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At least 1,333 records · Page 74Linked to original sources
PubMed2000

New eyebrow lift technique using a semiautomatic suturing device (maniceps) for patients with facial paralysis.

Direct browlift and the traditional fascial suspension technique sometimes leave a prominent scar above the eyebrow. Coronal browlift, mid-forehead browlift, and endoscopic browlift leave no prominent scar, but they are sometimes not suitable for patients with facial paralysis because they have been developed for rejuvenative surgery. The authors present a new browlift fascial suspension technique for patients with facial paralysis. This method uses a semiautomatic suturing device (Maniceps), which they have used to graft three fascial strips to the forehead from the fascia lata, and to suspend and lift the eyebrow with only two small incisions posterior to the hairline. The authors treated 13 facial paralysis patients, with follow-up periods of more than 6 months. The lifted eyebrows adapted to stabilized positions within 3 months. The results in all 13 patients were satisfactory, with no severe complications. This new technique is very useful because it has wide applicability, including facial paralysis patients who experience severe ptosis.

Adult↗
PubMed1992

The frontal tiara.

A technique for the construction of a frontal bar and a forehead plate as a single unit is described. This technique could be used in any procedure in which a frontal bandeau is advanced and the forehead needs to be remodeled. By using microscrew fixation, the bulkiness of miniplates and wires is eliminated.

Bone Screws↗
PubMed1995

Critical analysis of results of craniofacial surgery for nonsyndromic bicoronal synostosis.

We retrospectively assessed the intermediate and long-term results of craniofacial surgery in 22 consecutive patients with nonsyndromic bicoronal synostosis to determine the outcome of corrective surgery. The study population consisted of 13 males and 9 females whose ages ranged from 6 weeks to 24 months (mean, 5.6 months) at the time of initial surgery. All patients had been assigned a diagnosis of nonsyndromic bicoronal synostosis. Each patient underwent resection of both coronal sutures and frontal orbital advancement with cranial vault remodeling using a floating forehead technique. Age at initial operation was 5 months or less in 13 patients and 6 months or more in 9. Complications occurred in 5 patients (23%), and 1 patient with an associated metabolic disorder died from respiratory arrest postoperatively. Follow-up ranged from 6 to 168 months (mean, 53.2 months). Results were graded according to the need for and extent of reoperation. Residual aesthetic deformities were documented in 12 patients (55%). Three patients (14%) required calvarial recontouring or cranioplasty to achieve satisfactory forehead contour or bony continuity. Total reoperation for recurrent deformity was required at a mean age of 29.7 months in 8 patients (36%) and is pending in another (4%). Four patients (18%) required a third operation (two total reoperations and two cranioplasties) to achieve satisfactory results. Eight of 13 patients (62%) operated on at 5 months of age or younger required total reoperation compared with 1 of 9 (11%) operated at 6 months of age or older. When analyzed alone, age of operation was a statistically significant determinant of the need for reoperation (p < 0.03). However, when subjected to multivariate analysis, neither age at operation nor the presence of an associated anomaly or positive family history had a significant effect on outcome.

Age Factors↗
PubMed2000

Brachycephaly and external pressure.

Browsing through some literatures, I happened to find out some records on the rite of imitation of the child's head to brachycephaly. In 1976, two skulls showing extraordinary forms were excavated out of an ancient tomb at Yean village of Daedong township in Kimhae County in Kyungnam Province, the Republic of Korea. The deformation in Yean village is judged to be an intentional frontal flattening. The frontal bone of deformed individuals is remarkably flattened by a primary deforming force. The parietal bone expands laterally and superoposteriorly as a major compensatory growth. The lambdoid or occipital flattening induced by the counterforce is light and unstable. In the facial skeleton, the maxilla shifts downward as a minor compensatory growth. These findings might be substantially correspondent to the custom in the southern area of Korea in the 4th century A.D. paragraphed by Han chuan of Wei-dynasty record, History of the Three Kingdoms. It described that the people gave a pressure onto the child's forehead with stones in order to mold it for preference. Flatheaded meant "free" among the Chinook and Salish tribes of American Indians. Babies of slaves were denied the year-long beauty treatment--a board tied to the infants' padded skull--that permanently flattened the foreheads of tribal members. Referring to these records, I presume that brachycephaly can be induced by direct extrinsic pressure at least until the soft infant's head gets hard.

Culture↗
PubMed1999

fMRI evidence for an inverted face representation in human somatosensory cortex.

We provide evidence that the face component of the somatosensory homunculus is actually upside down rather than right-side up along the central sulcus of the human brain. We pneumatically stimulated the forehead or chin of neurologically intact humans while acquiring fMRI images of somatosensory cortex. During forehead stimulation cortical regions along relatively inferior portions of the postcentral gyrus were most active whereas during chin stimulation relatively superior regions were most active. These data are consistent with an inverted face representation along the central sulcus of the human brain.

