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At least 1,117 records · Page 62Linked to original sources
PubMed2005

[The anatomy of the surgical treatment of migraine].

OBJECTIVE: The transpalpebral resection of the corrugator and depressor supercilii muscles is a new treatment option for migraine headaches. Hyperactive contractility of these muscles can provoke the peripheral compression of the supratrochlear nerve and induce a neurogenic inflammation triggering the symptoms of migraine. In order to gather detailed knowledge of the respective anatomy in the eyebrow region, a macroscopic cadaver study was conducted. MATERIALS AND METHODS: The relevant muscles of the forehead, glabella and eyebrow were dissected in five fresh, non-preserved heads. The supracanthal origins and dermal points of insertion were marked. Following the preparation of the neurovascular structures, the muscles were measured and weighed. The course of the supraorbital and supratrochlear nerves was demonstrated from the forehead to the orbital cavity. RESULTS: There are three, paired groups of muscles in the superomedial region of the orbital rim. They can be divided into the superficial frontalis and procerus muscle, the orbicularis muscle in a middle layer and the corrugator and depressor supercilii in a deeper layer. The corrugator measured approximately 4.5 cm, whose origin is superior and posterior to the depressor origin situated cranial to the medial canthus. The corrugator inserts lateral to the exit of the supraorbital nerve in the dermis above the eyebrow after penetrating the orbicularis and frontalis muscles and a subgaleal fat pad. The length and weight of the muscles is highly variable. The muscle is penetrated by the supratrochlear nerve whereas the supraorbital nerve runs underneath it. The corrugator is innervated medially and laterally by branches of the facial nerve. CONCLUSION: A detailed knowledge of the complex arrangement of the muscles acting upon the glabella and the different communicating subgaleal and preseptal fat pads allow the identification and resection of the corrugator and depressor muscles without damaging the supratrochlear nerve. The course of the specific nerves is variable. The double-innervation of the corrugator suggests its complete resection instead of the selective denervation of the muscle.

Cadaver↗
PubMed2006

Rejuvenation of the aging upper third of the face.

Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.

Botulinum Toxins, Type A↗
PubMed2000

Glabellar frown lines as a reliable landmark for the supratrochlear artery.

OBJECTIVE: Preservation of the supratrochlear vascular pedicle (SVP) during use of the paramedian forehead flap can be accomplished by the aid of Doppler imaging; however, a reliable surface landmark may be invaluable in cases where Doppler examination fails. Our observations showed that the most prominent glabellar frown lines (GFLs) are very close to the SVP; however, the actual relationship of these structures remains unclear. STUDY DESIGN: The relationship between GFLs and the SVP was investigated in 19 volunteers by the aid of Doppler imaging and in 8 cadaver heads by dissection. The distance between the GFLs and the SVP was measured. SETTING: The study took place at an academic tertiary-care facility. RESULTS: The SVP was located just at the GFLs in almost 50% of the cases and an average of 3.2 mm lateral to GFLs in the remaining cases. CONCLUSION: GFLs may serve as reliable surface landmarks in the use of the paramedian forehead flap where Doppler imaging was not helpful.

Adult↗
PubMed2003

CD30 (Ki-1)-positive large-cell cutaneous T-cell lymphoma with secondary xanthomatous changes after radiation therapy.

A 72-year-old woman with a large mass on her forehead was found to have primary cutaneous CD30-positive large T-cell lymphoma and was treated with radiation therapy. Five weeks after the completion of radiation therapy, a large, yellow plaque developed on the forehead. Histopathologic examination showed numerous xanthoma-like cells with clear and foamy cytoplasm that infiltrated the upper and mid dermis with no residual lymphoma. To our knowledge, this is the first report of xanthomatous change after radiation therapy for primary cutaneous CD30-positive large cell lymphoma. We believe that the xanthomatous change after radiation therapy probably was caused by lysis of radiosensitive lymphoma cells and histiocytic scavenging of lipid-membrane debris.

