Frontal Flap Research Articles

Interplay of static and dynamic features in biomimetic smart ears

Horseshoe bats (family Rhinolophidae) have sophisticated biosonar systems with outer ears (pinnae) that are characterized by static local shape features as well as dynamic non-rigid changes to their overall shapes. Here, biomimetic prototypes fabricated from elastic rubber sheets have been used to study the impact of these static and dynamic features on the acoustic device characteristics. The basic shape of the prototypes was an obliquely truncated horn augmented with three static local shape features: vertical ridge, pinna-rim incision and frontal flap (antitragus). The prototype shape was deformed dynamically using a one-point actuation mechanism to produce a biomimetic bending of the prototype’s tip. In isolation, the local shape features had little impact on the device beampattern. However, strong interactions were observed between these features and the overall deformation. The further the prototype tip was bent down, the stronger the beampatterns associated with combinations of multiple features differed from the upright configuration in the prominence of sidelobes. This behavior was qualitatively similar to numerical predictions for horseshoe bats. Hence, the interplay between static and dynamic features could be a bioinspired principle for affecting large changes through the dynamic manipulations of interactions that are sensitive to small geometrical changes.

Total nasal reconstruction with total rib cartilage framework

To investigate a new technique for nasal reconstruction with total rib cartilage framework. The expanded frontal flap was fabricated by skin expansion and flap delay to cover the reconstructed nose. The dorsal flap was reversed as the lining of reconstructed nose. The whole framework was made by rib cartilage. Secondary revision operation was also performed to make the reconstructed nose more natural. Total nasal reconstruction was performed successfully in 37 cases. Each patient underwent 4-7 operation during a period of 6-8 months. 32 patients were followed up for 12-24 months. The reconstructed nose had a natural skin color and symmetric appearance with good ventilation and less scar. Both doctors and patients were satisfied with the results. Satisfactory cosmetic result and ventilation function can be achieved by nasal reconstruction with total rib cartilage framework.

Orbital malignant melanoma associated with nevus of Ota

Nevus of Ota (oculodermal melanosis) is a dermal melanocytic hamartoma with bluish hyperpigmentation along the first and second branches of the trigeminal nerve. Extracutaneous involvement, especially ocular, has been reported. A 45-year-old male presented with malignant melanoma of the left orbit in association with nevus of Ota. Being locally invasive, a modified exenteration with frontal flap repair was done on left eye. Adjuvant chemotherapy was given after wound healing. All pigmented lesions of the eye require close monitoring to help in the early diagnosis. Since malignant transformation has been reported in oculodermal melanosis, close follow-up and patient education will facilitate early diagnosis and prompt management. This case is reported for its rarity and unusual presentation.

A novel technique for tailoring frontal osteoplastic flaps using the ENT magnetic navigation system

Conclusion: The ENT magnetic navigation system is potentially useful and offers the most accurate technique for harvesting frontal osteoplastic flaps. It represents a valid tool in the wide range of instruments available to rhinologists. Objective: Precise delineation of the boundaries of the frontal sinus is a crucial step when harvesting a frontal osteoplastic flap. We present a novel technique using the ENT magnetic navigation system. Methods: Nineteen patients affected by different pathologies involving the frontal sinus underwent an osteoplastic flap procedure using the ENT magnetic navigation system between January 2009 and April 2011. Results: The ENT magnetic navigation system was found to be a safe and accurate tool for delineating the frontal sinus boundaries. No intraoperative complications occurred during the osteoplastic procedures.

Direct Frontalis Flap with and without Levator Pulley for Correction of Severe Ptosis with Poor Levator Function in the Same Patient

Purpose: To compare two techniques of frontalis muscle flap suspension in different eyelids of the same patient for correction of severe ptosis with minimal levator function.Material and methods: A prospective study of four patients with severe bilateral ptosis and poor levator function, who underwent direct frontalis muscle flap on the right eyelid and frontalis muscle flap with levator pulley on the left eyelid was conducted. Eyelid studies measurements were taken at baseline, 2 months, one year and 5 years after surgery. The presence of complications, flap function and palpebral contour were evaluated.Results: Despite the surgical technique performed, good results in terms of functionality, contour and aesthetics were observed. In the eyes that underwent frontalis muscle flap (FMF)-direct, there were 2 cases with moderate anteriorization of eyelid margin in extreme upgaze and all patients showed eyelash ptosis that persisted one year after surgery, but improved after 5 years. In the eyes that underwent FMF-pulley, no upgaze anteriorization of eyelid margin was observed and three patients had eyelash ptosis of lesser extent than the fellow eye, improving after 1 year follow-up. FMF-pulley showed more long-term stability in eyelid height, compared with FMF-direct.Conclusions: Frontalis muscle flap with a pulley in the levator aponeurosis prevents some complications caused by the excessive vertical component of the direct frontalis muscle flap, especially in deep-set eye patients, with better stability of the eyelid height and contour over time.

