Optimizing two-stage surgery by expanding single-stage nasal reconstruction in the COVID-19 era.

The COVID-19 pandemic led to a decrease in the number of operating rooms available. Single-stage islanded forehead flaps have emerged as a good alternative to the classic frontal flap helping to diminish the surgical waiting list. We present our case series of 6 patients reconstructed with islanded forehead flaps between February and July 2020.The purpose of this report is to assess the advantages and disadvantages of this technique in order to inform which subgroup of patients may benefit from the one-stage flap, now the pandemic is better controlled.

Anatomical Proposal for Botulinum Neurotoxin Injection for Glabellar Frown Lines.

Botulinum neurotoxin injection for treating glabellar frown lines is a commonly used method; however, side effects, such as ptosis and samurai eyebrow, have been reported due to a lack of comprehensive anatomical knowledge. The anatomical factors important for the injection of the botulinum neurotoxin into the corrugator supercilii muscle has been reviewed in this study. Current understanding on the localization of the botulinum neurotoxin injection point from newer anatomy examination was evaluated. We observed that for the glabellar-frown-line-related muscles, the injection point could be more accurately demarcated. We propose the injection method and the best possible injection sites for the corrugator supercilii muscle. We propose the optimal injection sites using external anatomical landmarks for the frequently injected muscles of the face to accelerate effective glabellar frown line removal. Moreover, these instructions would support a more accurate procedure without adverse events.

Forehead, Temple and Wrist Temperature Assessment of Ethnic Groups using Infrared Technology.

Non-contact infrared sensors are widely used as a diagnostic tool for elevated body temperature during initial screening for coronaviruses. The aim of this study was to investigate the thermal differences at three anatomical points: temple, forehead, and wrist, in the initial screening for temperature indicative of febrile and non-febrile states in skin pigmentation variations in Black, Half-Black and Caucasian skins, correlated with height and weight variables. Temperatures were obtained by means of an infrared thermometer in 289 volunteers with mean age of 18.30 ± 0.76, in a controlled environment according to Singapore Standard, SS582 part 1 and 2, normative standard IEC 80601-2-59, with standard technical protocols established by the International Organization for Standardization, ISO / TR 13154. The data were processed in MATLAB® R2021a, and data normality verified by Kolmogorov-Smirnov test, non-parametric data paired between temple / forehead / wrist were compared using the Wilcoxon signed-rank test. The results show different median temperatures in these anatomical regions, 37.2°C at the temple, 36.8°C at the forehead and 36.4°C at the wrist. As the temple region presents a temperature higher than the other investigated regions and, therefore, close to the core temperature, it should be considered for the initial screening of SARS-CoV-2 when using non-contact infrared thermometers. Furthermore, no significant changes were found due to variation in skin tone, height, or weight.

Predicting Deep Body Temperature (Tb) from Forehead Skin Temperature: Tb or Not Tb?

There is a need to rapidly screen individuals for heat strain and fever using skin temperature (Tsk) as an index of deep body temperature (Tb). This study's aim was to assess whether Tsk could serve as an accurate and valid index of Tb during a simulated heatwave. Seven participants maintained a continuous schedule over 9-days, in 3-day parts; pre-/post-HW (25.4 °C), simulated-HW (35.4 °C). Contact thermistors measured Tsk (Tforehead, Tfinger); radio pills measured gastrointestinal temperature (Tgi). Proximal-distal temperature gradients (ΔTforehead-finger) were also measured. Measurements were grouped into ambient conditions: 22, 25, and 35 °C. Tgi and Tforehead only displayed a significant relationship in 22 °C (r: 0.591; p < 0.001) and 25 °C (r: 0.408; p < 0.001) conditions. A linear regression of all conditions identified Tforehead and ΔTforehead-finger as significant predictors of Tgi (r2: 0.588; F: 125.771; p < 0.001), producing a root mean square error of 0.26 °C. Additional residual analysis identified Tforehead to be responsible for a plateau in Tgi prediction above 37 °C. Contact Tforehead was shown to be a statistically suitable indicator of Tgi in non-HW conditions; however, an error of ~1 °C makes this physiologically redundant. The measurement of multiple sites may improve Tb prediction, though it is still physiologically unsuitable, especially at higher ambient temperatures.

Temperature should not be measured on forearm with infrared thermometers for Covid-19 screening.

Not available.

Diagnostic accuracy of infrared thermal imaging for detecting COVID-19 infection in minimally symptomatic patients.

