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PubMed2005

The K stitch for hypertelorbitism: improved soft tissue correction with glabellar width reduction.

After correction of moderate to severe hypertelorbitism (greater than 40 mm interdacryon distance) with facial bipartition or orbital box osteotomy, excess glabellar soft tissue and brow width should be addressed. Traditional methods described used a midline excision down the forehead and nasal dorsum, and left an unsightly scar. With a series of 12 patients, the authors document the K stitch technique with no external vertical scar. A mean 38.8% reduction of interbrow distance was noted using this technique. Two patients underwent revisions, and two patients had temporary eyelid ptosis. All patients reported satisfaction once the skin contracture was completed.

Acrocephalosyndactylia↗

PubMed2005

Insertion of frontalis muscle relating to blepharoptosis repair.

The aim of the study is to elucidate the precise anatomy and histologic structure of frontalis muscle relating to blepharoptosis repair. Five Korean adult cadavers were used. The soft tissues of the lower forehead, including muscle and periosteum, were dissected at different sagittal planes and then observed histologically and photographed. Masson's trichrome was used for staining the section specimens. The frontalis muscle passed through and inserted into the bundles of the orbicularis oculi muscle on the superior border of the eyebrow at middle and medial side of the upper eyelid. However, at the lateral side it inserted about 0.5 cm below the superior border of eyebrow. At the medial side of the eyelid, the most distal frontalis muscle was located deep to the procerus muscle and superficial to the corrugator muscle. A knowledge of the distal insertion of the frontalis muscle is referred to the muscle transfer procedure for blepharoptosis repair.

Aged↗

PubMed2006

Aesthetic results of fronto-orbital correction in trigonocephaly.

The aesthetic results of craniofacial surgery for trigonocephaly were evaluated by a panel assessment using a scoring system based on deformities typical for this type of craniosynostosis. In this retrospective study pre-and postoperative photographs of 45 patients were scored for items typical for trigonocephaly: shape of the forehead, hypotelorism, 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 temporal depression and this remained to be the most obvious deformity after surgery. There was a good overall correction of the presenting deformities with a decline in the mean score preoperatively from 4.49-1.13 postoperatively. There was a significant weak correlation between pre- and postoperative score only for hypotelorism. This indicates that the severity of the initial disease is not a major contributor to the final surgical result. Furthermore, surgical outcome seemed to be stable over time and was not influenced by the timing of surgery when surgery was scheduled between the ages of 6-15 months. Early craniofacial correction for trigonocephaly results in a stable, acceptable aesthetic result on which the initial deformity has little effect. The most common associated craniofacial characteristics are well- to very well-corrected when surgery is performed within the first 6-15 months. Main focus of deformity on short and long term remains the temporal depression, and thus requires extra attention during surgery.

Craniosynostoses↗

PubMed1982

The effect of accumulated lipids on measurements of sebum secretion in human skin.

When sebum is collected from the skin surface in an absorbent material, the amounts obtained in successive collections at the same site decline steadily. In the present study, sebum was absorbed into bentonite clay applied to 2.5 sq cm areas on the foreheads of 3 subjects for 3-hr intervals during 24 hr. The amounts of sebum obtained, measured by thin-layer chromatography, declined for 12 hr and then remained constant for the remaining 12 hr. It was inferred that the final, sustainable rate represents the true rate at which sebum was being secreted by the sebaceous glands, and that the additional sebum collected at earlier intervals was obtained from an accumulation in the stratum corneum or in the follicular canals. For the 3 subjects, the accumulated sebum averaged 213 micrograms/sq cm, compared with a sustainable secretion rate of 25 micrograms/sq cm/hr. The large quantity of accumulated sebum, relative to the secretion rate, could obscure differences between subjects when sebum secretion rates are measured by short-term collections of sebum in absorbent materials.

Bentonite↗

PubMed2004

Primary cutaneous CD30 anaplastic large cell lymphoma with keratoacanthoma-like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia.

