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PubMed2003

In vivo absorption and scattering spectroscopy of biological tissues.

Different approaches for absorption and scattering spectroscopy of living tissues are discussed. In particular, a unique system for time-resolved reflectance and transmittance spectroscopy is presented, capable of acquiring in vivo absorption and scattering spectra of diffusive media between 600 and 1000 nm. A review of typical spectra obtained from a variety of tissue structures is shown, including female breast, forearm, abdomen, and forehead. A second-level analysis of the measured spectra permits an estimation of the concentrations of the key tissue absorbers, as well as of the Mie-equivalent scattering radii. Further, absorption and scattering spectra can be used to estimate the penetration depth of light in tissues as a function of wavelength, which is a crucial parameter in view of the possible application of optical in vivo molecular imaging in clinical diagnosis. Finally, an example of the applicability of the methodology to other biological media such as fruits and vegetables is shown.

Abdomen↗
PubMed1999

Near-infrared monitoring of tissue oxygenation during application of lower body pressure at rest and during dynamical exercise in humans.

During the application of a wide range of graded lower body pressures (LBP) (-50 to 50 mmHg), we examined how (1) the tissue oxygenation in the lower and upper parts of the body changes at rest, and (2) how tissue oxygenation changes in the lower extremities during dynamical leg exercise. We used near-infrared spectroscopy (NIRS) to measure the changes induced by LBP in total Hb content and Hb oxygenation in seven subjects. At rest, total Hb increased and Hb oxygenation decreased in the thigh muscles during -25 and -50 mmHg LBP, while both decreased during +25 and +50 mmHg LBP. However, in the forearm muscles during graded LBP, the pattern of change in total Hb was the reverse of that in the thigh. Measurements from the forehead showed changes only during +50 mmHg LBP. These results demonstrated that the pattern of change in total Hb and Hb oxygenation differed between upper and lower parts with graded LBP at rest. During dynamical leg exercise, total Hb and Hb oxygenation in the thigh muscles decreased during stepwise increases in LBP above -25 mmHg, Hb oxygenation decreasing markedly during +50 mmHg LBP. These results suggest that during dynamical exercise (i) LBP at +25 mmHg or more causes a graded decline in blood volume and/or flow in the thigh muscles, and (ii) especially at +50 mmHg LBP, the O2 content may decrease markedly in active muscles. Our results suggest that NIRS can be used to monitor in a non-invasive and continuous fashion the changes in oxygenation occurring in human skeletal muscles and head during the graded changes in blood flow and/or volume caused by changes in external pressure and secondary reflexes both at rest and during dynamical exercise.

Adolescent↗
PubMed1999

Epidermodysplasia verruciformis treated using topical 5-aminolaevulinic acid photodynamic therapy.

We describe a 65-year-old woman who had had wart-like lesions on the hands, lower arms and forehead for about 45 years. She had already had several basal cell carcinomas excised. Histological study, electron microscopy and in situ hybridization [human papilloma virus (HPV)-types 5/8/12/14/19-23/25/36] of skin biopsies confirmed a diagnosis of epidermodysplasia verruciformis (EV). Photodynamic therapy (PDT) was performed using a 20% 5-aminolaevulinic acid ointment applied for 6 h to the lesions and irradiating using an incoherent light source (lambda = 580-740 nm, 160 mW/cm2, 160 J/cm2). Following PDT, blistering and crusting of the lesions occurred, but these healed completely within 2-3 weeks without scarring, and the cosmetic result was excellent. Six months after PDT a skin biopsy was taken. In situ hybridization was positive for HPV type 8 in skin which was clinically and histologically normal. Twelve months after PDT a few lesions had recurred on the hands. Although permanent cure of EV cannot be achieved by any therapy at present and single lesions continue to appear in this patient, topical PDT might result in better control of HPV-induced lesions.

Administration, Topical↗
PubMed2002

Impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption.