Repair for upper eyelid defect using frontal flap with supratrochlear artery

Objective To investigate the effect of supratrochlear artery frontal flap on the repair for upper eyelid defect.Method 7 cases of full-thickness upper eyelid defect were corrected by supratrochlear anery frontal flap. The clinic results were observed follow-up for 6 - 24 months. Results The follow-up period for all the patients was in the range of 6 months to 2 years.All flaps and the surrounding skin were survived. No apparent overstuffed flaps were observed in upper eyelid.Eyes open and eyes close were flexible.No complications and no discomfortableness were observed during follow-up period.No obvious scars were observed on flap pedicle and frontal graft.Conclusion Supratrochlear artery frontal flap effectively maintains function and conture of upper eyelid for the repair of upper eyelid defect. Key words: Supratrochlear artery; Flap; Defect,eyelid,upper

Skull base reconstruction using various types of galeal flaps

Failure of skull base reconstruction is a life-threatening issue. This study describes surgical techniques utilising various types of galeal flaps and reports on outcome of these procedures for skull base reconstruction. Clinical records of 136 patients (75 men, 61 women; mean age, 50.0 years) who required skull base reconstruction with galeal flaps were reviewed retrospectively. Patients had undergone skull base surgeries with simultaneous reconstruction for benign tumours in 77 patients, malignant tumours in 53, and other lesions in 6. We repaired dural defects using a fascial patch, and covered the skull base defects using various types of galeal flap according to the size and location of the skull base defects. Routine spinal drainage was not used in any patients. Reconstruction was performed as planned in all patients. We utilised a galea frontalis flap in 17 patients, temporoparietal galeal flap in 95, temporoparietal galeal flap with calvarial bone in 9, and bipedicled temporoparietal galeal flap in 15. Postoperative complications included scalp wound necrosis in 8 patients (5.9%), transient leakage of cerebrospinal fluid in 3 (2.2%), and intracranial infection in 2 (1.5%). Necrosis of the galeal flaps was not encountered. Galea is a well-vascularised tissue with homogenous thickness. Since the galeal layer covers the entire head area, various types of galeal flap can be elevated to cover any size and location of skull base defect.

Reconstruction of Complex Nasal Dorsal and Sidewall Defects

To demonstrate that by the extended use of cheek advancement flaps, the need to maintain the nasal dorsal side unit is obviated. Retrospective case series. Tertiary care clinic and hospital. Twelve patients aged 48 to 88 years who underwent Mohs micrographic surgery for nasal skin neoplasms, presenting with dorsal sidewall and nasal dorsal cutaneous defects. All patients underwent nasal reconstruction with adjacent tissue cheek advancement flaps with or without contralateral nasal dorsal and sidewall advancement flaps. Avoidance of ipsilateral nasal sidewall scars to allow a natural-appearing transition between the cheek and nose and avoidance of forehead flap morbidity. Results Satisfactory results were achieved in all but 1 patient who had partial flap necrosis. To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed using a variety of techniques, including skin grafts and regional flaps, such as glabellar flaps and frontal flaps. We demonstrate that creation of the nasal dorsal sidewall unit is often not necessary, and excellent results can be achieved through the expanded use of cheek advancement flaps.

Carcinome adénoïde kystique du cuir chevelu

Few cases of adenoid cystic carcinoma of the scalp have been described in the literature. Herein, we report a new case illustrating the difficulties of diagnosis and treatment of this rare form of tumour. A 49-year-old man consulted for a large ulcerated scalp tumour. The biopsy sample exhibited an aspect of cystic adenoid carcinoma. Bone invasion had occurred. Extremely wide surgical excision was carried out, extending down to the dura mater, with covering by means of a frontal flap with left temporal pedicle. Since the edges of the resection were also tumoural, postoperative radiotherapy at 56Gy was given. Twelve months later, the patient was still in remission. The standard treatment for adenoid cystic carcinoma is complete surgical excision but this approach may be complicated by difficulties relating to the degree of tumour spread or to the anatomical site. Postoperative radiotherapy appears to improve local control, as illustrated by our case.

Application of bi-pedicled frontal expanded flap for cervical cicatricial contracture

To investigate the therapeutic effect of bi-pedicled frontal expanded flap for cervical cicatricial contracture. Tissue expanders were implanted under frontal muscle. After expansion, the frontal flaps were designed based on bilateral superficial temporal vessels and were transferred to the neck wound. The cervical spine movement and the mento-cervical angle was measured and analyzed by SPSS16.0 and t test. From September 2006 to May 2010, 7 patients were treated by this method. The range of active cervical movement was improved in all direction. The mento-cervical angle decreased from (152.7 +/- 1.9) to (90.7 +/- 2.2) degrees after operation. The patients were followed up for 5 months to 3 years with satisfactory result and no contracture recurrence. The bi-pedicled expanded frontal flap has a reliable blood supply and is very suitable for cervical cicatricial contracture with good functional and esthetic results, leaving less morbidity at donor site.

