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PubMed1995

Forehead flap in nasal reconstruction.

We establish criteria for anesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and 10 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contracture that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction.

Computer Simulation↗
PubMed1998

Improvements in forehead flap design for nasal reconstruction.

Joseph Carpue introduced us to the use of the forehead flap for nasal reconstruction in 1814 after he read an account of its use in India. The forehead flap was the first pedicled flap to be described in European literature and it set off an immediate search for similar flaps elsewhere on the body. In fact, this initial use of the forehead flap was so inspirational that it has been given credit for the rise of plastic surgery as a specialty. The forehead flap is well situated to replace missing nasal skin due to its excellent vascularity, close proximity, and similar histologic qualities. In fact, it is safe to say the forehead flap is the first choice for reconstruction of nasal defects larger than 2.0 cm in diameter. Over the last 180 years there has been considerable refinement in the under stage and standardization of forehead flap design. This short monograph is intended to provide refinements in forehead flap design which, in these authors' opinion, provide superior nasal reconstruction results while minimizing donor site morbidity. Some of these modifications are fairly subtle while others fundamentally affect the design of a forehead flap. Incorporating these modifications will advance the sophistication of the reconstructive surgeon and improve results.

Forehead↗
PubMed2003

[Usefulness of monitoring forehead deep-tissue temperature as an index of core temperature in adult patients undergoing laparotomies under general anesthesia--investigation in operating rooms with air-movement control system using vertical flow].

BACKGROUND: Acute changes in air temperature in the vicinity of the patents' forehead may impair clinical usefulness of the forehead deep-tissue thermometry. We thus investigated usefulness of monitoring the forehead deep-tissue temperature as an index of core temperature in 12 adult patients undergoing laparotomies in operating rooms with air-movement control system using vertical flow. METHODS: Nasopharyngeal, forehead deep-tissue, palm deep-tissue, and fingertip skin-surface temperatures were recorded during surgery every 5 minutes in operating rooms where room temperature was thermostatically controlled at approximately 25 degrees C. The patients were not actively warmed with forced-air warmers, but covered with cotton blankets where possible. The deep-tissue and fingertip skin-surface temperatures were compared with the nasopharyngeal temperature using regression and Bland and Altman's analyses. RESULTS: The four temperatures continued decreasing during surgery, and the nasopharyngeal temperature decreased to below 36 degrees C 2 hours after induction of anesthesia. Only the forehead deep-tissue temperature satisfactorily correlated with the nasopharyngeal temperature (r = 0.76, n = 300, P < 0.0001). The difference between nasopharyngeal and forehead temperatures was +0.26 degree C, and its standard deviation was 0.34 degree C. CONCLUSIONS: The forehead deep-tissue temperature has sufficient accuracy and precision for clinical use in operating rooms with air-movement control system using vertical flow. However, the core temperature appears to be slightly underestimated with the forehead deep-tissue thermometry.

Adult↗
PubMedDate not supplied

Forehead rhytidoplasty: endoscopic approach.

The difficulty in determining how much skin must be resected to achieve an adequate forehead and eyebrow lift through the coronal approach led the author to search for another forehead rhytidoplasty procedure. The endoscopic approach yields a natural lift of the eyebrows without skin excision through a minimal incision. It has been useful for patients who have a prominent forehead or have had a forehead rhytidoplasty. In addition, this technique provides a smooth forehead that is achieved by breaking the continuity of the forehead and glabella muscles. Despite the fact that the endoscopic approach is in the early stages of development, the results obtained from its use allow it to be an alternative procedure for treating the aging forehead and glabella.

Adult↗
PubMed1995

Optimal sites for forehead oscillometric blood pressure monitoring.

OBJECTIVE: Blood pressure is usually measured noninvasively with a cuff on the arm of the leg. Circumstances exist, however, when an alternative site for blood pressure measurement is desirable. This study is designed to identify a location on the forehead where blood pressure can be reliably measured noninvasively. METHODS: We mapped the superficial temporal artery and/or the supraorbital artery in 65 volunteers and found a rectangular area where an adhesive pressure pad could be placed over each artery. Oscillometric signals were recorded from four different locations over the forehead in 19 of the 65 volunteers to compare the amplitude of the signal and mean blood pressure between locations. RESULTS: The course of the supraorbital artery is quite consistent. It passed through a 2.5- x 1-cm rectangular area on the forehead in all volunteers in which it was mapped. The medial border of the rectangle is 0.5-cm medial and 1-cm above the medial corner of the left eyebrow. The course of the superficial temporal artery differed remarkably from person to person. We could not find an area of reasonable size to cover the artery in all wounds. Mean blood pressures were the same in all forehead locations. The signal was the weakest on the center of the forehead and strongest directly over the superficial temporal artery. CONCLUSIONS: Our results show that the supraorbital artery, an end-artery of the internal carotid artery, which emerges through the supraorbital foramen and cross the forehead near the center, is the preferred site to monitor blood pressure noninvasively on the forehead with an adhesive pressure bladder.

