Cosmetic

Question 1

Which of the following is a major mechanism for nasal tip support?
(A) Size and shape of nasal bones
(B) Medial crural feet attachment to the nasal septum (C) Anterior nasal spine
(D) Soft tissue thickness of the ala

Answer 1

(B) Medial crural feet attachment to the nasal septum

COMSSAT: 2019
Explanation:
Source:
Kennedy, B.D. (1992). Indications and techniques of rhinoplasty. Principles of oral and maxillofacial surgery. Peterson, L.J. (Eds.). JB Lippincott C.
Koehler, J. & Waite, P.D. (2004). Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed), (pp. 1350). London: BC Decker Inc.
Kennedy, B.D. (2000). Cosmetic Rhinoplasty. In Focesca, R., Baker, S., Wolford, L.M. (Eds.), Oral and maxillofacial surgery, (vol. 6), (pp. 332). Philadelphia, PA: WB Saunders.
Epker, B.N. (1990). Cosmetic oral and maxillofacial surgery. Oral and maxillofacial surgery clinics of north America, (pp.289-338).
Fonseca, R.J. (2000). Cosmetic rhinoplasty. In Oral and maxillofacial surgery, (vol. 6), (pp. 325). Philadelphia, PA: Saunders.
Koehler, J. & Waite, P.D. (2004) Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed.), (pp. 1362). London, England: BC Decker Inc.
Janis, J.E. (2005). Clinical decision-making in rhinoplasty. In F. Nahai (Ed.), The art of esthetic surgery, 1, 1971. St. Louis, MO: Quality Medical Publishing.
Koehler, J. (2009) Basic rhinoplasty. In R.J. Fonseca, Oral and maxillofacial surgery (vol. 3) (2nd edition) (pp. 573). St. Louis, MO: Saunders.

Question 2

The open roof nasal deformity is best corrected by:
(A) nasal septoplasty.
(B) shield graft placement.
(C) lateral nasal osteotomies.
(D) shaving upper lateral cartilages.

Answer 2

(C) lateral nasal osteotomies.

COMSSAT: 2019
Explanation:
Source:
Kennedy, B.D. (1992). Indications and techniques of rhinoplasty. Principles of oral and maxillofacial surgery. Peterson, L.J. (Eds.). JB Lippincott C.
Koehler, J. & Waite, P.D. (2004). Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed), (pp. 1350). London: BC Decker Inc.
Kennedy, B.D. (2000). Cosmetic Rhinoplasty. In Focesca, R., Baker, S., Wolford, L.M. (Eds.), Oral and maxillofacial surgery, (vol. 6), (pp. 332). Philadelphia, PA: WB Saunders.
Epker, B.N. (1990). Cosmetic oral and maxillofacial surgery. Oral and maxillofacial surgery clinics of north America, (pp.289-338).
Fonseca, R.J. (2000). Cosmetic rhinoplasty. In Oral and maxillofacial surgery, (vol. 6), (pp. 325). Philadelphia, PA: Saunders.
Koehler, J. & Waite, P.D. (2004) Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed.), (pp. 1362). London, England: BC Decker Inc.
Janis, J.E. (2005). Clinical decision-making in rhinoplasty. In F. Nahai (Ed.), The art of esthetic surgery, 1, 1971. St. Louis, MO: Quality Medical Publishing.
Koehler, J. (2009) Basic rhinoplasty. In R.J. Fonseca, Oral and maxillofacial surgery (vol. 3) (2nd edition) (pp. 573). St. Louis, MO: Saunders.

