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PubMed2000

Growth restriction of cranial sutures in the fetal lamb causes deformational changes, not craniosynostosis.

Newborns with in utero cranial vault molding can present with severe forms of plagiocephaly. Intrauterine constraint has been proposed as one cause for craniosynostosis. The purpose of this experiment was to investigate whether rigid plate fixation across a fetal cranial suture, representing a severe form of growth restriction in utero, would lead to cranial suture fusion in a fetal lamb model. Six fetal lambs at 85 to 95 days gestation (term = 145 days) underwent laparotomy, hysterotomy, fetal coronal scalp incision, and miniplate screw fixation across the right coronal suture in utero. Two unoperated twins and four unoperated age-matched lambs were used as controls (n = 12). Animals were killed at both 4 and 8 weeks postoperatively. Fetal head analysis consisted of gross examination, photography, basilar and lateral radiographs, and three-dimensional computed tomographic scans. Cranial suture analysis consisted of imaging by computed tomographic scan (axial and sagittal cuts) and histology of experimentally plated coronal sutures, contralateral nonplated coronal sutures and twin control coronal sutures. Gross examination, radiographs, and three-dimensional computed tomographic analysis of heads with cranial suture plating showed ipsilateral forehead flattening, contralateral forehead bossing, superiorly displaced ipsilateral orbital rim, anterolateral projection of ipsilateral malar eminence, and anterior position of the ipsilateral ear point compared with the contralateral side of the same animal and normal controls. There was no change in nasal root, chin point, or predentition occlusal plane. Although analysis of the plated coronal sutures by computed tomographic scans showed diminished width or even stenosis, the histology revealed narrowed but patent experimental coronal sutures at 4 and 8 weeks. Contralateral, nonplated coronal sutures were not only patent, but widened compared with normal control sutures. This finding may have represented compensatory changes in the contralateral coronal suture caused by growth restriction at the plated suture. These data demonstrate that intrauterine growth restriction across a cranial suture caused by compression plate fixation resulted in deformational skull changes, not craniosynostosis. In addition, these data strongly support a role for in utero positional molding secondary to growth restriction in the maternal pelvis as a cause for nonsynostotic plagiocephaly seen in newborns.

Animals↗
PubMed1980

Comparison of four biofeedback treatments for migraine headache: physiological and headache variables.

Forty-two migraine headache patients participated in an appraisal of biofeedback for differential finger warming--forehead cooling, frontalis EMG relaxation, alpha enhancement and vasoconstriction of the temporal scalp arteries. All patients provided 8 weeks of baseline charting of headache and then received 24 training sessions in one of the above conditions. Headache charting continued throughout training and for 8 months posttraining. During the training period measures were made of each biofeedback variable plus forehead temperature, heart rate, skin conductance, and finger pulse amplitude. Analyses revealed that all groups had a significant reduction in number of headaches per week with no change in intensity, disability or length of headache. Physiological changes were consistently small and unrelated to headache outcome. A nonspecific effect for biofeedback is suggested with the likely candidates being a relaxation phenomenon or a cognitive explanation based upon perceived control.

Adult↗
PubMedDate not supplied

Determinants of endothelium-dependent femoral artery vasodilation in youth.

OBJECTIVE: Decreased endothelium-dependent arterial dilation to reactive hyperemia has been shown in adults to be associated with various manifestations of cardiovascular diseases and cardiovascular risk factors. In a sample of children, we examined the relationships between flow-mediated femoral artery dilation and anthropometric, demographic, cardiovascular, and serum lipid variables that have been associated with cardiovascular diseases. METHOD: Thirty-three asymptomatic, healthy 11 to 14 years olds were randomly selected from participants in a longitudinal cardiovascular health study. There were 17 boys and 16 girls; 21 whites and 12 blacks. Sixteen had documented family history of premature myocardial infarction (ie, < or = 55 years of age) in first-degree relatives and 17 did not. Measurements included fasting lipids, anthropometrics, blood pressure and heart rate at rest and during supine exercise, postural change, and forehead cold stimulation. Femoral artery dilation to reactive hyperemia was measured via high resolution ultrasound. RESULTS: Bivariate analyses indicated flow-mediated dilation was negatively correlated with systolic pressure increases to postural change, forehead cold stimulation and dynamic exercise, greater average skinfold thickness, and body fat via dual x-ray absorptiometry and positively correlated with cardiovascular fitness (all ps < .05). Stepwise multiple regression revealed that cardiovascular fitness and systolic pressure reactivity to exercise significantly predicted flow-mediated dilation accounting for 31% of the variance (p < .01). CONCLUSIONS: Decreased flow-mediated dilation is associated with decreased cardiovascular fitness, increased systolic pressure reactivity to various stressors, and increased indices of body fatness in asymptomatic youth. Further research is warranted to better understand early relationships between this noninvasive measure of endothelial function and cardiovascular risk factors in youth.

