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PubMed1988

Geometric considerations in the design of rotation flaps in the scalp and forehead region.

The classical transposition and rotation flaps are well known. Cosmetic considerations in the scalp and forehead region limit the use of a flap design that requires a skin graft for a donor defect. On sound geometric principles, the classical flap designs are suitably modified here to have a somewhat equal proportion of transposition and rotation. This "modified rotation flap" design works to a maximum advantage in the inextensible region of the scalp and forehead by providing single-stage primary closure of moderate to large defects. No backcuts are ever necessary with this flap design. Use of this principle to modify the rotation flap design for closure of an extended midline forehead defect following rhinoplasty allows a still wider (up to 6.5 cm) midline forehead flap to be available for rhinoplasty with primary closure of the donor defect.

Adolescent↗
PubMed1990

The effect of early fronto-orbital advancement on frontal sinus development and forehead aesthetics.

The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ("frontal bone") advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development.

Adolescent↗
PubMed2000

Endoscopic approach for the resection of forehead masses.

Over the past several years, surgery aided by the endoscope has come into favor for a number of reasons. Because it is minimally invasive surgery, it has less morbidity, thus, reduced postoperative pain and complications. It results in earlier mobilization and shorter hospitalization, and most importantly, it contributes to an improved cosmetic appearance as a result of a shortened incision line concealed within the hairline in most cases. We have proposed an alternative approach to the surgical resection of forehead masses by means of the endoscope, which has proven to be useful not only for diagnosis but also as a therapeutic tool for the removal of forehead lesions. This report described the clinical experience with the removal of forehead masses in four patients. The cases illustrated the feasibility and ease of resecting a variety of forehead masses with excellent cosmetic results. We hope that more plastic surgeons will use the proposed technique and will continue to explore the safe limits of endoscopic plastic surgery.

Adult↗
PubMed2001

Eyelids and eye socket reconstruction using the expanded forehead flap and scapha composite grafting.

After trauma or excision of malignant tumor, it is difficult to achieve satisfactory results when reconstructing deformed eyelids and the socket for an ocular prosthesis. The authors demonstrate examples of successful reconstruction for a prosthetic eye that provided adequate and aesthetic soft-tissue support achieved by applying a three-step surgical procedure of reconstruction of the eye socket, the eyelids, and the tarsus and eyelid margin. Because it is highly vascularized and its distal end can be divided into two or three portions for easy three-dimensional reconstruction, the expanded forehead flap alone, with a galea flap, or with a free rectus abdominis muscle perforator flap was used. The expanded forehead flap also provides excellent thin upper lid contour and good color-matching with a recipient site. For the eye socket, sufficient volume of tissue was provided from the expanded forehead flap with or without a galea or a free rectus abdominis muscle perforator flap, and a deep and convex fornix was formed. This resulted in a good fit and in stability of the ocular prosthesis. The surface and the inner lining of the eyelids were reconstructed using portions of the expanded forehead flap. For the tarsus and eyelid margin, conventional reconstruction techniques use cartilage of the concha, which has limitations of length and which does not fit the shape of the tarsal margin. The authors used the scapha composite graft, and a natural shape and good elasticity resulted.

Adult↗
PubMed2006

Update on brow and forehead lifting.

PURPOSE OF REVIEW: The purpose of this review is to provide the latest findings in the constantly changing field of brow and forehead lifting. Significant articles published in the last 24 months are reviewed and discussed based on the personal experience of the senior author (F.P.). RECENT FINDINGS: Important anatomical findings have been made over the last few years which will have an impact on plastic surgery of the upper third of the face, with new ligamentous structures of the forehead and more precise landmarks of the supraorbital neurovascular bundle being described. The short-term efficacy of a new device for periosteal fixation has been evaluated and new data have been collated about the time required for forehead periosteal readhesion. SUMMARY: In the last few years there have been important anatomical findings which will allow the development of more detailed and safe techniques for forehead lift surgery. New absorbable materials are available that allow efficient mechanical fixation of the soft tissues. The senior author of this review has extensive personal experience involving more than 400 cases. In addition to commenting on recent articles, we detail the methods we have used over the last 8 years, especially regarding the fixation technique.

Cadaver↗
PubMed2003

Selective myotomy in forehead endoscopy.

Endoscopic forehead surgery in a subgaleal plane allows selective manipulation of the forehead and glabellar muscles in accordance with their influence in forehead and brow deformity. Myotomy begins by interrupting the blend of the fibers of the elevator and depressor muscles, thereby exposing the bone fixation and cutaneous insertions of the depressor muscles. Myotomy of the depressor group is performed by section of the muscle fibers as close as possible to their bone fixation, with release of the cutaneous insertions at the brow level. The involuntary frontalis contraction free from the active opposition of the depressor muscles and free from the restriction of the inelastic structure of the periosteum stabilizes the brow elevation and gives a natural, long-term result. No fixation methods are used to hold the forehead flap in position. Transverse section of the frontalis muscle is performed to restore brow symmetry or excessive lift of the brow.

