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PubMed1999

Soft tissue facial growth and development as assessed by the three-dimensional computerized mesh diagram analysis.

The normal growth and development of facial soft tissues from 6 years to adulthood has been studied by the 3D computerized mesh diagram analysis. The analysis allows independent quantifications of size and shape modifications both between different age groups, and between males and females. Normal age-related and sex-related references are provided. The three-dimensional facial morphometry method has been used for the collection of the x, y, z coordinates of 22 soft tissue landmarks in 2023 examinations performed on 1157 healthy white children and adolescents between 6 and 17 years of age and 191 young adults. The method detects the three-dimensional coordinates of retroreflective, wireless markers positioned on selected facial landmarks using two charge-coupled device cameras working in the infrared field. For each sex and age class, mean values were computed, and a standardized mesh of equidistant horizontal, vertical, and anteroposterior lines was consequently constructed. Within each age group, male meshes were superimposed on female meshes. Moreover, within each sex, the adult reference mesh was superimposed on the reference mesh of each age group. The global (size plus shape) difference was then evaluated by the calculation of the relevant displacement vectors for each soft tissue landmark. A global difference factor was calculated as the sum of the modules of all the displacement vectors. Consequently, a size normalization was performed, and the shape difference (size standardized) was then evaluated by the calculation of new relevant displacement vectors for each landmark, as well as a shape-global difference factor. When compared to the young adult situation, the largest child discrepancies were found in the soft tissue profile. After size standardization, shape differences were found in the forehead, nose, and chin. The soft tissue facial dimensions of boys and girls grow with similar characteristics and at the same rate between 6 and 11 years of age, but showed different patterns after this age. Within each age class, most of the sex-related differences were dimensional discrepancies that were corrected after size standardization. Nevertheless, before adolescence even these size differences were limited. On average, male faces had a larger forehead, longer and more vertical nose, more inferior and posterior gonia, more inferior and prominent lips, and a larger mouth than female faces of corresponding age.

Adolescent↗
PubMed1999

A surgical method for treating anterior skull base injuries.

Skull base surgery was performed on 18 patients with anterior skull base injuries. The operative technique consisted of opening the operative field in the anterior skull base via a coronal incision and a frontal craniotomy, debridement of the anterior skull base including the injured dura mater, performing drainage from the anterior skull base to the nasal cavity by ethmoidectomy, and reconstructing the resulting dural and anterior skull base defect using bilateral temporal musculo-pericranial flaps and a bone graft. Seventeen of the 18 patients recovered without any complications, although epidural abscesses in the anterior skull base had been present in four patients at the time of the operation. Only one patient developed an epidural abscess in the anterior skull base after the operation. None of the patients developed any other complications including meningitis, recurrent liquorrhoea or cerebral herniation. Satisfactory aesthetic results were achieved in 16 of the 18 patients. In one patient, uneven deformity of the forehead, which was caused by the partial sequestration of the frontal bone due to postoperative infection, was observed. In another patient, a depressed deformity of the forehead, which was caused by the partial loss of the frontalis muscle following the use of the frontal musculo-pericranial flap instead of a temporal musculo-pericranial flap, was observed. Anterior skull base reconstruction using bilateral temporal musculo-pericranial flaps provides excellent results in terms of patient recovery and aesthetics.

Adolescent↗
PubMed2003

Standardization of transcranial magnetic stimulation in the horse.

The influence of coil position on the peak-to-peak amplitude and onset latency of transcranial magnetic motor evoked potentials (MMEPs) in the extensor carpi radialis and cranial tibial muscles of horses was evaluated. Seven different stimulating coil positions were obtained by constructing a frame on the forehead. Two stimulation intensities (80% and 100% of maximal stimulator output) and two different coil currents (clockwise and counter-clockwise) were tested. For both recording sites MMEPs with the shortest onset latency and the largest peak-to-peak amplitude were detected when the coil was placed in the median of the forehead. There was no significant difference between left and right side recordings. The direction of the current flow in the coil had no influence on the onset latency of the MMEPs.