Adult↗
PubMed2006

Management of the ageing eyebrow and forehead: an objective dose-response study with botulinum toxin.

OBJECTIVE: To determine if clinical use of two different doses of botulinum exotoxin A (BTX-A) injections to the forehead area result in wrinkle reduction and modifications of eyebrow position. DESIGN: Prospective study. SETTING: Private practice, Dermatologic Laser Centre, Marseille, France. SUBJECTS: Twenty-four adult patients treated with BTX-A (Vistabel) injections for forehead rhytides. INTERVENTION: Of the 24 patients, 12 received BTX-A injections of 5 U only and 12 received injections of 10 U into the forehead, with or without treatment of the lateral forehead. The eyebrow position, forehead height and number of forehead lines determine the number of injection points. Patients were evaluated before injection and every 2 months after treatment during next 8 months. RESULTS: In the two groups of 12 patients, we found no significant change between the two doses. At each time after injections (every 2 months until 8 months), both groups showed a statistically significant improvement except at 8 months. Both groups exhibited the same results on standardized photos and on 3D skin profilometry. CONCLUSIONS: The two doses of BTX-A injections into the forehead gave the same results. The duration of the effect is similar along 8 months. This study emphasizes the role of low doses of BTX-A injections to obtain good clinical results without freezing aspect.

Adult↗
PubMed2003

[Bladder temperature versus tympanic membrane and forehead skin temperature].

INTRODUCTION: The purpose of the study was to compare three different methods of assessing the core temperature: by measuring the bladder temperature, the tympanic temperature, (Braun Thermoscan 3000) and the forehead skin temperature (Philips SensorTouch). Measuring of the bladder temperature and the tympanic temperature are wellknown methods whereas measuring of the forehead skin temperature by the use of Sensor Touch is a fairly new method by which the temperature at the warmest area of the forehead is measured. MATERIAL AND METHODS: Forty-two randomly chosen adult patients who all had a bladder catheter with a thermometer and a normal urine output. The patients were admitted to an intensive care unit and none were intubated nasally. Otoscopy was performed prior to temperature measurement. The temperatures were measured almost simultaneously. At the same time a white blood cell count and the C-reactive-protein value was recorded. RESULTS: There was a good linear coherence between the bladder temperature and the tympanic temperature (r = 0.97). The linear coherence between the bladder temperature and the forehead skin temperature was poor (r = 0.59). We found a mean deviation of 0.07 degree C and a standard deviation of 0.3 degree C of the difference between the bladder temperature and the tympanic temperature (p = 0.19). The mean of the difference between the bladder temperature and the forehead skin temperature was 0.5 degree C and a standard deviation of 0.8 degree C (p = 0.0003). Furthermore the forehead skin thermometer was not able to measure temperatures < 35.0 degrees C. We found no statistically significant coherence between the core temperature and the white blood cell count or C-reactive-protein. DISCUSSION: Tympanic temperature was well coherent with bladder temperature--forehead skin temperature was poorly coherent with bladder temperature. By evaluating the core temperature in intensive care patients the tympanic temperature is a reliable alternative to the bladder temperature.

Adult↗
PubMed2003

[Contour changing of forehead].

OBJECTIVE: To bring forward a method to improve the prominence of the forehead contour. METHODS: 16 patients(age 29-53 years, female 11, male 5) were treated through a bicoronal incision. Following the incision, the forehead soft tissues are reflected down to the level of the superior orbital rims with the protection to the supraorbital neurovascular bundles. To adjust the forehead contour, both superior orbital rims and frontal bossing was reduced by burring down the excess bone or removing the anterior wall of the forehead. RESULTS: The operative effect were satisfactory during 3-12 months of follow-up. No recurrence or osteogenesis were found in the cases. Nasofrontal angle and forehead angle were normal. The prominence of the supraorbital ridges disappeared and forehead became nature. CONCLUSION: Cranioplasty via an osteomy or burring of the outer line of forehead bone are safe, compact and effective way to improve the prominence of the superior orbital rims or frontal bossing.