Adult↗
PubMed1994

Blindness after blow-out fracture repair.

Blindness following uncomplicated repair of orbital blow-out fracture has been reported previously. Mechanisms that have been implicated in this devastating complication include direct intraoperative injury to the optic nerve, increased orbital pressure, retrobulbar hemorrhage, and bone spicule impingement on the optic nerve. Two additional cases of blindness following uneventful surgical repair of a blow-out fracture are described herein. The first patient had sustained severe blunt trauma to the forehead after discharge from the hospital. The computed tomography (CT) scan of his orbit suggested a swollen optic nerve, and he was thus assumed to have traumatic optic neuropathy secondary to postoperative blunt trauma to the forehead. The second patient had prolonged, severe orbital edema. The operated eye had been patched, and the patient took analgesics ad lib to control orbital pain. Intraoperative and postoperative measures to help prevent such complications are emphasized.

Adult↗
PubMedDate not supplied

Neonatal auditory brain stem responses from ipsilateral and contralateral recording montages.

Ipsilateral and contralateral auditory brain stem responses were recorded from both ears of 10 neonates between 37 and 43 weeks from conception with normal auditory brain stem function. The most prominent component of the contralateral response was a forehead positive deflection occurring 0.3 millisecond before the ipsilateral wave III followed by two forehead negative waves, the latter present at the same latency as the ipsilateral wave V. The amplitude of the contralateral response was small: at 30 dB nHL only 7 of the 20 ears showed clear responses from this montage. The morphology of the neonatal contralateral response is thus considerably different than the ipsilateral, unlike the adult. A neonate could be mistakenly diagnosed as hearing impaired or neurologically involved if the interpretation is based on the contralateral recording.

Audiometry, Evoked Response↗
PubMed1990

Correlation study of two-channel recordings of the brain stem auditory evoked potential.

Two-channel recordings of the brain stem auditory evoked potential (BAEP), for example, forehead to ipsilateral mastoid and forehead to contralateral mastoid, presumably provide "views" of the generators from different, nearly orthogonal, directions. The two channels thus are expected to register somewhat different waveforms, as revealed by past research. Still, the absolute latencies of the peaks are expected to be strongly correlated between channels. To test this notion, correlation analyses were made of the latencies of positive and negative peaks of normal-appearing BAEPs. The results demonstrated the expected high correlations for brain stem components but less tight coupling between peaks of waves of more peripheral origins. The possible influence of residual noise also was considered. Implications of the findings for clinical and multichannel recording applications are discussed.

Adult↗
PubMed1997

Nasal reconstruction using a combination of alloplastic materials and autogenous tissues: a surgical alternative.

Re-creation of a functional and aesthetically acceptable nose after partial nasal defect requires accurate reproduction of nasal lining, support, and coverage. Most authors recommend an approach to reconstruction with cantilevered bone grafting and paramedian forehead flap placement. The authors propose an alternative approach for selected patients with total or near-total nasal defects combining both alloplastic and autogenous tissues. This method uses vitallium or titanium mesh for the dorsal framework formation, tissue-expanded paramedian forehead flap for soft tissue coverage, and composite chondrocutaneous auricular grafts for tip reconstruction. Nine individuals underwent nasal reconstruction using this method. The indications, details, and potential advantages of this technique are described with accompanying photographic results. A flexible approach using a combination of alloplastic materials and autogenous tissues provides additional reconstructive options for individuals with total or near-total nasal defects.

Adolescent↗
PubMed2003

Vascularized radial forearm free tissue transfer for lining in nasal reconstruction.

OBJECTIVES/HYPOTHESIS: Total and near-total nasal reconstruction requires the surgeon to replace external nasal cover, skeletal support, and internal nasal lining. The successful result must re-create the form and function of the original nose. In large defects, traditional sources of internal lining may be unavailable. The study describes the recreation of nasal lining in three patients with extensive nasal defects with vascularized radial forearm tissue. STUDY DESIGN: Retrospective review of three patients who underwent nasal reconstruction with radial forearm for internal lining, costal cartilage grafts for skeletal support, and paramedian forehead flap for cover. METHODS: The charts of three patients who underwent total nasal reconstruction with radial forearm tissue transfer for lining were retrospectively reviewed. The technique was evaluated. The authors present a method for internal lining reconstruction in extensive nasal defects. They discuss the advantages and disadvantages of this method. RESULTS: Three patients underwent successful total nasal reconstruction with radial forearm tissue transfer for lining, costal cartilage for skeletal support, and paramedian forehead flap. None of the patients had adequate septal mucosa or nasal subunit skin to support mucosal rotation grafts or epithelial turn-in flaps. All patients have completed reconstruction and have satisfactory nasal form and function. Loss of the lining flap or graft loss did not occur. CONCLUSION: Vascularized radial forearm tissue supplies ample quantities of skin to recreate nasal lining. The tissue provides excellent support of graft material, and it prevents contracture of the covering flap. Because of its bulk and donor site morbidity, free forearm tissue transfer should not be considered for reconstruction of smaller defects when another lining flap will suffice.