BACKGROUND: It is not known whether distinct anatomical locations will respond with different recovery rates following acute barrier challenges. OBJECTIVES: To investigate whether barrier parameters differ at five body sites during recovery from acute disruption. METHODS: Acute barrier disruption was achieved by tape stripping and by acetone extraction of stratum corneum lipids. Transepidermal water loss (to assess barrier function), capacitance (for stratum corneum hydration) and skin surface pH were measured at each of five different body sites in 14 human volunteers. Individual measurements were obtained every 24 h for 96 h. RESULTS: Lipid-rich skin areas (e.g. the forehead) were the most vulnerable to barrier disruption by either method. While acetone treatment affected barrier function and decreased stratum corneum hydration, tape stripping similarly altered barrier function but increased capacitance values. Although the effect of barrier disruption on surface pH appeared to vary with location, no significant pattern of variation emerged. Independent of the method used for barrier disruption, the pH normalized within 96 h. CONCLUSIONS: Skin at different body sites shows distinct patterns of barrier recovery that are likely to be related to structural and physiological differences. Therefore, 'anatomically specific' regimens appear possible and relevant for the treatment of cutaneous disorders. In addition, adequate statistical analyses are essential to detect real differences in barrier recovery parameters.

Acetone↗
PubMed2002

Pattern of soft tissue injuries to the oro-facial region in Nigerian children attending a teaching hospital.

OBJECTIVE: This study was designed to determine the aetiological factors and pattern of oro-facial soft tissue injuries among children in a suburban Nigerian population. The problems encountered in the management of the patients are also highlighted. SETTING: Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State Nigeria. SAMPLE AND METHODS: This prospective study was carried out in children aged < or = 15 years who presented with oro-facial soft tissue injuries between July 1996 and December 1997. Data was collected from a clinical examination of the child and a questionnaire completed by the parent or carer. RESULTS: During the study period, 174 children were managed for oro-facial soft tissue injuries, an incidence of 1.1%, out of a total of 15 582 child admissions. A male preponderance was found (1 : 0.74). The mean age +/- SD was 7.3 +/- 4.2 years and the range was 9 months-15 years. Falls were the most common aetiology followed by road traffic accident. The forehead was the most frequently injured site. A mortality of 3.4% was found. Although animal bites and burns accounted for only 13.8% of all injuries, all the deaths were a result of these aetiologies. Road traffic accidents and burn victims had the longest hospital stay. CONCLUSION: Although falls and road traffic accidents are frequent causes of oro-facial soft tissue injuries, less common causes, like burns and dog bites are more likely to result in death.

Accidental Falls↗
PubMed2000

Wireless optoelectronic recordings of mandibular and associated head-neck movements in man: a methodological study.

Human mandibular movements in space are the result of combined motions of the mandible and the head-neck. They can be simultaneously monitored by an optoelectronic recording technique via markers at different locations on the mandible and on the head. Markers can be attached to the teeth or to the facial skin. Mandibular movements relative to the head can be calculated by one- or three-dimensional (1D and 3D, respectively) mathematical compensation for head movements. The present study analysed mandibular and associated head movements during maximal jaw opening-closing tasks in 10 healthy subjects using a wireless 3D optoelectronic movement recording system. The study aimed to: (i) estimate the soft tissue related displacement of skin-attached markers at different locations on the face; (ii) compare 1D with 3D mathematical compensation for associated head movements; (iii) evaluate the influence of marker location on the recorded head and mandibular movement amplitudes; and (iv) compare skin-attached markers with teeth-attached markers with regard to temporal estimates of recorded mandibular and head movements. Markers were attached to the upper and lower incisors and to the skin of the forehead, nose-bridge, nose-tip and chin. Soft tissue related displacement of skin-attached markers varied between locations. The displacement for the chin marker was larger than that of other markers. The least displacement was found for the nose-bridge marker. However, relative to mandibular and head movements, respectively, the displacement of the chin marker was of the same order as that of the nose-bridge marker. The temporal estimates were not significantly affected by displacement of the skin-attached markers. Markers at different locations on the head and the mandible registered different amplitudes. The mandibular movement patterns calculated by 1D and 3D compensation were not comparable. It is concluded that markers attached to the chin and the nose-bridge can be reliably used in temporal analyses of mandibular and head movements during maximal jaw opening-closing. With certain limitations, they are acceptable for spatial analyses. Selection of method of marker attachment, marker location, and method of compensation for associated head movements should be based on the aim of the study.

