Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCS Plastic Surgery > CHAPTER 06: EAR, EYELID & NOSE > Flashcards

CHAPTER 06: EAR, EYELID & NOSE Flashcards

1
Q

Describe the embryology of the ear

Name the parts of an ear

A 
• 4th week: External ear dvlpmt
• By 6th week: 3 anterior hillocks from 1st branchial arch, + 3 posterior hillocks from 2nd branchial arch
• Between arches
- 1st brachial cleft externally 
- 1st pharyngeal pouch internally
  • 1st brachial cleft → Ext auditory meatus
  • Lower anterior hillock → tragus
  • Middle ant hillock → crus of helix
  • Upper ant hillock → major part of helix
  • Lower post hillock→ lobule and lower helix
  • Middle post hillock → antitragus
  • Upper post hillock → antihelix
  • Initially the ear is sited in the lower neck region but as the mandible develops they ascend to the side of the head at the level of the eyes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the blood supply of the ear?

A
  1. Post auricular artery
    → br of external carotid, runs up in sulcus behind ear,
    supplies post skin and lobule.
  2. Superficial temporal artery
    → terminal br of ext carotid. Runs up in front of ear ω auriculotemporal nerve.
  3. Occipital artery
    → dominant supply to the posterior ear in 10% of people.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the nerve supply of the ear?

A
  1. Great auricular
    → Sensation to inner and outer aspects of lower half of ear
  2. Auriculotemporal (V3)
    → Sensation to outer aspect of the superior half
  3. Lesser occipital
    → Sensation to inner aspect of superior half
  4. Auricular branch of Vagus (Arnold’s or Alderman’s nerve)
    → Sensory to conchal fossa + ext auditory meatus
    o Stimulation of nerve ω cold then warm water to conchal fossa induces vagal-induced vomit.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the classification of congenital ear deformity?

A

Tanzer 1975 classified auricular deformities

Type 1 ​= anotia
​Type 2A ​= microtia with atresia of the external auditory meatus
​Type 2B ​= microtia without atresia of EAM
Type 3 ​= Hypoplasia of the middle-third of the ear
Type 4 ​
​Type 4A Constricted ear – lop/cup/pixie
​Type 4B​= Cryptotia
​Type 4C ​= Hypoplasia of the entire upper-third of the ear
Type 5 ​= Prominent Ear

(Stahl’s Ear – Extra Crus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Nagata’s classification of microtia?

A

Lobule type
Concha type
Small Concha type
Atypical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the epidemiology of microtia?

A

Caucasians 1/6000, Japan 1/4000, Navajo Indians 1/1000

Male:female 2.5:1, R:L:B 6:3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What genetic conditions are associated w microtia?

A 
Treacher Collins (bilat)
Hemifacial microsomia (uni)
Goldenhars syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who described different methods of ear recon?

What is the 1st stage of ear recon?

A

Tanzer - Brent – Nagata – Firmin – Gault

Stage 1
Contours of good ear are traced onto x-ray sheet
Cartilage framework prefabricated → main block + helical rim
o helical rim = 8TH RIB (first floating)
o Base of ear = synchondrosis between 6th and 8th

o Sculpt framework with wood carving chisel ω exaggerated helical rim
 Make subcutaneous pocket through incision anterior to auricular vestige (into mastoid skin)
 Remove residual cartilage
 Framework into pocket, suction drains to encourage draping
 Temporoparietal fascial flap may be needed to cover framework

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2nd and subsequent stages of ear recon?

A

Stage 2
Lobule rotated from anterior position into correct site
(+/- release of ear and post auricular FTG in 2 stage only.)

Stage 3
sulcus created, incision just outside helical rim
2-4mm of posterior auricular skin advanced onto helical rim, sulcus then skin grafted.

Stage 4
Tragus construction
conchal excavation
contralateral otoplasty if needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications of ear recon?

