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PubMed1983

Rhythmical variations in human skin blood flow.

Rhythmical variations in human skin blood flow have been studied with laser Doppler flowmetry. In healthy adults the appearance of the rhythmical activity and its magnitude were found to differ widely between subjects, while the individual frequencies of the oscillations studied on forehead skin were close to the group average (8.6 +/- 0.7 cycles/min, mean +/- S.D.). Intraindividual variations in frequency of the blood flow rhythmicity were found in different skin regions, indicating the local nature of its control mechanism. Application of anaesthetic paste on forearm skin completely blocked the rhythmical variations in blood flow that were recorded before the experiment. Increasing frequency of the rhythmical variations in blood flow with skin temperature was demonstrated on the forehead, upper arm and forearm skin. Neither oxygen breathing nor anaesthetic block of the nerves innervating the skin region examined influenced the rhythmical variations in skin blood flow. On the basis of the results obtained, it was concluded that the oscillatory variations in skin blood flow are intimately associated with the rhythmical active vasomotion (small vessel rhythmical diameter changes) reported previously in the literature.

Adult↗
PubMed1983

Head and/or torso cooling during simulated cockpit heat stress.

Liquid-conditioned garments (LCG's) may be useful in alleviating heat stress on aircrew members. This study evaluated the effects of a liquid-cooled vest and/or cap on subjects exposed to a thermal environment which simulated the stress of low-level flight in hot weather. The chamber was set at dry bulb temperature 35 degrees C, wet bulb temperature 26 degrees C, and black globe temperature 43 degrees C. Subjects were eight men, aged 23-45 yr. Each subject was studied in four 100-min exposures: uncooled control (XX); head cooling only (HX); torso cooling only (XT); and combined head and torso cooling (HT). Cooling effects were evaluated by using rectal temperature (Tre); heart rate (HR); sweat rate (SRF and SRT for forehead and total body, respectively); and subjective comfort. Uncooled runs (XX) produced final values: Tre = 37.8 degrees C, HR = 94 beats/min, SRT = 25 g/m2 X h and SRF = 45 g/m2 X h. Combined head and torso cooling maintained the subjects at nearly their initial (baseline) state. Cap effects per se were assessed by comparing HX to XX, and HT to XT. Head cooling proved 2-3 times as efficient as torso cooling, although limited by the small surface area involved. We conclude that the specific effects of head cooling in improving comfort and diminishing forehead sweating, as well as the efficient systemic cooling observed, justify further work on cockpit applications.

Adult↗
PubMedDate not supplied

Occlusion effect in bone conduction pure tone and speech audiometry.

Two experiments were conducted to determine the occlusion effect (OE) for pure tone and spondee stimuli. Results of experiment I using mastoid placement and unilateral occlusion yielded a mean OE for bone conduction speech reception thresholds of 4.67 dB, which was in agreement with the average OEs of 0.50, 1.0 and 2.0 kHz, or simply the same as the OE for 1.0 kHz. However, the magnitude of the observed OEs for test frequencies of 0.25 to 4.0 kHz was considerably less than the OEs reported in previous investigations. In an attempt to explain this discrepancy, experiment II used unilateral and bilateral occlusion with mastoid and forehead placement for pure tone stimuli. Significant differences (p less than 0.05) were found between OEs obtained with mastoid versus forehead placement and for unilateral versus bilateral occlusion.

Adult↗
PubMed1996

Moderators of ethnic differences in vasoconstrictive reactivity in youth.

Three hundred and forty-one children (170 males and 171 females: 155 whites and 186 blacks) with a mean age of 11.2 years completed laboratory stressors of forehead cold and a video game. Impedance cardiography was used to assess total peripheral resistance indexed by body surface area (TPRI) at rest and during the stressors. Black youths exhibited greater TPRI and mean arterial pressure (MAP) reactivity to both stressors. It was hypothesized that anthropometric, demographic, lifestyle, and psychosocial variables might partially account for ethnicity differences in vasoconstrictive reactivity. Black youths' higher resting MAP and TPRI and greater MAP and TPRI reactivity to forehead cold were accounted for by anthropometric characteristics, physical activity, sedentary behavior (i.e., TV viewing) and family cohesion. The ethnic differences in TPRI and MAP video game reactivity were not accounted for by the various parameters.