Animals↗
PubMed2002

Galvanic-evoked myogenic responses in patients with an absence of click-evoked vestibulo-collic reflexes.

OBJECTIVES: To show that galvanic-evoked responses on the sternocleidomastoid muscle (SCM) are useful for differentiating labyrinthine lesions from retro-labyrinthine lesions in patients with an absence of click-evoked vestibulo-collic reflexes. METHODS: We studied the average responses in the unrectified electromyographic (EMG) activities of the SCM to galvanic stimulation (3mA, 1ms). The cathodal electrode was on the mastoid, and the anodal electrode was on the forehead. Twenty-two healthy subjects and 28 patients with vestibular disorders were studied. All of the 28 patients showed the unilateral absence of vestibulo-collic reflexes evoked by 95dBnHL clicks on the affected side. RESULTS: In healthy subjects mastoid-forehead galvanic stimulation produced a positive-negative biphasic EMG response at short latency on the SCM ipsilateral to the cathodal electrode. All patients with labyrinthine lesions showed biphasic EMG responses even in the affected side. In contrast, almost all patients with retro-labyrinthine lesions (16/18) showed no response or a decreased response on the affected side. CONCLUSIONS: These results suggest that galvanic-evoked myogenic responses on the SCM may be useful in the differential diagnosis of labyrinthine lesions from retro-labyrinthine lesions in patients with an absence of vestibulo-collic reflexes evoked by clicks.

Acoustic Stimulation↗
PubMed2000

Complicated eyelid reconstruction after an unusual glabellar flap repair.

Remote flaps may be used for lid reconstruction when tissue loss is extensive and there is insufficient tissue in the adjoining areas. Median forehead flaps are usually used for upper lid, medial canthal or nasal repairs. We describe a complicated reconstruction of the lid and correction of a deformity which resulted from the injudicious use of a glabellar flap for lower lid repair. Improper use of a median forehead flap may interfere with the functioning of the lid, leading to corneal exposure and poor cosmesis. Lower lid defects are better repaired by advancement flaps or techniques like Tenzel's semicircular flap, reverse Cutler Beard, Hughes procedure or Mustarde's repair.

Adult↗
PubMed2000

Autofluorescence spectrum of skin: component bands and body site variations.

BACKGROUND/AIMS: The autofluorescence spectrum of skin consists of a number of overlapping single spectra emitted by fluorescent molecules. The overlapping makes it difficult to distinguish changes in the overall spectrum and the molecular basis for it. We applied curve fitting analysis to decompose the autofluorescence spectrum of normal human skin and studied the variation in different body sites. METHODS: Skin autofluorescence spectra were obtained in vivo from the normal skin of 17 subjects, using 5 excitation wavelengths: 340, 350, 360, 370 and 380 nm. The spectra were displayed in the wavelength range of 400 nm to 800 nm. Curve fitting was performed for each spectrum using the Levenberg-Marquardt algorithm. RESULTS: The skin autofluorescence spectra, provoked by all the excitation wavelengths, consisted of three component bands with center wavelengths at 450 nm, 520 nm and 625 nm. The 450 nm band contributed about 75% to the intensity of the overall spectrum, the 520 nm band contributed 25%, and the 625 nm band contributed about 2%. The three bands may correspond mainly to the fluorescence of nicotinamide adenine dinucleotide (NADH), flavin adenine dinucleotide (FAD), and porphyrins. Significant differences were found between the spectra of forehead and buttock skin. In forehead skin, the 625 nm band contributed more to the intensity of the overall spectrum, while the 450 nm and 520 nm bands had much lower peak heights, and the 450 nm and 625 nm bands were broader. CONCLUSIONS: The autofluorescence of skin is an overlapped spectra of molecules such as NADH, FAD, and porphyrins. These molecules contribute differently to the overall spectrum in different body sites.

Journal Article↗
PubMed2000

Comparison of surface free energy between reconstructed human epidermis and in situ human skin.