A

Specific
Donor site: pneumothorax, loss of contour, pain, haematoma

Ear
haematoma, loss of definition, infection, skin flap necrosis, graft failure, cartilage resorption, extrusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Reconstruction of ear following partial loss

A 
Conchal
FTSG
trap door flap
Banner flap
islanded post auricular flap

Upper 1/3
Antia & Buch helical advancement
Banner flap
Pocket technique (bury chondral cartilage post auricular & suture to cut edge of ear. 2nd stage elevate and FTSG back)

Middle 1/3
wedge / Antia & Buch
composite grafts (contralateral ear)
tubed bipedicle flaps from postauricular skin (2 stage)

Lower 1/3
2 or 1 stage - local flaps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What techniques are there for prominent ear correction?

A

Neonatal - splintage

Surgical

  • Suture
  • Excisional
  • Cartilage moulding
  • Combination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe some suture techniques

A

Furnas - conchomastoid
- Gault modification - excise post-auricular muscle
Mustarde - conchoscaphoid
mattress sutures - ↑ the degree of antehelical folding.
Fossa-fascia - scaphoid fossa to temp fascia for upper pole prominence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe some excisional techniques

A

skin excision - recurrence
lobule correction (fishtail / transverse excision closed vertically)
conchal fossa excision (Skoog)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe some cartilage moulding techniques

A

Gibson principle - cartilage bends away from scored surface
Chongchet - anterior scoring
Stenstrom - percutaneous scoring
(posterior scoring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe your technique of otoplasty

A
  • Get pts to show you what they want in a mirror!
  • Balance the ear rather than just reducing prominence
  • 7% chance inadequate correction
  • Posterior dumbbell de-epithelialised, not excised
  • Fascial flap to cover stitches
  • Round bodied Ethibond
  • 5 or 6 sutures - keeps superior one untied until end
  • 19mm is usual projection at 25-30deg angle
  • Leave an extra stitch untied at superior pole to use, before closing, if needed
  • Look at slope - vertical more formal, slanted in line with nose more attractive - change if necessary
  • Using splints more and more at up to 8 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the anatomy of the eyelid and draw!

A

Anterior lamella
- skin, orbicularis oculi

Posterior lamella
- tarsal plate and conjunctiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the anatomy of the eyelid retractors?

A
  1. Levator palpebrae superioris
    origin - lesser wing of sphenoid → tented over Whitnall’s lig → medial & lat canthal tendon
    insertion - levator aponeurosis
  2. Levator aponeurosis → inserts into tarsal plate (posteriorly) and skin and orbicularis oculi muscle (anteriorly) = upper eyelid fold
3. Muller's muscle
origin - undersurface of LPS
insertion - tarsal plate
adjacent to conjuntiva
sympathetic innervation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the anatomy of Oriental eyelid without fold

A

levator aponeurosis inserts solely to tarsal plate and not to skin therefore there is no upper eyelid fold
post septal fat pads can herniate down anterior to tarsal plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does the orbital septum originate and insert?

A

origin - orbit

insertion - levator aponeurosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the location of the fat pads

A

Post-septal (preaponeurotic) fat pads
upper lid: 2
lower lid: 3

Pre-septal fat pads
upper lid: ROOF (retro-orbicularis oculi fat)
lower lid: SOOF (suborbicularis oculi fat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the lower eyelid retractor?

A

Capsulopalpebral fascia - continuous posteriorly with Lockwood’s ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the bones of the orbit?

A

Medial - Ethmoid, Sphenoid - Lesser Wing, Palatine, Lacrimal (SPEL)

Floor - Maxilla, Zygoma

Lateral - Zygomatic, Frontal

Roof - Frontal

Posterior - Sphenoid – Greater Wing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is ectropion?

A

Rotation of the eyelid margin away from the globe (c.f. retraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the causes of ectropion?

A

Congenital

  • orbicularis spasm
  • skin shortage e.g. Downs

Acquired ‘PICM’

  • paralytic (VII palsy)
  • involutional (ageing)
  • cicatricial (skin shortage - test - open mouth & look up)
  • mechanical (e.g. Meibomian cyst)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the principles of surgical correction?

A

CICATRICIAL
- release tethered structures and skin graft / flap defect

INVOLUTIONAL - reconstruction choice depends on

  • amount of laxity
  • canthal tendon stability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What procedures are used to correct ectropion?