Black or African American↗
PubMed1997

The endo-facelift. Basics and options.

This article presents our approach to performing an endoscopically assisted facelift. The advantages of the subperiosteal dissection are discussed. The procedure is expoused considering different approaches and variations depending on each particular case. Surgical procedures for the forehead, cheeks, and neck are discussed separately. Each procedure considers key maneuvers to liberate and relocate the deep soft tissues; for example, the transpalpebral approach to the forehead, the transpalpebral approach to the centrofacial area, and the subperiosteal mandibular dissection. Indications, limitations, and some advice to avoid complications also were presented.

Cheek↗
PubMed2006

Development of atopic dermatitis during the first 3 years of life: the Copenhagen prospective study on asthma in childhood cohort study in high-risk children.

OBJECTIVES: To describe the development of atopic dermatitis (AD) during the first 3 years of life and identify the localization of the early skin lesions that predicts the development of AD. DESIGN: Prospective, longitudinal, birth cohort study of children born to mothers with a history of asthma, followed up for 3 years with scheduled visits every 6 months as well as visits for onset or acute exacerbations of skin symptoms. SETTING: The cohort was recruited from greater Copenhagen, Denmark, and followed up at a clinical research unit, which controlled all diagnoses and treatment of skin diseases. PARTICIPANTS: A total of 411 infants were enrolled in the cohort; 55 had incomplete follow-up and were excluded from certain analyses. MAIN OUTCOME MEASURES: Atopic dermatitis was defined based on the criteria of Hanifin and Rajka, and severity was assessed by the SCORAD (Scoring Atopic Dermatitis) index. Predictive odds ratios of early skin lesions for those who developed AD vs those who did not were calculated. RESULTS: The cumulative incidence of AD by age 3 years was 44% (155/356). The prevalence rate peaked at age 2 years for boys and at age 2.5 years for girls, but there were no other sex differences in the proportion of children developing AD. Skin involvement in infants with AD was found to begin at the scalp, forehead, ear, and neck in a balaclava-like pattern and continue to the extensor sides and trunk, finally affecting the flexor sides of the extremities. Early skin lesions of arms and joints best predicted AD at age 3 years. CONCLUSIONS: Atopic dermatitis begins at the scalp, forehead, ear, and neck in a balaclava-like pattern. Eczema at the arms and joints provides the highest predictive value for the development of AD at age 3 years. This may be used for early prediction and intervention of AD.

Age Factors↗
PubMedDate not supplied

Reconstruction of nasal alar defects.

OBJECTIVE: To evaluate aesthetic and functional results of reconstruction of the nasal alar subunit using free cartilage grafts with an interpolated cheek or forehead flap and a vascularized mucosal flap when required. SETTING: University-based facial plastic surgery practice. PATIENTS: A case series of 50 patients with primary alar defects undergoing nasal alar reconstruction. MAIN OUTCOME MEASURES: Observer's and patient's rating of the final results, patient's rating of breathing and level of self-consciousness, and medical record review of complications. RESULTS: Most aesthetic outcomes were excellent to good. Breathing from the reconstructed side can be returned to preoperative status in most of these patients. CONCLUSION: Staged reconstruction of the nasal ala using free cartilage grafts, interpolated cheek or forehead and mucosal flaps when necessary, result in a highly aesthetic and functional outcome in most patients.

Adult↗
PubMedDate not supplied

Anthropometric facial analysis of the African American woman.