Adolescent↗
PubMed1976

Reconstruction of the oral cavity after obliterative surgery for cancer.

Simple and reliable methods for reconstruction of the oral cavity after obliterative surgery for carcinoma include (1) nasolabial cheek flaps, (2) hemiforehead and total forehead flaps, and (3) temporal island flaps. In general, the nasolabial flap is sufficient for resurfacing areas of the oral cavity anterior to the second molar tooth, while the temporal island flap provides satisfactory coverage posterior to this area. The forehead flap, which is very durable and reliable, is reserved for reconstruction of the more massive defects. Technics and use of each reconstructive procedure are described.

Face↗
PubMed1995

Evaluation of the effectiveness of the Minerva cervicothoracic orthosis.

STUDY DESIGN: This study evaluated a lightweight Minerva cervicothoracic orthosis with an occipital flare and forehead strap. OBJECTIVE: The orthosis was evaluated for its ability to immobilize the cervical spine in normal healthy volunteers. SUMMARY OF BACKGROUND DATA: Previous studies have been performed to evaluate cervical orthoses. Exception for the halo brace, none have controlled the upper cervical spine very well. The brace tested in the present report incorporates an occipital flare and forehead strap to better control the upper cervical spine. METHODS: Sixteen healthy male volunteers were evaluated in and out of the orthosis in three planes of motion. Maximal active cervical flexion, extension, and lateral bending were recorded and measured radiographically. Rotation was measured from overhead photographs. RESULTS: In a comparison of the present results with those of similar previous studies, improvement in control of flexion/extension of the upper cervical spine and in control of rotation was found. The occiput to C1 level, however, remained poorly controlled. CONCLUSION: This orthosis provides good control of the cervical spine below C1.

Braces↗
PubMed2006

Neck injury mechanisms during direct face impact.

STUDY DESIGN: Digitized measurements of the intervertebral motions using cervical cineradiographs of 10 volunteers during direct impacts applied to their faces. OBJECTIVES: To clarify the cervical spine motion during direct face impact and postulate some mechanisms of neck injuries. SUMMARY OF BACKGROUND DATA: Neck injury occurs mostly in traffic or falling accidents. Hyperextension of the neck is considered the most common mechanism of the injury because most victims have lacerations or contusions on their faces. METHODS: A low-level backward impact load was applied to 10 healthy male volunteers' faces at the forehead and maxilla via a strap using a free-falling small mass. Cervical vertebral motion was recorded by radiograph cineradiography during the impact. RESULTS: The upper cervical spine showed a flexion motion for both conditions. Consequently, the cervical spine had an S-shaped curvature similar to that in cervical retraction. Intervertebral motions of the cervical spine were evaluated using an radiograph frame taken at the maximum cervical retraction. For the forehead load, intervertebral motion at C1-C2 was flexion, and motions of the lower cervical spine were extension. For the maxilla load, intervertebral motions from occiput-C1 through C4-C5 were flexion. The inflection point of the curvature was influenced by the impact location. CONCLUSION: We detected a flexion motion of the upper or middle cervical spine during direct face impact. In an actual accident, if the cervical spine is forced into similar motion, we speculate that neck injury would occur in this retraction-like curvature of the cervical spine.

Adult↗
PubMed2004

Involvement of the bony orbit in infantile myofibromatosis.