A

medial laxity, stable medial canthus
→ medial wedge excision (but risk to punctum)

medial laxity, unstable medial canthus
→ medial canthopexy = canthal plication

lateral laxity, stable lateral canthus
→ Kuhnt-Szymanowski = differential wedge excision of (obsolete)

lateral laxity and lateral canthus unstable
→ Lateral canthal sling = lateral tarsal strip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is entropion?

A
  • Movement of the lower eyelid margin towards the globe

- Lashes and eyelid margin cause pain, trauma and corneal scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the causes of entropion?

A 
Congenital
Involutional - vertical deficiency of posterior lamella
Cicatricial
Spastic
(Enophthalmos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do you correct entropion?

A

Cicactricial

  • Release posterior lamella cicatricial bands & graft
  • Everting sutures
  • Transverse fracture of tarsal plate
  • Everting wedge excisions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
What is blepharoptosis or ptosis?
What is blepharophimosis?
What is dermatochalasis?
What is blepharochalasis?
What is blepharochalasis syndrome?
A

A - drooping of upper eyelid
B - congenitally small palpebral fissures
C - redundancy of eyelid skin and herniation of orbital fat
D - rare AD condn, atopic eyelid oedema results in atrophy of upper lid tissues
E - recurrent bouts of eyelid oedema, unknown aetiology, results in excess eyelid skin & canthal laxity

32
Q

What are the causes of ptosis?

What are the causes of blepharophimosis?

A

A - MyMAN
Myogenic → Congenital levator dystrophy, Myasthenia gravis, Blepharophimosis
Mechanical → Blepharochalasis, Tumour, Scar
Aponeurotic → Congenital or acquired defect in levator mechanism
Neurogenic → CN III palsy, Horner’s (Ptosis, Meiosis, Anhydrosis, Enophthalmos → ptosis due to the paralysis of the sympathetically innervated Muller’s muscle)

B
congenital ptosis
epicanthal folds
telecanthus

33
Q

What is Hering’s law?

A

Hering’s law - in unilateral cases elevate ptotic lid, normal lid will drop (bilateral compensatory over-innervation)
in these cases, after unilateral ptosis correction, the normal lid is no longer over-innervated and ptosis results

33
Q

How do you assess ptosis 1?

A
  1. Observe
    - ocular alignment
    - scars on the forehead or lids from previous surgery
    - head position
    - pupils (Horners?)
  2. Palpebral aperture
    (F 8-12mm, M 7-10mm)
    “look at distance”
  3. Marginal reflex distance
    - distance b/t centre of upper lid margin and light reflex on cornea
    (4-4.5mm)
  4. Pretarsal show (reduced in dermatochalasis due to hooding and orbital fat herniation)
34
Q

How do you assess ptosis 2?

A
  1. Lid margin to crease distance
    (F 10mm, M 8mm)
    “look down”
6. Upper lid to corneal limbus distance PTOSIS
<2mm - normal
2mm - mild
3mm - moderate
4mm - severe
35
Q

How do you assess for ptosis 3?

A
  1. Levator excursion FUNCTION
    - distance the eyelid travels from downgaze to upgaze while frontalis muscle is held inactive at the brow
    < 4mm – poor
    5-11 mm – fair
    12-14 mm – good
    >15mm - normal
  2. Check for
    - Orbital fat herniation
    - Lid lag
    - Bell’s phenomenon
    - Corneal sensation
    - Dry eyes (Schirmers test 1)
36
Q

What are the operations for ptosis correction? What factors affect the choice of operation?

A
  1. Levator function
  2. Degree of ptosis
     Good Levator >10mm with mild ptosis <2mm → Fasanella-Servat Mullerectomy
     Good/Poor Levator >10mm with mod ptosis 2-4mm → Levator surgery
     Poor Levator <10mm with marked ptosis >4mm → Brow suspension
37
Q

What is Fasanella-Servat Mullerectomy?

A
  • Transconjunctival approach
  • Demarre retractor
  • 9mm of conjunctiva and lower Muller’s muscle clamped in artery clip, sutured & excised
38
Q

What is levator surgery?