OBJECTIVE: To assess the differences in facial proportions between African American and Caucasian women. Differences within the African American population are sought. DESIGN: Anthropometric survey. PARTICIPANTS: Volunteer sample of African American women (N = 108), aged 18 through 30 years, with African American parents and no previous facial surgery or trauma. INTERVENTION: Photographs and 16 standard anthropometric measurements were taken in concordance with the 9 neoclassical canons. Results were compared with the North American white standard and the neoclassical canons, and an intragroup evaluation was performed. One-way analysis of variance, 99.7% confidence intervals, and t tests were used to test differences for significance. MAIN OUTCOME MEASURES: Anthropometric measures. RESULTS: Compared with white women, the following measurements were found to be significantly different (P<.003) in African American women: special head height was shorter; forehead height II was longer; nose length was shorter; lower face height was longer; height of the calva was shorter; forehead height I was longer; and ear length was shorter. In addition, most horizontal measures were wider, ie, eye-fissure width, nasal width, mouth width, and facial width. The nose and ear have greater angles of inclination. Of the 9 neoclassical canons, the orbital proportion was found to include the most proportional subjects (30.6%), followed by the nasoaural proportion (13.0%) and the nasofacial proportion (9.3%). Subcategorization based on nasal dorsal height yielded the most significantly different measures. CONCLUSIONS: African American female facial anthropometric measures, especially those of the horizontal dimension, differ significantly from those of young white subjects. The average African American woman does not fit the neoclassical standard of facial proportion.

Adolescent↗
PubMedDate not supplied

Reconstruction of the nasal columella.

OBJECTIVE: To report techniques successful for nasal columella reconstruction. METHODS: Retrospective medical chart review of patients undergoing columella reconstruction by 2 of us (D.A.S. and P.A.H.) from January 1, 1982, to December 31, 2000. Photographs before tumor resection or trauma, after resection or trauma, and after reconstruction were examined by facial plastic surgeons masked to the cases and were rated on a 10-cm visual analogue scale. RESULT: Sixteen patients were identified, most of whom had columellar defects repaired with forehead flaps, nasolabial flaps, or nasofacial sulcus flaps. The mean improvement on the 10-cm visual analogue scale was 2.0 from before tumor resection or trauma to after reconstruction, and 5.0 from tumor resection or trauma to after reconstruction. CONCLUSION: Skin grafts, composite grafts, and several flaps, including nasolabial, nasofacial sulcus, and forehead flaps, are useful in repairing defects of the nasal columella.

Adolescent↗
PubMedDate not supplied

Total nasal reconstruction: utility of the free radial forearm fascial flap.

BACKGROUND: Total nasal defects present daunting challenges to the reconstructive surgeon. The nasal skeleton can be successfully fabricated with bone and cartilage. Reconstruction of the nasal skin with a forehead flap produces an excellent color match for nasal skin. Resurfacing of the internal lining is the most difficult of the 3 layers. Local tissue is often unsatisfactory in amount and/or vascular supply. METHODS: A patient requiring total nasal reconstruction was prospectively examined. Intraoperative technique was recorded, and postoperative function was determined. RESULTS: A paramedian forehead flap was used to resurface the external defect. Split calvarium and conchal cartilage were used to reconstruct the nasal skeleton. A fascial flap harvested from the forearm was used to replace the intranasal lining. Turbinate grafts were placed to line the flap. Postoperative breathing was excellent. CONCLUSIONS: The intranasal portion of a total nasal defect can be successfully reconstructed with a fascial forearm flap. Placement of a turbinate or mucosal graft allows for a thin mucosalized lining with an excellent functional outcome.

Aged↗
PubMedDate not supplied

Internal brow elevation at blepharoplasty.

OBJECTIVE: To present data on a transblepharoplasty technique that provides a safe and reliable brow elevation and glabellar furrow reduction by releasing inferior tethering and weakening the brow depressor muscles. DESIGN: Nonrandomized retrospective case series and surgical technique description. RESULTS: One thousand patients who underwent internal brow elevation for cosmesis associated with upper blepharoplasty over the past 9 years were reviewed. Follow-up ranged from 6 months to 9 years. There were no serious long-term complications. All patients experienced forehead hypesthesia, which was temporary in most patients. Only 2 patients complained of prolonged and bothersome forehead hypesthesia lasting longer than 2 years. CONCLUSION: The internal brow elevation at blepharoplasty is a reproducibly safe and effective technique to improve eyebrow appearance without fixation.

Blepharoplasty↗
PubMed1998

Replantation of the amputated nose.

