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PubMed1977

[Primary covering of oropharyngeal defects after block resection of large malignant tumors (author's transl)].

The covering of defects in ablative oral surgery is associated with particular problems because, in order to avoid the formation of salivary fistulas, a primary closure should be aimed at. Between 1973 and 1975 86 carcinomas of the floor of the mouth, the tongue or the oropharynx were treated by block resection including radical neck dissection without preoperative radiation in 28 Cases the forehead flap and in 20 cases the tongue flap were employed. While the foreheaded flap necessitates the preservation of the ipsilateral A. carotis externa, the tongue flap can be used even if the ipsilateral lingual artery is sacrified. The tongue flap has functional and cosmetic advantages in comparison to the forehead flap. The temporarily transsected mandibula was refixed by compression plates without intermaxillary wiring.

Forehead↗

PubMed1991

Postural responses of head and foot cutaneous microvascular flow and their sensitivity to bed rest.

To explore the mechanism for facial puffiness, headache, and nasal congestion associated with microgravity and cephalad fluid shifts, the postural responses of the cutaneous microcirculation in the forehead and dorsum of the foot of eight healthy men were studied by changing body position on a tilt table and measuring blood flows with a laser-Doppler flowmeter. Increasing arterial pressure in the feet by moving from a -6 degree head-down tilt to a 60 degrees head-up posture decreased foot cutaneous flow by 46.5 +/- 12.0% (mean +/- S.E.; p less than 0.05). Raising arterial pressure in the head by tilting from the 60 degree head-up to -6 degree head-down posture increased forehead cutaneous flow by 25.5 +/- 7.2% (p less than 0.05). To investigate the possibility that these opposite responses could be modified by simulated microgravity, tilt tests were repeated after 7 d of -6 degrees head-down tilt bed rest. On the 1st and 2nd days after bed rest, flows in the foot were decreased by 69.4 +/- 8.8% and 45.8 +/- 18.7%, respectively, and increased in the head by 39.3 +/- 8.6% and 15.5 +/- 5.9%, respectively. These responses were not significantly different from those recorded before bed rest. Therefore, cutaneous microcirculatory flow in the feet is well regulated to prevent edema when shifting to an upright position, whereas there is less regulation in the head microcirculation. The lack of regulation in the forehead cutaneous microcirculation increases capillary flow, and consequently increases fluid filtration. This phenomenon helps explain the facial edema associated with the stimulated or actual microgravity environment.

Adult↗

PubMed1983

Precision and accuracy of intraoperative temperature monitoring.

Using tympanic membrane (TM) temperature as a standard for core temperature, we quantitated the accuracy and precision of seven other temperature monitoring sites during anesthesia, namely, the nasopharynx, esophagus, rectum, bladder, axilla, forehead, and great toe. Accuracy was quantitated as the difference between TM temperature and the temperature at each of the other sites; precision was quantitated as the correlation between TM temperature and the temperature at each of the other sites. Results indicate that the accuracy of measurements made using the great toe, forehead, and axilla is less than the accuracy of measurements made using the nasopharynx, esophagus, bladder, and rectum. Precision of measurements made using the nasopharynx, esophagus, and bladder is greater than the precision at the axilla, forehead, and rectum, and much higher than the precision at the great toe. Measurements of body temperature using the nasopharynx, esophagus, and bladder are recommended for intraoperative use as providing the best combination of accuracy and precision.

Adult↗

PubMed1981

Transcutaneous bilirubinometry. The cephalocaudal progression of dermal icterus.

The transcutaneous bilirubinometer (TcB) was used to document the cephalocaudal progression of dermal icterus in neonates. The TcB index of a specific area was compared with that of the forehead (TcB ratio). Four surface regions were identified, placed in the following sequence with respect to decreasing TcB ratio values: (1) forehead and sternum; (2) elbow, upper part of the back, and upper part of the abdomen; (3) lower part of the back and knee; and (4) palm and sole. To examine the relationship of the skin region of different serum bilirubin levels, a model was created that allowed the correlation of the TcB index with the specific region's distance from the forehead. Area differences in TcB values at lower bilirubin concentrations were less marked than at high levels. While the mechanism of this phenomenon has not been elucidated, the role of biophysical properties of the skin remains to be explored.