A
  • skin / transconjunctival approach
  • incise skin at lid crease (or future crease)
  • suborbicularis dissection superiorly
  • expose orbital septum to enter preaponeurotic space (w fat & levator aponeurosis visualised)
  • continue suborbicularis dissection inferiorly to expose superior aspect of tarsal plate
  • medial & lateral horns of levator are divided
  • levator advanced and sutured to sup tarsus
  • pt asked to gaze up and down, adjust as necessary
  • permanent sutures, excise excess levator
  • skin closed +/- lid crease repositioning
  • LA - use minimally so levator not paralysed
    adrenaline may stimulate Mullers muscle (can under correct, but better than overcorrect!)
39
Q

What is brow suspension?

A
  • Brow suspension = frontalis fixation
  • Static procedure, for little / no levator func
  • Strip of fascia lata inserted transversely just above lid margin
  • Fascial slip is then tunnelled suborbicularis and subfrontalis and secured to periosteum in forehead via stab incisions
40
Q

What are the principles of eyelid reconstruction?

A
  1. Anterior and posterior lamellae should be considered separately
  2. Upper eyelid is a curtain, lower is a support
  3. Upper lid is sacrosanct - lower can be used to reconstruct upper, but not upper for lower
41
Q

How do you reconstruct the upper eyelid?

A

Upper
<33% - primary repair
33-50% - Lateral canthotomy & cantholysis, advancement of lateral myocutaneous flap
50-75% - Tenzel semicircular flap
75% - Cutler-Beard, tarsoconjunctival graft etc

42
Q

How do you reconstruct the lower eyelid?

A 
Lower
<33% - as for upper
33-50% - as for upper
50-75% - Tenzel, Mustarde cheek rotation
75% - Hughes Procedure - 2 stage - tarsoconjunctival flap from inside of upper lid and FTSG
43
Q

How do you close eyelid defects up to a 1/3 in the upper and lower eyelid?

A
  • Pentagon / wedge excision
  • Close lid margin first with 3 interrupted sutures (6→7/0 PDS) passing through grey line (b/t ant and post lamellae at margin)
  • Tarsus and orbicularis closed in layers 6/0 absorbable. Deep layers 6/0 or 7/0 absorbable sutures, passing through tarsal plate and just picking up conjunctiva, then passing backwards through conjunctiva and tarsal plate. The knot should be buried deep within eyelid anterior to tarsal plate.
  • 7/0 non-absorbable everting sutures to skin
44
Q

How do you treat eyelid defects 1/3 - 1/2 of entire upper (or lower) lid?

A
  1. Close with advancing semicircular skin flap medially. Suture lid margin first then tarsus and orbicularis.
  2. Lateral canthotomy (=cantholysis) of upper (or lower) canthal tendon
    - Medial traction applied to lateral part of lid - Canthal tendon can then be felt as a tight band
    - The tendon is dissected by spreading scissors along its edges
    - It is then divided allowing lower eyelid to advance medially
  3. Lateral myocutaneous flap advancement
45
Q

How do you treat upper eyelid defects >1/2?

A
  1. Cutler-Beard flap – 3 layers:
    - Inferiorly based U shaped skin-muscle flap taken from the lower eyelid.
    - Superiorly based conjunctival flap from lower lid
    - Interposed ear cartilage graft for support
    - The apex of the skin-muscle flap lies ~ 5mm below the margin of the lower eyelid
    - The sides of the flap run vertically downwards from the apex. The flap is composed of the full thickness of the lower eyelid.
    - The flap is advanced into the upper eyelid defect under the 5mm bridge of intact lower eyelid. It is sutured into place to lie across the globe.
    - The eyelids are secured to each other by the flap for 6 weeks then divided as a second procedure.
  2. Mustardé lower-lid switch flap
    - A laterally based transverse flap of the lower eyelid is transposed to the upper lid.
    - The lower lid is reconstructed with a cartilage/mucous membrane graft
    - It may not be possible to close the lower lid defect primarily so this will also need reconstruction
    - The transposed flap is divided as a second procedure
46
Q

How do you treat lower eyelid defects >1/2?