BACKGROUND: Pseudocarcinomatous hyperplasia (PCH) and marked tissue neutrophilia have been observed in cutaneous CD30(+) anaplastic large cell lymphoma (ALCL) occasionally and may cause misdiagnosis. METHODS: An unusual case of CD30(+) ALCL of the skin resembling keratoacanthoma (KA) both clinically and pathologically was described. Histologic examination and immunostaining were performed. RESULTS: A 55-year-old woman presented with a 3-month history of an enlarging hyperkeratotic tumor on the forehead with a central keratinous plug. Microscopic examination showed epithelial hyperplasia resembling KA and a diffuse background infiltrate of large atypical lymphoid cells in the dermis. The atypical cells resembled epithelial cells and were obscured by a massive infiltrate of eosinophils and neutrophils. Immunostaining confirmed the presence of a diffuse infiltrate of CD30(+) cells; these cells were negative for CD45RO, CD20, CD15, epithelial membrane antigen, anaplastic lymphoma kinase-1, and cytokeratin. There was no evidence of extracutaneous involvement. The findings were consistent with primary cutaneous CD30(+) ALCL of null cell phenotype with KA-like epithelial hyperplasia and marked eosinophilia and neutrophilia. CONCLUSIONS: Our case illustrates that primary cutaneous ALCL may be associated with KA-like PCH and concurrent marked tissue eosinophilia and neutrophilia. Diagnosis in such cases is challenging both clinically and histologically because the large atypical lymphoid cells may easily be obscured by the massive infiltrates of eosinophils and neutrophils or confused with invasive squamous cell carcinoma.

Carcinoma, Squamous Cell↗

PubMed2005

Lymphoepithelioma-like carcinoma of the skin with spindle cell differentiation.

BACKGROUND: Primary cutaneous LELC is a cutaneous neoplasm with histopathologic features identical to those seen in the undifferentiated subtype of nasopharyngeal carcinoma. It is extremely rare, with only approximately 30 cases reported in the literature. METHODS: We report a case of primary cutaneous LELC arising on the forehead of a 72 year-old male in which a proportion of the neoplastic cells demonstrated distinctive spindle cell morphology. RESULTS: Microscopic examination showed a dense lymphoplasmacytic infiltrate admixed with large spindle-shaped cells with vesicular nuclei, prominent nucleoli, and frequent mitotic figures. These cells were negative for an extensive panel of immunohistochemical markers and positive only for broad-spectrum cytokeratins and epithelial membrane antigen. There was no connection between the tumor and the epidermis and no epidermal dysplasia. In situ hybridization for Epstein-Barr virus was negative. CONCLUSIONS: The spindle cell differentiation in this case is unusual and suggests that in some cases the differential diagnosis of cutaneous spindle cell neoplasms might include primary cutaneous LELC.

Aged↗

PubMed1996

Solitary piloleiomyoma with an unusual clinical appearance.

We present a 66-year-old man with a solitary piloleiomyoma on the forehead. The lesion had unusual clinical features; it was a crusted and dome-shaped nodule, which exhibited rapid growth. Histology revealed the typical features of piloleiomyoma. The unusual clinical features may have been due to its unique location, in which the downward growth of the tumor was prevented by the underlying frontal bone.

Aged↗

PubMed2002

Aneurysmal fibrous histiocytoma showing transition from factor XIIIa-positive to -negative.

A 39-year-old woman visited us because of a subcutaneous induration on her forehead of 7 months' duration. The tumor was tender, firm, and colored blue-black. Microscopically, the tumor was composed of fibroblastic and histiocytic cells showing no atypicality. In some part intra- or extracellular haemosiderin was diffusely seen. There were some blood-filled spaces of varying size without endothelial lining. From these findings, this case was diagnosed as aneurysmal fibrous histiocytoma (AFH), a variant form of dermatofibroma. Immunohistochemical analysis showed that factor XIIIa-positive histiocytic cells were distributed in the area without haemosiderin, but such cells were absent in the area with its deposition. Furthermore, the cells near the blood-filled space showed transition from factor XIIIa-positive to -negative, suggesting that the stromal instability induced by the attenuation of factor XIII may lead the formation of the blood-filled spaces in AFH.

