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PubMed1990

Aesthetic refinements in use of forehead for nasal reconstruction: the paramedian forehead flap.

Historically, surgeons have avoided use of the forehead for nose reconstruction because they felt larger areas of tissue were required. As plastic surgery has evolved to achieve successful replacement of major nasal defects, the paramedian forehead flap has been refined as the best alternative. Judicious use of central forehead tissue will provide sufficient skin of excellent tint to allow total repair. Scars are almost always unobtrusive. The forehead flap covers fabricated composite flaps of intravasal lining and primary cartilage grafts that create the subsurface architecture of the external nose. The result is a nose with correct shape and color that appears normal.

Forehead↗

PubMed1992

Bilobed flap reconstruction of the temporal forehead.

The temporal forehead is a particularly challenging area for reconstruction. Temporal forehead skin lies in a broad flat plane that varies in thickness. The eyebrow, scalp hairline, and lateral canthus comprise its aesthetic boundaries and limit the available tissue for repair of defects. Characteristically, skin tumors of the temporal forehead have extensive subclinical spread and their removal leaves large defects. The goal of temporal forehead reconstruction is to recreate the aesthetic boundaries of the forehead and to regain symmetry with the contralateral side. The temporal forehead bilobed flap is a single-stage procedure that takes advantage of the best color match of adjacent tissue and often allows primary closure of the donor sites in relaxed skin tension lines with minimal distortion. Several cases are presented for illustration of the technique.

Aged↗

PubMed1987

Distribution of skin surface pH on the forehead and cheek of adults.

The skin surface pH on the forehead and cheek of 574 men and women aged 18-95 was measured. No differences were found between men and women regarding forehead and cheek pH distribution. The group over the age of 80 showed higher pH values on both the forehead and the cheek. In 89% of the subjects measured, the skin surface pH on the cheek was higher than that on the forehead. The central 90%, i.e., the "representative range", for the population below the age of 80 is between 4.0-5.5 on the forehead and between 4.2-5.9 on the cheek.

Adult↗

PubMed1988

Forehead pulse oximetry compared with finger pulse oximetry and arterial blood gas measurement.

Usual monitoring sites for pulse oximetry involve the fingers, toes, ear lobe, and nasal septum. This study examined the performance of a forehead sensor compared with a finger sensor for the pulse oximeter and arterial blood gas (ABG) analysis. Ten healthy adult volunteers and 22 ventilator-dependent patients were studied. The arterial oxygen saturation detected by forehead pulse oximetry (SpO2) correlated well with finger SpO2 and arterial oxygen saturation (SaO2) determined by arterial blood gas analysis in the healthy volunteers. Forehead SpO2 in mechanically ventilated patients correlated well with finger SpO2 and SaO2 when heart rate detected by pulse oximeter differed less than 10% from apical heart rate. Factors that caused a difference in oximeter-detected heart rate and apical heart rate were extensive tissue edema, head movement, and difficulty securing good tape placement. This suggests that when signal strength is weak, causing poor pulse rate detection, there will also be problems associated with accurate SpO2. The forehead pulse oximeter sensor works well on healthy, well-oxygenated volunteers. Difficulty was experienced when applying and using the sensor on critically ill patients. The reliability of the forehead pulse oximeter sensor has not been established at low saturations.

Adolescent↗

PubMed1991

A systematic aesthetic approach to primary closure of the donor site following transposition of vertical forehead flaps.

Twenty patients underwent transposition of a vertical forehead flap to correct defects of the middle third of the face. The treatment and results are reported and evaluated. Based of the width of the secondary forehead defect, the best technique of direct closure was determined. Simpler cases were resolved by careful application of the basic techniques of plastic surgery--undermining and scalp flap rotation. When a forehead defect larger than 4.5 cm was expected, previous forehead skin expansion seemed advisable. A primary, tension-free suture of the forehead defect was achieved in every case, thus significantly improving the aesthetic outcome of the operation.

Adult↗

PubMed1987

Use of expanded temporal flaps to resurface the skin grafted forehead.

The forehead flap, whilst providing a reliable method of intra-oral reconstruction, leaves an unsightly donor defect in the skin grafted forehead. We describe a technique of resurfacing the forehead using tissue expansion. Axial pattern flaps of expanded hairless temporal scalp are transposed to the forehead. This technique is likely to have wide applications since no other satisfactory method of resurfacing the entire forehead exists.

Adult↗

PubMed1989

[Experimental study of forehead temperature in autogenic training].