BACKGROUND/AIMS: The objectives of this study were to characterise the Episkin(R) model of reconstructed epidermis histologically and energetic, and to compare the results with the data obtained by Mavon (9, 10) on different areas of skin on the human body and on different skin types. METHODS: Histologically, the two skin systems studied were stained using Goldner's trichome METHOD: Surface free energy was determined by the measurement of contact angles, using the posed drop METHOD: RESULTS: Histologically, the two skin systems demonstrated the same cellular organisation in stratified layers. With regard to surface free energy, Episkin, skin from the forehead, normal and hyper-seborrheic skins are hydrophilic surfaces, while skin from the forearm or of an oligo-seborrheic type tends to be hydrophobic. Episkin and skin from the forehead exhibit similar surface free energy profiles. It is impossible to state whether Episkin has characteristics closer to those of normal or hyper-seborrheic skin, but they differ significantly from those of oligo-seborrheic skin. CONCLUSION: The results obtained during this study justify the use of Episkin in a range of tests where the use of in situ human skin raises problems.

Journal Article↗
PubMed2006

Evolutionary genetics: evolution of mate choice in the wild.

Qvarnström et al. test whether the preference of female collared flycatchers (Ficedula albicollis) for males with large forehead patches could have evolved as a by-product of selection acting on male patch size. They find that the crucial genetic correlation between female choice and male patch size is not significant, and conclude that preference for large patches must have been shaped directly by selection. However, their use of the patch size of a female's social partner as a measure of choice is incomplete, and will result in low estimates of the potential for direct selection to shape female preference. Their study is therefore unable to resolve the question of how female preference for large forehead patches has evolved.

Animals↗
PubMed2004

Effect of radiant warmer on transepidermal water loss (TEWL) and skin hydration in preterm infants.

OBJECTIVE: To evaluate the effect of radiant warmers on skin barrier function in preterm infants. METHODOLOGY: Transepidermal water loss (TEWL) and stratum corneum hydration were measured in 30 preterm infants (birth weight 825 to 2220 g) in seven body areas: forehead, upper back, cubital fossa, palms, soles, abdomen, and inguinal region. Measurements were performed under radiant warmer and incubator conditions. Each patient served as his/her control. RESULTS: TEWL was significantly higher in the radiant warmer compared to the incubator condition in only two areas: forehead and back. The overall mean difference in percentage TEWL between the conditions was 15%. Stratum corneum hydration was not affected by the radiant warmer. CONCLUSIONS: The use of radiant warmers does not significantly decrease barrier function in the preterm infant.

Body Water↗
PubMed2002

Thermoregulatory responses to exercise and warm water immersion in physically trained men with tetraplegia.

OBJECTIVE: To compare thermoregulatory responses of highly trained men who are tetraplegic during 40 min exercise at 65% [Vdot]O(2) peak and 60 min immersion in 39 degrees C water. METHODS: Four physically trained men who are tetraplegic participated in three laboratory visits. The first visit involved familiarisation and then determination of [Vdot]O(2) peak using open circuit spirometry during an incremental test to exhaustion with each man propelling his sport wheelchair on a motor driven treadmill. The order of second and third visits was randomly allocated. Visit 2 involved 40 min of exercise at 65% [Vdot]O(2) peak propelling each man's sport wheelchair on treadmill. Visit 3 involved sitting immersed to nipple line in 39 degrees C water for 60 min. Venous blood was obtained pre, during and after each intervention and analyzed for haemoglobin, haematocrit and changes in plasma volume were calculated. Separated plasma was analyzed for noradrenalin and adrenalin (high performance liquid chromatography). Heart rate, rectal temperature, and sweat rate estimated from a sweat capsule placed on forehead (dew point hygrometry) were recorded throughout. RESULTS: [Vdot]O(2) peak and HR max of these subjects were 1.14+/-0.16 l.min(-1) and 99+/-4 b.min(-1) respectively. Heart rate preimmersion was 67+/-4 b.min(-1) rising to 75+/-4 b.min(-1) after 40 min and 87+/-3 b.min(-1) after 60 min immersion. Heart rate was 68+/-3 b.min(-1) pre-exercise rising to 91+/-5 b.min(-1) after 40 min exercise. Rectal temperature rose from 35.97+/-0.30 degrees C pre immersion to 37.32+/-0.51 degrees C after 60 min immersion, and from 36.42+/-0.20 degrees C pre-exercise to 36.67+/-0.19 degrees C after 40 min exercise. Haemoconcentration occurred during 40 min of exercise and haemodilution occurred throughout 60 min of water immersion. Three participants demonstrated no sweating on the forehead during immersion or exercise. One subject commenced sweating after 20 min exercise and after 5 min of immersion. CONCLUSION: Compared to exercise, immersion was associated with a lower heart rate, a lower plasma noradrenalin concentration and an expanded plasma volume. When considering exercise or warm water immersion as therapeutic modalities in men who are tetraplegic, attention should be paid to heat gain and changes in plasma volume.