Abdomen↗

PubMed1978

Temperature-touch interaction: Weber's phenomenon revisited.

The six experiments reported here stemmed from Weber's (E. H. Weber, In R. Wagner (Ed.), Handwnörterbuch der Physiologie, 1846. Vol. 3, pp. 481-588) report that cold objects on the forehead feel heavier than warm ones, implying an effect of temperature on the touch modality. The experiments arrived at first-order answers to how temperature, force of stimulation, areal size of stimulation, and body locus might influence the magnitude of touch sensation. Typically, concomitant cooling greatly intensifies touch magnitude as perceived via the forehead and the forearm. Warning has little or no effect via the forehead but gives a significant intensification (less pronounced than that of cooling) on the forearm. When the areal size of the stimulation becomes very small, the intensification effects cannot be reliably demonstrated. The findings are reviewed in the light of what is known about the physiology of the cutaneous nerves.

Body Surface Area↗

PubMed1995

Midforehead incision: an approach to the frontal sinus and upper face.

The coronal incision has established itself as the principal surgical approach to the forehead. It allows for a well-hidden scar and a wide field of surgical exposure. The midforehead incision, described in the brow-lift literature, is a cosmetically acceptable alternative to the coronal incision for patients with forehead wrinkles or who are at risk for male pattern baldness. In an analysis of 33 consecutive open frontal sinus procedures, we compared patients who underwent i coronal approach to a midforehead approach for operative time, blood loss, length of hospital stay, and cosmetic result. There was a trend toward decreased operative time and decreased blood loss with the midforehead approach. The cosmetic result was acceptable in all patients. We advocate the use of a midforehead approach to the frontal sinus in patients with deep forehead creases and with hairline recession and elderly or infirmed patients who cannot tolerate prolonged procedures or significant blood loss.

Esthetics↗

PubMed1997

Auditory and tactile bone-conduction thresholds using three different oscillators.

Determination of tactile bone-conduction (BC) thresholds is essential to provide proper diagnosis of individuals with profound hearing loss. In this study, auditory and tactile BC thresholds were compared using three oscillators: the Radioear B-70-A, B-71, and B-72 with mastoid and forehead placement. Subjects included 12 adults with normal hearing (to establish auditory thresholds) and 12 adults with profound sensorineural hearing loss (to establish tactile thresholds). All 24 subjects were tested at octave intervals from 250 through 4000 Hz. As demonstrated in previous studies, tactile thresholds were lower for the low frequencies. Some differences in tactile thresholds were evinced as a function of different oscillators. One fact that emerged from this study is the lower tactile threshold with forehead placement as compared to the mastoid. While ostensibly a disadvantage to forehead BC testing, there are some clinical advantages to be gleaned from this discovery.

Acoustic Stimulation↗

PubMedDate not supplied

Carbon dioxide laser abrasion. Is it appropriate for all regions of the face?

OBJECTIVES: To evaluate the effectiveness of the carbon dioxide laser for treatment of facial acne scarring and to determine if certain regions of the face would respond more favorably to carbon dioxide laser resurfacing than other areas of the face. METHODS: Twenty-five patients with facial acne scarring were treated with the carbon dioxide laser with the flash-scanning attachment. Physician and patient evaluations were performed at postoperative follow-up. The face was evaluated for improvement by 5 anatomic regions: medial and lateral cheeks, perioral region, temple, and forehead. SETTING: Office ambulatory surgery center. RESULTS: Patients demonstrated overall improvement with the carbon dioxide laser. However, certain areas, such as the lateral cheek and temple, responded less favorably than other areas, such as the medial cheek, perioral region, and forehead. These findings were found to be statistically significant (P < .001) for physician and patient assessments. No long-term complications were reported. CONCLUSIONS: The carbon dioxide laser is an effective modality for the treatment of facial acne scarring. Physician and patient satisfaction is high. Nevertheless, multiple treatments may be necessary to achieve improvement, especially in the temple and lateral cheek areas; these anatomic sites respond less favorably to laser resurfacing than the medial cheek, perioral region, and forehead.