Question 3

Cephalic trimming of the lower lateral cartilages of the nose during rhinoplasty has which of the following effects on the nasal tip?
(A) Upward rotation
(B) Downward rotation 
(C) Widening
(D) No effect

Answer 3

(A) Upward rotation

COMSSAT: 2019
Explanation:
Source:
Kennedy, B.D. (1992). Indications and techniques of rhinoplasty. Principles of oral and maxillofacial surgery. Peterson, L.J. (Eds.). JB Lippincott C.
Koehler, J. & Waite, P.D. (2004). Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed), (pp. 1350). London: BC Decker Inc.
Kennedy, B.D. (2000). Cosmetic Rhinoplasty. In Focesca, R., Baker, S., Wolford, L.M. (Eds.), Oral and maxillofacial surgery, (vol. 6), (pp. 332). Philadelphia, PA: WB Saunders.
Epker, B.N. (1990). Cosmetic oral and maxillofacial surgery. Oral and maxillofacial surgery clinics of north America, (pp.289-338).
Fonseca, R.J. (2000). Cosmetic rhinoplasty. In Oral and maxillofacial surgery, (vol. 6), (pp. 325). Philadelphia, PA: Saunders.
Koehler, J. & Waite, P.D. (2004) Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed.), (pp. 1362). London, England: BC Decker Inc.
Janis, J.E. (2005). Clinical decision-making in rhinoplasty. In F. Nahai (Ed.), The art of esthetic surgery, 1, 1971. St. Louis, MO: Quality Medical Publishing.
Koehler, J. (2009) Basic rhinoplasty. In R.J. Fonseca, Oral and maxillofacial surgery (vol. 3) (2nd edition) (pp. 573). St. Louis, MO: Saunders.

Question 4

Bilateral brisk bleeding 48 hours following septorhinoplasty is uncontrollable with anterior nasal packs. What is the next most appropriate step to control the bleeding?
(A) Attempt electrocautery for hemostatsis
(B) Schedule surgical exploration and vessel ligation
(C) Place anterior and posterior nasal packs
(D) Provide external nasal pressure and Afrin nasal spray

Answer 4

(C) Place anterior and posterior nasal packs

COMSSAT: 2019
Explanation:
Source:
Kennedy, B.D. (1992). Indications and techniques of rhinoplasty. Principles of oral and maxillofacial surgery. Peterson, L.J. (Eds.). JB Lippincott C.
Koehler, J. & Waite, P.D. (2004). Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed), (pp. 1350). London: BC Decker Inc.
Kennedy, B.D. (2000). Cosmetic Rhinoplasty. In Focesca, R., Baker, S., Wolford, L.M. (Eds.), Oral and maxillofacial surgery, (vol. 6), (pp. 332). Philadelphia, PA: WB Saunders.
Epker, B.N. (1990). Cosmetic oral and maxillofacial surgery. Oral and maxillofacial surgery clinics of north America, (pp.289-338).
Fonseca, R.J. (2000). Cosmetic rhinoplasty. In Oral and maxillofacial surgery, (vol. 6), (pp. 325). Philadelphia, PA: Saunders.
Koehler, J. & Waite, P.D. (2004) Basic principles of rhinoplasty. Principles of oral and maxillofacial surgery, (2nd ed.), (pp. 1362). London, England: BC Decker Inc.
Janis, J.E. (2005). Clinical decision-making in rhinoplasty. In F. Nahai (Ed.), The art of esthetic surgery, 1, 1971. St. Louis, MO: Quality Medical Publishing.
Koehler, J. (2009) Basic rhinoplasty. In R.J. Fonseca, Oral and maxillofacial surgery (vol. 3) (2nd edition) (pp. 573). St. Louis, MO: Saunders.

Question 5

Which of the following rhinoplasty procedures would lend itself to concomitant treatment with a Le Fort I advancement?
(A) Dorsal augmentation
(B) Nasal tip rotation
(C) Nasal tip narrowing
(D) Decreasing nasal projection

Answer 5

(A) Dorsal augmentation

COMSSAT: 2019
Explanation:
Source:
Ghali, G.E. & Sinn, D.P. (1996). Nasal surgery as an adjunct to orthognathic surgery. Oral and maxillofacial surgery clinics of north America (vol. 8) (pp. 33-43).

Question 6

The etiology of fullness in the lateral aspect of the upper eyelid is:
(A) orbital septum weakness and prolapse of the lacrimal gland.
(B) orbicularis oculi laxity and herniation of temporal fat.
(C) disinersetion of the levator palpeprae aponeurosis.
(D) injury to CN III with Mueller’s muscle paresis.

