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PubMed1989

Electrode placement and mode of recording (differential vs. single-ended) effects on the early auditory-evoked response.

The effects of electrode placement and mode of recording (single-ended vs. differential) on latencies and amplitudes of the early auditory-evoked response were studied. The following electrode arrays were evaluated (1) vertex-neck, (2) forehead-ear canal (Enhancer I), and (3) vertex-nape. Responses were obtained on 10 normally hearing subjects at sensation levels (SLs) ranging from 15 to 75 dB. Test-retest reliability was excellent for absolute and interwave latencies for all conditions. The reliability of absolute amplitude was poor, and the stability of the amplitude ratios between waves I and V was even worse. No consistent absolute or interwave latency differences were found among electrode montages. The amplitude data suggest that the forehead-ear canal montage is preferred for differential diagnosis because it enhances the probability of detecting wave I. The electrophysiologic threshold for wave I was 5-10 dB lower with the Enhancer I. However, the vertex-neck and vertex-nape combinations are best for estimating auditory sensitivity because they gave the largest wave V amplitudes and 10-dB lower electrophysiologic thresholds. Although the differential vertex-neck and single-ended vertex-nape recordings yielded comparable results, the single-ended montage employs only two electrodes and the test leads do not require rearrangement when the test ear changes.

Adult↗
PubMed1981

Threshold of hearing by bone conduction. A contribution to international standardization.

Threshold measurements with a Präcitronic KH 70 bone vibrator were carried out on 25 young, otologically normal subjects (50 ears) in the frequency range between 125 Hz and 8 000 Hz. The vibrator was applied to the human mastoid as well as to the forehead. The non-test ear was masked. Equivalent threshold force levels were determined on an artificial mastoid type B & K 4930. Between 125 Hz and 2 000 Hz, the equivalent threshold force levels for mastoid placement decrease steadily by about 13.5 dB/octave, they then increase again by about 10 dB and remain constant between 4 000 Hz and 8 000 Hz. The equivalent threshold force levels for forehead application were found to be higher by about 11 dB in the whole frequency range.

Adolescent↗
PubMed1987

Effects of amplifier type (single-ended vs. differential) and electrode placement on early auditory evoked potentials.

The effects of amplifier type (single-ended versus differential) and electrode location on early auditory evoked potentials were investigated in normally hearing subjects. Each subject was tested with six electrode combinations using 70 dB nHL clicks. One differential recording was made for each subject by placing the non-inverting (A+), inverting (A-), and common (C) electrodes on the vertex, ipsilateral neck, and contralateral neck, respectively. Five single-ended recordings were obtained from each subject. One electrode (positive) was situated on the vertex, whereas the second electrode (negative) was variously placed on (1) ipsilateral mastoid, (2) ipsilateral neck, (3) seventh cervical vertebra, (4) ipsilateral wrist, and (5) lower forehead. Because the vertex-lower forehead montage yielded identifiable responses in only one of 13 subjects, this condition was omitted from data analyses. No statistically significant latency or amplitude differences were observed among the remaining five electrode combinations for Waves I, III, or V. These data suggest that any of the five electrode combinations may be used for recording early auditory evoked potentials. Moreover, it is important to note that the single-ended recordings can yield auditory evoked potentials comparable to conventional differential recordings.

Adult↗
PubMed1979

Implantology for correction of cranio-facial defects with an elastomer composite and bone.

The correction of cranio-facial disfigurement in the upper part of the face is the most difficult to achieve. Various materials have been utilized and are still in use. Each has advantages and disadvantages. Autogenous bone has been used with good results, except for the unacceptable irregularities of the forehead and upper orbital region. The combination graft offers the advantages of both: the bone graft will be in contact with the dura, the periorbita and the contaminated sinuses. The polyrane implant produces a smooth and contoured forehead and immediately protects the vital structures during osteoneogenesis. Twenty-six selected patients had this technique used to correct their deformity without any incidence of major complication.

Adult↗
PubMed2006

Long-term aesthetic results of frontoorbital correction for frontal plagiocephaly.