INTRODUCTION: Despite being widely used as a screening tool, a rigorous scientific evaluation of infrared thermography for the diagnosis of minimally symptomatic patients suspected of having COVID-19 infection has not been performed. METHODS: A consecutive sample of 60 adult individuals with a history of close contact with COVID-19 infected individuals and mild respiratory symptoms for less than 7 days and 20 confirmed COVID-19 negative healthy volunteers were enrolled in the study. Infrared thermograms of the face were obtained with a mobile camera, and RT-PCR was used as the reference standard test to diagnose COVID-19 infection. Temperature values and distribution of the face of healthy volunteers and patients with and without COVID-19 infection were then compared. RESULTS: Thirty-four patients had an RT-PCR confirmed diagnosis of COVID-19 and 26 had negative test results. The temperature asymmetry between the lacrimal caruncles and the forehead was significantly higher in COVID-19 positive individuals. Through a random forest analysis, a cut-off value of 0.55°C was found to discriminate with an 82% accuracy between patients with and without COVID-19 confirmed infection. CONCLUSIONS: Among adults with a history of COVID-19 exposure and mild respiratory symptoms, a temperature asymmetry of ≥ 0.55°C between the lacrimal caruncle and the forehead is highly suggestive of COVID-19 infection. This finding questions the widespread use of the measurement of absolute temperature values of the forehead as a COVID-19 screening tool.

Covid-19 screening: are forehead temperature measurements during cold outdoor temperatures really helpful?

BACKGROUND: Body temperature control is a frequently used screening test for infectious diseases, such as Covid-19 (Sars-CoV-2). We used this procedure to test the body temperature of staff members in a hospital in Tyrol (Austria), where the Covid-19 disease occurred in March 2020. The hospital is located in a mountain area at 995 m above sea level with low outdoor temperatures during early spring season. Under these conditions, we analyzed whether forehead temperature control offers a sufficient screening tool for infectious diseases. METHODS: Forehead temperature of 101 healthy male and female employees was measured with an infrared thermometer directly after entering the hospital (0 min), followed by further controls after 1 min, 3 min, 5 min and 60 min. We also tracked the outside temperature and the temperature at the entrance hall of the hospital. RESULTS: Complete data of body temperature were available for 46 female and 46 male study participants. The average forehead temperature measured directly after entrance to the hospital was the lowest (0 min) 33.17 ± 1.45 °C, and increased constantly to 34.90 ± 1.49 °C after 1 min, 35.77 ± 1.10 °C after 3 min, 36.08 ± 0.79 °C after 5 min, and 36.6 ± 0.24 °C after 60 min. The outside temperature ranged between -5.5 °C and 0 °C, the indoor temperature had a constant value of 20.5 °C. CONCLUSION: Our results indicate that forehead infrared temperature control is not an appropriate tool to screen for infectious disease directly at the entrance of a building, at least during early spring season with cold outdoor temperatures.

"Masking" our emotions: Botulinum toxin, facial expression, and well-being in the age of COVID-19.

BACKGROUND: The globally devastating effects of COVID-19 breach not only the realm of public health, but of psychosocial interaction and communication as well, particularly with the advent of mask-wearing. METHODS: A review of the literature and understanding of facial anatomy and expressions as well as the effect of botulinum toxin on emotions and nonverbal communication. RESULTS: Today, the mask has become a semi-permanent accessory to the face, blocking our ability to express and perceive each other's facial expressions by dividing it into a visible top half and invisible bottom half. This significantly restricts our ability to accurately interpret emotions based on facial expressions and strengthens our perceptions of negative emotions produced by frowning. The addition of botulinum toxin (BTX)-induced facial muscle paralysis to target the muscles of the top (visible) half of the face, especially the corrugator and procerus muscles, may act as a therapeutic solution by its suppression of glabellar lines and our ability to frown. The treatment of the glabella complex not only has been shown to inhibit the negative emotions of the treated individual but also can reduce the negative emotions in those who come in contact with the treated individual. CONCLUSIONS: Mask-wearing in the wake of COVID-19 brings new challenges to our ability to communicate and perceive emotion through full facial expression, our most effective and universally shared form of communication, and BTX may offer a positive solution to decrease negative emotions and promote well-being for both the mask-wearer and all who come in contact with that individual.

Investigation of the Impact of Infrared Sensors on Core Body Temperature Monitoring by Comparing Measurement Sites.

Many types of thermometers have been developed to measure body temperature. Infrared thermometers (IRT) are fast, convenient and ease to use. Two types of infrared thermometers are uses to measure body temperature: tympanic and forehead. With the spread of COVID-19 coronavirus, forehead temperature measurement is used widely to screen people for the illness. The performance of this type of device and the criteria for screening are worth studying. This study evaluated the performance of two types of tympanic infrared thermometers and an industrial infrared thermometer. The results showed that these infrared thermometers provide good precision. A fixed offset between tympanic and forehead temperature were found. The measurement values for wrist temperature show significant offsets with the tympanic temperature and cannot be used to screen fevers. The standard operating procedure (SOP) for the measurement of body temperature using an infrared thermometer was proposed. The suggestion threshold for the forehead temperature is 36 °C for screening of fever. The body temperature of a person who is possibly ill is then measured using a tympanic infrared thermometer for the purpose of a double check.