Adult↗
PubMed1996

Unusual cases of syringoma of the forehead.

Syringoma involving the forehead is rare and can be confused with other diseases that are common on the forehead. Therefore, we describe here three patients with syringoma who developed numerous skin colored papules on the forehead. To our knowledge, syringoma of the forehead was reported previously only once by Tagami et al.

Adult↗
PubMed2004

Forehead SpO2 monitoring compared to finger SpO2 recording in emergency transport.

Continuous peripheral oxygen saturation monitoring using a finger pulse oximeter is standard in prehospital emergency medicine. Forehead peripheral oxygen saturation monitoring has been enhanced for better performance during movement and in cold ambient temperatures, both of which are common during emergency transport. We compared a new forehead monitor with standard finger pulse oximeter. The forehead technique had significantly fewer mean (SD) alarms per patient (3.0 (2.2)) than the finger pulse oximeter (7.8 (4.0)) and shorter durations of malfunction (76 (60) s compared to 333 (170) s) when using the finger pulse oximeter. We conclude that measuring peripheral oxygen saturation monitoring with a forehead sensor provides better monitoring quality in emergency care.

Adult↗
PubMed1982

A comparative study of refatting kinetics on the scalp and forehead.

A modified photometric technique has shown considerable differences between the refatting kinetics of the scalp and forehead. The refatting on the forehead occurs rapidly, probably due to the large follicular reservoir. The follicular reservoir of the scalp, which bears a large terminal hair, is much smaller and so the refatting time is longer. Thus, sebum excretion and sebum production rates probably correlate better on the scalp than on the forehead, and we suggest that the scalp may be a better site than the forehead for investigating sebaceous gland physiology.

Adult↗
PubMed1986

The forehead V-to-T plasty (Dieffenbach's winged V-plasty).

The principles of the V-to-T plasty (Dieffenbach's winged V-plasty) are adaptable to many regions of the forehead. This paper demonstrates the use of the V-to-T plasty to reconstruct an extensive area of the lower central forehead and glabella following excision for basal cell carcinomatosis. Dual hemi-forehead advancement-rotation flaps were used in a single-stage reconstruction. The same technique adapts to other forehead and facial areas as well.

Basal Cell Carcinoma↗
PubMed2004

Treatment of neck lines and forehead rhytids with a nonablative 1540-nm Er:glass laser: a controlled clinical study combined with the measurement of the thickness and the mechanical properties of the skin.

BACKGROUND: Nonablative remodeling has been recently proposed as a new, no-down-time, anti-aging treatment. Objective. The objective was to evaluate the efficacy and safety of nonablative skin remodeling with a 1540-nm Er:Glass laser on neck lines and forehead rhytids. METHODS: Twenty female patients (mean age 45 years) were enrolled. Skin thickness and mechanical properties were measured before the first treatment, 1 month after the third treatment, 1 month after the fifth treatment, and 3 months after the fifth treatment. RESULTS: All patients reported an improvement in both skin tone and texture. Using ultrasound imaging, dermal thickness of neck and forehead increased, respectively, by 70+/-13 microm (p<0.001) and 110+/-19 microm (p<0.003). A dramatic increase of initial stress of the forehead skin (firmness) was obtained, from 7.62+/-3.68 before treatment to 16.68+/-7.44 3 months after the fifth treatment (p<0.0002). No immediate or late adverse effects were noted throughout the treatment regimen. CONCLUSION: This study demonstrates that irradiation with a 1540-nm Er:Glass laser emitting in a pulsed mode and coupled with an efficient contact cooling system increases dermal thickness and firmness, leading to a clinical improvement of neck lines and forehead rhydits.

Adult↗
PubMed1990

Posttraumatic headache with ptosis, miosis and chronic forehead hyperhidrosis.

Injury to the right lateral forehead was followed by headaches, and chronic ipsilateral ptosis, miosis, and forehead hyperhidrosis. Episodes of headache were accompanied by an increase in ptosis, miosis and forehead hyperhidrosis. The headaches abated within 6 weeks but the ptosis and miosis, due to postganglionic sympathetic insufficiency, were persistent. Spontaneous forehead hyperhidrosis, was also persistent at the time of last follow-up, 15 months later. Autonomic assessment of the oculocephalic sympathetic dysfunction, localization of the lesion and possible explanation of the autonomic findings are discussed.

Adult↗
PubMed1999

Frontal mucocele presenting as a subcutaneous tumour on the forehead.