Infantile myofibromatosis is a rare disorder of infancy that can provoke osteolytic lesions. A 15-day-old infant presented with three round, firm lesions located on the forehead, shoulder, and back. Excisional biopsy of the forehead lesion revealed that the tumor was composed of spindle cells resembling normal smooth muscle arranged in short fascicles. Immunohistochemical staining was positive for vimentin and actin. Five months later, the child presented with three new lesions, including one in the superolateral aspect of the left orbit. It is important to recognize the multicentric form of infantile myofibromatosis because, despite its aggressive clinical presentation, the disease is benign and usually does not require extensive surgery or chemotherapy.

Actins↗
PubMed2004

Facial nerve in parotidectomy: a topographical analysis.

OBJECTIVE: Establish normative data concerning parotidectomy and facial nerve dissection and determine the relationship between the length of the facial nerve dissected during parotidectomy and subsequent facial nerve paresis. STUDY DESIGN: Prospective mapping of facial nerve during parotidectomy and comparison with postoperative facial nerve function. METHODS: A prospective observational study of 78 patients who underwent 79 parotidectomy procedures. During each procedure, various topographical measurements were recorded. These measurements included the distance from the tragal pointer to the main trunk of the facial nerve, the distance to the pes anserinus, and length of each segmental branch dissected. In addition, a designation of the patient's tumor location was made by drawing a line from the ear canal to the nasal spine. Tumors above this line were designated anatomic zone A and those below the line were designated anatomic zone B. Finally, facial nerve function was quantified at a 1-week follow-up visit using the House-Brackmann Scale. RESULTS: The distance from the main trunk of the facial nerve to the tragal pointer was significantly (P < .000) less than the previously accepted standard of 1 cm. The cervical and marginal mandibular branches had more nerve dissected, whereas the eye and forehead branches were the least dissected. Results of an independent t test and logistic regression (P = .01, both) indicated that patients with temporary facial nerve paresis had a significantly greater amount of nerve dissected than patients without temporary facial nerve paresis. Patients with short-term facial nerve dysfunction had significantly (P < .01) more total nerve dissected (136.73 mm vs. 94.73 mm) than patients without short-term facial nerve dysfunction. Patients with nerve dissection lengths at the third quartile (130.0 mm) were 3.8 times more likely to experience temporary facial nerve paresis than patients with nerve dissection lengths at the first quartile (64.5 mm). CONCLUSIONS: The axiom that the main trunk of the facial nerve is located 1 cm from the tragal pointer may need to be modified to less than 1 cm. The cervical and marginal mandibular branches had more nerve dissected, whereas the eye and forehead branches were the least dissected. Facial nerve paresis after parotidectomy is associated with the length of the facial nerve dissected during the procedure. The greater the length of facial nerve dissected, the higher the chance of facial nerve paresis, albeit temporarily, in this particular series of patients.

Adolescent↗
PubMed2004

A rational approach to nasal reconstruction in leprosy.

Destruction of the nasal septum and nasal bones by Mycobacterium leprae and subsequent infection is still seen regularly in leprosy endemic areas. The social stigma associated with this deformity is significant. Many different procedures have been developed to reconstruct the nose. Patients operated on at Anandaban Hospital and the Green Pastures Hospital and Rehabilitation Center between 1986 and 2001 were reviewed. There were 48 patients with an average age of 47 years. Five deformities were mild, 22 were moderate, 13 were severe, and eight were not graded. Bone grafting with nasolabial skin flaps was performed in 14 cases, bone grafting alone was performed in 10 cases, flaps alone were performed in seven cases, and cartilage grafting was performed in 10 cases. In three patients, a prosthesis was inserted, and in three patients a gull-wing forehead flap was performed. Overall, excellent or good cosmetic results were obtained in 83 percent of cases. Grafting with conchal cartilage was associated with the best cosmetic results and had minimal complications. Bone grafting with or without nasolabial flaps was associated with a 50 percent complication rate of infection or graft resorption. In mild to moderate deformities, cartilage grafting is recommended; for more severe deformities, bone grafting with bony fixation and skin flaps is recommended. Perioperative antibiotics must be used, and these procedures should be performed by an experienced surgeon. In very severe cases with skin deficiency, reconstruction with a forehead flap gives good results.