OBJECT: Long-term aesthetic results of craniofacial surgery for frontal plagiocephaly were evaluated by two observers who used a scoring system based on deformities typical for this type of craniosynostosis. METHODS: In this retrospective study, pre- and postoperative photographs of 59 patients were scored for items typical of frontal plagiocephaly: shape of the forehead, orbital dystopia, and temporal depression. Each item was quantified as normal or absent (0 points), a mild deformity (1 point) or a severe deformity (2 points). Preoperatively, the most obvious deformity was the shape of the forehead, whereas postoperatively temporal retrusion was the main deformity. There was a good overall correction of the presenting deformities, with a decline in the mean score from 3.7 to 0.86. There was a statistically significant weak correlation between pre- and postoperative scores for orbital dystopia alone. This finding indicates that the severity of the initial disease is not a major contributor to the final result. Furthermore, the surgical outcome seemed to be stable over time and was not influenced by the timing of surgery if it took place when the children were between 6 and 15 months of age. CONCLUSIONS: Early craniofacial correction for frontal plagiocephaly results in a stable, acceptable aesthetic outcome on which the initial deformity has little effect. The most common associated craniofacial characteristics are corrected well to very well when surgery is performed within the first 6 to 15 months of life. The main focus of the deformity in both the short and long-term remains the temporal depression, and thus it requires extra attention during surgery.

Child↗
PubMed2006

The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. Case report and review of the literature.

The Pott puffy tumor is a subperiosteal abscess of the frontal bone that appears as a localized swelling of the overlying region of the forehead associated with frontal osteomyelitis. The authors report the case of an 11-year-old boy who presented with a 6-week history of frontal headaches and a recent sudden-onset, progressively enlarging swelling of his midline forehead associated with immediate relief of headaches. A computed tomography (CT) study revealed 1) a subperiosteal abscess with intracranial extension through the perforated posterior table of the frontal sinus and 2) a large epidural abscess overlying a compressed and narrowed superior sagittal sinus. Emergency surgical relief of the epidural abscess, curettage of the osteomyelitic bone, and excision of the periosteal granulomatous puffy lump were performed. A 6-week course of intravenous antibiotic medication was completed, and the patient had an excellent recovery. The Pott puffy tumor remains a serious complication of frontal sinusitis. In the past 5 years, the frequency of published pediatric cases has increased. Undiagnosed or partially treated frontal sinusitis may lead to this serious complication, and the apparent increase in incidence rate may suggest that this complication of frontal sinusitis could be underestimated in clinical practice. The authors conclude that early diagnosis and complete treatment of frontal sinusitis is crucial.

Anti-Bacterial Agents↗
PubMed2004

Mechanical properties and anthropometry of the human infant head.

The adult head has been studied extensively and computationally modeled for impact, however there have been few studies that attempt to quantify the mechanical properties of the pediatric skull. Likewise, little documentation of pediatric anthropometry exists. We hypothesize that the properties of the human pediatric skull differ from the human adult skull and exhibit viscoelastic structural properties. Quasi-static and dynamic compression tests were performed using the whole head of three human neonate specimens (ages 1 to 11 days old). Whole head compression tests were performed in a MTS servo-hydraulic actuator. Testing was conducted using nondestructive quasi-static, and constant velocity protocols in the anterior-posterior and right-left directions. In addition, the pediatric head specimens were dropped from 15cm and 30cm and impact force-time histories were measured for five different locations: vertex, occiput, forehead, right and left parietal region. The compression stiffness values increased with an increase in velocity but were not significantly different between the anterior-posterior and right-left directions. Peak head acceleration during the head impact tests did not significantly vary between the five different impact locations. A three parameter model that included damping represented the pediatric head impact data more accurately than a simple mass-spring system. The compressive and impact stiffness of the pediatric heads were significantly more compliant than published adult values. Also, infant head dimensions, center of gravity and moment of inertia (Iyy) were determined. The CRABI 6-month dummy impact response was similar to the infant cadaver for impacts to the vertex, occiput, and forehead but dramatically stiffer in lateral impacts. These pediatric head anthropomorphic, compression, and impact data will provide a basis to validate whole head models and compare with ATD performance in similar exposures.

Journal Article↗
PubMed1990

Regional variations in analgesic efficacy of EMLA cream. Quantitatively evaluated by argon laser stimulation.