A 57-year-old Japanese woman had a 3-month history of an asymptomatic subcutaneous tumour on the forehead. The patient presented a slightly elevated, elastic soft subcutaneous mass, 3 cm in diameter, on the mid to left-side forehead. Slight swelling of the left upper eyelid was observed. CT scanning and magnetic resonance images revealed a sharply demarcated cystic mass from the subcutaneous area on the forehead expanding into the frontal sinus and intracranial space. The tumour was diagnosed as a frontal mucocele and combined external and endoscopic approaches were performed. It is rare that a patient with a frontal mucocele is initially referred as a case of a subcutaneous tumour because most of the patients complain primarily of the ophthalmic symptoms. However, the present case reminds us that frontal mucocele is one of the differential diagnoses for a subcutaneous mass on the forehead.

Diagnosis, Differential↗
PubMed1997

Versatility of expanded forehead flaps for facial reconstruction. Case report.

Forehead flaps, sometimes with tissue expansion, are usually used for nasal reconstruction because of the severe aesthetic morbidity of the donor area. In this paper we describe six patients who had facial soft-tissue defects that were repaired by versatile design of the expanded forehead flaps and minimal donor morbidity. The results indicate that forehead tissue expansion can provide ample, thin, well-vascularised, and colour-matched flaps for facial reconstruction. Versatile design of the expanded forehead flap can reduce the donor morbidity to a minimum without a visible unsightly scar.

Adolescent↗
PubMed1990

[Mechanical impedance of the human mastoid and forehead--a critique of the mechanical coupler of the IEC373].

Mechanical impedances of human mastoids and foreheads were measured on frequencies from 250 to 6300 Hz for 80 young adults by means of B&K impedance head (#8000) and shaker (#4810) as main parts of the measuring setup. The measurements revealed the following problems in the IEC373 (1971/1981) which had defined the mechanical impedance characteristics of the mechanical coupler for calibration of bone vibrators in audiometric use. The average impedance levels of the mastoids differ significantly from those of the foreheads in middle and high frequencies. The impedance levels of the IEC373 mechanical coupler are higher than those of the present measurements of the mastoids and the foreheads. The differences exceeded the tolerance limits of IEC373 (1981) in every frequency. These findings strongly suggest that the coupler is neither the artificial mastoid nor the artificial forehead but a coupler having a specified impedance, therefore, disregard for effect of the type of bone vibrator on the Reference Equivalent Threshold Force Level, as seen in ISO7566, should be revised and that the RETFL should be determined for an each type of bone vibrator.

Adult↗
PubMed1999

[Conservative forehead facelift. Design and preliminary results].

The digastric occipitofrontalis muscle, as described in classical anatomy text books, does not exist. The epicranial aponeurosis or galea aponeurotica receives the occipitalis muscle on its deep surface and the frontalis muscle on its superficial surface. This revised anatomy of the concept of the frontal cutaneo-musculo-aponeurotic unit, combining skin, galea and frontalis muscle (frontal CMAU) is the basis for a new forehead facelift which corrects ageing of the forehead, essentially related to recession of the forehead and relaxation of the galea. The essential advantage of this new facelift is preservation of the frontalis muscle which plays a fundamental role not only in forehead expression, but also in support and elevation of the eyelids. The absence of any direct procedure on the frontalis muscle decreases the extent of skin resection and avoids or minimizes sensory or motor neurological complications.

Adult↗
PubMed2000

[Simultaneous nasal reconstruction and facial defect repair using expanded forehead flap].

OBJECTIVE: To improve the method for the repair of facial defect using expanded forehead flap. METHODS: 10 patients were treated with the expanded forehead flap for total nose reconstruction and repair of facial defects. The expanded flap was divided two parts: the supratrochlear vessels for nasal reconstruction and the frontal branch of the superficial temporal vessels for facial defects. The periorbital or zygomatic area, the upper or lower lip. The defect of the forehead donor site was directly closed. RESULTS: Nasal reconstruction and repair of facial defects were satisfactory in all patients. CONCLUSION: Nasal reconstruction and simultaneous repair of facial defects extend the scope of use of expanded forehead flap.

Adolescent↗
PubMed2004

Nasal reconstruction with vascularized forehead flap (preliminary communication).

AIM: The authors have studied the anatomical characteristics of the vascularization of the forehead flap used for nasal reconstruction. MATERIAL AND METHODS: For the period 1990--2000 ten cadaver dissections were performed and three patients underwent reconstructions using the forehead flap. The results obtained reveal that the blood supply of the flap is provided by the suprathrochlear, supraorbital and frontal branch of the superficial temporal vessels, which form a network of anastomoses between the frontal muscle and the skin. Three cases of successful nasal reconstruction are presented. Two of the patients had traumatic injury of the nose and one was with postoperative defect in the naso-labial area, nose and maxilla obtained after ablation surgery for neoplasm (spinocellular carcinoma). The reconstruction was done with vascularized oblique forehead flap. DISCUSSION: The results were evaluated as good. There were no complications. CONCLUSION: The results of the anatomical study of the blood supply of the forehead flap and the clinical results of nasal reconstruction are discussed in relation with the literature data.

Aged↗