Adult↗
PubMed2005

The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry.

BACKGROUND: Bell's palsy is an idiopathic neuropathy of cranial nerve VII, and the incidence ranges from 15 to 40 per 100,000. The majority of patients recover, but up to 16 percent of patients have significant sequelae. The phenomenon of the "late recovered" Bell's palsy has the following specific features and has not formerly been described: (1) tightening of the facial muscles, with a deepening nasolabial fold and reduced palpebral fissure; (2) blepharospasm; and (3) incomplete recovery of peripheral VIIth nerve branches, with ipsilateral forehead paralysis, reduced depressor anguli oris function, and poor excursion of the angle of the mouth on smiling. METHODS: Nonsurgical treatment involved four monthly botulinum toxin injections. Patients had injections to paralyze the ipsilateral orbicularis oculi, contralateral forehead rhytides, and depressor anguli oris and to treat blepharospasm and muscle tightness. The effectiveness of the botulinum toxin injections on facial symmetry and patient appreciation of this were assessed by measuring brow height and teeth exposure before and 3 weeks after injection. RESULTS: Twenty-three patients were followed up for a mean period of 37 months. The difference in brow height and teeth exposure after injection was less than preinjection measurements, but this did not reach statistical significance. Patient self-assessments showed improvements in their appreciation of the facial symmetry, ability to go out in public, and feelings of self-worth (visual analogue scale). Surgical treatment options include ipsilateral brow lift, division of the contralateral frontal branch, contralateral tarsorrhaphy to equalize the palpebral fissures, and bilateral upper blepharoplasty. CONCLUSIONS: The true benefit of botulinum toxin injections was more apparent during facial animation and not when the face was static. The patients greatly appreciated the improvement in facial symmetry. Various treatment options are available to improve the quality of life for patients with late recovered Bell's palsy.

Adult↗
PubMed2006

Monobloc advancement by distraction osteogenesis decreases morbidity and relapse.

BACKGROUND: Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction. METHODS: Group 1 (conventional monobloc; n = 12) underwent traditional monobloc advancement with bone grafting. Group 2 (modified monobloc; n = 11) did not receive ventriculoperitoneal shunts and underwent the above procedures with placement of a pericranial flap and fibrin glue over the midline defect. Group 3 (monobloc distraction; n = 24) underwent advancement of the monobloc segment by distraction osteogenesis using internal distraction devices. Complications included meningitis, cerebrospinal fluid leak, frontal bone flap loss, and wound infection. Preoperative, postoperative, and follow-up lateral cephalograms were used to assess horizontal changes of the forehead, midface, and maxilla. RESULTS: Group 3 (distraction monobloc) had the lowest complication rate (8 percent), followed by groups 2 (modified monobloc; 43 percent) and 1 (conventional monobloc; 61 percent) (p < 0.05). Group 3 achieved greater advancement (12.6 mm) than did group 2 (9.4 mm) or group 1 (9.1 mm) (p < 0.05). Relapse was least in group 3 (8 percent) compared with groups 2 (67 percent) and 1 (45 percent). CONCLUSIONS: Monobloc advancement by distraction osteogenesis had less morbidity and achieved greater advancement with less relapse compared with conventional methods of acute monobloc advancement with bone grafting. Monobloc distraction is superior to conventional methods of acute monobloc advancement and is an alternative to staged fronto-orbital advancement followed by Le Fort III advancement.

Adolescent↗
PubMed2006

A new approach to retroauricular flap transfer: parietal branch-based reverse flow superior auricular artery island flap.