OBJECTIVE: To assess the effectiveness of replantation in the treatment of nasal amputations. DESIGN: Retrospective chart review. SETTING: A university medical center. RESULTS: In no case did the replant survive completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defect. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportionate and appropriate growth. CONCLUSIONS: It is our belief that replantation serves many therapeutic functions. At the very least, there is the psychological/emotional factor that is involved in attempting to replace a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has been handled with kid gloves by paramedics, maintaining its pink "alive" color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a "failed" replantation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Certainly, the need for vestibular lining reconstruction is far less. Thus, the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction.

Aged↗
PubMed2001

Titanium mesh repair of the severely comminuted frontal sinus fracture.

BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. METHODS: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: Titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.

Adult↗
PubMed2003

Videomimicography: the standards of normal revised.

BACKGROUND: Studies aiming to objectively evaluate facial movements have focused on the technique of measurement, whereas the most pertinent measurements of basic facial movements have not been well characterized. OBJECTIVE: To determine the best normal measures of 5 basic facial movements in healthy patients. METHODS: In 5 healthy subjects, 11 facial landmarks were placed on the face, and 5 movements (forehead lift, eye closure, nose wrinkling, lip puckering, and smiling) with maximal contraction force were requested. Each subject repeated each movement 3 times, and the entire session was repeated on 4 different days. No specific immobilization of the head was performed. The session was filmed with a digital camera, and the frames with maximal movement were selected. Measurements were performed with Osiris public domain image analysis software. For each measure, the change from rest was computed. Intersubject and intrasubject variability were determined by a multivariate analysis of variance. RESULTS: In all movements, surface changes (mean +/- SD) were higher than distance changes. For forehead lifting and eye closure, the best measure was the eye surface changes of 13% +/- 5% and -32% +/- 9%, respectively. For nasal wrinkling, lip puckering, and smiling, the best measures were the paranasal area (change, -28% +/- 9%), upper lip area (change, -23% +/- 8%), and mouth area (change, 63% +/- 21%), respectively. Most distance changes were below 10%. Same-day repeatability variation was below 15%, and day-to-day repeatability variation was below 7%. In healthy subjects, more than 80% of the total variation was accounted for by the intersubject variability. CONCLUSIONS: Videomimicography is a simple and objective linear measurement system based on facial surface changes. The measures exhibit good reliability.

Adult↗
PubMed1996

Sotos syndrome: evolution of facial phenotype subjective and objective assessment.

Sotos syndrome is characterised by pre- and post-natal growth acceleration, advanced bone age, developmental delay and a typical facial Gestalt. We have evaluated 45 individuals with Sotos syndrome who were between age 1 and 25 years, in order to better define the change in facial appearance over time. In each individual, a thorough assessment was made, serial photographs were reviewed, and a series of anthropometric craniofacial measurements was obtained. These were compared with age- and sex-matched normal standards. Both clinical and anthropometric evaluations show that the facial appearance which most clinical geneticists would regard as "classical" is established early in life. The head is large and dolichocephalic, with a rounded and prominent forehead, accentuated by frontoparietal balding. There is narrowing at the temples, fullness of the cheeks, and tapering to a pointed chin. With time, the normal process of facial change occurs, superimposed on that typical Gestalt. As the face lengthens, the dominance of the forehead diminishes and the chin achieves greater prominence. The mandible is long and narrow inferiorly, square or pointed, but prognathism is rare. In a small proportion of patients, a rounder face early in life may challenge diagnosis, but follow-up of these large newborn and older infants should allow diagnosis by early childhood. Visualisation of pattern profiles at different ages, supplemented by statistical measures of variability and similarity, support the clinical impressions outlined above.

Adolescent↗
PubMed2000

Comparison of narrow-band reflectance spectroscopy and tristimulus colorimetry for measurements of skin and hair color in persons of different biological ancestry.