Aged↗
PubMedDate not supplied

New tridimensional approach to the evaluation of the spine through surface measurement: the BACES system.

The aim was to test a new instrument, the BACES system, an articulated arm connected to a computer, to improve noninvasive examination of the spine and to reduce X-ray examinations. To this aim, four observers performed three series of eight measurements on a dummy and two healthy volunteers. Data on the projection of the spine, any curve detectable on the frontal and sagittal plane, and any rotation at each thoracolumbar level were collected and analysed. To detect the role of the observer, of the procedure and of the object in measurement variability, a two-factor analysis of variance was performed. The results showed measurement errors for kyphosis and scoliosis generally below 3 degrees, whereas the lordosis showed a major variability, especially in volunteers, because of the attitude role. Rotations showed a limited variability too, generally below 2 degrees. In the clinical setting, > 2 SD may reasonably be considered a clinical change because it has not a great chance of being a measurement error. Thus, the BACES system allowed us to identify with fairly good precision kyphosis, scoliosis and trunk rotations. Even though at the moment no surface measurement method can replace X-rays, the instrument can integrate and limit the use of radiographic evaluations.

Analysis of Variance↗
PubMed1989

Dermal absorption of the insecticide lindane (1 delta, 2 delta, 3 beta, 4 delta, 5 delta, 6 beta-hexachlorocyclohexane) in rats and rhesus monkeys: effect of anatomical site.

Dermal absorption of the insecticide lindane (1 delta, 2 delta, 3 beta, 4 delta, 5 delta, 6 beta-hexachlorocyclohexane) was determined in rats and rhesus monkeys. Lindane is in widespread use as a 1% cream or lotion scabicide formulation and as a 1% miticide shampoo for body lice control in humans. Results obtained following our in vivo dermal absorption procedure demonstrated that 18 +/- 4.1%, 34 +/- 5.2%, and 54 +/- 26.3% of the applied dose was absorbed following topical applications at a rate of 1.5 micrograms/cm2 (6.2 micrograms/100 microliters of acetone) of the 14C-labeled pesticide to 4.2-cm2 regions of the forearm (n = 8), forehead (n = 7), and palm (n = 4) of rhesus monkeys, respectively. Dose sites were washed with soapy water 24 h posttreatment. Comparative studies in rats (n = 5) dosed middorsally demonstrated 31 +/- 9.5% absorption. Statistical analysis of the 14C excretion kinetics demonstrated slower clearance of lindane from rats than monkey forearm, forehead, or palm. Intramuscular (im) injections of 14C-lindane gave 52 +/- 7.1% recovery in monkey (n = 8) and 64 +/- 5.9% in rats (n = 5), suggesting body storage of this lipophilic chemical.

Administration, Topical↗
PubMed1978

The biological suppression of malaria: an ecological and nutritional interrelationship of a host and two parasites.

The interrelationship of malaria and severe ascariasis was studied in Anjouan children with a previously described syndrome of enlarged parotids, localized forehead edema, heavy infestation with Ascaris lumbricoides, and unusual freedom from malaria. After treatment of 37 such children with the ascaricide piperazine, 35 had resolution of parotid enlargement and forehead edema, but 19 developed attacks of malaria. Children treated with placebo had neither resolution of clinical findings nor attacks of malaria. We propose that suppression of the malaria in these children is a nutritional consequence of severe ascariasis and may represent an ecological balance for optimum co-survival of the host and the two parasites.

Adolescent↗
PubMed1994

Clinical evaluation of liquid crystal skin thermometers.

