- Email: [email protected]
Hand Position Over Face to Hide Cleft Lip
Accepted Manuscript Hand Position over Face to Hide Cleft Lip Robert M. Doroghazi, MD PII:
S0002-9343(15)00576-8
DOI:
10.1016/j.amjmed.2015.06.025
Reference:
AJM 13075
To appear in:
The American Journal of Medicine
Received Date: 22 June 2015 Accepted Date: 22 June 2015
Please cite this article as: Doroghazi RM, Hand Position over Face to Hide Cleft Lip, The American Journal of Medicine (2015), doi: 10.1016/j.amjmed.2015.06.025. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 15-1011
07/07/15
1
Title Page Hand Position over Face to Hide Cleft Lip By Robert M. Doroghazi, MD
115 Bingham Road Columbia, MO 65203 [email protected]
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No Funding Source
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Affiliation: The Physician Investor Newsletter
No Conflict of Interests
All authors had access and participated in writing
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Clinical Communication to the Editor American Journal of Medicine
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Key words: Cleft Lip, Self-conscious, Self-esteem, Embarrassment
ACCEPTED MANUSCRIPT 15-1011
07/07/15
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Hand Position over Face to Hide Cleft Lip
In general, the more severe a facial defect, the greater the self-consciousness and potential loss of self-
exact same position over their faces to hide their defect (Figure 1). Case Presentations
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esteem (1). I observed two patients with cleft lip, one repaired, one not, who held their hand in the
SC
A female in her mid-to-late 50s had an unrepaired cleft lip. When just walking around, she made no effort to hide the defect. However, in face to face conversation, she held her hand to her face as in
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Figure 1.
A male in his mid-to-late 20s seated at a chest-high table for 20-30 minutes held his hand over his face in the position illustrated for the entire time. When he arose to leave, his hand went to his side, revealing a repaired cleft lip underneath a mustache.
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Discussion
Patients often respond to problems in a similar fashion. Those with the chest pain of myocardial ischemia will place a clenched fist over their chest to describe the strangulating, elephantine-like
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sensation (Levine’s Sign) (2). Those with an acute aortic dissection often choose appropriately
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descriptive adjectives such as “ripping” or “tearing” to describe the pain (3). Infants and children with cyanotic congenital heart disease, especially Tetralogy of Fallot, quickly appreciate on their own that the fetal position and squatting improves their breathlessness (4). Patients may try to draw attention away from or hide something of which they are self-conscious. Those with the chorea of acute rheumatic fever (chorea minor, Sydenham’s Chorea, or St. Vitus Dance), will often make what began as an involuntary movement of their arm appear voluntary by continuing on to stroke their hair or their clothes (5). I report two patients who held their hand over their cleft lip in
ACCEPTED MANUSCRIPT 15-1011
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the exact same manner and position to hide their defect. This is an observational study. Neither individual was a patient: both were observed under casual
study was based on observation only (6). Conclusions
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circumstances. Parkinson did not appreciate the cogwheel rigidity of the “The Shaking Palsy” because his
their face to minimize the exposure of their defect.
SC
Patients with unrepaired or repaired cleft lip may hold their hand in a characteristic position over
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Even in the age of meta-analysis of thousands of studies, big data, and super-computers, casual observation can add to the medical literature.
References
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1. Tobiasen JM. Craniofacial Psychology: New Directions. In: Berkowitz S, ed. Cleft Lip and Palate. 2nd ed. Berlin: Springer; 2006: 263-270. 2. Schlant RC, Alexander RW. Diagnosis and Management of Chronic Ischemic Heart Disease. In: Schlant RC, Alexander RW, et al., eds. Hurst’s The Heart. 8th ed. New York: McGraw-Hill; 1994: 1055-1082. 3. Slater EE, DeSanctis RW. The clinical recognition of dissecting aortic aneurysm. Am J Med. 1976; 60: 625-633. 4. Goldblatt A. Approach to the Infant and Young Child with Heart Disease. In: Eagle KA, Haber E, et al., eds. The Practice of Cardiology. 2nd ed. Little, Brown & Co.; 1989: 1057-1090. 5. Adams RD. Tremor, Chorea, Athetosis, Ataxia, and Other Abnormalities of Movement and Posture. In: Wintrobe MW, Thorn GW, Adams RD, et al., eds. Harrison’s Principles of Internal Medicine. 7th ed. New York: McGraw-Hill; 1974: 85-94. 6. Parkinson J. An Essay on the Shaking Palsy. London: Sherwood, Neely and Jones; 1817.
