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A comparison of the effect of povidone-iodine and 60% n-propanol on the resident flora using a new test method.

The efficacy and safety of povidone-iodine (PVP-I) and 60% v/v% n-propanol on the forehead of patient's were examined using a newly developed method. Significantly higher reduction factors (RFs) of the total resident flora were obtained using PVP-I immediately after and 3-6 h after application (1.4, 1.4, 1.4) than with isopropanol (0.6, 0.6, 0.8) using the detergent scrub method. No significant difference was found using the cyanoacrylate method. Propionibacter spp. showed similar results. With Staphylococcus epidermidis, RFs of 1.8 were obtained with both bath agents using the detergent scrub method, but using the cyanoacrylate method significantly higher RFs were obtained with isopropanol immediately and 3 h after application (1.3, 1.3) than with PVP-I (0.4, 0.5). This phenomenon seems to be due to the limit of complete elimination of the resident bacterial counts in vivo.

1-Propanol↗

Experimental cranial pain elicited by capsaicin: a PET study.

Using a positron emission tomography (PET) study it was shown recently that in migraine without aura certain areas in the brain stem were activated during the headache state, but not in the headache free interval. It was suggested that this brain stem activation is inherent to the migraine attack itself and represents the so called 'migraine generator'. To test this hypothesis we performed an experimental pain study in seven healthy volunteers, using the same positioning in the PET scanner as in the migraine patients. A small amount of capsaicin was administered subcutaneously in the right forehead to evoke a burning painful sensation in the first division of the trigeminal nerve. Increases of regional cerebral blood flow (rCBF) were found bilaterally in the insula, in the anterior cingulate cortex, the cavernous sinus and the cerebellum. Using the same stereotactic space limits as in the above mentioned migraine study no brain stem activation was found in the acute pain state compared to the pain free state. The increase of activation in the region of the cavernous sinus however, suggests that this structure is more likely to be involved in trigeminal transmitted pain as such, rather than in a specific type of headache as was suggested for cluster headache.

Acute Disease↗

Garlic burns.

A patient with a second-degree burn of the forehead, induced by topical application of crushed garlic is reported. The literature on garlic burns is reviewed.

Asthma↗

Short-latency EMG potentials elicited by head taps in sternocleidomastoid muscles: a study on normal human subjects and patients with central or vestibular lesions.

The aim of the present study was to determine whether a tap on the forehead evokes a vestibulospinal reflex in sternocleidomastoid muscles in normal human subjects and patients with central or vestibular lesions. While first positive-negative short-latency EMG potentials with a mean positive potential peak of about 12 ms and a mean negative potential peak of about 17 ms were found in the bilateral sternocleidomastoid muscles in normal subjects, they disappeared or were attenuated in patients with central or peripheral vestibular lesions.

Adult↗

Dental and facial skeletal characteristics and growth of males and females with class II, division 1 malocclusion between the ages of 10 and 14 (revisited)-part I: characteristics of size, form, and position.

The purpose of this study was to describe and analyze the craniofacial and dentofacial skeletal characteristics associated with Angle's Class II, Division 1 malocclusion. The material examined included 613 lateral head radiographs comprising 2 series: (1) 278 films of children with "normal" occlusion and (2) 335 films of children with Class II, Division 1 malocclusion. Each series was subdivided into 6 samples (3 female and 3 male; skeletal ages 10, 12, 14, [+/-6 months]), representing children with chronological ages ranging from 8.5 to 15.5 years. The radiographs were converted to computer-readable X and Y coordinate data and 52 linear, angular, and coordinate axis measurements were taken. Findings were visually verified by superimposing the computer-drawn composite plots of the Class II, Division 1 series over those of the normal series. In all 6 intergroup comparisons, it was found that: (1) the mandible and its dentition is similar to the controls in size, form, and position except for the position of the lower incisors in males; (2) the forehead (Gl), anteriorcranial base (Nas), maxilla (A) and dentition (molars and incisors) are protrusive (mesial positioned), with an increased frontal bone thickness at the level of the sinus, and a larger A-P maxilla, the palate of which is inclined superiorly at its anterior half; (3) no vertical dysplasia was evident; (4) the cranial base angle is larger, as are the anterior and posterior sections that compose it, but it is not related to mandibular position; (5) angular indexes of maxillary and mandibular position that included point Nasion are highly misleading indicators of maxillary and mandibular size and position. Visualized diagnosis via a composite norm based on age and sex might offer a more reliable alternative or supplement to the numeric reference standards now in use. Enlarged sinuses may contribute to the cause of Class II, Division 1 malocclusion.