Adult↗
PubMed2002

Hemodynamic responses to stress among black women: fitness and parental hypertension.

PURPOSE: We compared hemodynamic aspects of the relationship between cardiorespiratory fitness and blood pressure changes during and after laboratory stress in young black women with or without parental history of hypertension. METHODS: Participants were 30 normotensive, black American women having low to moderate fitness levels (i.e., VO2peak) assessed by cycle ergometry who performed standard active and passive coping laboratory stressors. Blood pressure, heart rate, stroke volume, cardiac output, total peripheral resistance (TPR), calf blood flow (CBF), and calf vascular resistance (CVR) were assessed during exposure to forehead and hand cold pressors, and mental arithmetic, as well as during recovery after the tasks. RESULTS: Fitness was positively related to increases in either TPR or CVR during each stressor. In contrast, fitness was positively related to blunted blood pressure during or after passive stress (i.e., hand or forehead cold) and enhanced recovery of blood pressure and TPR after the active stressor (i.e., mental arithmetic); effects of fitness on the vascular responses during and after mental arithmetic were stronger among women having a negative history of parental hypertension. CONCLUSION: The findings confirm our previous report that fitness blunts systolic blood pressure response during the hand cold pressor in young women. They also suggest that future studies of fitness and blood pressure reactivity during stress should focus on the regulation of vascular responses and their recovery after stress. Weaker effects of VO2peak after mental arithmetic in the positive history group indicate that the level of fitness required to modify recovery from mental stress among black American women may differ according to parental history of hypertension.

Adolescent↗
PubMed1976

Reconstructive rhinoplasty for the lower two-thirds of the nose.

A general format has been developed and used for reconstruction of the lower two-thirds of the nose in patients retaining some septum who have a low forehead. The lining above the alae comes from strategic local flaps, while the alar lining and most of the columella are produced by a pair of nasolabial flaps. Support is provided by the residual septum (sometimes advance), and by a later costal chondroperichondrial hinge graft. The cover comes from a "headless" gull-shaped, forehead flap.

Aged↗
PubMed1985

Inclinations of the facial profile: art versus reality.

The average inclinations of five basic facial profile lines and five individual facial profile segments were determined by direct anthropometry in a total group of 232 healthy young adults, all North American Caucasians. Significant sex-related differences were found only in the inclination of the forehead, the lower face, and the lower third of the face, with greater inclinations in males. These results were compared with data obtained from 49 art works produced by ancient, Renaissance, post-Renaissance, and contemporary artists and drawings of the face in scientific papers published by anthropologists, orthodontists, anatomists, and plastic surgeons. In the population study the average inclination of the general and the aesthetic profile lines, the lower face, the forehead, and the lower lip show a receding trend. The upper face is slightly protruded in the males and close to vertical in the females. The chin and the nose are equally prominent in both sexes. The only significant difference is in the greater recession of the lower face in males. The average female population values are reminiscent of those of the Renaissance. The average male inclinations come closest to the findings in the statues of antiquity. The population sample and the contemporary artists showed similar inclinations of the nasal bridge and the lower lip. Generally, the average inclination of the chin in the population is smaller than in any artistic style.

Adult↗
PubMed1994

Free composite latissimus dorsi muscle-rib flap not containing the intercostal artery and vein for reconstruction of bone and soft-tissue defects.

Reconstruction of bone and soft-tissue defects of the forehead and leg was done with use of a free latissimus dorsi muscle-rib flap. By utilizing the curve characteristic of the rib and by filling the cavity with latissimus dorsi muscle, the forehead could be restored in a good shape. In our application of this flap to the leg, it is considered in retrospect that reconstruction with the use of two ribs should have been done. Furthermore, it was concluded that in comparison with the heretofore employed vascularized rib graft, the scope of operative invasion is small in the use of this flap with hardly any risk of thoracostomy.

Adolescent↗
PubMed1994

A cadaver investigation of the blood supply of the galeal frontalis flap.

