loss following the facial injections of physician-compounded (PCP) foam sclerotherapy which was created by room air. A 3-year-old boy underwent injection of 5ml polidocanol foamed with room air to treat the venous malformation on the cheek near the left orbit. The boy experienced the whole facial swelling on day 2 after the third injection, especially involving the left side, the visual acuity in the left eye was counting fingers at 30 cm and the swelling reduced at 7 days later after referral. Fundus examination on day 15 revealed hemorrhage inferior to the optic disc and fluorescein angiography revealed blocked fluorescein. The OCT on day 15 showed the edema of the nerve fiber layer beside the fovea. The patient\'s hearing was also impaired. PCP foam sclerotherapy with room air produced in typical concentrations, preparations as well as volumes always causes vision loss among children. Continued evaluation on the effects of product, gas, volume, and patient age identify optimal approaches will avoid the toxicity and side-effects caused by facial foam sclerotherapy.

UNASSIGNED: Granular cell tumors (GCTs) are uncommon soft tissue tumors, predominantly benign lesions. Approximately 50% occur in the tongue, with a peak incidence in the fifth and sixth decades of life. However, in this case, a rare presentation of GCTs on the cheek of a 16-year-old young female, including a review of the literature.
UNASSIGNED: The medical records and histopathological slides of the case were retrospectively reviewed. This work has been reported based on Surgical CAse REport (SCARE) criteria.
UNASSIGNED: A 16-year-old female presented with a non-painful exophytic and pigmented cheek lesion that is rapidly growing. A primary concern was expressed as cosmetic in nature, a biopsy of the mass was taken, and histopathological findings showed a malignant tumor, mostly consistent with GCTs. She was recommended to have a total excision of the mass. During follow-up, facial MRI findings indicate granulation tissue versus recurrent/residual tumor at the site of surgery, without any evidence of cancer metastasis or spread.
UNASSIGNED: GCT is a tumor of Schwann cells, which is mostly benign with a 2% risk of malignant transformation. The peak incidence of this tumor is around the age of 50, and it is uncommon in young individuals. Clinically, GCT presents as a single, asymptomatic dermal or subcutaneous, brown-red nodule or papule, which grows slowly with diameter ranging from 0.5 to 3 cm. The definitive treatment for both benign and malignant GCTs is sufficient local excision with safe margins.
UNASSIGNED: GCT is an extremely rare tumor, with a peak incidence of fifth and sixth decay of age, which usually appear in the tongue (50% of cases); however, in this case, we present a 16-year-old female with a cheek mass diagnosed as GCT. In short, we think that GCT should be considered as one of the differential diagnoses of solitary facial masses at young ages.

Vascular anomalies are categorized as vascular tumors or vascular malformations (VMs) based on the system of classification (updated in 2018) established by the International Society for the Study of Vascular Anomalies. In the orofacial region, such anomalies are most likely to occur in the lips or tongue, and only rarely in the buccal fat pad. This report describes a case of a VM in the buccal fat pad. A 47-year-old woman was referred to our hospital with a mass lesion in her left cheek. On palpation, an elastic, hard, painless, and mobile mass was found anterior to the left masseter muscle. Computed tomography, magnetic resonance imaging, and ultrasonography revealed a mass in the left buccal fat pad. The lesion was identified as a benign tumor and surgical excision performed under general anesthesia. Histopathological examination revealed that the lesion was composed of a large number of vascular structures of various sizes covered with endothelial cells. Based on the clinical and histopathological findings, a diagnosis of a venous VM was made. One year has passed since the operation and no recurrence has been observed. Long-term follow-up is planned.

Although animal bites account for a fair number of emergency department visits, donkey bites account for a very limited proportion. A 12-year-old boy presented to our department with a severe donkey bite involving his face. The injury included his left cheek with a laceration of the left ear cartilage. The examination revealed no serious morbidity (no vascular or nerve involvement). The patient received prophylactic antibiotics and anti-rabies/anti-tetanus vaccination. The wound was cleaned thoroughly with copious irrigation. Afterward, the patient underwent surgery to correct the defect in the cheek using a rotational advancement cervicofacial flap, while the penetrated ear cartilage was repaired and the skin margins were approximated and sutured. During the follow-up period, no complications were observed and the functional and cosmetic outcomes were satisfactory. Donkey bites are rarely encountered and they can result in different presentations and morbidities/outcomes. It is suggested that the timing from the bite injury to presentation, the stage/extent of the bite, the use of anti-tetanus and anti-rabies vaccines, and the prophylactic use of antibiotics may play a role in determining the outcomes and/or complications of donkey bites.

BACKGROUND: The parotid glands are one of the major components of the salivary glands. Their function is to secrete serous saliva to facilitate chewing and swallowing. The normal position of the parotid glands is anterior to and below the lower half of the ear; superficial, posterior, and deep to the ramus of the mandible.
METHODS: In this article, we present a rare case of an ectopic left parotid gland located in the left cheek of a 45-year-old Middle-Eastern female who presented with a painless mass inside the left side of her face. Magnetic resonance imaging revealed a well-defined mass in the left buccal fat, which was isosignal with the right parotid gland.
CONCLUSIONS: Further evaluations of detected cases are necessary to obtain more information regarding the pathogenesis and possible etiologies of this condition. There is a need for more reports of similar cases, as well as diagnostic and etiologic studies, to understand the cause of this condition further.

Biting fibroma, an irritation fibroma or traumatic fibroma associated with a history of a prior lesion-related tooth bite or biting injury at the site, is a commonly acquired benign reactive lesion of the oral cavity. It is usually an asymptomatic, small, mucosa-colored, smooth, pedunculated or sessile papule. A biting fibroma is most commonly located on the buccal mucosa, followed by, in decreasing frequency, on the tongue or lip or hard palate or gingiva. It typically presents as a solitary lesion; however, it can appear as multiple lesions. Excision is the treatment of choice for a biting fibroma; however, the resolution of the lesion-associated chronic inflammation is also necessary to prevent a recurrence. The clinical history, lesion morphology, and pathology findings of an illustrative patient with a biting fibroma were included in this case report. An 80-year-old woman was described who developed a biting fibroma at the site of a tooth bite on her lower lip. An excisional biopsy not only confirmed the suspected diagnosis of a biting fibroma but also successfully treated her condition by removing the lesion; there was no recurrence. In conclusion, the diagnosis of a biting fibroma should be considered when a patient presents with a new intraoral lesion, particularly if associated with an acute injury or chronic inflammation of the site. Since the clinical differential diagnosis of a biting fibroma includes various other benign conditions and less common malignant neoplasms, a biopsy that removes the lesion may not only establish the diagnosis but also potentially provide adequate treatment.