The effect of EMLA cream (a eutectic mixture of local analgesics) applied for 30, 60, 90 and 120 min on the forehead, cheek, back, cubital fossa, and dorsum of the hand was studied. Analgesic onset, efficacy and duration were evaluated by sensory and pain thresholds to laser stimulation measured before, and 5, 60, 120, and 180 min after the cream was removed from the skin. Cutaneous blood flow was measured and found to be 4-5 times as high on the face as on the other locations. On the forehead the analgesic efficacy decreased with increased application time. For all other locations, efficacy increased with increasing application time. On the back, onset was rapid and sufficient analgesia could be obtained, but analgesias began to wane immediately after removal of the cream. In the cubital fossa and on the hand, onset was tardy, and efficacy continued to increase for 60 min after cream removal, followed by a slow decline. Blood flow, epidermal and dermal thickness are important factors affecting onset, efficacy and duration of EMLA analgesia.

Adult↗
PubMed1999

Repair of a large "coup de sabre" with soft-tissue expansion and artificial bone graft.

The authors present a case of a "coup de sabre"--a linear form of scleroderma--in an 18-year-old woman treated by means of an expanded forehead and scalp flap, a hydroxyapatite implant, and an autologous iliac bone graft. Hydroxyapatite was implanted to augment a depressive bony deformity. The nasal deformity was repaired with an expanded forehead flap and an autologous iliac bone graft. This is the first reported case in which a deformity of scleroderma was treated with a combination of an expanded skin flap and a hydroxyapatite implant.

Adult↗
PubMed1999

Regional differences of cerebral hemoglobin concentration in preterm infants measured by near infrared spectrophotometry.

Near infrared spectrophotometry has been used to measure total cerebral hemoglobin concentration (micromol/l) as a major indicator of the oxygen transport capacity in neonates. The aim of this study was to find out how the position of the probe influences the quality of the measurement and the actual cerebral hemoglobin concentration-values. We studied 10 healthy preterm infants with a mean gestational age of 31.5 weeks and a birthweight of 1513 g. The data were collected by a two channel near infrared spectrophotometry system using a geometrical principle to measure absolute cerebral hemoglobin concentration. The incoming signal of the light emitting diode as a value allows a prediction of the quality of the measurement: a high value refers to a high signal/noise ratio. Starting from the centre of the forehead (0%) for each measurement the probe was moved by 2.5% of the headcircumference to the left respectively right side of the head up to 20%. The cerebral hemoglobin concentration-values increased from 87 respectively 93 micromol/l up to 164 respectively 173 micromol/l on the right respectively left side, while the light emitting diode signal-values decreased from 21 respectively 21 down to 10 respectively 11, the more laterally the probe was moved. There were two plateaus of these variables in the frontal (0-5%) respectively lateral (15-20%) region. A further investigation on a solid phantom for premature heads showed that hair has either no or a contrary effect on the cerebral hemoglobin concentration-values than expected. The extracerebral tissue (soft tissue, skull, cerebrospinal fluid layer) is discussed to have a significant influence on the light attenuation in adult heads. Still there is no evidence for a significant effect on prematures, because this overlying tissue is much thinner and more translucent than the one in adults. Absolute cerebral hemoglobin concentration measured by near infrared spectrophotometry is substantially influenced by the position of the probe at the infant's head. Considering our results we recommend placing the probe at 2.5% of the headcircumference away from the centre of the forehead for the measurement of cerebral hemoglobin concentration in premature infants.

Brain↗
PubMed1976

Interaction of spatial and temporal summation in the warmth sense.

Two experiments explored the interaction of spatial and temporal summation in the perception of radiant heat. The first experiment showed that the absolute threshold for detecting two brief (0.1 sec) pulses of heat, one presented to each side of the forehead, is lower than the threshold for detecting a single pulse, even when the two pulses are separated in time by as muchas 0l75 sec. The second experiment showed that a single, 4-sec pulse of heat presented to one side of the forehead feels no warmer than two successive, 2-sec pulses, one to each side. Spatial and temporal summation appear to take place at least partly in the central nervous system.

Differential Threshold↗
PubMed1999

[The changes of peripheral skin temperature in elderly patients under spinal anesthesia].

The purpose of this study was to evaluate the changes of body temperature in elderly compared with younger patients during spinal anesthesia. Twenty six patients, ASA I-II were divided into two groups, (13; under 30 years of age, 13; above 60 years) who received spinal anesthesia with 0.3% dibucaine at the interspace between L 3 and L 4. All patients were anesthetized below T 8 level. Central temperature was measured at the forehead, and peripheral skin temperature was measured at the finger tip and the toe tip for 25 minutes at every 5 minutes. In both groups, forehead temperature and finger tip skin temperature were unchanged, but toe tip skin temperature increased 5 minutes after spinal anesthesia. The degree of toe tip skin temperature change was significantly lower (P < 0.01) in elderly patients and the speed was also slower. We recognized that the change in peripheral skin temperature during spinal anesthesia is not different between elderly and younger patients, but the speed of temperature change is slower in elderly patients.