Adult↗
PubMed2006

Comparison of a new forehead reflectance pulse oximeter sensor with a conventional digit sensor in pediatric patients.

BACKGROUND: During conditions of poor perfusion, the accuracy of conventional extremity-based pulse oximeters may be limited. Limited evidence suggests that forehead perfusion may be better preserved during such periods, but pediatric experience with newer forehead reflectance sensors is limited. We prospectively compared the accuracy of a forehead reflectance sensor, the Max-Fast, with a new-generation digit sensor in pediatric patients. METHODS: Pediatric patients > 10 kg and who had arterial catheters were eligible for enrollment. Blood oxygen saturation was simultaneously measured with forehead and digit sensors, and compared to corresponding CO-oximetry-measured arterial oxygen saturation values (S(aO2)) taken at the same times. We used Bland-Altman analysis to calculate the bias and precision of the forehead sensor and the digit sensor relative to the S(aO2) values. RESULTS: We obtained 116 sample sets from 28 patients. The S(aO2) values ranged from 84.1% to 99.2%. The bias and precision of the forehead-to-S(aO2) difference were 0.6% and 2.7%, respectively, versus 1.4% and 2.6%, respectively, for the digit-to-S(aO2) difference (p < 0.05). Bias and precision were 0.7% and 2.6% versus 1.7% and 2.3% for the forehead and digit sensors, respectively, (p < 0.05) in patients who received vasoactive medications, compared with 0.5% and 2.8% versus 1.1% and 2.8% (p = not significant), respectively, in patients who did not receive vasoactive medications. CONCLUSIONS: The Max-Fast sensor estimated S(aO2) as accurately as did a new-generation digit sensor in well-perfused pediatric patients.

Adolescent↗
PubMed1994

Forehead-brow rhytidoplasty: reassessing the goals.

Forehead-eyebrow rhytidoplasty traditionally has been advocated for senile brow ptosis. As the procedure became more widely accepted, it became a routine consideration in facial rejuvenation surgery. Indeed, over time, forehead-eyebrow rhytidoplasty also has withstood the initial criticism that was lodged against it of limited longevity, and it is realized that as with all other lifting procedures, it will gradually succumb to time, gravity, and the aging process. Moreover, refinements in techniques have added versatility to the procedure so that a variety of problems encountered in the upper face in addition to brow ptosis can be addressed. Consequently, an eclectic population with a range of deformities benefits from the procedure. Recently, though, it has seemed that the pendulum is swinging back, and that some surgeons are hesitating to incorporate forehead surgery because patients are voicing dissatisfaction with it. In order to assess the goals and indications for surgery, we reviewed a series of 350 patients who had a variety of aesthetic complaints in the upper face. Traditionally, patients' "other" indications for surgery, exclusive of brow ptosis, have been referred to as secondary (minor) indications. Now, with closer scrutiny, it appears that such problems, including forehead rhytids, frown muscle imbalance, upper eyelid aesthetics, lateral temporal laxity, and an abnormal expression, as a newly defined group, may actually be more frequent reasons than brow ptosis alone for performing a forehead-brow rhytidoplasty. As evaluated by the authors and supported by independent reviewers, low brow position alone should now account for less than half the forehead-brow surgery candidates. Furthermore, it is recognized that in considering the benefits achieved for patients with brow ptosis, often the results were due to "ancillary" surgical maneuvers routinely employed for the secondary indications. On balance, surgeons are advised to avoid adhering to traditional formulas for skin excision/brow elevation when operating on the brow; these can ultimately be the source of unsatisfactory outcomes. We believe that this philosophy will ultimately account for improved outcomes in forehead surgery. In addition, objective guidelines for the upper face have been reviewed and visual criteria defined which can be used in supplementing established brow spatial relationships for determining the ideal normal criteria for the upper third of the face.

Adult↗
PubMed1997

Secondary healing of Mohs defects of the forehead, temple, and lower eyelid.