We have used two modern computerized handheld reflectometers, the Photovolt ColorWalk colorimeter (a tristimulus colorimeter; Photovolt, UMM Electronics, Indianapolis, IN) and the DermaSpectrometer (a specialized narrow-band reflectometer; Cortex Technology, Hadsund, Denmark), to compare two methods for the objective determination of skin and hair color. These instruments both determine color by measuring the intensity of reflected light of particular wavelengths. The Photovolt ColorWalk instrument does so by shining a white light and sensing the intensity of the reflected light with a linear photodiode array. The ColorWalk results can then be expressed in terms of several standard color systems, most importantly, the Commission International d'Eclairage (CIE) Lab system, in which any color can be described by three values: L*, the lightness; a*, the amount of green or red; and b*, the amount of yellow or blue. Instead of a white light and photodiodes, the DermaSpectrometer uses two light-emitting diodes (LEDs), one green and one red, to illuminate a surface, and then it records the intensity of the reflected light. The results of these readings are expressed in terms of erythema (E) and melanin (M) indices. We measured the unexposed skin of the inner upper arm, the exposed skin of the forehead, and the hair, of 80 persons using these two instruments. Since it is important for the application of these measures in anthropology that we understand their relationship across a number of different pigmentation levels, we sampled persons from several different groups, namely, European Americans (n = 55), African Americans (n = 9), South Asians (n = 7), and East Asians (n = 9). In these subjects, there is a very high correlation between L* and the M index for the inner arm (R(2) = 0.928, P < 0.001), the forehead (R(2) = 0.822, P < 0.001), and the hair (R(2) = 0.827, P < 0.001). The relationship between a* and the E index is complex and dependent on the pigmentation level. We conclude that while both types of instruments provide accurate estimates of pigment level in skin and hair, measurements using narrow-band instruments may be less affected by the greater redness of certain body sites due to increased vascularization.

Adult↗
PubMedDate not supplied

Midsagittal facial soft-tissue growth of French Canadian adolescents.

This study examines changes in 12 midline soft-tissue thicknesses from the forehead, nose, lip, and chin regions in girls and boys from 10 to 16 years of age. The soft-tissue changes are compared to changes in two hard-tissue distances (sella-nasion and nasion-menton). The subjects are from a mixed-longitudinal sample studied at the Montreal Human Growth Research Center in the 1960s and 1970s. Total sample size is 242 (from lateral cephalographs of 124 males and 118 females), with numbers varying by age and measurement. For hard-tissues, boys show clearly defined adolescent spurts, while girls display small velocity increases indicative of only very minor spurts. Forehead tissue thicknesses for both sexes change little and show no demonstrable growth spurts. For the nose and philtrum region, which have the greatest absolute soft-tissue growth changes, both boys and girls show adolescent spurts. Peak velocities are attained between 13 and 14 years in boys and between 11.9 and 12.5 years in girls. Boys appear to have small adolescent spurts for upper (13.7 years) and perhaps lower lip thicknesses. Neither sex displays clear evidence for adolescent spurts in the chin region.

Adolescent↗
PubMed1987

Isochromosome 12p mosaicism (Pallister mosaic aneuploidy or Pallister-Killian syndrome): report of 11 cases.

We report on 11 cases of isochromosome 12p mosaicism (or Pallister mosaic aneuploidy syndrome) in which the isochromosome is usually absent in cultured lymphocytes but present in fibroblasts. The patients range in age from a 22-week-gestation fetus to a 45-year-old man. They have a distinct pattern of anomalies which enables one to make a diagnosis based on clinical manifestations alone. Craniofacial manifestations include "coarse" face with prominent forehead, sparsity of scalp hair, hypertelorism, epicanthal folds, flat bridge of nose, and highly arched palate. Affected newborn infants are profoundly hypotonic with sparsity of scalp hair especially bitemporally and a prominent forehead. Most have accessory nipples. Birthweight and growth parameters are usually normal; however, some newborn infants are unusually large. In infancy, the facial appearance becomes "coarse," hypotonia persists, and seizures may occur. As adults, growth may be normal, scalp hair is thicker and the mandible becomes prominent. Most have a generalized pigmentary dysplasia which may be evident with a Wood's lamp only. All cases have been sporadic and there is no consistent pattern of advanced parental age.

Abnormalities, Multiple↗