Adult↗
PubMed1999

Vertical preperiosteal rejuvenation of the frame of the eyelids and midface.

Aging usually shows first on the eyelids, the periocular frame, and the midface, which is the anterior mobile area of facial expression. The author, therefore, recommends performing a blepharoplasty and rhytidectomy of the upper two-thirds of the face in patients from their mid-30s on. Instead of a subcutaneous approach, correction can be performed at the deep level, with either a lateral or a vertical approach to the midface. The deep lateral approach to the midface was initiated by Skoog in 1974, the vertical subperiosteal approach by Tessier in 1979, and the vertical preperiosteal midface approach by Hinderer in 1985, followed by de la Plaza in 1988. The author's technique is analyzed according to the level of undermining, the transection of the retaining ligaments, the vector of tissue elevation, the stabilization of the superficial musculoaponeurotic system, and the safety of the procedure, mainly regarding the facial nerve. The related anatomy is described. The technique is reliable. No damage to the facial nerve occurred in a consecutive series of 535 patients who were operated on from 1983 through 1998; this was because the author respected the pathway of the nerve, which was determined using cadaver dissections when the technique was first developed. Long-term follow-up, some lasting 15 years, has shown that the results are long-lasting; this is because of the stabilization of the vertically elevated soft tissues, which is done by suturing the temporoparietalis fascia to the temporalis fascia and by using the author's orbicularis suspension technique. A short-scar variation instead of the coronal approach can also be used; the latter is indicated for patients with high foreheads or large forehead ptosis. The author prefers to use the preperiosteal approach, which elevates the soft tissues themselves, after transecting the retaining ligaments, rather than the vertical approach.

Adult↗
PubMed2000

Norman-Roberts syndrome: prenatal diagnosis and autopsy findings.

We report on the autopsy findings of a male fetus in the 27th week of gestation with Norman-Roberts syndrome. The unaffected parents are first cousins and have a five-year-old child with a low, sloping forehead, broad and prominent nasal bridge, widely set eyes, severe psychomotor retardation, and an agyric cortex. Prenatal diagnosis showed a small head at the 25th week of gestation. At this time, a slowing-down of the growth of the sonographic measurements of the biparietal diameter and head circumference was found. Both the biparietal diameter (57 mm, <5th percentile) and the head circumference (207 mm, <5th percentile) showed a delay of at least two weeks in comparison with other non-cephalic somatometric parameters, that were normal for the gestational age (femur length: 46 mm=median value). After termination of pregnancy, post-mortem examination showed a normotrophic fetus with microcrania and marked microcephaly (brain weight: 50 g), low, sloping forehead, broad and prominent nasal bridge, and widely set eyes. The cerebral hemispheres displayed an almost completely smooth surface with poorly defined sylvian fissures and failure of operculization of the insula. Microscopic examination showed a predominantly four-layered cortex (lissencephaly type I). Karyotype was normal and in situ hybridization did not show any deletion in the Miller-Dieker/isolated lissencephaly critical region on 17p13.3. The syndromes with lissencephaly are reviewed.

Adult↗
PubMed2000

Distribution of craniofacial variables in south Dalmatian and middle Croatian populations.

The objective of the present work was to determine some relevant craniofacial parameters, particularly in relation to sex, for the study of the distribution of basic head and face types, and to investigate craniofacial and morphological differences between two population samples. The study sample comprised 100 subjects of both sex aged 18 to 30 from South Dalmatia and 200 subjects from Middle Croatia. Eight basic craniofacial variables were measured to obtain head, forehead and face indexes. The data indicate that average values of all variables can be used as standard craniofacial parameters for the examined population groups. All the craniofacial variables are considerably higher in men than in women (p < 0.05). In the South Dalmatian population mesocephalia (48.0%) and leptoprosopia (82.0%) prevail, while in the Middle Croatian population the brachycephalia (62.0%), and euriprosopia (73.5%) are present to a greater degree. The most significant craniofacial and morphological differences between the examined study samples are head width (Eu-Eu), face width (Zy-Zy), and forehead height (Tr-N). They were found to be statistically significant in the examined Middle Croatian population (p < 0.05). The presented measurements are highly relevant to orthodontic diagnostics and therapy.