Answer 6

(A) orbital septum weakness and prolapse of the lacrimal gland.

COMSSAT: 2019
Explanation:
Source:
Waite, P.D. & Matukas, V.J. (1993). Maxillofacial esthetic surgery. Journal of oral and maxillofacial surgery (vol. 51) (pp.82).
Gentile, R.D. (2005). Upper lid blepharoplasty. Facial plastic surgery clinics of north America (vol. 113(4)) (pp. 5111-5124).
Castro, R.D. & Foster, J.A. (1999). Upper lid blepharoplasty. Facial plastic surgery (vol.15), (pp.173- 181).

Question 7

The most important factor determining the stability of counterclockwise occlusal plane rotations in bimaxillary orthognathic surgery is:
(A) preoperative removal of orthodontic compensations. (B) favorable alteration of the posterior facial height.
(C) modest changes to the anterior facial height.
(D) minimizing muscle dissection in the mandible.

Answer 7

(B) favorable alteration of the posterior facial height.

COMSSAT: 2019
Explanation:
Source:
Wolford, L. M., Chemello, P.D. & Hilliard, F.W. (1993). Occlusal plane alteration in orthognathic surgery. Journal of oral and maxillofacial surgery (51), (pp. 730-740).
Epker, B.N. (1993). Discussion (re) occlusal plane alteration in orthognathic surgery. Journal of oral and maxillofacial surgery, (51), (pp. 740-741).
Reyneke, J.P., Bryant, R.S., Suuronen, R. & Becker, P.J. (2006). Postoperative skeletal stability
clockwise and counter clockwise rotation of the maxillomandibular complex compared to conventional
orthognathic treatment. British journal of oral and maxillofacial surgery, (45), (pp. 1)

Question 8

Which of the following is true regarding the 2 layer SMAS (superficial musculoaponeurotic system) technique?
(A) Skoog popularized the procedure of undermining the superficial fascia and skin as a unit.
(B) The ability to adjust both vectors and the differential movement of skin and fat elevation allows greater artistic precision.
(C) This procedure is synonymous with the composite procedure described by Hamra.
(D) This technique releases the superficial fascia from the retaining ligaments while retaining its blood supply.

Answer 8

(B) The ability to adjust both vectors and the differential movement of skin and fat elevation allows greater artistic precision.

COMSSAT: 2019
Explanation:
Source: Azizzadeh, B., Murphy, M., & Johnson, C. (Eds.). (2007).Master techniques in facial rejuvenation. Short- flap SMAS rhytidectomy (pp. 153). Saunders.
Stuzin, J.M., Baker, T.J. & Gordon, H.L. (1992). The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plastic reconstruction surgery (89), (pp. 441).

Question 9

Which of the following statements regarding the use of botulinum toxin for facial rejuvenation is true?
(A) The potency of Botox may be increased by aminoquinolones.
(B) The toxin crosses the blood-brain barrier.
(C) Following reconstitution, Botox must be used within 12 hours.
(D) The use of injected local anesthetic in conjunction with Botox injections is contraindicated.

Answer 9

(D) The use of injected local anesthetic in conjunction with Botox injections is contraindicated.

COMSSAT: 2019
Explanation:
Source: Faigen, S. & Brandt, F. Primary and adjunctive use of botulinum toxin type A in facial aesthetic surgery.

Question 10

60. Which of the following statements regarding the use of dermabrasion is correct?
    (A) Dermabrasion is effective for the treatment of ice-pick scars.
    (B) Scars that improve with manual stretching respond in greater than 50% of cases with a single dermabrasion procedure.
    (C) Repeat dermabrasion should ideally be done within the first 6 weeks following the previous treatment.
    (D) It is preferable to perform a rhytidectomy prior to a dermabrasion in a staged treatment plan.

Answer 10

(B) Scars that improve with manual stretching respond in greater than 50% of cases with a single dermabrasion procedure.

COMSSAT: 2019
Explanation:
Source: Orentreich, N. & Orentreich, D. (2001). Dermabrasion. Clinics of plastic surgery, (28(1)).