Adult↗

PubMed2005

Multiple cutaneous fibrous histiocytomas in association with systemic lupus erythematosus.

Cutaneous fibrous histiocytomas are usually regarded as superficial lesions and commonly known as dermatofibromas; however, unusual cases histologically showing fibrohistiocytic proliferation extending into the deeper dermis or subcutaneous tissues are occasionally experienced. Some authors propose this type as benign fibrous histiocytoma of the skin, distinct from dermatofibroma. We describe herein a case of systemic lupus erythematosus (SLE) who developed multiple nodules on the face, trunk and extremities. The nodule on the forehead did not present a typical clinical appearance of dermatofibroma, and histopathological examination showed fibrohistiocytic proliferation with a storiform pattern extending into the deep dermis and subcutaneous tissues. By contrast, histology of the nodule on the abdomen showed fibrohistiocytic proliferation confined to the dermis and compatible with dermatofibroma. Although multiple dermatofibromas are occasionally seen in patients with SLE, benign fibrous histiocytoma of the skin showing deeper invasion than dermatofibroma is rarely associated with SLE.

Adult↗

PubMed1984

Liquid crystal thermometry during anaesthesia.

The use of cutaneous liquid crystal thermometry (EZ Temp) as an estimate of core temperature during routine surgery was investigated in 20 patients. Seventeen per cent of the recordings made with the EZ Temp were more than 1 degree C different from oesophageal temperature. There was a poor correlation between EZ Temp values and both oesophageal and aural temperatures (r = 0.54 for both sites). We conclude that liquid crystal thermometry of the forehead is not sufficiently accurate to be used as an indicator of core temperature during routine surgery.

Anesthesia, General↗

PubMed1985

Measurement of sebum excretion rate and skin temperature above and below the neurological lesion in paraplegic patients.

The sebum excretion rate (SER) was measured above and below the neurological lesion in seventeen male and four female paraplegic patients and at comparable sites in a similar number of age-matched controls. There was no significant difference between paraplegics and controls for forehead SER. For the thigh SER there was a highly significant difference between paraplegics and controls (t = 6.27:P less than 0.001), the level for paraplegics being twice that for controls. Simultaneous thigh skin temperature measurements showed no significant difference between paraplegics and controls.

Acne Vulgaris↗

PubMed1986

A direct gravimetric technique for measuring sebum excretion rate.

The standard gravimetric method for measuring sebum excretion rates involves ether extraction of the collected sebum. We have evaluated a more direct method in which the collecting papers were pre- and post-weighed in glass beakers under conditions of stable temperature and humidity. Weights were adjusted allowing for control weight gain or loss, due mainly to day to day changes in weight room humidity. The direct method compared favourably with the ether extraction method in determining: (1) sebum collected from 43 subjects (r = 0.991, P less than 0.001), (2) left versus right forehead comparisons in 19 subjects (direct method: r = 0.966, P less than 0.001; ether extraction method: (r = 0.963, P less than 0.001), and (3) recovery of sebum from 32 premeasured standards (r = 0.997, P less than 0.001). The findings demonstrate the accuracy of the direct gravimetric procedure which is also simpler, safer and less expensive than methods currently in use.

Forehead↗

PubMed1988

Ectopic cutaneous schistosomiasis and schistosomal ocular inflammatory disease.

We describe a patient with unilateral ectopic cutaneous schistosomiasis as a feature of Schistosoma mansoni infection. In addition to skin lesions he also suffered from schistosomal ocular inflammatory disease. The infection appeared to have been acquired during a visit to Tanzania. Ectopic cutaneous lesions usually affect the perineal area or trunk, and our patient is unusual in the localization of his skin lesions to the forehead.

Adolescent↗

PubMed2004

Suggestion for the treatment of steatocystoma multiplex located exclusively on the face.

