Application analysis of a modified retroauricular hairline incision in the resection of a benign parotid gland tumor / 华西口腔医学杂志

OBJECTIVES@#This study aimed to evaluate the application value of a modified retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle in the resection of benign parotid gland tumors.@*METHODS@#Forty-eight patients with benign parotid gland tumors were retrospectively analyzed: 19 cases were included in the experimental group with an improved retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle, and 29 cases were assigned in the control group with a modified facelift incision. Operation time, postoperative drainage, postoperative esthetic degree, and incidence of facial nerve paralysis, salivary fistula, and Frey's syndrome were compared.@*RESULTS@#After the esthetic procedure, the average score of the experimental group was higher than that of the control group, and the esthetic effect of the former was better than that of the latter (@*CONCLUSIONS@#The modified retroauricular hairline incision and sternocleidomastoid flap with an inferior pedicle can be applied to resect benign parotid gland tumors safely. It shows a better cosmetic effect and does not cause obvious postoperative complications. Therefore, it should be promoted for tumor treatments.

Natural sideburn reconstruction with retroauricular expanded flap with original hairline / 中华整形外科杂志

Objective@#To introduce a reconstruction procedure of natural sideburn, with combined expanded retroauricular flap and scalp flap.@*Methods@#A retrospective study was produced in Plastic Surgery Hospital, PUMC, from January 2014 to December 2017. Twenty patients (21 sides) underwent sideburn reconstruction with combined expanded retroauricular flap and scalp flap (double pedicled flap, n=3; single pedicled flap, n=17) were included in this study. There were 12 male (12 sides) and 8 female (9 sides), with the mean age of (23.8±3.2) years. The sideburn defect was caused by burn in 19 patients, and it was resulted from hemangioma in 1 patient.@*Results@#The size of flaps ranges from 8 cm×12 cm to 10 cm×16 cm. Venous congestion at the distal end of the flap occurred in 1 patient, which was cured after dressing change, and the sideburn was not affected. The reconstructed sideburns are natural, symmetric, and without obvious scar. The follow-up time was 3-40 months. Fourteen patients were very satisfied with the reconstructed sideburn, and 6 patients were satisfied. No severe complication was observed during follow-up time.@*Conclusions@#The combined retroauricular flap and scalp flap is an alternative method for sideburn reconstruction, which provide natural hair distribution, inconspicuous scars and less complications.

Síndrome de Klippel-Feil: a propósito de un caso en Ecuador / Klippel-Feil syndrome: about a case in Ecuador

El síndrome de Klippel-Feil (KFS) es un grupo heterogéneo de malformaciones a nivel vertebral que presentan un componente genético monogénico; se caracteriza por presentar un defecto en la formación o segmentación de las vértebras cervicales, que da como resultado una apariencia fusionada. La tríada clínica consiste en un cuello corto, una línea de implantación baja del cabello y un movimiento limitado del cuello. Presentamos el caso de un paciente masculino de 17 años que manifiesta los hallazgos clínicos y radiológicos de esta anomalía. (AU)

Klippel-Feil syndrome (KFS) is a heterogeneous group of vertebral malformations that presents a monogenic genetic component, characterized by a defect in the formation or segmentation of the cervical vertebrae, which results in a fused appearance. The clinical triad consists of a short neck, a low hairline and a limited movement of the neck. We present the case of a 17 year-old male patient who presented the clinical and radiological findings of this anomaly. (AU)

Extracapsular dissection of the upper part of parotid gland benign tumor using a tragus edge combined retroauticular hairline incision approach / 口腔疾病防治

Objective@#To investigate the clinical effect of dissection in the upper part of parotid gland benign tumor using a tragus edge combined retroauticular hairline incision approach.@*Methods@#20 cases of upper part of parotid gland benign tumor were resected using the tragus edge combined retroauticular hairline incision approach, the surgery and cosmetic effect were analyzed. @*Results@#Parotid gland tumors were checked by CT before the operation and diagnosed by frozen section analysis during the operation. The tumors were successfully complete resected in all cases. There were no complications of Frey’s syndrome, postoperative bleeding, and flap necrosis, 2 cases showed a temporary earlobe numbness, 1 case of temporary facial nerve paralysis and 1 case of salivary fistula. There were no tumor recurrence after 24 ~ 48 months followed up. Surgical incision cosmetic effect is satisfactory. @*Conclusion@#The tragus edge combined retroauticular hairline incision is safe and feasible, with less complications for the upper part of parotid gland benign tumor resecetion.