We have examined two types of liquid crystal thermometers (LCT) designed for clinical use: one designed to measure skin surface temperature (LCTS) and the other had its calibration shifted by 1.9 degrees C to read a "core" temperature (LCTC). In laboratory tests with LCT on a glass beaker, there were highly significant correlations between temperatures measured by thermocouples, LCTS (r = 0.99) and LCTC (r = 0.99). In five patients undergoing cooling and warming during cardiopulmonary bypass with an LCT on their forehead, next to a thermocouple, the smallest correlation coefficient was 0.92. In 7.3% of observations in patients, the LCT scale was blurred, but readable. The graph relating LCT temperature and forehead thermocouple temperature showed hysteresis between the cooling and warming phases. An additional laboratory experiment suggested that LCT might be affected by draughts; they should therefore be protected from draught in use.

Cardiopulmonary Bypass↗
PubMed2003

Different patterns of parasympathetic activation in uni- and bilateral migraineurs.

Several lines of evidence support involvement of the parasympathetic system in migraine: (i) migraine-associated symptoms, such as exaggerated facial flushing, lacrimation and rhinorrhea; (ii) increased levels of cranial venous vasoactive intestinal peptide in migraineurs during attacks; and (iii) reports of migraine pain alleviation by intranasal instillation of lidocaine, which can block some of the parasympathetic outflow to the cranium. This study assessed cranial parasympathetic function in migraineurs in between attacks, assuming that abnormal function might imply involvement of the parasympathetics in migraine pathogenesis. We tested 39 female migraineurs outside attacks, of whom 11 had bilateral pain, 20 unilateral at a specific side and eight alternating unilateral head pain, and 16 controls. The trigemino-parasympathetic reflex was studied, using soapy and saline eye drops for stimulation of the afferent limb of the reflex arch, and cutaneous vascular response at the forehead for the efferent limb. The latter was recorded by photoplethysmography on both sides of the forehead. We found no difference in vasodilatation between migraineurs as a group and controls (83.7 +/- 6.5% and 80.8 +/- 7.6%, respectively, not significant). However, when analysing data by the site of pain, we found that those with bilateral pain had the largest vasodilatation response (141.6 +/- 16.2%, P < 0.05 versus controls, analysis of varance, post hoc Tukey-Kramer HSD), while those with unilateral pain had the least vasodilatation (45.5 +/- 3.3%, P < 0.05). The response of patients with alternating pain (97.2 +/- 12.6%) did not differ from controls. It is concluded that cranial parasympathetic function does differ among patients with various migraine types at rest. Based on the understanding of dysfunctional brainstem pain modulation in migraine, we suggest a model of within-brainstem interaction between the two locus coeruleus nuclei, which are involved in control of pain and cranial parasympathetic outflow. The model assumes various levels of inhibitory inter-relationships between these two nuclei; diminution or absence of the normal reciprocal inhibitory relationships between them may underlie the augmented cranial parasympathetic response in bilateral migraineurs, while an excess of reciprocal inhibitory relationship between them may underlie the diminished cranial parasympathetic response in unilateral migraineurs. These findings might help in clarifying inter-relationships between brainstem nuclei in the context of migraine pathogenesis.

Adult↗
PubMed1994

Skin disorders among hand solderers in the electronics industry.

Full-time solderers (n = 150) and non-soldering administrative staff (n = 52) were interviewed and examined to determine the prevalence of work-related rashes, to assess their acne status and to measure their forehead skin sebum levels with a Sebumeter. The period prevalence rates (of ever having a work-related skin rash since working as a solderer) for the 82 solderers using multicored solder wire and for the 68 workers using liquid flux were 19.5 per cent and 10.3 per cent respectively. Among the liquid flux solderers, 29 used cotton gloves. The prevalence rate of work-related skin rashes was 3.4 per cent in this group, compared to 15.4 per cent among the 39 ungloved workers. A similar finding was noted among the multicored solder wire users (9 per cent of the 11 gloved workers and 21 per cent of the 71 ungloved workers). On examination, six solderers (all ungloved multicored flux users) had work-related dermatitis of the hands or fore-arms. The point prevalence rate of work-related dermatitis among all solderers was 4 per cent. For non-occupational dermatitis, the point prevalence rate was 2.7 per cent among the solderers and 4 per cent among the administrative staff. The point prevalence and severity of acne among the 150 solderers were the same as those of the 52 administrative workers who were of a similar age and sex distribution. Forehead skin sebum levels, after adjusting for possible confounding factors such as age, atopic status and time elapsed since the last face wash, were also similar in the two groups of employees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Scleroderma en coup de sabre.