BACKGROUND: Although there are numerous reports of different treatment methods, the long-term management of steatocystoma multiplex remains difficult. In this article we describe a simple technique that we used to treat the cysts on the face of a patient. METHODS: A 31-year-old male with steatocystoma multiplex located on the forehead and both temples was treated by inserting the tip of a needle and extirpating the contents, without removing the cyst wall. RESULTS: The procedure was very well tolerated by the patient. There have been no complications during or following the procedure. There were no recurrences after 10 months of follow up. CONCLUSIONS: We suggest that this very simple technique is worth trying as a treatment of choice, especially for the management of facial lesions, where scarring is unacceptable.

Adult↗

PubMed1996

Partial trisomy 10 mosaicism with cutaneous manifestations: report of a case and review of the literature.

A female infant with partial trisomy 10 mosaicism and hypomelanosis of Ito is presented. Features include a prominent forehead, hypertelorism, large dysplastic ears, prominent nasal root, a cleft lip and alveolar ridge, bilateral metatarsus adductus, and streaks and whorls of hypopigmented skin. The skin findings were diagnostic for hypomelanosis of Ito. A peripheral blood karyotype was normal. Fibroblasts from a junctional skin biopsy revealed mosaicism for partial trisomy of chromosome 10 [46, XX/47, XX, +del(10) (q11.2q23.2)]. The physical findings of this patient are compared to five published cases of complete trisomy 10 mosaicism and 94 cases of isolated trisomy 10p and trisomy 10q.

Abnormalities, Multiple↗

PubMed1996

Subcutaneous granuloma annulare in a patient with rheumatoid arthritis and diabetes mellitus.

A case is reported of multiple subcutaneous nodules over the forehead and scalp of a 67-year-old male with moderately severe seropositive rheumatoid arthritis and corticosteroid-induced diabetes mellitus. The histology was initially reported as consistent with a rheumatoid nodule, but on review, was regarded as typical of subcutaneous granuloma annulare (SCGA). The nodules resolved spontaneously within 4 months, which is also in keeping with SCGA. A brief review of the relevant literature is presented.

Aged↗

PubMed1998

Botulinum toxin for the correction of hyperkinetic facial lines.

The present article illustrates the effects of low dose botulinum toxin (BTx) injections for the improvement of hyperkinetic facial lines and presents a grading treatment chart designed to standardize the reporting of the improvement seen. A questionnaire of patient acceptance, the patients' impression of therapy and short-term results and complications are reported. Twelve patients with 26 injected-paired regions were charted and the response to injection was graded. Patients had hyperkinetic facial lines in glabella, periorbital regions or horizontal forehead lines. Diluted BTx type A (1 IU/0.1 mL) was injected and patients were assessed at 10 days. A second follow up injection was offered to patients at this stage if required. Objectively, all patients' hyperkinetic actions and lines improved or diminished. The degree of improvement was similar in all areas injected and a symmetry of results was always observed. In a minority of cases, all movement was lost (7/26) and in others it was weakened but present (19/26). In some injected areas the actual expression line that was visible at rest disappeared entirely (11/26): in the others it was diminished (15/26). Complications were few. Two patients had temporary brow ptosis that spontaneously recovered within the first week. No eyelid ptosis was noted. Bruising and headaches were the most common reported complications. Low dose BTx is an effective and well-tolerated treatment for hyperkinetic facial lines with few significant complications in this small pilot study. The grading chart may allow easier comparisons of results between studies on the effects of BTx therapy.

Botulinum Toxins, Type A↗

PubMed2004

Metastatic Merkel cell carcinoma to the soft tissues of the lower back.

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma. It has a propensity for both locoregional and distant recurrence despite treatment. We describe the case of a 51-year-old man diagnosed with MCC of the left forehead. At 14 months post surgery and adjuvant radiotherapy he developed an isolated deposit of metastatic MCC in the paraspinal soft tissues of his lower back. This atypical site of metastatic disease was treated with radiotherapy and combination chemotherapy. Atypical and isolated sites of metastatic MCC, although infrequently reported, highlight the often bizarre nature of this aggressive skin cancer. Treatment in such cases needs to be individualized.

Antineoplastic Combined Chemotherapy Protocols↗