Adult↗
PubMed2002

Prayer marks.

BACKGROUND: Prayer marks (PMs) are asymptomatic, chronic skin changes that consist mainly of thickening, lichenification, and hyperpigmentation, and develop over a long period of time as a consequence of repeated, extended pressure on bony prominences during prayer. METHODS: Three hundred and forty-nine Muslims and 24 non-Muslims were examined for the appearance of PMs at different body sites. RESULTS: The prospective study of 349 Muslims (both males and females) with regular praying habits showed the occurrence of PMs on specific locations, such as the forehead, knees, ankles, and dorsa of the feet, leading to dermatologic changes consisting of lichenification and hyperpigmentation. The incidence of PMs was significantly higher in males than in females. Older subjects (over 50 years of age) demonstrated a significantly higher frequency of lichenification and hyperpigmentation, suggesting that repeated pressure and friction for prolonged periods are the causative factors for the development of PMs. Histologic examination of skin biopsies from the affected sites showed compact orthokeratosis, hypergranulosis, dermal papillary fibrosis, and dermal vascularization. PMs were not associated with any risk of secondary complications, such as erythema, bullous formation, and infections. CONCLUSIONS: PMs are commonly occurring dermatologic changes in Muslims who pray for prolonged periods.

Adult↗
PubMed2000

Concepts of sliding and lifting tissue movement in flap reconstruction.

BACKGROUND: The optimal design of a skin flap requires an understanding of the concepts of tissue movement. OBJECTIVE: The purpose of this manuscript was to demonstrate concepts of sliding and lifting tissue movement for flap reconstruction. METHODS: Six similar defects located in the forehead-temple-eyebrow region were repaired using a different skin flap. RESULTS: The specific flap design for a given defect is based on the answer to three predictable events that result from tissue transfer: Where is the tension? Where are the final incision lines? Where is the redundant tissue? CONCLUSION: A mental exercise assessing all available reconstruction options should be performed for each individual patient and defect. Both patient and defect considerations need to be assessed. A thorough understanding of both anatomy and tissue movement is necessary for optimal skin flap reconstruction.

Adult↗
PubMed2005

[Impacted canine tooth and the eyebrow: the orbit-eyelid impact of occlusal dysfunction].

The orbital region and the dental occlusion are biomechanicaly interdependant. The maxillary basal bone is located in the orbital region due to the presence of the maxillary sinus. Any trouble of the dental occlusion such as a retained canine can involve a lack of projection of the supra and the infra-orbital rim. This lack of projection of the infra-orbital rim is responsible of lower eyelid fat pad; the lack of projection of the supra-orbital rim is responsible of an eyebrow-forehead ptosis. Clinical variations can be observed according to the side of the preeminent eye.

Adipose Tissue↗
PubMed1996

Endoscopic techniques in facial rejuvenation surgery.

The endoscopic approach to rejuvenation surgery of the forehead is standing the test of time. We feel that aesthetic results obtained from this procedure are equal to or better than results associated with the conventions coronal lift, while remarkably reducing recovery time and incision-related morbidity (Figs. 9,10).

Endoscopy↗
PubMed2000

Prevention and correction of the "face-lifted" appearance.