Five cases of scleroderma en coup de sabre are reported, along with a brief review of the literature [3, 10, 11]. Surgical management was tailored to the defects. Involved discolored skin was excised and the resultant wound repaired by direct closure (forehead, lower lip) or with full-thickness skin grafts. Soft tissues were augmented with dermal or dermal-fat grafts. Bony defects were corrected with prefabricated silicone implants (forehead) or autogenous bone (mandible).

Child↗
PubMed1990

Bandeau--the focal point of frontocranial remodeling.

Reconstructing the proper balance and harmony of the face begins with the manipulation and positioning of the bandeau. The bandeau or brow is the key architectural component of craniofacial reconstruction. Advancement of the supraorbital bar and forehead can result in functional improvements. This article details the historical development of the surgical procedures available for use in recontouring the forehead. Specific surgical procedures are described and evaluated including the method of removing an unsuitable, unusable bandeau, fashioning a new one from a strip of parietal cranial bone, and repositioning it. The advantages of the bilateral lamellar split bandeau are discussed.

Adult↗
PubMed1996

The "back to sleep campaign" and deformational plagiocephaly: is there cause for concern?

In April 1992, the American Academy of Pediatrics recommended back or side sleeping for healthy newborns to reduce the risk of sudden infant death syndrome. Subsequently, the US Public Health Service organized a health care coalition to promote a "Back to Sleep Campaign" to advocate back or side sleeping for infants. Since 1992, our craniofacial anomalies center has witnessed a marked increase in the incidence of infants with defomational changes of the cranium and face. The purpose of this project was to study the etiologies of deformational plagiocephaly and possible correlation with infant head position. We reviewed 52 consecutive patients presenting with deformational plagiocephaly from January 1992 to December 1994. A diagnosis of deformational plagiocephaly was determined by (1) history (date when head shape change was first noted), (2) clinical examination (occipital flattening, contralateral forehead flattening, lowering of the eyebrow, and ear shearing), and (3) skull radiographs (patent cranial sutures). All infants had medical photography to document baseline craniofacial morphology and any follow-up changes after nonsurgical therapy. Cranial asymmetry was first noted after birth at a mean time of 3.6 months. All infants were initially positioned on their back/side. In 52 patients, 61% had right-sided flattening of the occiput (vs 39% left-sided). All infants had flattening of the occiput, contralateral brow lowering or inferior displacement of the brow, contralateral forehead flattening, and posterioinferior displacement of the ear. All skull radiographs demonstrated patent sutures. Follow-up of patients ranged from 3 to 22 months with a mean of 10.5 months. Follow-up clinical examination and photography demonstrated significant improvement of cranial form in all patients with recommended frequent head turning (73%), helmet molding (23%), and surgery (4%). Our unit has seen an increase in the number of infants with deformational plagiocephaly over the last three years. All of the affected infants in this study had been managed according to the officially recommended protocol of back/side positioning. These findings suggest a possible relationship between this type of infant positioning and the development of a deformational plagiocephaly. However, cranial asymmetry in this group of patients decreased significantly with nonsurgical therapy. We have not recommended cranial vault remodeling surgery for the mild and moderate types of this deformity. However, if there is evidence of increasing asymmetry of deformational plagiocephalic infants during follow-up and evidence of severe variants of these deformities, surgical correction of the cranial vault is recommended.

Cranial Sutures↗
PubMed1992

Comparison of reflection and transmission pulse oximetry after open-heart surgery.