A

Combination of

  • cheek advancement flap (anterior lamella)
  • septomucosal graft (posterior lamella)
  1. Septomucosal graft
    - via lateral rhinotomy incision in alar groove
    - harvest strip of septum and mucosa avoiding perforating other sides mucosa
    - graft then scored and secured to tarsal plates or canthal tendon
    - superiorly the mucosa of the graft should slightly overlap the underlying graft so that the eyelid margin is reconstructed with mucosa
  2. Cheek rotation flaps
    - is then advanced over the graft and secured
    - McGregor pattern - with Z-plasty superiorly
    - Mustardé pattern - without
47
Q

What alternatives are there to reconstruct the anterior lamella?

A
  1. Tripier transposition flap
  2. Transposition flaps from cheek or lateral border of nose
  3. Glabellar flaps (medial canthus)
48
Q

What alternatives are there to reconstruct the posterior lamella?

A
  1. Hughes tarsoconjunctival flap (for upper and lower)
  2. Septomucosal graft (nasal)
  3. Conchal graft (ear)
49
Q

Definitions of the following conditions

  1. Trichiasis
  2. Symblephron
  3. Epicanthic folds
  4. Evisceration
  5. Enucleation
  6. Exenteration
A
  1. eyelashes turned inwards toward globe
  2. fusion of eyelids to globe (e.g. after chemical burn)
  3. removal of globe with sclera intact
  4. removal of globe with orbital tissues intact
  5. complete removal of orbital contents and eyelid
50
Q

What are the principles of nasal reconstruction?

A

skin
cartilage
lining

51
Q

Who described the nasal subunits and what are they?

A 
Gonzales-Ulloa 1956
dorsum
tip
columella
sidewall x2
ala x2
soft triangle x2
52
Q

What local flap options are there for nasal recon?

A
  • banner
  • bilobed
  • dorsonasal (Rieger) - Hatchet
  • Rintala - advancement
  • forehead flap
  • nasolabial flap (ala recon)
53
Q

What factors affect your choice of surgery?

A

Choice determined by:

  1. Levator function
  2. Degree of ptosis

 Good Levator >10mm with mild ptosis <2mm → Fasanella-Servat Mullerectomy
 Good/Poor Levator >10mm with mod ptosis 2-4mm → Levator surgery
 Poor Levator <10mm with marked ptosis >4mm → Brow suspension

54
Q

Describe the anatomy of the nose

A

Skin
varies in texture, colour and appearance
glabellar area - thin, pale, pliable
sidewalls - thin, pale, matt
nasal tip - thick, sebaceous, shiny, pink, telangectasia, porous
alar rim - thickened, spongy, or refined in females

Musculature
procerus (glabellar transverse lines), depressor septi (widens nasal aperture), compressor nasalis (compresses nasal aperture)

55
Q

What is the blood and nerve supply of the nose?

A

Nerve

Arterial

Lymphatic

56
Q

What should be considered in nasal recon?

A

incisions made at natural lines if poss
replace subunit if >50%?
areas of tissue availability - nose, forehead, glabellar, retroauricular, cheeks, neck

57
Q

What flaps are used for medial canthal recon?

A

glabellar flaps - rotation, midline transposition (finger flap), glabellar island flap
Other recon options - leave to granulate, FTSG

58
Q

nasal sidewall

A

Banner, bilobed, nasolabial (sup based), (NL island flap)

59
Q

nasal tip

A

composite graft

Rintala flap, bilobed, Hatchet

60
Q

columella

A

Nasolabial (2 stage)
Fork flaps (cleft lip only)
Alar rim flaps

61
Q

For a complex nasal reconstruction, what needs to be considered?

A

Reconstruction of 3 layers
nasal lining
cartilage
skin

62
Q

How do you reconstruct the nasal lining?