Acne Vulgaris↗

PubMed1997

The management of hyperfunctional facial lines with botulinum toxin. A collaborative study of 210 injection sites in 162 patients.

OBJECTIVE: To determine the optimum dose and efficacy of botulinum toxin injections in the management of hyperfunctional facial lines. DESIGN: This study included 210 hyperfunctional facial sites in 162 different patients. The patients had preinjection and postinjection photographic documentation and ratings on a 4-point qualitative evaluation scale of lines at rest and with action. The patients then had botulinum toxin type A injections via a monopolar hollow bore, Teflon-coated electromyographic needle into the facial muscles associated with the hyperfunctional lines. The total dose for each region of 1.25 to 25 U was divided into 1.25- to 5-U aliquots representing 0.1 to 0.2 mL per injection site, depending on the site and the prior experience with that patient on using toxin. The patients had their reevaluation at 2 to 3 weeks after injection. Patients returned for further follow-up when the therapeutic effect diminished. PATIENTS: One hundred sixty-two patients had 210 hyperfunctional sites evaluated and injected. The group consisted of 25 male patients and 137 female patients ranging in age from 21 to 78 years with a mean (+/-SD) of 46.1 (+/-1.98) years. All patients had cosmetically troubling hyperfunctional lines involving the forehead, glabella, crow's feet (lateral canthal lines), nasolabial area, platysma, and mentalis region. RESULTS: All patients had an effect of toxin within the first 24 to 72 hours. Ninety-five percent of the patients treated had cosmetic improvement of unsightly facial lines or contractions. The best results were achieved in management of the forehead lines, followed by glabella, crow's feet, and nasolabial. The dose for forehead lines was 5 to 25 U (mean +/- SD, 17.3 +/- 6.2 U); glabellar lines, 5 to 20 U (mean +/- SD, 11.1 +/- 3.1 U); crow's feet, 5 to 15 U (mean +/- SD, 6.2 +/- 1.6 U); nasolabial, 2.5 to 5 U (mean +/- SD, 3.12 +/- 1.2 U); and platysma, 10 to 20 (mean +/- SD, 15 +/- 4.0 U). Evaluation by age and site suggested a trend of increased toxin dose with increased age. Effects of the toxin are usually seen 24 to 72 hours after injection, and last from 3 to 6 months, whereon the increased muscular activity returns, as do the hyperfunctional lines. The only morbidity was related to temporary mild weakness of other adjacent facial muscles. There were no systemic side effects noted. CONCLUSION: Botulinum toxin is a safe and important adjunctive technique for the management of patients with symptomatic hyperfunctional facial lines.

Adult↗

PubMed1984

The first Meckel oration: on the causes of morphological differences in a population of guinea pigs.