OBJECTIVE: To determine if there was a difference between reflection and transmission pulse oximeters in their ability to regain data display after hypothermia in patients recovering from open-heart surgery. DESIGN: Prospective, randomized, controlled study. PATIENTS: Nineteen adult patients scheduled for open-heart surgery were studied immediately after surgery in the ICU. INTERVENTIONS: Transmission and reflection sensors were used in random order in two simultaneously monitoring identical oximeters and probes. The time difference at the start of display between the oximeters was measured and the skin temperatures in the region of the probes, cardiac index, systolic BP, pulse pressure, and systemic vascular resistance index were recorded. RESULTS: The mean skin temperatures at the probe sites differed significantly (p = .001) at the moment of data acquisition. The mean forehead, ear lobe, and fingertip temperatures (simultaneously measured) were 33.9 degrees C, 31.8 degrees C, and 28.8 degrees C, respectively. The hemodynamic variables were comparable at the moment when the oximeters resumed display. The reflection probe was the first to resume function in 12 patients and the transmission probe was the first to resume function in four patients (p less than .02). The bias of the reflection probe was 1.4% (SD 2.2) and that of the transmission probe was -0.4% (SD 2.7). All the patients were normoxic throughout the study. CONCLUSION: The forehead reflection probe regained signal detection earlier than the transmission probe on the ear lobe in patients with compromised peripheral blood flow and cool periphery. This finding may be due to higher skin temperature at the reflection probe site, since the systemic hemodynamic conditions were equal at the time of the data acquisition of both sensors.

Adult↗
PubMed1995

Corrugator supercilii muscle resection through blepharoplasty incision.

Corrugator supercilii muscle resection through an upper blepharoplasty incision, with or without concomitant blepharoplasty, is suitable for patients who have significant corrugator hyperactivity and deep frown lines without eyebrow or forehead ptosis. This procedure is also appropriate for patients who decline a forehead rhytidectomy. After infiltration of local anesthesia with intravenous sedation, skin and fat are excised when a concurrent blepharoplasty is planned. The plane between the orbicularis oculi muscle and the orbital septum is dissected until the corrugator supercilii muscle is exposed. This muscle is identified immediately cephalad to the medial half of the superior orbital rim. The muscle is resected carefully to prevent injury to the supratrochlear nerve medially and the supraorbital nerve laterally. The resultant depression is eliminated with fat removed during the blepharoplasty, or fat or dermis from other sites should the aesthetic plan not include eyelid surgery. Eight patients, seven females and one male, underwent this procedure. The follow-up period ranged from 11 to 19 months, with a mean of 14.5 months. Patients' ages ranged from 25 to 66 years, with a mean of 51.3 years. A scale of 1 to 5, with 5 being excellent, was used to rate postoperative appearance, producing a mean of 4.25. The advantages of fewer skin incisions, less tissue mobilization, and a direct approach to the origin of the problem make this procedure a valuable adjunct to the cosmetic surgery armamentarium.

Adult↗
PubMed1996

An anatomically based study of the mechanism of eyebrow ptosis.

The development of eyebrow ptosis with aging is commonly attributed to progressive laxity of scalp and forehead soft tissues. If the change in eyebrow position with aging resulted entirely from this basic mechanism of tissue stretching, uniform lowering of the medial and lateral eyebrow segments should occur. Clinical observations show, however, that the lateral eyebrow segment usually becomes ptotic earlier than the medial segment, indicating that a more complex mechanism exists. To clarify this process, anatomic studies were done on 20 (40 half-head) fresh cadaver specimens. Histologic studies also were performed to complement the gross anatomic findings. These studies confirm that the mechanism producing eyebrow ptosis has a relatively greater effect on the lateral eyebrow segment. The lateral eyebrow has less support from deeper structures than the medial eyebrow, and the balance of forces acting on the eyebrow selectively depresses the lateral segment. Structures that may promote mobility and gravitational descent of the eyebrow, especially the lateral eyebrow segment, are (1) the galea fat pad, (2) the preseptal fat pad, and (3) the subgalea fat pad glide plane space. Three forces that act on the lateral eyebrow are (1) frontalis muscle resting tone, which suspends that eyebrow segment medial to the temporal fusion line of the skull, (2) gravity, which causes the soft-tissue mass lateral to the temporal line to slide over the temporalis fascia plane and push the lateral eyebrow segment downward, and (3) corrugator supercilii muscle hyperactivity in conjunction with action of the lateral orbicularis oculi muscle, which can antagonize frontalis muscle activity and directly facilitate descent of the lateral eyebrow. The axis point for these forces is the temporal fusion line of the skull near the superior orbital rim. The interaction of those structures and forces contributing to the mechanism producing eyebrow ptosis is discussed. Derived concepts are applied to the execution of the forehead lift procedure.