Challenge of Reconstructive Surgery of the Eyelids

<p><strong>Introduction.</strong> In eyelid as well as the face reconstruction, besides functional, it is significant to respect aesthetic aspects as well. In this paper the results of eyelid reconstruction in 42 patients with malign tumour of the eyelid skin are shown. <strong>Methods.</strong> In all patients within preoperative preparation CT and/or MRI were carried out depending on consultative decision of maxillofacial surgeon and radiologist, as well as exploration of lacrimal system. In eyelid reconstruction, transpositional flaps were used according to Lagebek and Tripier, frontal flaps according to Mustard, skin graft and mucousal transplants. <strong>Results. </strong>On the basis of frequency of postoperative complications, functional results and the degree of satisfaction with postoperative appearance, the best results were found in elderly patients since elasticity of their eyelids is decreased, therefore their mobilisation is easier. In two patients the use of skin grafts caused the development of ectropion, and distant metastases in two other patients. Eyelid reconstruction in patients with malignant skin tumours cannot be performed with simple skin transplants in most cases, and it is not possible to correct the defect with direct suture if it is larger than the third of the eyelid dimension. For defects expanding these measures it is necessary to perform cantholysis because of relaxation of eyelid tissue and to use local flaps. However, none of the local flaps is ideal for the reconstruction of eyelid edge. <strong>Conclusion.</strong> Eyelid reconstruction requires individual planning which depends on many factors, out of which the size of defect and the age of patients are especially significant. In planning of this reconstruction, an individual character of their vascularisation should be taken into consideration, which can be significant for development of complications and the result of surgical reconstruction.</p>

Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: A reassessment after 212 cases

The purpose of this study was to define the optimal surgical strategy for sinonasal inverted papilloma in relation to the site of origin and tumor extent. Retrospective analysis of patients affected by inverted papilloma treated by purely endoscopic or combined approaches at the Department of Otorhinolaryngology of the University of Brescia and Pavia-Varese from November 1991 to December 2007. Two hundred twelve patients were considered eligible for this study. An exclusive endoscopic approach was performed in 198 patients (93.4%); the remaining 14 patients (6.6%) underwent an endoscopic approach combined with an osteoplastic frontal flap. Follow-up ranged from 24 to 192 months (mean, 53.8 months). A single recurrence was observed in 12 patients (5.7%). Twenty complications (9.4%) were observed. Endoscopic surgery is the first choice in the treatment of inverted papilloma; only lesions with extensive involvement of frontal sinus and/or supraorbital cell may require a combined approach. A minimum follow-up of 5 years is recommended.

Reconstruction of Complex Nasal Dorsal Sidewall Defects

Conclusion: To maintain the nasal dorsal sidewall unit, superior, central dorsal, and nasal sidewall defects have traditionally been reconstructed utilizing a variety of techniques including skin grafts and regional flaps such as glabellar flaps and frontal flaps. We demonstrate that maintaining the nasal dorsal sidewall unit is not necessary and excellent results can be achieved through the expanded use of cheek advancement flaps. Numerous benefits were encountered by repairing nasal sidewall defects with contralateral nasal skin and extended cheek flaps, and the overall outcome in this series was felt to be superior to the results which would be expected with more traditional methods of repair.

Inverted Frontal Bone and Pericraniogaleal Flap for Frontal Sinus Hypertrophy

A 31-year-old man with frontal sinus hypertrophy was treated with an inverted frontal bone and pericraniogaleal flap. Through a coronal incision and anterior supragaleal dissection, a pericraniogaleal flap was raised down to the supraorbital rim, and the frontal bone was exposed. The protruded anterior wall of the frontal sinus was removed with a drill. The excised piece of bone was inverted and replaced and fixed with microplates. The depressed surface of the inverted bone was made full with a folded pericraniogaleal flap. We think that an inversion of the anterior wall of the hypertrophied frontal sinus and topping with a folded pericraniogaleal flap are an alternative measure to treat frontal sinus hypertrophy.