Adult↗
PubMed2005

Cheyne-Stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients.

STUDY DESIGN: Case reports. OBJECTIVES: To describe Cheyne-Stokes respiration (CSR) and associated circulatory abnormalities in three patients with spinal cord lesions. SETTING: Veterans Administration Hospital, USA. SUBJECTS: One paraplegic patient with coronary artery disease in congestive heart failure, one tetraplegic patient with alcoholic cardiomyopathy and postural hypotension, and one tetraplegic complete patient with cardiomegaly, severe aortic atherosclerosis, and postural hypotension. METHODS: Breathing activity was measured with a nasal thermistor or abdominal stretch transducer. Cardiac activity was estimated with a photoelectric sensor for cutaneous blood flow placed on the forehead or a piezoelectric transducer for pressure positioned over an artery or the cardiac apex. Tracings were drawn on a strip chart recorder. The subjects were at rest in semireclining positions. RESULTS: Survey times were 17-21 min, and cycling periods were 41-72 s. Periodic changes in the depth of breathing were accompanied by periodic changes in amplitude of forehead cutaneous pulse, blood pressure, or apical cardiac impulse in all patients. Peak circulation occurred at or following peak respiration. In addition, cyclical pulsus alternans occurred in two patients. CONCLUSION: Three spinal cord injury patients sustained CSR and circulatory periodicity associated with cardiac disease and postural hypotension.

Aged↗
PubMed1990

The cold face test (diving reflex) in clinical autonomic assessment: methodological considerations and repeatability of responses.

1. Cold stimulus applied to the face causes bradycardia and peripheral vasoconstriction (i.e. the diving reflex), and has been suggested as a test of the autonomic pathways involved. The purpose of this study was to define standard procedures for conducting the test and analysing the responses to the cold face test, to evaluate variability in responses between subjects and within subjects when the same test is repeated, and to examine its usefulness in clinical autonomic assessment. 2. Sixteen (nine female, seven male) healthy adult (21-35 years old) subjects were used. Cold stimulus was applied with gel-filled compresses. Forehead temperature under the compress as an indication of stimulus magnitude, heart rate, blood flow in the finger, toe and calf by venous occlusion plethysmography, and systolic and diastolic blood pressure were monitored. Three protocols were carried out in which the temperature (0, 5, 10, 15 degrees C), placement (whole face, unilateral, forehead) and duration (20, 40, 60, 120 s) of the cold compress application were varied. 3. The data indicate that 0 degrees C compresses applied bilaterally for 40 s produced the maximum bradycardia and peripheral vasoconstriction. No subject found this test to be obnoxious, but a 120 s application was objectionable to some subjects. This cold face test resulted in 22%, 72%, 59% and 44% reductions in heart rate and blood flow to the finger, toe and calf, respectively. There was significant between-subject variability, but good consistency in responses to tests repeated in the same subject on different days, at different times of day and in different seasons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

An evaluation of the role of skin temperature during heat adaptation.