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ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
Hand Position over Face to Hide Cleft Lip By Robert M. Doroghazi, MD
American Journal of Medicine Conflict of Interest Statement
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Clinical Communication to the Editor
Signed
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The author has no conflicts of interest to report
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Robert M. Doroghazi, MD
S0002-9343(15)00576-8
DOI:
10.1016/j.amjmed.2015.06.025
Reference:
AJM 13075
To appear in:
The American Journal of Medicine
Received Date: 22 June 2015 Accepted Date: 22 June 2015
Please cite this article as: Doroghazi RM, Hand Position over Face to Hide Cleft Lip, The American Journal of Medicine (2015), doi: 10.1016/j.amjmed.2015.06.025. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT 15-1011
07/07/15
1
Title Page Hand Position over Face to Hide Cleft Lip By Robert M. Doroghazi, MD
115 Bingham Road Columbia, MO 65203 [email protected]
SC
No Funding Source
RI PT
Affiliation: The Physician Investor Newsletter
No Conflict of Interests
All authors had access and participated in writing
M AN U
Clinical Communication to the Editor American Journal of Medicine
AC C
EP
TE D
Key words: Cleft Lip, Self-conscious, Self-esteem, Embarrassment
ACCEPTED MANUSCRIPT 15-1011
07/07/15
2
Hand Position over Face to Hide Cleft Lip
In general, the more severe a facial defect, the greater the self-consciousness and potential loss of self-
exact same position over their faces to hide their defect (Figure 1). Case Presentations
RI PT
esteem (1). I observed two patients with cleft lip, one repaired, one not, who held their hand in the
SC
A female in her mid-to-late 50s had an unrepaired cleft lip. When just walking around, she made no effort to hide the defect. However, in face to face conversation, she held her hand to her face as in
M AN U
Figure 1.
A male in his mid-to-late 20s seated at a chest-high table for 20-30 minutes held his hand over his face in the position illustrated for the entire time. When he arose to leave, his hand went to his side, revealing a repaired cleft lip underneath a mustache.
TE D
Discussion
Patients often respond to problems in a similar fashion. Those with the chest pain of myocardial ischemia will place a clenched fist over their chest to describe the strangulating, elephantine-like
EP
sensation (Levine’s Sign) (2). Those with an acute aortic dissection often choose appropriately
AC C
descriptive adjectives such as “ripping” or “tearing” to describe the pain (3). Infants and children with cyanotic congenital heart disease, especially Tetralogy of Fallot, quickly appreciate on their own that the fetal position and squatting improves their breathlessness (4). Patients may try to draw attention away from or hide something of which they are self-conscious. Those with the chorea of acute rheumatic fever (chorea minor, Sydenham’s Chorea, or St. Vitus Dance), will often make what began as an involuntary movement of their arm appear voluntary by continuing on to stroke their hair or their clothes (5). I report two patients who held their hand over their cleft lip in
ACCEPTED MANUSCRIPT 15-1011
07/07/15
3
the exact same manner and position to hide their defect. This is an observational study. Neither individual was a patient: both were observed under casual
study was based on observation only (6). Conclusions
RI PT
circumstances. Parkinson did not appreciate the cogwheel rigidity of the “The Shaking Palsy” because his
their face to minimize the exposure of their defect.
SC
Patients with unrepaired or repaired cleft lip may hold their hand in a characteristic position over
M AN U
Even in the age of meta-analysis of thousands of studies, big data, and super-computers, casual observation can add to the medical literature.
References
AC C
EP
TE D
1. Tobiasen JM. Craniofacial Psychology: New Directions. In: Berkowitz S, ed. Cleft Lip and Palate. 2nd ed. Berlin: Springer; 2006: 263-270. 2. Schlant RC, Alexander RW. Diagnosis and Management of Chronic Ischemic Heart Disease. In: Schlant RC, Alexander RW, et al., eds. Hurst’s The Heart. 8th ed. New York: McGraw-Hill; 1994: 1055-1082. 3. Slater EE, DeSanctis RW. The clinical recognition of dissecting aortic aneurysm. Am J Med. 1976; 60: 625-633. 4. Goldblatt A. Approach to the Infant and Young Child with Heart Disease. In: Eagle KA, Haber E, et al., eds. The Practice of Cardiology. 2nd ed. Little, Brown & Co.; 1989: 1057-1090. 5. Adams RD. Tremor, Chorea, Athetosis, Ataxia, and Other Abnormalities of Movement and Posture. In: Wintrobe MW, Thorn GW, Adams RD, et al., eds. Harrison’s Principles of Internal Medicine. 7th ed. New York: McGraw-Hill; 1974: 85-94. 6. Parkinson J. An Essay on the Shaking Palsy. London: Sherwood, Neely and Jones; 1817.
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ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT
Hand Position over Face to Hide Cleft Lip By Robert M. Doroghazi, MD
American Journal of Medicine Conflict of Interest Statement
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Clinical Communication to the Editor
Signed
SC
The author has no conflicts of interest to report
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Robert M. Doroghazi, MD