The first morphological abnormality considered here was of a very superficial sort: deviations from the smooth coat of wild cavies and most guinea pigs. The deviations of "rough-furred" individuals range from a single irregularity or a single pair of rosettes to the "full rough" pattern. Roughness may be restricted to the hind toes, forehead, or hair around the eyes or belly, or (very rarely) to a small area on one side of the back. There is no indication of gene control in the last, and no analysis of the only strain (in Professor Castle's laboratory) that I have seen, of roughness restricted to the belly. A dominant gene, R, in combination with a semidominant modifier, M, account for the fancier roughs (R-MM toes only, R-mm full rough). A gene, st, that is completely dominant in the absence of R, semidominant in its presence, was descended from 3 animals from outside the colony. It accounts for a large forehead rosette, usually with a small white spot in front of its center. A statistically semidominant gene, Re, with extremely irregular, often asymmetric penetrance tends to cause rosettes about the eyes. This arose by mutation late in the history of the Whitman colony. It is strengthened by presence of R MM. Considerable variation occurs in the numbers of dorsal rosettes of R Mm and R mm. These have not been analyzed satisfactorily because the genetic differences are confounded by nongenetic ones. It is not practicable to summarize briefly all of the complex interaction effects of these factors, but it may be noted that the most surprising one had to do with genes St and R. The forehead rosette due to rr St closely resembles that of R mm (except for the absence of the pleiotropic white spot). The combination, R mm St St, shows none of the expected enhancement but instead shows nearly complete cancellation of the rosette. Moreover, the anterior dorsal rosettes of R mm st st are much reduced and seemingly shoved backward and laterally to give a large smooth shield back of the ears. St St also reduces the usual dorsal pair of rosettes of R Mm. With St st, all of these antagonistic effects are weaker and less regular. Another morphological deviation to be considered was the fairly common restoration of an atavistic little toe.(ABSTRACT TRUNCATED AT 400 WORDS)

Abnormalities, Severe Teratoid↗

PubMed2004

Dissipation of three organochlorine and four pyrethroid pesticides sprayed in a greenhouse environment during hydroponic cultivation of gerbera.

A wide range of pesticides (insecticides, acaricides and fungicides) is used in the hydroponic cultivation of gerbera. The fate and behaviour of some of these commonly used pesticides (organochlorine and pyrethroid insecticides/acaricides) in a greenhouse installation was investigated. The concentrations of endosulfan, dicofol, tetradifon, permethrin, bifenthrin, cypermethrin and deltamethrin in the air of the greenhouse were related to their physicochemical properties and respective application rates. Of these compounds, endosulfan exhibited the highest concentration in the greenhouse air 2 h after application (10 microg m(-3)), due to its highest volatility; afterwards, up to 12 h post-application, a rapid decrease was recorded which finally led to a concentration of 0.41 microg m(-3) at 6 days post-application. Dicofol exhibited the same trend of dissipation in the greenhouse air; its concentration decreased from 0.27 microg m(-3) immediately after the application to 0.12 microg m(-3) at 6 days post-application. Tetradifon, bifenthrin and permethrin were found at concentrations lower than 0.1 microg m(-3) at 2 h post-application, and cypermethrin and deltamethrin could not be detected. The concentrations of all the above pesticides in the drain water of the open hydroponic system were relatively high immediately after application and decreased rapidly during the following 3 days. In the closed hydroponic system, all the pesticides accumulated in the nutrient solution during the first 24 h after application and slowly decreased in concentration over the following 3 days. The spray operators applying these pesticides were exposed to rather high concentrations and the spray deposits were monitored on the chest and forehead of the operator. Endosulfan exhibited the highest concentrations of the seven pesticides. The organochlorine pesticides (endosulfan, dicofol and tetradifon) were usually detected at higher concentrations on the chest than on the forehead of the operator; pyrethroids were detected at higher concentrations on the forehead than on the chest of the operator.

Aerosols↗

PubMed1987

Patient monitoring during and after open heart surgery by an improved deep body thermometer.

The deep body thermometer developed by Fox was improved by Togawa by thermal insulation of the probe. The present status of medical progress in clinical thermometry through the improved deep body thermometer was reviewed from the view point of cardiac surgery. The forehead and sole temperatures obtained by this improved thermometer were monitored and recorded by a multipotentiometric recorder continuously up to 12 days in the patients admitted to the ICU who underwent open heart surgery. The forehead tissue temperature measured by this thermometer is slightly lower than and parallel to the rectal temperature, being close to the pulmonary arterial blood temperature. On the other hand, the sole tissue temperature fluctuates from room temperature to the forehead tissue temperature, sometimes showing rhythmic changes. The former seems to be the core temperature and the latter, the shell temperature. The dissociation when the two temperatures are more than 7 degrees C apart from each other suggests that the hemodynamical condition is worse than in the convergence when they remain within 2 degrees C. A state of shock can be diagnosed when the arterial systolic pressure is less than 90 mmHg and the urine output less than 1 ml/min/mg in addition to the dissociation. The effect of treatment and the prognosis for the patient are predictable according to the trends of the two temperatures as divergent or convergent. The dynamic thermometry by this thermometer is very informative and the procedure is noninvasive without discomfort to the patient.