Application of functional parotidectomy via retroauricular hairline incision in the excising superficial parotid tumor / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the usefulness of retroauricular hairline incision (RAHI) in partial superficial parotidectomy (PSP) by comparison with modified Blair incision (MBI).@*Methods@#A retrospective analysis of 64 medical records for patients with benign parotid tumors who underwent partial superficial parotidectomy was undertaken (28 were in MBI group, 36 in RAHI group). Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey′s syndrome, and cosmetic outcomes were compared between RAHI and MBI groups.@*Results@#Compared with MBI group, RAHI group showed better cosmetic results for benign parotid tumors in mean satisfaction score(P<0.001). There were no significant differences in size and location of tumors, operative time, incidence of transient or permanent facial nerve paralysis and Frey′s syndrome between two groups (P>0.05).@*Conclusions@#Partial superficial parotidectomy can be performed safely via RAHI in most cases of benign parotid tumors. Compared with MBI, RAHI for benign parotid tumorscan improve the cosmetic outcome, without increasing the operative time or operative morbidity.

Reconstruction of Postburn Sideburn and Frontal Hairline Alopecia by Various Tailored Scalp Flaps Transfer

PURPOSE: Reconstruction of sideburn and frontal hairline alopecia after burn injuries is one of the challenging tasks in reconstructive surgery. We report on the successful experiences to reconstruct the sideburn and frontal hairline alopecia with various scalp flaps such as Beak scalp flap, scalp rotation flap, scalp transposition flap and scalp expansion operation. METHODS: We experienced the patients who had postburn scalp alopecia after severe facial burn injuries. Among them we selected 8 patients of postburn sideburn and frontal hairline loss and reconstructed with variable scalp flaps. The types of scalp flaps for reconstruction were the Beak scalp flap which is made of the extended postauricular scalp flap combined with the central scalp rotation flap, scalp rotational flap, scalp transposition flap, and scalp expansion operations. We studied the indication of the transferred various scalp flaps for each case considering the size and shape of hair loss lesion, complications, problems of donor site, appearance of reconstructed frontal hairline and sideburns through follow survey. The follow-up periods were 3 months to 2 years. RESULTS: We experienced 8 patients of postburn sideburn and frontal hairline alopecia. Patients' age ranged from 13 to 16 years. male to female ratio was 2:6. Reconstruction methods were 1 case of Beak scalp flap, 1 case of scalp rotation flap, 1 case of scalp transposition flap and 5 cases of scalp expansions. All transferred scalp flaps were completely survived. As complications, 1 case hematoma, 1 case partial edge extrusion of expander, 1 case of persistent headache in scalp expansion operation were noted. There were no remarkable problems in scalp donor site. After 3 months to 2 years follow up, satisfactory results were obtained in all patients. Illustrated Case: The 31-years-old female patient had loss of right frontal hairline, sideburn caused by flame burn. With aid of 3D computerized graphic design, the extended posterior auricular scalp flap with the central frontal scalp rotation flap, which is called as the Beak scalp flap, is a newly designed scalp flap for correction of her frontal hairline and sideburn alopecia. The size of the central frontal scalp rotation flap was 12x11 cm, and the size of the extended postauricular scalp flap was 7x1.5 cm. This flap is elevated simultaneously and could cover the sideburn and frontal hairline alopecia in a single procedure. At postoperatively, the transferred the Beak scalp flap was survived completely. The 9 months follow-up after operation, well reconstructed her right sideburn and frontal hairline was shown. CONCLUSION: For reconstruction of postburn sideburn and frontal hairline alopecia, the scalp flaps transfer should be precisely design in accordance with size, location of hair loss, direction of hair, and also it is emphasized to minimize postoperative scalp donor scars. We had successful reconstruction of postburn sideburn and frontal hairline alopecia by the Beak scalp flap, as a newly designed the composite scalp flap, which is made of the extended postauricular scalp flap combined with the central frontal scalp rotation flap, this flap can be used for reconstruction of loss of sideburn and frontal hairline in a single stage procedure. And also we have used scalp rotation flap, scalp transposition flap, and scalp expansion operations for this purpose. We present these method's reliability and validity.

Klippel-Feil syndrome: a case report.

Klippel-Feil Syndrome (KFS) is defined as congenital fusion of two or more cervical vertebrae. The most common signs are short neck, low hairline at the back of head and restricted mobility of neck. We report a case of a neonate who presented with complaint of respiratory difficulty and later diagnosed as case of Klippel-Feil syndrome.