Thermometry of the forehead and cheeks was done in 35 longtime trainees of Autogenic Training (AT). Results revealed a significant increase in forehead skin temperature rather than the hypothesized decrease. Cheek temperature rose significantly more than forehead temperature. This difference between cheek and forehead temperatures could explain the subjective impression of coolness of the forehead during the sixth standard exercise of Autogenic Training.

Adult↗

PubMed1987

[Subaponeurotic lipoma of the forehead].

On the forehead, the epicranial fascia or aponeurosis (galea) splits to enclose the musculus frontalis. The superficial fascia, thin and transparent, separates the muscle from the fatty layer (panniculus) of the overlying skin. The deep fascia, thick and fibrous, is separated from the periosteum by a loose areolar tissue which allows the whole skin to move over the skeleton. The two bellies of the m. frontalis are anchored jointly on the midline, where their superficial and deep fasciae are tightly joined together. The loose areolar tissue beneath the galea is a cleavage plane facilitating plastic surgery of the scalp. On the scalp and forehead of adult male patients, benign, well differentiated and encapsulated lipomas may develop in this deep plane. This localization seems to be particularly frequent but has seldom been described. According to the available literature, 1.9 to 14.5 per cent of cutaneous lipomas are situated on the head and neck. In a retrospective review of 246 skin lipomas from our own files, we found 20 lipomas of the forehead (8 per cent), and among these 12 were located beneath the galea, between the frontal muscle and the periosteum. While the M/F sex ratio is approximately 2:1 for the cervico-cephalic lipomas, subfascial lipomas of the forehead prevail in adults and old men (90 per cent). Clinically, the "subfacial forehead lipoma" presents as a round or oval, smooth, flat or dome-shaped tumour. The skin is raised above the lesion, glides over its surface, and the parallel pattern of its wrinkles remains unaltered. The lesions are usually symptom-free and are ascribed by some patients to a minor, woundless trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1975

Modified nondelayed forehead flap.

The versatility and benefit of the forehead flap need not be lost when the external carotid artery system has been ligated. By basing the forehead flap laterally on the scalp, nourishment from the opposite external carotid artery gives the head and neck surgeon another advantage in reconstruction with nondelayed expedience. We report three cases of wide cheek ablative surgery, external carotid ligation, and utilization of the forehead flap. The occasions to use this modified nondelayed forehead flap are few, but it offers the same advantage without staging. It definitely can be used in any situation requiring a forehead flap when the external carotid artery system has been ligated.

Aged↗

PubMed1990

Management of the aging forehead.

Browlifting and forehead procedures are a critical element in the contemporary surgical management of the aging face. Esthetics of the upper third of the face will dictate brow position and its relationship to the supraorbital rim and eyes. Treatment of deformities of the upper third of the face can be varied according to the sex and age of the patient as well as contour of the hairline and forehead. The indications, advantages, disadvantages, and techniques of the coronal forehead, modified pretrichal forehead, midforehead, and direct browlifting procedures are discussed.

Aged↗

PubMed1992

The anatomic basis for the design of forehead flaps in nasal reconstruction.

The detailed arterial anatomy of the medial forehead region was evaluated using roentgenographic examinations of injected cadaver heads, anatomic dissections of injected cadaver heads, and Doppler examination of normal subjects. The supratrochlear artery was seen to be the dominant artery of the medial forehead (not the supraorbital). The supratrochlear artery exited the orbit 1.7 to 2.2 cm from the midline, passing superficial to the corrugator and deep to the orbicularis and frontalis muscles. The supratrochlear artery then passes just medial to the eyebrow and pierces the frontalis muscle, ascending the rest of the forehead in a subcutaneous plane 1.5 to 2.0 cm from the midline (paramedian position). The implications of this vascular anatomy on forehead flap design and execution for nasal reconstruction are discussed and clinical cases are presented.

Arteries↗

PubMed1992

Do forehead lifts lift or unfurl?

Forehead lifts are becoming increasingly more popular as an adjunct to facial rejuvenation. Considerable confusion exists as to how much the eyebrow should be elevated and how much scalp should be removed to achieve this goal. In an effort to evaluate this question, we have reviewed our recent forehead lift experience. These were done with forehead flap dissection down to glabella and supraorbital ridge, partial resection of corrugator supercilii, procerus, and frontalis muscles, and limited skin resection. We suggest that a natural-appearing, rejuvenating forehead lift should unfurl facial wrinkles without excessive eyebrow elevation. Technical maneuvers to obtain this goal are discussed.

Forehead↗

PubMed1991

Criteria for the forehead lift.