Adolescent↗

Blood-flow mapping of oral tissues by laser Doppler flowmetry.

The purpose of this study was to develop a rapid protocol for noninvasive quantification of blood flow at intraoral sites by laser Doppler flowmetry. For each flow measurement, the lowest flow observed over a 30-s period was recorded. Three flow readings at each site were averaged and recorded. Forehead and dorsal right-hand blood flows measured agreed with previous laser Doppler flow measurements. Flows measured with a hand-held probe were not different from flows measured with a stent-stabilized probe on the attached gingiva and an adhesive-stabilized probe on the dorsal hand. High flows were found in the tongue, buccal mucosa, and buccal vestibule. Medium flows were found in the attached gingivae. The lowest flows were found in the teeth. These results indicate that flow in intraoral tissues varies by site and can be noninvasively quantified with the laser Doppler flowmeter when a rigorous measurement protocol is used.

Adult↗

A clinical study of the craniofacial features in Apert syndrome.

A clinical study of the craniofacial features in Apert syndrome is based on our experience with 136 cases. Characteristics included hyperacrobrachycephaly, steep wide forehead, flat occiput, common craniofacial asymmetry, ocular hypertelorism and proptosis, downslanting palpebral fissures, divergent upgaze and esotropic downgaze, a tendency towards large ears, and marked depression of the nasal bridge. The nose is short and wide with a bulbous tip, and the anterior facial height is reduced. Common features during infancy included horizontal grooves above the supraorbital ridges that disappear with age, a break in the continuity of the eyebrows, and a trapezoidal-shaped mouth at rest. Radiographic aspects of Apert syndrome were also assessed. Tables are provided which compare the craniofacial features of Apert and Crouzon syndromes.

Acrocephalosyndactylia↗

Use of thigh pressure cuffs to modulate simulated microgravity-induced changes in the skin measured with high-resolution B-scan ultrasound.

OBJECTIVE: The aim of the present study was to evaluate the fluid shift in a simulated microgravity experiment and to test the use of thigh cuffs to help alleviate the problem. METHODS: The change in skin thickness was assessed by a 20 MHz B-scan ultrasound device. This was performed on eight volunteers who underwent two successive 7-day periods of -6 degrees anti-orthostatic bed-rest, with or without the daytime use of thigh cuffs. The thigh cuffs were used to counteract the development of facial oedema. RESULTS: In the control group (without thigh cuffs), the results showed a steady increase in skin thickness of the combined dermis and hypodermis of the forehead and a reduction of the thickness of this tissue on the tibia. For the countermeasure group, although thigh cuffs were only employed during the daytime - being removed at night - their use reduced the amplitude and kinetics of the fluid shift, resulting in greater beneficial effects at the end of the day than early in the morning. CONCLUSION: These results of objective measurements of skin made using a non-invasive high frequency ultrasonography method confirm reports by cosmonauts of a reduction in facial oedema and a more 'comfortable' adaptation to microgravity by the use of thigh cuffs during space flight. This system is potentially promising for investigating fluid shifts in the skin and may prove useful in the evaluation of some oedematous skin diseases, as well as their therapy.

Adult↗

Reconstruction of craniofacial bone defects with individual alloplastic implants based on CAD/CAM-manipulated CT-data.

Reconstruction of craniofacial bone defects by intraoperative modelling of autogenous or alloplastic materials may cause undesirable results concerning the implant shape or the long-term maintenance of this shape. Furthermore, the use of alloplastic materials to be modelled intraoperatively may result in an inflammatory tissue response. Therefore the question is raised whether CAD/CAM-techniques may be used for the pre-operative geometric modelling of the implant based on helical computed tomography data. A numerically based 3-dimensional model of the skull defect serves as the basis for a freeform-surfaces design of the implant shape, position and thickness, using modelling tools and programmes developed for industrial CAD/CAM. The precise and individual fit of the implant results from generating its margins by the borders of the defect, whereas the implant surface is generated by the geometry of the non-affected neighbouring bone contours. The implant data run a numerically controlled milling machine to fabricate the individual implant. The reconstruction of post-traumatic defects of the forehead, of post-surgical temporal defects after intracranial haemorrhage, and of a parieto-occipital defect due to ablative tumour surgery are presented as the first clinical experiences of this new method.

Adolescent↗

G syndrome: a review of the literature and a case report.