The retroauricular region provides adequate tissue of excellent color and texture match for the reconstruction of small- and medium-sized facial defects. In this study, parietal branch of the superficial temporal artery (STA) was used as the pedicle for the retroauricular island flap. Anastomoses between the parietal branch of STA, occipital artery, and contralateral STA were observed to deliver adequate nutritional blood supply to the flap. Total upper eyelid defect in 1 case, malar defect in 1 case, and forehead defects of various sizes in 4 cases were included in our study. Sizes of the flaps varied from 4 x 4.5 cm to 6 x 8 cm (mean 4.7 x 6.6 cm). All cases had venous congestion for 2-4 days (mean 3.4 days). Only 1 case experienced a superficial dermal necrosis of 1 x 3 cm in size in the distal part of the flap. Esthetic and functional results were satisfactory during the 1- to 14-month (mean 7) follow-up period. This flap is thought to be advantageous for the repair of defects and traumas of the forehead and upper eyelid as the pedicle does not develop torsion and dissection is easy.

Adult↗
PubMed2006

An alternative fixation technique for the endoscopic brow lift.

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow, since only 3 hardly noticeable incisions of the scalp are needed for this subperiosteal dissection and final repositioning of the brow. It has become an acceptable technique, an alternative to the conventional technique or transcoronal browpexy. One of the controversial points is the fixation of the flap in the elevated position. METHOD: Endoscopic brow lift allows separation and repositioning of the periosteum of the orbital rims and zygomaxilla. In a 6-year period from September 1999, 300 patients underwent endoscopic brow lift using our fixation approach, which was accomplished with an absorbable suture subperiosteally. RESULTS: Satisfactory forehead rejuvenation was obtained in all patients, with correct eyebrow movement. CONCLUSIONS: Long-term results of 6 years confirm the strength and durability of this fixation approach. We consider this approach to be a simple, secure, and reliable forehead fixation method, an alternative to other fixation methods, that allows satisfactory and long-lasting cosmetic results.

Blepharoptosis↗
PubMed2003

Endoscopically assisted repair of frontal sinus fracture.

BACKGROUND: Classic approaches to frontal sinus fracture involve bicoronal or direct forehead incisions. However, these incisions cause paresthesia, scarring, and even alopecia. In the field of plastic and reconstructive surgery, endoscopically assisted surgery is now widely accepted, particularly for esthetic surgery. It also is applied for the management of midface and lower-face fractures, but rarely for treatment of the frontal area. The authors present their experience with the repair of frontal sinus fractures using the endoscopically assisted method. METHODS: The surgery was performed with the patients under general anesthesia. Two slit incisions were placed in the hair-bearing area, through which a 4-mm 30 degrees endoscope was inserted. The subperiosteal dissection was performed toward the fracture site using an endoscopic periosteal elevator. The depressed fracture segments of the anterior table of the frontal sinus were reduced and fixed with microplates to restore the contour of the forehead. Seven consecutive patients received endoscopic correction of frontal sinus depressed fractures. RESULTS: No patients required conversion conventional bicoronal incisions. Good anatomic reduction of the fracture sites, acceptable surgical scar, and esthetic recontour were obtained in all the patients. The postoperative course was uneventful, without any complications. CONCLUSION: The endoscopically assisted method allows feasible reduction and fixation of a frontal sinus fracture. It avoids the complications of traditional methods and yields improved convalescence and esthetic results. It also helps in the diagnosis of unsuspected cerebrospinal fluid leaks. Thus, for anterior table fractures with an intact nasofrontal duct, endoscopically assisted surgery provides an alternative option of treatment.

Adult↗
PubMed1987

The hairless rat: a relevant animal model to predict in vivo percutaneous absorption in humans?

Percutaneous absorption of 4 radiolabeled molecules was compared in the hairless rat (back) and in different anatomic sites in human (arm, abdomen, postauricular, forehead). The conditions under which these 4 compounds were administered (area treated, dose, vehicle, contact time, etc.) were similar in both species. The results showed that, in humans and rats, there exists the same rank order in total absorption: benzoic acid sodium salt less than caffeine less than benzoic acid less than acetylsalicylic acid. In both species there was a factor of 3 between the most and the least absorbed molecule. Although skin permeability varied significantly with the physicochemical nature of the compound administered, it also depended on the anatomic site involved. Independent of the molecule studied, the rank order of permeability of the sites tested in humans appeared as follows: arm less than or equal to abdomen less than postauricular less than forehead. There was a factor of 3 between the most and the least permeable sites. For each molecule and each anatomic site, the ratios of total percutaneous absorption human/hairless rat (back) were determined. For a given anatomic site and whatever the molecule tested, these ratios were constant. It thus appears that when conditions are carefully controlled, it may be possible, by measurements on animals, to predict the absorption of a compound in humans. Further experimentation with chemicals of varied physicochemical properties will be required for validation of the model.