Total Hairline Correction in Female Patient

BACKGROUND: The shape of the hairline and the ratio of the forehead to the face are both important factors for a balanced and attractive face. Because males primarily have a hairline with a rectangular or M shape (a frontotemporal-recessed shape), females with such shapes often have a strong masculine image and appear older. Follicular unit (FU) transplantation was used recently so that the forehead could be reduced naturally and effectively by changing the rectangular or M-shape hairline to a round-shape hairline, thus reducing the forehead. So the author is going to introduce a harmonious, balanced correction, named as total hairline correction that presents not only the frontal midpoint and fronto-temporal line, but also a temporal point, infra-temporal area, and/or sideburn. METHODS: Author studied 300 operation patients in last three years whose mean age was 29.3 years (range 19-57 years). RESULTS: The average reduced length was followed: frontal mid-point: 0.63 (0-1.5 cm), frontotemporal apex: 3.38 (1-4.5 cm), Rt 3.18 (1-4.5 cm) Lt, temporal point: 0.91 (0-3 cm) Rt, 0.88 (0-3 cm) Lt, infratemporal apex: 0.92 (0-1.5 cm) Rt, 0.93 (0-2 cm) Lt. CONCLUSIONS: In female patient with M shaped or rectangular hairline, total hairline correction which included not only mid-frontal area and fronto-temporal recession, but also temporal peak, infratemporal area and sideburn is better than simple correction of frontotemporal recess in reducing the facial area and maintaining the aesthetic facial balance.

Asian Female Hairline Surgery Using Follicular Unit Extraction

BACKGROUND: Asian female hairline surgery is unique part among hair transplantation surgerys. Most of Asian female hairline surgery had been done by single strip harvesting technique which leave noticeable linear scar. As follicualr unit extraction is introduced1, female hairline surgery can take advantage of the Follicular Unit Extraction technique;leaving no linear donor scar. There has been a belief among surgeons who are somewhat reluctant to use follicular unit extraction for female hairline surgery that the inspection of the naturally occurring curl direction of hair, which is believed one of the critical steps for appropriate operative result in Asian female hairline surgery, is impossible in follicular unit extraction. So follicular unit extraction has to be 'plan B' in respect of Asian female hairline surgery. But author thought differently about this belief. METHODS: From December 2012 to May 2013, 78 consecutive cases of female hairline surgerys were done by follicular unit extraction. The ages of patients were 18 to 57 and mean was 34.5. The cases can be categorized in 3 groups; 1) Correction of fronttemporal recession only. 2) Whole hairline correction (including fronto-temporal recession, temporal recession and lowering of the central hairline). 3) Correction of the hairline with scar by previous aesthetic surgery just like forehead lift or forehead reduction surgery. Donor hair was harvested by follicular unit extraction and preparation of donor area was done by micro-strip shave pattern, by which no short haircut window was needed. Follow up periods were 4 months to 8 months. RESULTS: Aesthetic results of the all cases were satisfactory. There were three cases which needed small session (less than 100 hairs) for relatively less survival area (all of these areas were the anterior part of hair part) and two cases of small 'moth-eaten pattern' on donor area which need no treatment or another session for aesthetic improvement. There was no lumpy graft which can be look unnatural or literal wall of plug graft in anterior part of corrected hairline. There was no linear harvesting scar, which is in-evitable in single strip harvesting, on donor area. CONCLUSIONS: Follucualr unit extraction can be versatile technique for hair restoration surgery and also hold good for Asian female hairline surgery.

A Beveled Frontal Hairline Incision for Subcutaneous Forehead Lift

Anterior frontal hairline incisions have been used for subcutaneous forehead lifts, reduction foreheadplasty, endoscopic forehead lifts in patients with long foreheads. However, the resulting visible hairline scar has been a major concern. To obtain a more aesthetic scar, different types of incisions have been used. Since 2005, we have been using 30~45degrees anteriorly beveled incisions 4~5 mm behind the anterior frontal hairline when performing subcutaneous forehead lifts. In the present study, 32 patients who underwent subcutaneous forehead lifts and could be followed up for more than 6 months were evaluated for the incisional scars. Using a questionnaire, all the patients were interviewed regarding their postoperative hairstyle changes and reaction to the scars from the subcutaneous forehead lifts. Their responses with respect to the scars were as follows: less than expected, 30 patients; equal as expected, 2 patients; worse than expected, no patients. The surgeon's evaluation of scar visibility was as follows: barely visible (scar and alopecia were not seen or barely seen), 19 patients; minimally visible (a fine scar was seen), 12 patients; markedly visible (a wide scar or alopecia was seen), 1 patient. Except 1 patient, all other patients did not change their hairstyles permanently to camouflage their scars. Therefore, the 30~45degrees anteriorly beveled incision 4~5 mm behind the anterior frontal hairline was demonstrated to result in an aesthetically acceptable scar.