We have developed clinically useful measurements to assist the surgeon in deciding when to do the forehead lift and where to place the incision. Also, we have reviewed our experience over the past decade and discuss the four categories and applications of forehead lifts. We use three indications for forehead lift: ptosis, creases, and previous facelift (PCP). There are four basic surgical techniques applicable to the upper face: (1) direct browlift, (2) midforehead crease incision, (3) prehairline incision, and (4) posthairline incision. We determined more accurate guidelines from measurements taken on 50 volunteers, as well as patients seeking a facelift. The line of measurement in a vertical plane extends from the midpupil to the top of the eyebrow and up to the hairline. We have found that the normal distance from the midpupil to the upper edge of the eyebrow on average is 2.5 cm and that the distance from the upper edge of the eyebrow to the hairline is approximately 5 cm on average. If the distance from pupil to brow is less than 2.5 cm, then the patient may benefit from a forehead lift. If the distance from brow to hairline is less than 5 cm, then we use a posthairline incision in females. If this same distance is greater than 5 cm in females, we advise the prehairline incision. In male patients we strongly consider direct crease incision. The direct browlift is reserved for minimal ptosis, asymmetry, or patients who wish a minimal procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Inadequacy of the forehead reference montage for detecting abnormalities of the spinal N13 SEP in cervical cord lesions.

Cervical somatosensory evoked potentials (SEPs) recorded using forehead and anterior cervical reference montages were compared in 6 patients whose MRI showed a cervical syrinx. All patients presented with a segmental loss of pain and temperature sensation in upper limbs, but no clinical evidence of dorsal column system dysfunction. Cervical SEPs recorded using the forehead reference montage were normal in all cases, while the N13 potential recorded using an anterior cervical reference was reduced, or absent, in 11 median nerve SEPs out of 12. This discrepancy results from persisting scalp P13-P14 far-field potentials, which were picked up by the forehead, but not by the anterior cervical, reference. It is concluded that the forehead reference montage is inadequate for assessing selectively the spinal N13 potential and should be abandoned for cervical SEP recording.

Adult↗

PubMed1988

Nasal reconstruction with the expanded forehead flap.

This report details the experience with nine patients over a 3-year period who had partial or total nasal reconstruction using an expanded forehead flap. The history of nasal reconstruction is reviewed, emphasizing the evolution of the forehead flap as the ideal donor site. The author's experience with skin expansion of the forehead to produce a thin ideal flap is presented in detail. Complications of the procedure are reviewed. Technical considerations to achieve a good result are emphasized. The forehead donor site is minimal and well accepted. This procedure provides a solution to a major problem with partial and total nasal reconstruction.

Adult↗

PubMed1988

Geometric considerations in the design of rotation flaps in the scalp and forehead region.

The classical transposition and rotation flaps are well known. Cosmetic considerations in the scalp and forehead region limit the use of a flap design that requires a skin graft for a donor defect. On sound geometric principles, the classical flap designs are suitably modified here to have a somewhat equal proportion of transposition and rotation. This "modified rotation flap" design works to a maximum advantage in the inextensible region of the scalp and forehead by providing single-stage primary closure of moderate to large defects. No backcuts are ever necessary with this flap design. Use of this principle to modify the rotation flap design for closure of an extended midline forehead defect following rhinoplasty allows a still wider (up to 6.5 cm) midline forehead flap to be available for rhinoplasty with primary closure of the donor defect.

Adolescent↗

PubMed1990

The effect of early fronto-orbital advancement on frontal sinus development and forehead aesthetics.

The frontal sinuses make an important contribution to normal forehead and glabellar contour. This study was designed to test our clinical impression that early fronto-orbital ("frontal bone") advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics. A retrospective study was conducted on 11 patients who had undergone fronto-orbital advancement and also had a long period of follow-up at the Institute of Reconstructive Plastic Surgery at New York University. The longitudinal cephalometric data were compared with unoperated controls. With one exception, no patient who underwent bilateral fronto-orbital advancement developed a frontal sinus, and all such patients had a flattened brow contour when compared with unoperated patients, of whom 82 percent developed at least one frontal sinus. Of the three patients who underwent unilateral fronto-orbital advancement for plagiocephaly (flattened forehead), two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses. The two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side. Fronto-orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities. patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto-orbital advancement (by the technique described) rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development.

Adolescent↗

PubMed1986

The forehead V-to-T plasty (Dieffenbach's winged V-plasty).

The principles of the V-to-T plasty (Dieffenbach's winged V-plasty) are adaptable to many regions of the forehead. This paper demonstrates the use of the V-to-T plasty to reconstruct an extensive area of the lower central forehead and glabella following excision for basal cell carcinomatosis. Dual hemi-forehead advancement-rotation flaps were used in a single-stage reconstruction. The same technique adapts to other forehead and facial areas as well.

Basal Cell Carcinoma↗