OBJECTIVE: To analyze the results of secondary healing of Mohs defects of the forehead, temple, and lower eyelid. DESIGN: Scars resulting from secondary healing in these 3 sites were rated by patient interviews and by analysis of postoperative photographs by 3 board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery. SETTING: Private facial plastic and reconstructive surgery practice in Florida. PATIENTS: Patients with Mohs wounds of the forehead, temple, and lower eyelid that were allowed to heal by secondary intention between January 1, 1989, and December 31, 1993, who were available for follow-up. There were 10 wounds of the forehead, 6 of the temple, and 10 of the lower eyelid that were available for analysis. MAIN OUTCOME MEASURES: Wound color, contour, distortion of surrounding structures, presence of telangiectasias or paresthesias, pain or infection during healing, and overall cosmetic result. RESULTS: Color, contour, and overall scar cosmesis were rated using the following scale: poor (0), fair (1), good (2), and excellent (3). Telangiectasias, paresthesias, and pain or infection during healing were recorded as present or absent. The respective color and contour ratings for the 3 sites were 2.2 and 2.2 for the forehead, 2.5 and 2.7 for the temple, and 2.7 and 3 for the lower eyelid according to patient interview and 1 and 1.3 for the forehead, 1 and 1.4 for the temple, and 2.6 and 2.5 for the lower eyelid according to surgeon analysis. Pain, infection, paresthesias, and distortion of surrounding structures were rare, but 7 of 10 forehead and 4 of 6 temple wounds had telangiectasias. CONCLUSIONS: Many defects of the forehead and temple will heal with acceptable results. Partial-thickness or small full-thickness lower eyelid wounds heal with excellent cosmetic and functional results. Patient satisfaction is greater than might be predicted by surgeon analysis of wound healing.

Adult↗
PubMed2000

The forehead flap for nasal reconstruction.

CONTEXT: Reconstruction of extensive nasal defects often represents a significant challenge owing to several unique qualities of the nose, such as complex topography, mobile free margins, and multiple nasal subunits. Furthermore, loss of internal nasal lining and/or structural skeletal support may be present following removal of extensive skin cancers. OBJECTIVE: To describe our experience with the use of forehead flap reconstruction for extensive nasal defects. DESIGN: Retrospective case series. SETTING: Academic health care hospital system. PATIENTS/INTERVENTION: One hundred forty-seven patients with extensive nasal defects repaired with a forehead flap. MAIN OUTCOME MEASURES: The functional and aesthetic results were assessed. The characteristics of defects repaired with the forehead flap and the need for lining and/or cartilage were examined. RESULTS: The forehead flap was used to repair 147 nasal defects after Mohs excision of nonmelanoma skin cancer. Full-thickness skin was lost in all cases, structural skeletal support in 68 cases (46%), and internal mucosal lining in 45 cases (31%). Our experience and surgical technique using the forehead flap are described. CONCLUSIONS: The forehead flap represents one of the best methods for repair of extensive nasal defects. Near-normal functional and cosmetic results can be achieved.

Adult↗
PubMed1992

Bilobed flap reconstruction of the temporal forehead.

The temporal forehead is a particularly challenging area for reconstruction. Temporal forehead skin lies in a broad flat plane that varies in thickness. The eyebrow, scalp hairline, and lateral canthus comprise its aesthetic boundaries and limit the available tissue for repair of defects. Characteristically, skin tumors of the temporal forehead have extensive subclinical spread and their removal leaves large defects. The goal of temporal forehead reconstruction is to recreate the aesthetic boundaries of the forehead and to regain symmetry with the contralateral side. The temporal forehead bilobed flap is a single-stage procedure that takes advantage of the best color match of adjacent tissue and often allows primary closure of the donor sites in relaxed skin tension lines with minimal distortion. Several cases are presented for illustration of the technique.

Aged↗
PubMed2005

A brief report on the normal range of forehead temperature as determined by noncontact, handheld, infrared thermometer.

BACKGROUND: Noncontact forehead temperature measurement by handheld infrared thermometer was used as a screening tool for fever. However, the accuracy data and normal range of forehead temperature determined by this method were not available. METHODS: The temperature readings from 3 handheld infrared thermometers were validated against an electronic thermometer. Normal range of forehead temperature was determined by measuring the forehead temperature in 1000 apparently healthy subjects. RESULTS: Significant differences were detected in readings obtained by the 3 different handheld infrared thermometers (analysis of covariance, P < .001) The most accurate one was chosen, and the normal range of forehead temperature in 1000 subjects detected by this method was 31.0 degrees C to 35.6 degrees C. CONCLUSIONS: Our study shows that commercially available, handheld infrared thermometers require individual validation. Forehead temperature in excess of 35.6 degrees C is suggestive of fever. Further studies are required to confirm accuracy of this value in detecting fever.