A Wedge-Shaped Anterior Hairline Extension Associated with a Tessier Number 10 Cleft

A wedge-shaped anterior hairline extension is a very rare skin manifestation usually associated with congenital anomalies including a Tessier number 10 cleft. Other associated conditions are the Tessier number 9 cleft, the Fraser syndrome, and the Manitoba oculotrichoanal syndrome (MOTA syndrome). The Tessier number 10 cleft features include a coloboma of the middle third of the upper eyelid, and an eyebrow divided into two portions. The medial eyebrow portion may be absent and the lateral portion is angulated vertically, joining the hairline of the scalp. This creates a wedge-shaped anterior hairline extension. Herein we report on a case of a wedge-shaped anterior hairline extension associated with the Tessier number 10 cleft.

The Shape and the Location of Forehead Hairline of Korean Males in Their 20s & 30s

PURPOSE: It is generally believed that alopecia is caused by various factors such as scars, stress, genetical factors, androgens, etc. Androgenic alopecia is one of the most common cause of alopecia and found mainly in males. Propecia(Merck & Co., USA) and Minoxidil(McNEIL-PPC, Inc, USA) were the drugs approved from FDA for treatment of androgenic alopecia. Surgical treatments such as flap, tissue expansion, scalp reduction and hair transplantation can be considered if necessary. Hair micrograft techniques were developed for natural hair shapes and minimal adverse effect. There were attempts to measure the length of the forehead of the Korean young adults. However attempts to classify the shape and location of forehead hairline were rare. This study attempted to find out standard hairlines of young adults in their 20s & 30s and the result would be the guideline of the hairline in hair replacement surgery of male patients in their 40s & 50s. METHODS: 200 male adults in 20s and 30s were photographed and measured the length of 11 vertical index lines to determine hairline. The indexes are the distances from hairline to intercanthal midpoint(A), to medial canthus (B), to upper eyelid fissure(C), to lower eyelid fissure(D), to lateral canthus(E) and distance from lateral highest point to medial lowest point, if the hairline is M-shape(F). Additionally, we classified the hairlines into 4 groups, M, horizontal, inverted U and irregular shapes. RESULTS: The most common hairline of male adults in their 20s is inverted U-shape(53.3%), followed by horizontal-shape, M-shape, irregular-shape. In their 30s, inverted U-shape(59%) is followed by irregular-shape, M-shape, horizontal-shape. The M-shape is more frequently found in males in 30s than those in 20s. The mean values of the indexes in their 20s are as follows: A(76.14mm), B(Rt: 75.78mm, Lt:76.41mm), C(Rt: 69.43mm, Lt: 69.92mm), D(Rt: 76.92mm, Lt:77.46mm), E(Rt: 64.16mm, Lt: 64.73 mm), F(4.09mm). Those in their 30s are as follows: A(76.13mm), B(Rt: 76.114mm, Lt: 76.02mm), C(Rt: 69.87 mm, Lt: 70.37mm), D(Rt: 77.37 mm, Lt: 77.58mm), E(Rt: 69.63mm, Lt: 69.85mm), F(6.14 mm). CONCLUSION: The knowledge about human body measurement is indispensable to plastic surgeons. In this study, inverted U shape is the most common type of hairline in 30s, and similar distribution is found in 20s. The percentage of M shape in their 30s is elevated more than 10% compared to that in their 20s. The study of hairline shapes and 11 indexes of hairlines can be useful for planning of the hair transplantation and postoperative evaluation. This study being based on photogrammetry, there may be differences between actual distance of curved face and projected distance on flat photographs.

The Morphology of Scalp Whorls and Anterior Hairlines in Koreans / 대한피부과학회지

BACKGROUND: Although scalp whorls and the anterior hairline are important parts for the morphology of the scalp hair pattern, only a few studies on them have been reported. OBJECTIVE: This study was performed to obtain data about the classification and incidence of various scalp whorl patterns, the average heights of the anterior hairlines, and the types of anterior hairlines and their incidence. METHOD: We evaluated the number, direction and location of the parietal scalp whorls, measured the heights of the frontal and temporal hairlines according to the 5 standard lines, and identified the shape of the anterior hairlines in 484 men and 171 women. RESULTS: Of the 655 subjects, 89.6% had single parietal scalp whorls, while 6.9% had double whorls. The single clockwise type was more common than the single counterclockwise types, and the location of single whorls were in the middle, right and left, in decreasing order of frequency. Of the double whorls, cases of the same direction were more common than those of opposite directions. The average height of the anterior hairline was higher in men than women. For the classification of the anterior hairline, the linear type was the most common in men and the round type more common in women. CONCLUSION: We describe the present results as a guideline for the further study of hair-related abnormalities and also for the esthetic design of hair transplantations.