Adult↗

PubMed1995

The topography of eccrine sweating in humans during exercise.

The purpose of this study was to investigate the distribution of steady-state sweating rates (msw), during stressful exercise and heat exposures. Six men completed 42-min trials: 2-min rest and 40-min cycling at 40% peak power in 36.6 degrees C (relative humidity 46.0%). The msw was monitored using ventilated capsules at the forehead, and at three additional sites. Repeat trials allowed monitoring from eleven skin surfaces. Auditory canal temperature (Tac) and 11 skin temperatures were measured. After normalising msw to the forehead response within subjects, differences in Tac and onset time thresholds, and transient and steady-state msw were examined. The pooled, lower torso msw onset [mean 45.5 (SEM 42.0) s] preceded that of the head [mean 126.5 (SEM 34.8) s, P < 0.05], but was not significantly different from the legs [mean 66.6 (SEM 25.7) s], upper torso [mean 80.2 (SEM 36.8) s] or arms [mean 108.6 (SEM 31.2) s]. Transient msw did not differ among regions (P = 0.16). Mean, steady-state forehead msw [3.20 (SEM 0.51) mg.cm-2.min-1] was not significantly greater than the scapula, forearm, hand, stomach and lower back msw (in descending order), but was greater than the chest [1.6 (SEM 0.2)], upperarm [1.6 (SEM 0.2)], calf [1.5 (SEM 0.3)] and thigh msw [1.0 (SEM 0.2), P < 0.05 for all comparisons]. The results did not support the caudal-to-rostral sweat onset evident during supine, resting heat stress. Equivalent Tac sweat thresholds existed between sites, while steady-state state msw topography varied among subjects and was not dominated by central regions.

Adult↗

PubMed1991

Advancement-onlay: an improved technique of fronto-orbital remodeling in craniosynostosis.

Eighteen patients with nonsyndromic craniosynostosis underwent fronto-orbital remodeling with an advancement-onlay technique. The mean age of the infants was 5 months (range = 2-11 months) when the procedure was performed for the following indications: unilateral coronal synostosis (n = 10); bilateral coronal synostosis (n = 3); metopic synostosis (n = 2); and multiple craniosynostoses (n = 3). The technique consists of (1) unilateral or bifrontal craniotomy, (2) superior orbital rim recontouring and advancement, and (3) frontal bone graft rotation and onlay. Posteriorly, the frontal bone graft is left "floating," while anteriorly, rigid fixation with microplates and screws has supplanted wire osteosynthesis. The use of rigid fixation prevents uncontrolled "float" of the forehead and eliminates the need for temporal struts. Follow-up time ranged from 6 to 60 months (mean = 2.6 years). There were no serious postoperative complications. Surgical results were good to excellent in 94% of cases and poor to fair in 6%. Only 1 patient with a Kleeblattschädel deformity required major revision, while another patient with trigonocephaly underwent a minor, extracranial recontouring procedure. Supraorbital rim and/or forehead recession suggestive of relapse or initial inadequacy of anterior projection occurred in 3 patients (17%). Residual, mild contour abnormalities of the forehead and/or temporal regions were found in 5 cases. To date, no gross disturbances in craniofacial growth related to our method of rigid fixation have been observed and no clinically detectable resynostosis has occurred.

Craniosynostoses↗

PubMed1988

Precedence of head homoeothermia over trunk homoeothermia in dehydrated men.