Adolescent↗
PubMed2000

[Metotopic craniosynostoses].

BACKGROUND: Premature closure of the metopic suture leads to inhibited growth of the frontal bones, producing a keel-shaped forehead (trigonocephaly). Simple metopic synostosis is usually sporadic. Trigonocephalic patients account for 8-16% of the referrals to craniofacial centers, with a marked male predominance. Intracranial pressure (ICP) may be increased, whereas shunt-dependent hydrocephalus is infrequent. Infrequently, patients have intra- or extracerebral anomalies; one third have varying degrees of neuropsychological problems. The treatment is primarily surgical. MATERIAL AND METHODS: We present two patients who during infancy developed increasingly keel-shaped foreheads, retruded orbital rims, increased biparietal diameter and close-set eyes (hypothelorism). Both had raised ICP, but normal psychomotoric development. They were operated using radical fronto-orbital surgical remodelling. RESULTS: Recovery was uneventful. Three months post-operatively, they had pleasing cosmetic results with no symptoms of increased ICP. INTERPRETATION: Where metopic craniosynostosis is suspected, the infant should be examined clinically with palpation of fontanelles and sutures, evaluated with respect to the shape and development of the facial skeleton, as well as by X-ray of the skull sutures. Radical fronto-orbital surgical remodelling gives a stable correction of the craniofacial deformity and generally a satisfactory cosmetic result.

Cephalometry↗
PubMed2000

[Radiation exposure to patient and radiologist during transcatheter arterial embolization for hepatocellular carcinoma].

PURPOSE: To evaluate radiation exposure to patients and radiologists during transcatheter arterial embolization(TAE) for hepatocellular carcinoma. MATERIALS AND METHODS: In 39 TAE procedures performed at eight institutes, skin doses were evaluated with thermoluminescence dosimeters at the patient's back(entrance surface) and lower abdomen, and at the radiologist's forehead and abdomen. Real-time dosimeters were also used to evaluate patient skin dose. RESULTS: The patients' mean entrance surface dose was 973 +/- 681 mGy(range, 185 to 3543 mGy) with the mean fluoroscopic time of 21 minutes and 6 digital subtraction angiography(DSA) acquisitions. The dose at the patients' lower abdomen was 0.98 +/- 0.77 mGy. Doses for the radiologists were 0.04 +/- 0.04 mGy at the forehead and 0.15 +/- 0.19 mGy and 0.005 +/- 0.01 mGy at the abdomen over and under the apron, respectively. Fifty-six percent of the patients' skin dose was from DSA and 44% from fluoroscopy. CONCLUSIONS: Patient skin dose may occasionally exceed the dose for transient erythema. Because a patient may have repeated TAEs, skin doses or X-ray conditions should be recorded. The exposed doses of radiologists were considered to be acceptable with proper techniques. Further efforts to reduce radiation should be directed toward both DSA and fluoroscopy.

Aged↗
PubMed2001

[Metastasis to the parotid gland].

BACKGROUND: The skin areas that primarily drain into the parotid lymph nodes include large parts of the face, cheek, anterior surface of the auricle, temporal region, scalp and forehead. Malignant tumours, mainly squamous cell carcinomas and malignant melanomas, may therefore metastasis to the parotid gland. It may, however, sometimes be difficult to decide whether the parotid tumour is a primary or secondary tumour. MATERIAL AND METHODS: Twenty-six patients treated for metastatic malignant disease to the parotid gland were evaluated retrospectively. The mean age of the 22 males and four female patients was 70 years. RESULTS: In nine patients (35%), the primary tumour was ignored and wrongly interpreted as a tumour originating in the parotid gland. The primary tumour was localised in the temple in six patients, in the cheek in six, in the anterior surface of the outer ear in five, in the eyelids in four, in the forehead in one, in the scalp in one, and in the nasal vestibulum or nasal cavity in three patients. 19 patients (73%) had squamous cell carcinomas and seven (27%) malignant melanomas. The treatment was surgery supplied by radiotherapy in 19 patients. Four (21%) of the patients with squamous cell carcinoma and four (57%) of those with malignant melanoma died from the disease. INTERPRETATION: When a tumour arises in the parotid gland, the physician should critically evaluate whether this represents a secondary tumour. Careful examination of the scalp and face for suspect skin lesions and scars from extirpation of previous skin cancer can help detect the primary tumour.

Adult↗