In spite of the increasing demand and popularity of facial rejuvenation procedures, there has been little real change of traditional techniques over the past few decades. Face lifts continue to be lateral vector techniques, whether skin lifts, superficial musculoaponeurotic system (SMAS) lifts, or deep plane malar fat maneuvers are done. Lower eyelid procedures continue to include removal of orbital fat in most cases. Laser blepharoplasties combine transconjunctival fat removal with laser skin abrasion. Forehead lifts continue to be optional in most cases, in spite of clear indications. The unfortunate results of these traditional procedures that may occur are becoming easy to recognize. The unopposed tension of lateral vector face lifts allows the cheek tissues to descend eventually over the tightened jawline, creating a "lateral sweep" or pulled appearance of the face. A crescent-shaped mound over the malar area is the inferior orbicularis oculi muscle, not repositioned with conventional procedures. Following conventional blepharoplasty, the lower eyelid contour becomes deeper, and often an hollow appearance develops. A composite face lift combined with an arcus marginalis release can correct these typical problems. The primary vector of the face is superiomedial, which will reverse the unopposed tension of lateral vector techniques and reposition the cheek tissues to their original position. The arcus marginalis release combined with repositioning of the complete orbicularis muscle in a zygorbicular midface flap can be used to correct the most severe hollow lower eyelid. Unwanted and unattractive results are not the fault of the surgeon or the patient but are caused by the surgical technique. As a primary rejuvenative procedure, a composite rhytidectomy will deliver an impressive result that will disallow the ultimate lateral sweep and hollow eyes. In patients that have the unhappy signs of surgery this procedure can effectively correct the face-lifted appearance.

Adipose Tissue↗
PubMed2001

Temporal facelift and corrugator resection.

On a path analogous to other surgical disciplines, the progression of facial cosmetic surgery has trended toward shorter scars and less invasive techniques. This article outlines an approach to facelifting that limits the scar to the temporal scalp, preauricular area, and retroauricular sulcus. It will enable the reader to identify those patients who are candidates for a less invasive procedure compared with the conventional facelift approach. Specifically, the temporal facelift addresses the lateral brow, the middle one third of the face, and the upper neck. In addition, this article examines the various and current methods for treatment of the glabellar area of the forehead. Medical and surgical options are outlined for the correction of those rhytids induced by corrugator and procerus muscle activity.

Blepharoplasty↗
PubMed2004

Endobrow-midface lift.

The introduction of endoscopes is responsible for the surge in many of the aesthetic facial plastic surgeries in the past decade. This relatively new technology is widely used in upper-third facial rejuvenation and created a natural evolution into the rejuvenation of the central midthird of the face. After careful patient selection and evaluation, several key maneuvers are accomplished to achieve forehead and midface rejuvenation: (1) a subperiosteal dissection of the scalp to the level of the superior and lateral orbital rims and zygomatic arch, (2) incision and release of orbital periosteum, (3) selective myectomies of the glabella muscles, (4) subperiosteal dissection of the midface (from infraorbital rim to the inferior aspect of the maxilla and laterally over the entire zygomatic arch to the gonial angle beneath the masseteric aponeurosis), and (5) suspension and reposition of the malar fat pad, suborbicularis oculi fat, and soft tissue overlying the angle of the mandible. Endobrow-midface lift is a safe and reliable method to rejuvenate the upper two thirds of the face with excellent results while minimizing the morbidities and complications associated with the traditional open procedures.

Endoscopy↗
PubMed1998

[Sebaceous gland hyperplasia as a side effect of cyclosporin A. Treatment with the CO2 laser].