Adult↗
PubMed2006

Endoscopic resection of forehead osteomas.

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow. Sometimes, a patient seeking a solution for rejuvenation of the upper third of the face may present other problems such as a forehead lesion. The authors describe their clinical experience in surgical endoscopic excision of forehead osteomas. PATIENTS AND METHODS: In nine patients with a forehead osteoma, seeking for a solution in rejuvenating the upper third of the face, we performed a combination of endoscopic brow lift and endoscopic excision of the forehead osteoma. We also performed an endoscopic excision of a forehead osteoma in two patients that did not request any additional aesthetic face procedure. RESULTS: No complication and no recurrence have been reported. The aesthetic result satisfied the patients. CONCLUSIONS: Endoscopic resection of a forehead osteoma offers sufficient, effective and safe access for dissection and suspension of the tissues released. It offers a superbly hidden scar and is well appreciated by the patients.

Adult↗
PubMed2006

Sensory changes in the forehead of patients with complex regional pain syndrome.

The aim of this study was to investigate involvement of central mechanisms in complex regional pain syndrome (CRPS). In particular, we wished to determine whether hyperalgesia extends ipsilaterally from the affected limb to the forehead. The heat-pain threshold, pressure-pain threshold, and ratings of cold and sharpness were investigated on each side of the forehead and in the affected and unaffected limbs of 38 patients with features of CRPS. In addition, touch thresholds were investigated in the limbs. The pressure-pain threshold was lower on the ipsilateral forehead than contralaterally, consistent with the presence of static mechanical hyperalgesia. Although the heat-pain threshold and ratings of sharpness and cold did not differ between the two sides of the forehead in the group as a whole, the sharpness of pinprick sensations in the affected limb was mirrored by similar sensations in the ipsilateral forehead. Conversely, diminished sensitivity to light touch in the affected limb was associated with diminished sensitivity to sharpness, cold and heat-pain in the ipsilateral forehead. These findings suggest that central nociceptive processing is disrupted in CRPS, possibly due to disturbances in the thalamus or higher cortical centres.

Adolescent↗
PubMed1980

Closure of large central forehed defect by coronal incision and bilateral forehead and posterior scalp advancement.

Forehead defects sometimes pose difficult reconstructive problems. Utilization of local tissue is especially desirable to preserve this facial unit. The authors present a technique of central forehead defect closure consisting of a coronal incision, elevation of the scalp and forehead at the subgaleal level, direct closure of the forehead, and advancement of the posterior scalp by galeal scoring. Advantages include limitation of the forehead scar and preservation of the existing blood supply to the forehead.

Accidents, Traffic↗
PubMed1995

Endoscopically assisted biplanar forehead lift.

The standard subgaleal coronal incision used for brow lifting is limited to patients with low foreheads. The subcutaneous hairline brow lift used for patients with high foreheads has a high rate of vascular complications. However, the main advantage of the subcutaneous approach is preservation of sensation posterior to the incision line. The subperiosteal approach, on the other hand, allows a better periorbital remodeling. I have combined the subperiosteal and the subcutaneous approach to take advantage of and minimize the disadvantages of each individual approach. The advent of the endoscopic technique has allowed more accurate and controlled periorbital dissection and brow depressor muscle modification. The operation is indicated in every patient in whom the anterior hairline incision is indicated. It is a good method for decreasing the height of the forehead. The dissection is done initially in the subcutaneous plane, and about halfway on the forehead slit incisions through the galea-periosteal layer and through the temporoparietal fascia are made to continue the dissection in the deep plane. The periosteal dissection and release at the arcus marginalis is done under endoscopic control. Likewise, the brow depressor muscle modification is done under endoscopic magnification. Deep anchoring sutures fix the brow in the elevated position. Trimming and closure of the cutaneous layer are done with minimal tension. The biplanar subperiosteal-subcutaneous forehead lift has been used in 24 patients with very satisfactory results. Complications have been of a minor nature. Patients have maintained sensation posterior to the hairline incision. The height of the forehead has been decreased in every case. Frontalis muscle function has been preserved.

Adult↗