Rescue of postoperative carotid blowout in head and neck neoplasms

To investigate the prevention and rescuing measures of postoperative fatal bleeding induced by carotid blowout in head and neck tumors. Seven cases with postoperative carotid bleeding treated from October 2003 to August 2009 were reviewed retrospectively. Of the patients, 6 were with common carotid blowout and one with internal carotid artery blowout. All patients underwent pre- or post-operative radiotherapy for primary head and neck tumours and 3 patients had neck defect repair with deltopectoral skin flap, frontal flap or free radial arm flap respectively. After carotid blowout bleeding, the patients were treated in time with X ray transcatheter intervention including transcatheter arterial embolization (TAE) and self-expanding covered stent implantation, followed by repairing the carotid region with appropriate myocutaneous flaps. Of 7 patients with carotid blowout, 5 patients were successfully rescued with X ray transcatheter intervention, of them 2 with self-expanding covered stent implantation and 2 with TAE respectively, and other 2 patients died due to rapid bleeding. Of the successfully rescued patients, 2 patients were with the repair of carotid area by pectoralis major myocutaneous flap, one by submental flap and one by local flap, but another one not with flap repair. Follow-up showed the 3 patients rescued with self-expanding covered stent implantation were survival for 6, 12, and 20 months, respectively, and the 2 patients rescued with TAE died of repeated carotid blowout in 2 and 13 months later, respectively. The planned and timely X ray transcatheter intervention is an effective method to treat carotid blowout bleeding in the patients underwent head and neck tumour surgeries. Compared with TAE, self-expanding covered stent implantation may be more reliable for restoring the blood supply of head and neck region, with less complications. One-stage repair of carotid region with myocutaneous flap is of great importance to protect the carotid and to promote the wound healing.

Hypertrophic Frontal Sinus Reduction by Using Anterior Wall Internalization and Galeal Frontalis Flap Obliteration

In this article, we are introducing the use of galeal-frontalis flap to reduce hypertrophic sinus based on 1 case: a 25-year-old amateur boxer who had prominent frontal area due to hypertrophic frontal sinus. Three-dimensional reformatted computed tomography scans were obtained for evaluation of the hypertrophy and the morphology of the frontal sinus. Reduction of the hypertrophic frontal sinus was performed by resection and shaping of the anterior wall and obliteration of the frontal sinus by right-side galeal-frontalis flap excision via bicoronal approach. The trimmed anterior wall was inserted into the frontal sinus and secured with three 3.0 PDS sutures to the bone edges, and the incision was closed. The outcome was satisfactory without any complications during 1-year follow-up, and sixth-month computed tomography scans revealed no bone resorption. Here we are introducing a novel technique to reduce hypertrophic sinus based on a clinical report.

Simultaneous resection and reconstruction of the nose using frontal flap

Simultaneous resection and reconstruction of the nose using frontal flap

Correction of Congenital Severe Ptosis by Suspension of a Frontal Muscle Flap Overlapped with an Inferiorly Based Orbital Septum Flap

Correction of Congenital Severe Ptosis by Suspension of a Frontal Muscle Flap Overlapped with an Inferiorly Based Orbital Septum Flap

A Case of Treatment of Traumatic Recurrent Frontal Sinusitis with T-tube

The most common disease process involving the frontal sinus is infection secondary to inadequate drainage through the frontal recess. Obstruction of the frontal recess may result from rhinosinusitis, allergic rhinitis, nasal polyposis, tumor and traumatic injury. The principle treatments are not only ventilation and drainage but also removal of predisposing factors. If there is no response to conservative treatment, surgical treatment is considered. To prevent closure of the frontal recess, external approach, endoscopic approach, grafts, indwelling tubes and mucoperiosteal flaps have been used. Insertion of silicone tube in frontal recess is a simple and easy method of drainage through frontal recess. We report a case of traumatic recurrent frontal sinusitis which was treated by endoscopic sinus surgery with silicone T-tube insertion. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:50-3 Key WordsZZFrontal sinusitis·Tube.

The anatomic features of supratrochlear artery

To explore the anatomical features of supratrochlear artery which is related to the blood supply of paramedian frontal flap in nasal reconstruction. 10 adult head specimens (20 sides) were used for observation of the course, layer and anastomosis of the supratrochlear artery. The horizontal line of supraorbital rim and the frontal middle line were used as X and Y axis to locate the position of supratrochlear artery. Supratrochlear artery is directed medially and upward after it gets out from orbit. Some arteries (9/20) have one sharp bend at the beginning. The frontal muscle penetration point of the artery is (15.2 +/- 2.6) mm above the X axis and (12. 1 +/- 1 .4) nun lateral to the Y axis. The artery goes subcutaneously after muscle penetration point. It goes more superficially and is anastomosed to the supraorbital artery and frontal branches of the superficial temporal artery at the same side, and also the contra-lateral supratrochlear artery. The pedicle of the paramedian frontal flap should not be too narrow. The dissection of the pedicle should not be too near to the artery, so as to protect the bend at the beginning. The flap elevation must be performed beneath the frontal muscle, when it is 2-3 cm above the supraorbital rim.