HISTORY AND CLINICAL FINDINGS: After renal transplantation 11 years previously followed by immunosuppression with cyclosporin A, a 59-year-old man developed, shortly after starting the medication, skin-coloured nodules in the region of both ears and the forehead. In the subsequent years the skin changes spread throughout the entire face. The nodes (up to 2 cm in diameter) and nodules were soft and yellowish-white in colour. In addition there were numerous distinct telangiectasias over the whole face. INVESTIGATIONS: Several skin biopsies were taken. They showed largely unremarkable epidermis but marked enlargement and multiplication of the sebaceous glands. DIAGNOSIS, TREATMENT AND COURSE: In view of the histological findings the diagnosis of sebaceous hyperplasia was established. After a trial with carbon dioxide laser, treatment over the entire surface of the two auricles was undertaken under full anaesthesia. The normal auricular contour was reconstituted by removal of the papules and nodes, without any scar formation. CONCLUSION: In the absence of an alternative medication and if the very marked skin changes show no sign of regression, "shaving off" by scalpel of the nodes and nodules or conventional surgery has been the available treatment. However, removal by carbon dioxide laser has the advantage of fewer side effect, is less stressful to the patient and provides a dry operative field.

Biopsy↗
PubMed1998

[Case report of epithelioid hemangioendothelioma of the frontal region metastatic to the parotid gland].

BACKGROUND: The epithelioid hemangioendothelioma is a soft tissue tumor of vascular origin. Typical localisations are subcutis, cutis, liver, lungs and bones. It has been described in 1982 by Weiss and Enzinger as a separate tumor entity. Due to the unpredictable biological behaviour of the tumor, a borderline malignancy is assumed. CASE REPORT: We report on the case of a 44-year old woman with a metastasising epithelioid hemangioendothelioma in the head and neck area. The primary tumor was located in the subcutis of the left forehead. Due to local recurrences surgical treatment was performed three times after the initial removal in 1993. At the time of the last local recurrence in 1996, a tumor in the left parotid gland was diagnosed and was the reason for a lateral parotidectomy. Pathohistologically, a metastasis of the epithelioid hemangioendothelioma was found. Postoperative radiotherapy was performed and no recurrence occurred until now (22 months follow-up). CONCLUSION: Metastatic epithelioid hemangioendotheliomas are rarely found in the head and neck area. Literature has not yet reported on metastasis formation in the parotid gland. The case illustrates the potentially malignant behaviour of epithelioid hemangioendotheliomas. Hence, therapy should consist of a combination of radical tumor removal and post-operative radiotherapy.

Adult↗
PubMed1998

Endoscopic facial surgery.

The emergence of endoscopically assisted cosmetic surgery has been very rapid. Public demand has burgeoned this trend resulting in the widespread use of these techniques prior to their proven efficacy. Fortunately, the results to date are favorable. The endoscopic brow and forehead lift appear to be as reliable as the open coronal approach while inflicting less incisional morbidity and decreased postoperative recovery time. This combination of decreased morbidity and post surgical discomfort have led to increased patient acceptance of browlifting. The soft-tissue orbital complex is composed of the eyebrow, upper and lower eyelids, and the malar prominence. When used in conjunction with blepharoplasties, the endoscopic browlift and midfacial suspension dramatically improve the appearance of the eye when compared to blepharoplasty alone. The applied surgical anatomy, indications, and operative technique used in endoscopic upper facial rejuvenation are detailed. Surgeons who are not utilizing the endoscopic techniques are encouraged to do so when repositioning the eyebrow and malar prominence would improve the aesthetic result.

Endoscopy↗
PubMed2002

Sinus pericranii: dermatologic considerations and literature review.

Sinus pericranii is a rare disorder characterized by a congenital or acquired epicranial blood-filled nodule of the scalp that is in communication with an intracranial dural sinus through dilated diploic veins of the skull. We describe two patients with sinus pericranii: a 3-year-old boy with a congenital lesion and a 3-year-old girl whose lesion appeared after head trauma. We discuss the clinical presentation, dermatologic manifestations, differential diagnosis, and management as described in the available published literature. Patients with sinus pericranii may be brought to the attention of dermatologists and dermatopathologists because of skin changes in the scalp or forehead. The diagnosis is difficult to make clinically, because the skin manifestations are highly variable and may resemble other disorders of the scalp and cranium. The potentially lethal complications including hemorrhage, infection, and air embolism warrant a high index of suspicion for sinus pericranii.

Child, Preschool↗