Cadaver↗
PubMed1997

Synostotic frontal plagiocephaly: anthropometric comparison of three techniques for surgical correction.

Surgical correction of synostotic frontal plagiocephaly ("unilateral coronal synostosis") focuses on distortions of the forehead and orbits. Technical variations include unilateral versus bilateral fronto-orbital positioning. Surgical alignment of the deviated nasal root was introduced in our unit. Anthropometry was used to assess anatomic outcome, and results were compared in 22 children with synostotic frontal plagiocephaly who had either (1) unilateral fronto-orbital advancement ("canthal advancement") (n = 8), (2) bilateral fronto-orbital advancement/ modeling without nasal straightening (n = 7), or (3) bilateral fronto-orbital advancement/modeling with closing wedge nasal osteotomy (n = 7). Postoperative fronto-orbital asymmetry was most marked in the group I patients wherein the ipsilateral supraorbital rim was retruded 3.9 mm and elevated 2.6 mm, on average relative to the corneal apex, compared with the normal side. Group II children averaged 2-mm orbital retrusion and 2.2-mm elevation. Group III patients averaged 1.4-mm orbital retrusion and 2.9-mm elevation. These differences in orbital rim measurements among the three groups were not statistically significant. Postoperative nasal root angulation of 4 degrees or more was found in more than 50 percent of children who had either a unilateral or a bilateral procedure, without nasal correction. In contrast, primary nasal osteotomy resulted in a nasal cant of 3 degrees or less in all children. This difference in nasal angulation among the three groups was statistically significant (p = 0.035). Group III had a straighter nasal angle than groups II and I (in that order). Measurement of the distances from nasion to inner and to outer canthi also reflected persistent deviation of the nasal root. Group III children had a more central radix than either group I or II (p = 0.05). The data in this study support an operative strategy of bilateral (parallelogrammic) positioning of the forehead/ superior orbits with primary correction of nasal root angulation.

Cephalometry↗
PubMed1999

Hairline lowering during foreheadplasty.

Many patients seeking rejuvenation of their foreheads have high hairlines and are troubled by the prospect that surgery will worsen the deformity. Hairline elevation occurs in both coronal and endoscopic foreheadplasty techniques and is at least part of the reason that many surgeons do not always recommend these procedures when otherwise indicated. Although a pretrichial "hairline" incision prevents hairline retro-displacement, it results in forehead shortening only and not true hairline lowering. When a pretrichial incision is used in combination with a posterior scalp advancement flap, however, true hairline lowering is possible. Experience with this technique encompasses 27 procedures performed over a 5-year period. Patients ranged in age from 35 to 71 years. A significant improvement was demonstrable in all cases and corresponded with a high degree of patient satisfaction. No serious complications were seen. A high hairline must be recognized as the source of both a disproportionate and aged appearance. The ability to lower the hairline and place it in a more proportionate, youthful relationship with the rest of the face adds a new dimension to foreheadplasty equal to or greater in importance to an overall improved appearance as other maneuvers typically performed during the procedure. For many patients, the benefits of hairline lowering far outweigh the trade-off of a more anteriorly situated, and possibly more visible, scar.

Adult↗