In 1969, Opitz et al. reported the first case of G Syndrome (Opitz-Frias Syndrome). They presented their clinical observations on 4 brothers from the 'G Family' who shared a constellation of findings with a generalised tendency to midline defects. Major manifestations of this multiple congenital anomaly syndrome include hypertelorism, prominent forehead, cleft lip and palate, narrow palpebral fissures with epicanthal folds, dysphagia, stridor, laryngotracheal oesophageal clefts, and hypospadias. The most significant manifestation of a midline field developmental defect in these infants is aspiration which poses the greatest threat to life. Urgent evaluation should include a water-soluble contrast oesophagram and aerodigestive endoscopy. In addition to repair of the laryngeal cleft, which occurs in approximately 30% of the cases, a tracheostomy, feeding gastrostomy, and Nissen fundoplication are often needed. We report a male infant born with G. syndrome. BBB Syndrome (Opitz Syndrome) is also discussed which bears a striking resemblance to the G Syndrome; in fact, they may be variants of the same allelic syndrome.

Abnormalities, Multiple↗

Representation of different trigeminal divisions within the primary and secondary human somatosensory cortex.

Clinical, neurophysiological, and neuroimaging studies have yielded controversial results about the representation of the face in the somatosensory cortex. To clarify this issue we mechanically stimulated the left forehead (ophthalmic trigeminal division, V1) and left lower lip (mandibular trigeminal division, V3) in 14 healthy volunteers during acquisition of whole-brain fMRI images. During V1 and V3 stimulation the fMRI signal in the primary (SI) and secondary (SII) somatosensory cortices in the contralateral hemisphere increased. Within both SI and SII, the foci activated by stimulation of the two trigeminal divisions largely overlapped. In contrast, the ipsilateral representation differed. Whereas V3 stimulation activated the contralateral somatosensory cortex alone, V1 stimulation activated SI and SII bilaterally. These results to some extent contrast with electrophysiological data in monkeys and disclose distinct cortical representations within facial territories in humans.

Adult↗

The endoscopic brow and midface lift.

Improvements in technology have increased the level of patient care in all aspects of medicine and surgery. This is no less true in the area of cosmetic surgery. The use of endoscopy has led to improved aesthetics with respect to postoperative scarring, decreased healing time for patients, and an increase in overall patient satisfaction. Because the endoscopic brow and midface lift accomplishes the three primary goals of facial cosmetic surgery (restoration, rejuvenation, and enhancement) while adhering to the concepts of working from inside out and repositioning rather than excising, it could be concluded that there is no longer any indication for either the coronal or trichophillic brow lifts. An argument could be made that a direct brow lift may be indicated in cases of extreme brow ptosis with deep frontal rhytids to allow concealment of the scar; however, even moderate-to-severe brow ptosis can be corrected endoscopically when deep forehead rhytids are not present.

Bone Screws↗

Radiographic and morphologic studies of multiple miliary osteomas of cadaver skin.

OBJECTIVES: The purpose of this study was to examine the frequency, chemical composition, and radiographic and morphologic features of multiple miliary osteomas of the facial skin. STUDY DESIGN: Facial skin was obtained from 33 cadavers. After contact radiographs were taken, osteomas were examined by photo and scanning electron microscopy. Radiographic microanalysis of inorganic elements of the osteomas was also performed. In addition, clinical dental radiographic examinations were performed on 158 living subjects. RESULTS: Radiographic examination revealed milia-like osteomas in the facial skin of all of the cadavers. Nodules of 0.5 to 2.0 mm in diameter were scattered symmetrically in the skin of the cheek, mandibular angle, and forehead. Each nodule consisted of a concentric, multilamellated, osteoid cortex and an adipose medulla. Microanalysis suggested the presence of hydroxyapatite similar in composition to that of normal cortical bone. The condition was detected in 28% (44/158) of the living subjects by clinical dental radiographic examination. CONCLUSION: Multiple miliary osteoma is a very common condition and may not be related to specific diseases.

Adipose Tissue↗

Endoscopic frontoplasty: 3-year experience.

UNLABELLED: Endoscopic forehead lift (EFL) represents a significant progress, even replacing the classic coronal and pretriquial techniques. AIM: To demonstrate a series of cases and to evaluate results and complications with EFL in the Department of Otorhinolaryngology of the Federal University of Uberlândia. MATERIALS AND METHODS: From January 2001 to January 2004, 67 patients were submitted to EFL, and 7 of these were submitted to the so called "triangles technique". Their ages ranged between 38 and 59 years; and 65 (97%) were females. RESULTS: Of these, 56 patients presented satisfactory result and 2 presented aesthetic deficits noticed by the surgeon and the patient. Of the 7 patients submitted to the "triangles technique", all showed satisfactory results. All the patients had improvements on their ptosis of the lateral and glabellar third of the brows and reduction in vertical and frontal wrinkles. Revision surgery was necessary in 2 patients that had ptosis recurrence. There was one unilateral paralysis of the front branch of the facial nerve. With the "triangles technique", 5 patients presented visible scars. CONCLUSION: EFL is a technique that produces satisfactory results in the great majority of patients, with low complication rates.