A 
skin graft
hinge flaps
nasolabial flaps
cheek axial flaps
forehead flap inturned
63
Q

Describe the paramedian forehead flapmake a template with steristrips

A
  • usu based on ipsilateral forehead to lesion
  • pedicle = supratrochlear artery (1.7 - 2.2cm lateral to midline)
  • supratrochlear artery exits orbit, pierces orbital septum, passes under orbicularis oculi and over corrugator supercilli. At the level or the eyebrow, it passes through orbicularis and frontalis muscles and continues vertically in subcutaneous tissue plane.
    When raising flap - dissect subcut up to eyebrow (corrugator starts), then submuscular dissection (under corrugator) and finally subperiosteal dissection under orbicularis oculi to supratrochlear notch (if necessary for reach)
  • can divide pedicle in 3 wks
  • can prelaminate flap (also delays flap)
64
Q

Describe the Washio flap

A
  • to reconstruct alar and heminose defects
  • flap raised from postauricular and mastoid area, based on superficial temporal artery (doppler out)
  • base of the flap is tip of the helix and temporal hairline
  • can delay flap to improve vascularity
    transilluminate flap to see pedicle!
    suture skin in place, and divide in 2-3wks, unused flap is returned to donor site
65
Q

How do you reconstruct conchal / antehelical defects?

A
  • FTSG
  • trap-door flap
  • islanded retroauricular flap
66
Q

What are the options for upper 1/3 defects?

A
  • Helical advancement (Antia Buch) 3cm or less
  • Banner flap and contralateral conchal cartilage graft
  • Pocket technique: dermabrade avulsed segment, insert under post-auricular skin incision, suture pocket to edge of stump, release after 4wks (poor cosmoses, jeopardises future autologous ear recon)
  • Chondrocutaneous composite flap (based on skin pedicle from root of helix, donor site grafted)
67
Q

What are the options for middle 1/3 defects?

A
  • Direct closure / wedge
  • Antia Buch

Rim defects

  • Tubed pedicled flaps - waltzed in (3 stage)
  • Converse tunnel technique - tunnel cartilage graft under post auricular skin and joined to edge of helical defect, released after 3wks
  • Composite grafts
  • Ipsilateral conchal cartilage graft
68
Q

What are the options for lower 1/3 / lob recon?

A

2 stage recon
contralateral composite graft
1 stage recon

69
Q

What surgical tips are there for replant of amputated ear?

A
  • use post auricular artery (do not sacrifice superficial temporal artery)
  • often no vein is found - leeches
  • banking avulsed cartilage rare provides good aesthetic result, don’t burn bridges!
70
Q

How is Stahl’s ear managed?

A

Stahl’s bar = 3rd crus protecting from anti helix with flattening of helical rim

  • Anterior stepped wedge excision of skin and cartilage, cartilage graft from conchal bowl inset behind approximated cartilage wedges
  • Turnover/ rotation flaps
71
Q

How is cryptotia managed?

A

Neonatal splintage

Retroauricular skin flaps

72
Q

How common is prominent ears?

A

5% popn
AD inheritance

Normal measurements

  • 1.5-2cm projection of helical rim to scalp
  • axis of ear to vertical 20deg
  • height 6.5cm
  • conchoscaphoid angle 90deg

Main features

  • poorly defined AHF
  • conchal excess (>1.5cm)
  • increased projection
73
Q

What are the risks of anterior scoring technique?

What is the recurrence rate of suture vs cartilage scoring techniques?

A 
asymmetry 18.4%
residual deformity 5%
chondritis
bleeding 2.6%, haematoma 0.4%wound dehiscence 0.4%, infection 0%
keloid scars 0.4%
inclusion cysts 0.6%
loss of sensation 3.9%
tender ears 5.7%

Recurrence
Suture 24%
Cartilage scoring 10%

74
Q

What are the different types of dermoid cysts?

A

Acquired - implantation type
Congenital teratoma type
Congenital inclusion type - at sites of embryonic fusion plates

Frontotemporal (lateral brow) 65%

  • split orbicularis oculi, excise down to periosteum
  • no workup

Orbital 25%

  • F:M 2:1
  • adhere to frontozzygomatic and medial sutures, no transosseus extensions, no workup

Nasoglabellar 10%

  • may present with split nasal bone
  • may have occult naso-ethmoid and cranial base abnormalities
  • dorsal nasal dermoids need CT MRI work up
  • midline or bicoronal approach

FRCS Plastic Surgery (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions