SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Crouzon's disease results in maxillary hypoplasia and a receding forehead, which produce characteristic exorbitism. Total correction of the deformity by Le Fort III osteotomy and face advancement with a simultaneous forehead advancement corrects all the deformities. The advantages and disadvantages of this major craniofacial procedure are discussed after 2 case descriptions.
The forehead skin is an ideal material for nasal reconstruction. With the "oblique" forehead flap one can easily reconstruct even distal defects, as demonstrated by the case presented here.
The forehead flap according to Converse is the most robust and most universally applicable flap for the reconstruction of defects of the nose and middle parts of the face. This flap has a rich supply of blood vessels and allows high-grade covering material to be brought from the immediate vicinity of the defect into the central facial region. This paper contains a detailed discussion of the various problems associated with this operation, the correct preparation of the flap in the forehead region, the adequate width of the distal end of the flap, and the restoration of the columella, internal lining and cartilaginous supporting tissue of the nose.
The midline forehead flap is a good, versatile alternative when more standard techniques cannot be used to reconstruct the eyelids, medial canthus or exenterated socket. Indications are where: (1) the recipient site has a poor blood supply; (2) standard reconstructive procedures have failed; (3) deep, as well as superficial, tissue loss is present; and (4) extensive tissue loss is present. Four patients illustrate the value and versatility of the midline forehead flap. Disadvantages also are discussed.
The history of using forehead flaps for nasal reconstruction is reviewed. A case of nasal reconstruction in a man who underwent amputation for squamous cell carcinoma is reported. The surface of the forehead flap was augmented by expanded tissues at the donor site. We describe the surgical procedure and its excellent results.
BACKGROUND: Cosmetic denervation of hyperfunctional facial lines using botulinum toxin (Botox, Allergan, Inc., Irvine, CA) has gained growing popularity over recent years. Understanding the clinical use and effects of botulinum toxin requires a thorough understanding of the muscular anatomy of the treatment areas. OBJECTIVE: The purpose of this article is to review the anatomy of the frown, forehead, and periocular regions. Function of individual muscles is discussed to understand proper injection technique. CONCLUSIONS: The anatomy of the frown, forehead, and periocular regions is complex. Individual muscles are tightly intertwined and treatment of one anatomic region may affect many different muscles. A complete understanding of the anatomy of the upper face is essential to ensure proper injection technique, safe and predictable results as well as anticipating complications.
OBJECTIVE: To describe our use of cheek-based 2-stage transposition flaps for repairing Mohs surgery defects of the lower third of the nose. DESIGN: Retrospective case series. SETTING: Private dermatologic day surgery facility. Patients Twenty-eight patients with defects of the lower third of the nose after Mohs surgery. Intervention Ten alar and 18 nasal tip defects repaired using cheek-based 2-stage transposition flaps. MAIN OUTCOME MEASURES: Acceptability of procedure to patient, complications, and appearance from photographic records. RESULTS: The procedures were well tolerated and achieved good cosmetic results without major complications. CONCLUSIONS: These flaps allow repair of extensive defects of the nasal tip and ala with the patient under local anesthesia. This approach provides an alternative to the median forehead flap for nasal tip repairs.
Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. All cases involving patients who underwent endoscopic brow-lifts by the senior author (Y.D.) from 1997 through 2003 with a minimum follow-up of 12 months were retrospectively reviewed. Demographic data were collected, and patient satisfaction was determined from postoperative interviews conducted at follow-up visits. Standard photographs were used to measure the degree of preoperative and postoperative brow asymmetry. A total of 31 cases were available for review. The average age of our patient population was 47 years (age range, 22-76 years), with a male-female ratio of almost 1.5:1. Twenty-three patients had a complete paralysis, and 8 patients had a palsy. The average preoperative difference in height at the desired apex of brow was 5.9 mm, with a range of 3.0 to 9.0 mm. The average postoperative difference (as measured at 12 months) in brow position was only 1.3 mm, with a range of 0 to 3 mm. Adjunctive periorbital procedures were performed in the majority of patients (90%) at the time of endoscopic brow-lifting. All patients felt that their brow position was much improved after surgery. No major complications were encountered. A single patient underwent a secondary open direct browpexy to optimize his result. Endoscopic brow-lifting may be associated with favorable outcomes in the majority of patients with facial nerve palsy or paralysis. Performing concurrent adjunctive periorbital procedures as deemed necessary to optimize lower eyelid position, eyelid closure, and upper eyelid symmetry appears to be safe and reliable.
We describe a 38-year-old woman with extensive dermatofibrosarcoma protuberans of the forehead and discuss the advantages of using a multispecialty approach in the treatment of this case. The patient had had an incomplete resection 15 years previously, with a misdiagnosis of the actual tumor type. After undergoing a biopsy and a computed tomographic scan, the patient underwent Mohs micrographic surgery, followed by split-thickness grafting. Ultimate reconstruction was performed 15 months later using bilateral temporoparietal fascial flaps, in addition to split-thickness grafting. The patient remains tumor-free 3 years after resection.
Full-thickness defects of the forehead and scalp after excision of extensive skin carcinomas are a reconstructive challenge. With loss of periosteum, bone can be covered by skin grafts after altering the outer table of the skull or by flaps. Axial subcutaneous fascial flaps and crane tissue methods are alternative techniques; clinical experience has elucidated their indications, benefits, and limitations.
The forerunners of the midline forehead flap date back to ancient India. The flap, as modified in this presentation, is often the treatment of choice for reconstructing significant full-thickness defects of the nose. The flap described is designed as a musculocutaneous flap incorporating skin, subcutaneous tissue, muscle, and aponeurosis. The enhanced vascularity of this flap allows precise thinning and tailoring at the distal end. A stepwise description of flap design is outlined.
We report a "crowsfoot-like" pattern in the smoke marks around the entrance of a close-range bullet wound in the center of the forehead; the weapon in this homicide was a revolver. This pattern only occurs if the facial muscles that form expression are completely contracted at the moment the shooting occurs and if the victim expects the event. The wrinkles gather around the entrance of the bullet, and this wound pattern may indicate that the shot was expected by the victim and represent a piece of the mosaic that might help clarify the circumstances in a case.
The case of an asymptomatic 7-year-old girl with a hard bulge in the left forehead is presented. The radiological evaluation disclosed a hyperostotic mass with a large intracranial extension. A surgical specimen revealed a meningioma. The presence of a localized cranial bulge as the only sign of an intracranial tumor and the diagnostic value of computerized tomography (CT) are discussed.
Forehead augmentation occasionally is necessary for obtaining a desirable upper facial contour. The final contour must be sexually appropriate and must project beyond the cornea of the eyes an amount that makes the contour aesthetically pleasing. Methylmethacrylate onlay implants, preformed or sculpted at the time of surgery, lend themselves to obtaining a desirable contour which can be modified easily at surgery, which is completed in a one-stage procedure, has few complications, and yields an aesthetically pleasing result. The methods for fabricating and implanting the onlay prosthesis in a single step and the results of such procedures, which have been performed over a 12-year period without complications, are presented.
In this study, we investigated the possibility of improving reflectance (back-scatter) pulse oximetry measurements by pressure applied to the probe. Optimal signal detection, with the probe applied to an easily accessible location, is important to prevent erroneous oxygen saturation readouts. At the foreheads of 10 healthy adult volunteers, the effects of pressure applied onto the reflectance pulse oximeter probe were studied. Distances between the LEDs (660 nm and 940 nm) and the three photodiodes in the sensor were 4 mm, 7 mm, and 10 mm. For each detector, recordings were evaluated regarding red-to-infrared (R/IR) ratios and pulse sizes in relation to the stepwise increased pressure applied to the probe. R/IR variability decreased with applied pressures between 60 and 120 mm Hg. These findings are partly attributed to a corresponding increase in red and infrared pulse sizes at the detectors, which results in an improved signal-to-noise ratio. It is thought that pressure onto the oximeter sensor forces venous blood out of the tissues underneath the sensor. Consequently, the disturbing influence of pulsating and non-pulsating venous blood is reduced. Moreover, the increased difference in vessel diameter between diastole and systole and the corresponding difference in light absorption and an increase in flow velocities, causes an increase in pulse size with increasing pressure on the probe. Pressure applied to the probe may be useful in increasing the accuracy of reflectance pulse oximetry.
The difference between periosteal and subperiosteal application of hydroxylapatite (HA) in aesthetic forehead augmentation in the subimplant bed was investigated in six adult Göttingen minipigs. These results were then transferred to clinical application. One exemplary case is described. We found that epiperiosteal augmentation with hydroxylapatite should be performed only if shape and location are stable. Subperiosteal augmentation with hydroxylapatite must be judged critically since HA particles migrate into the subimplant bone.
We investigated whether a tap with a reflex hammer to the forehead can elicit responses in the leg muscles and whether vestibular stimulation is the crucial prerequisite for eliciting these responses. We also measured the postural changes caused by the tap and by the compensatory, presumably reflex-like reactions of the subject. Tap-evoked activity of leg muscles was easily elicited during upright stance in normal subjects and was also seen in two subjects without vestibular function. The pattern of muscle activation clearly showed a counteraction to the tap-evoked perturbation of stance. Taps applied to the chest elicited similar reflexes. Since these two conditions imply a different activation of the vestibular apparatus, the vestibular input alone cannot account for the observed leg muscle reflexes. We suggest that multisensory reflex pathways that integrate vestibular and proprioceptive inputs account for these reflexes.
Many methods have been used to make the soft tissue fixation in endoscope-assisted forehead lifting (EAFL). Since we started doing EAFL, we have employed the fixation with stainless screws and absorbable screws. After noticing that the temporary fixation with metallic screws had some negative effects, we changed to temporary fixation by bioabsorbable (polylactic acid copolymer) screws. The purpose of this study is to transmit our experience and to comment on some points that we believe will improve this method. Our study includes the endoscopic surgeries we have performed over the last four years. Ninety-nine patients were operated on. In 61 of them, absorbable screws were used. We have had very good results using these screws without important complications. We think that they offer a great improvement to endoscopic facial surgery.