This project sought to evaluate the importance of skin temperature during heat acclimation, using an isothermal-strain model. Two groups of seven matched males, participated (1 h per day, 10 days) in one of two conditions: (i) temperate physical training (TEMP: 22.4 +/- 0.7 degrees C, relative humidity (r.h.) 41.0 +/- 0.9%); or (ii) combined physical training and heat acclimation (HEAT: 38.2 +/- 0.7 degrees C, r.h. 39.7 +/- 1.3%). Isothermal strain was induced in both groups by rapidly elevating rectal temperature by 1 degree C (cycling), then holding it constant by manipulating external work. Subjects completed two three-phase heat stress tests (39.8 +/- 0.1 degrees C, r.h. 38.6 +/- 1.2), consisting of 20 min rest, then 20 min cycling at each of 30% and 45% of peak power, before and after each regimen. While there was a difference of 4.2 degrees C in mean skin temperature between treatments, both regimens elicited a similar peripheral sudomotor increase, indicating a core temperature dependent adaptation. However, based on significant pre- vs. post-acclimation decreases in average auditory canal temperature (0.4 +/- 0.1 degree C), average forehead skin blood flow (26%), average perceived exertion (11%), and a 5% increase in average forehead sweat rate (0.1 +/- 0.04 mg cm-2 min-1), the HEAT regimen elicited a more complete acclimation. While elevation in core temperature is critical to acclimation, it also appears necessary to expose subjects to an external thermal stress. This observation has not been previously demonstrated under conditions of isothermal strain, and verifies the importance of skin temperature elevation in the acclimation process.

Acclimatization↗
PubMed1998

Lyme disease with facial nerve palsy: rapid diagnosis using a nested polymerase chain reaction-restriction fragment length polymorphism analysis.

A 64-year-old woman with Lyme disease and manifesting facial nerve palsy had been bitten by a tick on the left frontal scalp 4 weeks previously. Erythema migrans appeared on the left forehead, accompanied by left facial paralysis. Nested polymerase chain reaction-restriction fragment length polymorphism analysis (nested PCR-RFLP) was performed on DNA extracted from a skin biopsy of the erythema on the left forehead. Borrelia flagellin gene DNA was detected and its RFLP pattern indicated that the organism was B. garinii, Five weeks later, B. garinii was isolated by conventional culture from the erythematous skin lesion, but not from the cerebrospinal fluid. After treatment with ceftriaxone intravenously for 10 days and oral administration of minocycline for 7 days, both the erythema and facial nerve palsy improved significantly. Nested PCR and culture taken after the lesion subsided, using skin samples obtained from a site adjacent to the original biopsy, were both negative. We suggest that nested PCR-RFLP analysis might be useful for the rapid diagnosis of Lyme disease and for evaluating therapy.

Adult↗
PubMed2003

Remarkable remission of a follicular lymphoma treated with rituximab and polychemotherapy (CHOP).

We describe a 50-year-old female patient who developed extensive lymphomatous infiltrates on her forehead, scalp and face within a few months. Histology and immunohistochemistry of skin tumours revealed a CD20 positive follicular B-cell lymphoma. Subsequently, extracutaneous manifestations were detected by computed tomography scans and bone marrow biopsy. The patient suffered from a primary nodular malignant lymphoma with extraordinary cutaneous infiltration of the head. Therefore, combination treatment with a monoclonal antibody against the CD20 antigen, rituximab, and polychemotherapy (CHOP scheme) was administered every 3 weeks. After the second course of treatment a complete regression of cutaneous infiltrates was noticed. Follow-up biopsies on the forehead showed no evidence of CD20 positive lymphoma cells, now. Despite mild leucocytopaenia therapy was well tolerated.

Antibodies, Monoclonal↗
PubMed1998

Evaluation of skin- versus teeth-attached markers in wireless optoelectronic recordings of chewing movements in man.