Absorption↗
PubMed2003

Facial variations in sensory responses.

Subjective effects such as stinging, itching and burning commonly occur in the absence of any visible irritation and give rise to discomfort, which may be enough to deter an individual from using even the most effective of skin care products. The purpose of this study was to evaluate the sensitivity of different anatomical regions of the face to determine which region displayed the most intense stinging response to the application of lactic acid. The effect of occlusion on the level of response was also investigated. 45 volunteers were treated with 10% lactic acid on the nasolabial fold, forehead, chin and cheek, occluded and unoccluded for 8 min. Sensory reactions were recorded at 2.5, 5 and 8 min. The response levels on the occluded sites were always significantly lower than on the unoccluded sites, despite the dose per unit area being comparable. Females showed a trend towards being more sensitive to the subjective effects elicited by lactic acid than males, but these results were not conclusive. Interestingly, there was not a complete correlation between individuals who reacted on the nasolabial fold and the other sites, particularly the forehead. A positive stinging response on the nasolabial fold may not necessarily predict subjective responses to a product when used on other areas of the face.

Administration, Topical↗
PubMed2005

Skin function parameters in intensive-care patients.

BACKGROUND/PURPOSE: The study was performed to investigate the transepidermal water loss (TEWL) and pH-value in patients in intensive care. METHODS: Forty intensive-care patients (22 men, 18 women) were included in the study. TEWL and pH-values were measured at admission, and after 24, 96 and 168 h. The areas of measurement were the forehead, the volar forearm, paraumbilical and the ventral thigh. The measurements were made under standardized environmental conditions according to the recommendations of the EMCO Group. RESULTS: Elevated values were found on the forehead compared with the other skin areas examined. There was no significant change in mean TEWL-values in any patient in the course of the study. There was also no significant influence of TEWL at the time of admission on the prognosis. The course analysis of the mean pH-values, however, showed that patients who developed a systemic inflammatory response syndrome (SIRS) or sepsis during the further course had a higher pH-value over the entire study period. CONCLUSION: TEWL and the pH of the skin surface could be measured at bedside in the intensive-care unit and delivered reproducible results. These parameters appear, however, to be relevant only for subgroups of patients under intensive care.

Critical Care↗
PubMed2006

The difference between the constitutive and facultative skin color does not reflect skin phototype in Asian skin.

BACKGROUND/PURPOSE: The assessment of the sensitivity of human skin to ultraviolet (UV) radiation is important in the area of phototherapy, photodermatoses, photo-aging, photo-carcinogenesis, and photo-protection. Some reports have shown that quantitatively measured skin color is a good indicator for predicting UV sensitivity to human skin in Caucasians. In this study, our aim was to define the correlation between skin color and the skin phototype assessed by the Fitzpatrick method in Asian brown skin. METHODS: A total of 180 medical students with similar life styles were included in this study. Their skin phototype was classified according to the system introduced by Fitzpatrick. Then, using a Minolta Spectrophotometer CM-2002, their skin color was determined on the buttocks and forehead. The buttock color was taken as the constitutive skin color, and the forehead color as the facultative skin color. Using these measured values, we compared the skin color with the skin phototype to find their correlation. Also, we investigated whether the difference between the constitutive and facultative skin colors of each individual had a relationship with his or her skin phototype. RESULTS: The constitutive skin color became darker with increasing skin phototype, and this change was statistically significant. As for the facultative skin color, it also became darker with increasing skin phototype, but was less well correlated with the skin phototype than the constitutive skin color. However, the difference between the constitutive and facultative skin colors did not show consistent results in predicting the skin phototype. CONCLUSION: In this study, we found that the constitutive skin color can be a good indicator of the skin phototype. However, the difference between the constitutive and facultative skin colors of each individual does not give any meaningful information for the assessment of his or her skin phototype in Asian skin.

Adult↗