Adult↗

Pigmented squamous cell carcinoma.

Pigmented squamous cell carcinomas have been reported in the oral and ocular mucosae, but rarely in the skin. We present a case of pigmented squamous cell carcinoma of the forehead and review the current English literature. Pigmented squamous cell carcinoma can be confused with pigmented basal cell carcinomas and melanoma, especially those melanomas associated with pseudoepitheliomatous hyperplasia and should be included in the differential diagnosis of atypical pigmented lesions.

Carcinoma, Squamous Cell↗

Psychophysiological reactions in dental phobic patients during video stimulation.

Electromyography (EMG) reflecting forehead muscle tension, heart rate (HR) and skin conductance (SC) were continuously recorded in dental phobic subjects (n = 126) and controls (n = 25) during exposure of dental and neutral video scenes in order to explore the relationship between dental fear and psychophysiological responses. This relationship is far from well established, and the present investigation was performed to contribute to the understanding of the psychophysiology of dental fear. Dental phobics had a mean anxiety level of 17.3 as measured by Corah's Dental Anxiety Scale (DAS) and refused conventional dental treatment. Control subjects reported regular dental treatment and a DAS score below population average (DAS < 8). Psychophysiological data was reduced to level (mean) and reactivity (means of intraindividual variations). Results showed that physiologic reactions to fear-relevant conditions measured by HR and EMG reflected degree of dental fear, and that neutral conditions, when presented for the second and third time, induced lower psychophysiologic reactions in phobics than in controls. Recordings of SC indicated that dental phobics may differ from individuals suffering from other types of specific phobia by showing weakened autonomic responsiveness to threat.

Adult↗

Characterisation of gravity-induced facial skin oedema using biophysical measurement techniques.

BACKGROUND/AIMS: In humans, the microgravity environment can be expected to induce swelling of facial tissues and shrinking of the tissues in the lower limbs, together with a loss in body weight. To evaluate fluid shifts in skin, the head-down bed-rest model was used. The aim of the present study was to evaluate the appearance of facial oedema in subjects undergoing anti-orthostatic bed-rest at an angle of -10 degrees. METHODS: The forehead of each of four subjects was measured before and after 1, 10 and 24 h in this head-down tilt position. At these time points, interstitial fluid migration and facial oedema were assessed using a high resolution B-scan ultrasound and a device for measuring the skin's mechanical properties. RESULTS: The results obtained showed a progressive increase in dermal thickness and initial stress, and a reduction in stiffness and elasticity of the skin during the study period. CONCLUSIONS: This preliminary study has demonstrated the feasibility of the method in measuring fluid displacement and retention in the skin. Furthermore, it highlights the influence of fluids on the mechanical behaviour of the skin. These techniques could be used for studying the redistribution of liquid masses during periods spent in space.

Aerospace Medicine↗

Comparison of skin sites for estimating serum total bilirubin in in-patients and out-patients: chest is superior to brow.

OBJECTIVE: [corrected] To compare transcutaneous bilirubin readings from the chest and forehead of inpatient and outpatient infants to investigate whether one site is more accurate for estimating serum bilirubin concentration. METHODS: In all, 31 infants were followed with serum and transcutaneous bilirubins using BiliChek trade mark at two skin sites. RESULTS: For inpatients average chest bilirubin was 0.4 mg/dl (7 micromol/l) higher than serum while brow was 0.3 mg/dl (5 micromol/l) lower. For outpatients, skin readings from both sites underestimated serum values. Chest estimates were 0.6 mg/dl (10 micromol/l) lower; brow was 2.1 mg/dl (36 micromol/l) lower (p<0.0001). Correlation coefficients and mean differences between skin and serum values for Hispanic and non-Hispanic infants were similar. CONCLUSIONS: In our inpatients, chest and brow readings approximated serum values. After discharge, brow readings were lower than serum values by almost 20%, while chest readings were underestimated by 5%. We recommend using the chest for transcutaneous bilirubin estimates.

Bilirubin↗