This study evaluated the applicability of skin- and teeth-attached reflex markers fixed to the mandible and the head for optoelectronic recording of chewing movements. Markers were attached to the upper and lower incisors and to the skin on the forehead, the bridge of the nose, the tip of the nose and the chin in seven subjects. Chewing movements were recorded in three dimensions using a high-resolution system for wireless optoelectronic recording. Skin markers were systematically displaced due to skin stretch. The largest displacement was observed for the chin marker, whereas minor displacement was found for markers located on the forehead and the bridge of the nose. In repeated recordings, the smallest intra-individual variation in displacement was found for the marker on the bridge of the nose. In spite of relatively large displacement for the chin marker, the temporal estimates of the mandibular movement were not affected. Teeth markers were found to significantly increase the vertical mouth opening, although the duration of the chewing cycle was unaffected. This indicates an increase in chewing velocity. We suggest that markers located on the bridge of the nose are acceptable for recordings of chewing movements. Skin markers on the chin can be reliably used for temporal analysis. They are also acceptable for spatial analysis if an intra-individual variability of 2 mm is allowed. Teeth-attached markers may significantly influence the natural chewing behavior. Thus, both types of marker systems have advantages as well as disadvantages with regard to the accuracy of the chewing movement analysis. Selection of a marker system should be based on the aims of the study.

Adult↗
PubMed1998

Skin lesions in children with tuberous sclerosis complex: their prevalence, natural course, and diagnostic significance.

BACKGROUND: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by widespread cutaneous and visceral hamartomas. METHODS: The prevalence of cutaneous lesions in 106 children with TSC (47 boys and 59 girls) aged 1 month-18 years was evaluated from 1984 to 1995. Assessing the diagnostic usefulness of each National Tuberous Sclerosis Association skin criterion was an aim of this study. RESULTS: Hypopigmented macules were the most frequent finding, seen in 103 of 106 children (97.2%). In 66 children they were evident at birth, and in 20 others their presentation was delayed until the first months of age. Facial angiofibromas were seen next most often (79 of 103, 74.5%), followed by a shagreen patch in 51 of 103 (48.1%), "cafe-au-lait" macules in 30 of 103 (28.3%), molluscum fibrosum pendulum (24 of 103, 22.6%), a forehead fibrous plaque (20 of 103, 18.9%), periungual fibromas (16 of 103, 15.1%) and "confetti-like" macules (3 of 103, 2.8%). The hypomelanotic macules were seen within the first 2 years of life in 95 children, as were café-au-lait spots in 24, facial angiofibromas in eight, shagreen patches in six, and forehead fibrous plaques in six, whereas molluscum pendulum and periungual fibromas were not evident. Seizures were seen in 102 of 106 children (98%), with 80 (75%) occurring during the first year of life. CONCLUSIONS: Hypomelanotic macules were the overwhelmingly most common early finding in TSC. Infants with seizures or other possible stigmata of TSC should be carefully evaluated for these hypomelanotic macules, as well as for other associated findings.

Adolescent↗
PubMed2000

Cornifying Darier's disease.

A 48-year-old Caucasian man recounted the onset of keratotic papules on the trunk at the age of 8 years, with subsequent spread to the forearms, scalp, and forehead. His most severe disease was present on the legs. He complained of pain, itching, and noted exacerbations in the summer and with sweating. The family history was negative. On physical examination, the most striking finding was that of extensive, markedly hyperkeratotic plaques on the lower legs >(Fig. 1). His scalp, forehead, chest, and back exhibited mild involvement, with scattered brown keratotic papules, while his forearms showed mildly hyperkeratotic plaques. Flat-topped brown papules were present on the dorsum of the hands, with a few keratotic papules on the palms, and a few nails with distal notching and red longitudinal streaks. There were no palmar pits or oral mucosal lesions. A shave biopsy was performed of a plaque on the leg, and showed a papillomatous and markedly hyperkeratotic lesion >(Fig. 2). Suprabasal acantholysis in the elongated rete produced characteristic lacunae. The acantholysis was associated with dyskeratosis including corps ronds and grains >(Fig. 3). Together, these features were characteristic of Darier's disease. Treatment years earlier with topical retinoids, topical steroids, topical keratolytics, and multiple oral antimicrobials had been unsuccessful, and isotretinoin had been discontinued due to elevated triglycerides. Treatment was initiated with acitretin and, after 3 months, mild improvement was noted

Acitretin↗