Three male humans were subjected repeatedly to 20 min exercise on a bicycle ergometer: twice when hydrated normally and twice when dehydrated. Tympanic (Tty) and oesophageal (Tes) temperatures were recorded and sweat rates on forehead and back were measured. Dehydration did not change the forehead sweat rate, but on the back it reduced significantly, resulting in an increase of Tes. However, Tty was decreased by dehydration. 20 min after the end of exercise subjects were allowed to drink water in order to trigger the potohidrotic response. A potohidrotic response was noted on the back of dehydrated subjects only. It is concluded that dehydration results in active inhibition of sweating on the body but not on the forehead, where evaporation is needed for selective cooling of the brain.

Body Temperature↗

PubMed1989

Rosacea: disturbed defense against brain overheating.

Tympanic (Tty), esophageal (Tes), forehead, and hand skin temperatures, as well as the forehead evaporation rate were recorded in six men (four suffering from rosacea and two healthy controls) before, during, and after 1 h of warm bath (38 degrees-39 degrees C). During the last 30 min of the bath, the subject's face was vigorously fanned (14 m/s). Blood flow was explored with ultrasonic Doppler in the emissary veins of the cranium during normothermia before entering the bath, and during hyperthermia just after leaving it. Under normothermic conditions, Tty was higher than Tes in all subjects. In three patients, no blood flow could be detected in the ophthalmic emissary veins whereas in the fourth patient as well as in both control subjects, blood flowed from the intracranium to the face. During hyperthermia, face fanning decreased Tty by 0.25 degrees +/- 0.05 degrees C (+/- SEM) below Tes in the control subjects whereas in all patients Tty remained warmer than Tes by 0.1 degrees C. Doppler recordings showed a rapid inward blood flow from the skin to the brain in the controls during hyperthermia. In patients, however, there was no change from normothermia in the blood flow patterns of vena angularis oculi. Their forehead temperature was permanently higher than in control subjects. Venous blood flow from the skin to the brain appears to be suppressed in rosacea, thus inhibiting selective brain cooling in hyperthermic conditions. The importance of this mechanism in the pathogenesis of rosacea and its significance as a means of investigation are discussed.

Adult↗

PubMed1994

Cardiovascular responses elicited by different simulated diving manoeuvres.

It has been documented that placing an ice-bag on the forehead causes similar cardiac and vascular responses as face immersion. There has been disagreement concerning the contribution of separate cold stimulation on the face and breathholding in the diving response. This study set out to unravel the extent to which these two factors contribute individually to the observed cardiovascular changes during the combined manoeuvre. It further aimed to reveal whether peripheral vascular responses to these stimuli are different in forearm and calf. We observed a significant rapid increase in the RR-interval, which was maintained until the end of the 25-s observation period and a homogeneous vasoconstriction in forearm and calf, despite minor changes in arterial blood pressure, during breathholding, placing the icebag on the forehead and the combined stimuli. Cardiac and peripheral vascular responses to the combined manoeuvre did not differ significantly from the responses elicited by the two stimuli separately. This test is another example that illustrates the heterogeneous cardiovascular response involving both parasympathetic and sympathetic activation. Moreover, since the icebag on the forehead test is technically easy to perform and does not require the active co-operation of the patient, it may be a valid method to replace a full face immersion test accompanied by breathholding.

Adult↗

PubMed1988

Beards, baldness, and sweat secretion.

The hypothesis according to which male common baldness has developed in the human species as a compensation for the growth of a beard in order to achieve heat loss has been tested. In 100 clean-shaven men direct measurement of the area of glabrous skin on the forehead and calvaria was found to be proportional to that of the hairy skin on the lips, cheeks, chin and neck. During light hyperthermia the evaporation rate on the bald scalp was 2 to 3 times higher than on the hairy scalp. Conversely the evaporation rate was practically equal on the foreheads and chins of women and unbearded young men, while in adult clean-shaven bearded men it was 40% less on the chin than the forehead. These results support the hypothesis that male baldness is a thermoregulatory compensation for the growth of a beard in adults.

Adolescent↗