The vascular anatomy of the galeal frontalis flap was studied in 12 fresh cadavers by an intraarterial dye injection technique. Special attention was directed to the length limit of this flap. The general belief that the galeal frontalis flap has a robust vascularity by means of the supratrochlear and supraorbital arteries was not demonstrated in this study. In the medial half of the forehead, superficial branches of both arteries penetrated the frontalis muscle immediately above the supraorbital rim and ran superficially in the subcutaneous tissue. In the lateral half, some of the superficial branches of the supraorbital artery traveled with the frontalis muscle and anastomosed with the frontal branch of the superficial temporal artery. Deep branches of the supratrochlear and supraorbital arteries showed an axial distribution on the periosteum only for a short distance. One or two branches of the supraorbital artery were found to take a superficial course within the subgaleal layer, pierce the frontalis muscle, and anastomose with the superficial temporal artery. These findings suggest that the galeal frontalis flap should be elevated in the lateral forehead. The preservation of the periosteum with the flap is recommended in order to ensure the temporoparietal extension.

Blood Vessels↗
PubMed1998

Variations of the frontal exit of the supraorbital nerve: an anatomic study.

Until now, it has been taken for granted that the point of emergence of the supraorbital nerve is by way of a notch or a foramen at the border of the inner to the medial third of the supraorbital rim. In contrast to several anatomic textbooks, we noticed that the exit point was repeatedly not at the site where anticipated when implanting lid springs for facial palsy. This gave us the idea of investigating these variations and how big they are, because most open and recent endoscopic forehead lift techniques have relied on a constant exit point of the supraorbital nerve. A total of 507 macerated skulls (1014 orbits) from three anatomic collections in Austria and Germany were studied. All skulls were adult European skulls gathered from the prehistoric age up to the twentieth century. Additionally, 18 fixed cadavers (36 orbits) and 25 fresh cadavers (50 orbits) were studied. These data were not included in the statistical analysis but in the discussion. The anatomic measurements on the skulls were carried out with an anthropometric calliper. The examinations concentrated on the configuration (notch/foramen) and the number of exit point(s) on the supraorbital rim, the vertical distance from the supraorbital rim, and the distance from the nasion to the various exit point(s). Combining all of these parameters, 74 percent of the skulls showed asymmetric findings between the right and left orbits. In 15 percent of both orbits, the supraorbital nerve left the orbital cavity already in its two branches, the medial and lateral branch, either through a notch or a foramen, the foramen being sometimes the exit of a supraorbital canal. The average distance from the nasion to the frontal notch/foramen was 25 mm on both orbits (range 16 to 55 mm) and to the supraorbital notch/foramen 31 mm (range 20 to 49 mm). The largest vertical distance from the supraorbital rim to its farthest exit point was 19 mm. Other than what is cited in literature, the variations concerning the configuration and the distance of the exit point(s) of the supraorbital nerve were so significant that all forehead operations, especially those using endoscopic techniques, must take into account these findings.

Adult↗
PubMed1999

Repair of wide coup de sabre without cutaneous excision by means of pericranial-galeal padding flap.

A case of double linear scleroderma of the forehead (coup de sabre) is described. The histopathology of this rare lesion is now well known with a normal epidermis and a sclerotic dermis. The correction was done with an original two-stage procedure: the lesion with alopecia was first treated by excision-suture and a transfer of the involved subcutaneous tissue along the right inner canthus; 1 year later, by a hemicoronal incision, we transferred a galeal-pericranial flap beneath the wider forehead lesion. We think that the use of a filling flap to correct wide coup de sabre lesions without cutaneous excision can be a simple alternative to the classic treatment by complete excision and flap reconstruction. The subcutaneous fascial system of the scalp can provide a good donor site with minimal morbidity.

Adult↗
PubMed2000

Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates.

Surgeons have constantly sought to achieve the most aesthetic scar. A major factor determining the final cosmetic appearance of a cutaneous scar is the tension acting on the wound edges during the healing phase. Since Theodor Kocher pioneered the alignment of skin incisions with Langer's lines in 1892, surgical techniques that attempt to overcome closing tension have become standard. Yet, no treatment has been available to minimize underlying muscle contractions, which are the major cause of this tension. Botulinum toxin A is a potent drug that produces temporary muscular paralysis when injected locally. It has proven to be safe and effective in the treatment of a variety of disorders, including hyperkinetic facial lines. The objective of this randomized, double-blind, placebo-controlled primate study was to investigate the efficacy of a single injection of botulinum toxin A to improve the cosmetic appearance of cutaneous scars. Symmetric pairs of standardized excisions were performed on either side of the forehead of six primates. The half foreheads were randomized to the botulinum toxin A treatment side versus the placebo injection side. A panel of three blinded facial surgeons assessed the cosmetic appearance of the mature scars 3 months postoperatively. The wounds that had been immobilized with botulinum toxin A were rated as significantly better in appearance than the control wounds (p < 0.01). Histologic examination confirmed that all scars were mature. Blinded, randomized, placebo-controlled human clinical trials are presently under way at the Mayo Clinic.

Animals↗