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questions pratiques de l'université montréal > Esthétique (visage) > Flashcards

Esthétique (visage) Flashcards

1
Q

Types de ride créées les corrugateurs

A

glabellaires obliques (pour chef oblique)

glabellaires obliques et verticales (pour chef transverse)

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2
Q

Types de ride créées par le depressor supercilii

A

glabellaires obliques

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3
Q

Types de ride créées par le procerus

A

ride glabellaires obliques + transverse nasal root line

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4
Q

types de rides créées par l’orbicularis oculi

A

crow’s feet

(peu d’effet sur les rides glabellaire)

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5
Q

3 structures à libérer dans un brow lift

A

-Adhésion ligamentaire temporal et supra-orbitaire
-Épaississement orbitaire latéral du septum orbitaire
-Orbital ligament

si 4e = brow retaining ligament

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6
Q

4 effets du vieillissement sur le front

A

accentuation des rides transverses
rides glabellaire
ptose du sourcil
dyschromie cutanée

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7
Q

Brow lift:
9 points clefs de l’éval pré-op

A
  1. Degré de convextié de os frontal
  2. Proéminence rebord supraorbitaire
  3. Position ligne des cheveux
  4. Position des sourcils
  5. Rides statiques
  6. Rides dynamiques
  7. Qualité de la peau (laxité, dyschromie)
  8. Évaluer ptose des sourcils
  9. Quantité de gras rétro-orbiculaire
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8
Q

comment faire pour évaluer la ptose des sourcils

A
  1. fermer yeux et relaxer sourcils
  2. immobiliser frontalis avec pression digitale
  3. demander ouvrir les yeux

Si sourcil est plus bas quand patient ouvre les yeux = était compensé par hyperactivité du frontalis

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9
Q

6 approches pour le brow lift

A

Coronale
Anterior hairline incision
Endoscopique
Temporale
Transblepharoplastie
Directe (suprabrow ou midforehead)

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10
Q

4 types de plans de dissection pour un brow lift

A

sous-cutané
sous-galéal
sous-périosté
biplanaire (sous-cut + sous-périosté)

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11
Q

brow lift: avantages et 2 inconvénients du plan de dissection sous-cutané

A

(+++)
-préserve branche profonde n. supra-orbitaire
-bon pour améliorer rides transverses
(—)
-Dissection difficile
-Lambeau moins vascularisé
-myectomie difficile

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12
Q

Brow lift: 3 façon d’affaiblir les muscles

A

Excision directe
Scoring du fascia
Neuromodulateur

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13
Q

Brow lift: combien de cm du frontalis faut-il garder au-dessus des sourcils pour préserver l’animation des sourcils

A

au moins 2 cm

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14
Q

brow lift: quel est le ratio de lift du sourcil p/r à l’exicion cutané
- en approche coronal
- en approche directe

A

coronale: 2:1
directe: 1:1

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15
Q

3 façons de sécuriser un browlift

A

exérèse cutanée
sutures
encre osseux

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16
Q

complication brow lift

A

Dimpling
Paresthésie front/scalp
Dlr chronique / dysesthésie
Nécrose cutanée
Alopécie
Asymétrie des sourcils
Overcorrection
Cicatrice visible ou vicieuse

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17
Q

buts d’une blépharoplastie

A
  • Créer un pli supratarsien bien défini
  • Exposer la peau pré-tarsienne lisse
  • Affiner le volume
  • Retirer l’excès cutané
  • Corriger la ptose
  • Retrouver la position normale des paupières
  • Minimiser les cicatrices (mettons pas en premier)
    -Éviter le webbing
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18
Q

4 indications de blepharoplastie

A

ptose
dermatochalasis
changement de pigmentation
steatoblépharon

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19
Q

5 contre-indications d’une blépharoplastie

A

yeux sec
absence de Bell phenomenom
lagophtalmos
conditions neurogéniques (ex: MG)
conditions inflammatoires

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20
Q

4 caractéristiques d’une paupière asiatique

A

tarse plus court
absence du pli supra-tarsien
ptose des cils
Gras pré-aponévrotique plus descendu

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21
Q

Décrire le traitement de la paupière inférieure selon la laxité

A

1-2mm, Peu de laxité -> LASER CO2, TCA, Suspension de l’orbicularis oculi

3-6mm, Laxité modérée -> Canthopexie

> 6mm, Laxité sévère -> Canthoplastie

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22
Q

Indications de fixation du tarse (4)?

A

-Paupière asiatique
-Pli supra-tarsien pré-op <4-7mm de la marge de la paupière
-Blépharoplastie secondaire
-Ptose du sourcil associé chez un

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23
Q

3 technique de fixation du tarse

A

i. Suture peau-tarse-lévator
ii. Encrage de l’orbicularis au lévator
iii. Excision 5mm d’orbicularis

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24
Q

Qu’est-ce que le « 5-step lower lid blepharoplasty »?

A
  • fat augmentation i(malar fat graft, deep medial compartmnet)
  • transconjunctival fat removal
  • release of orbital retaining ligament,
  • lateral retinacular suspension (lateral canthopexie)
  • removal of skin
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25
Q

prise en charge d’un hématome rétro-bulbaire

A

○ Hypotension contrôlé
○ Élevé tête du lit
○ Libérer des sutures
○ Cantholyse latérale
○ Mannitol (12.5g IV bolus sur 5 min)
○ Acetazolamide (diamox: 500mg IV bolus)
○ Steroide (Solumedrol: 100mg IV)
○ Respirer dans un sac, ou O2 95%, CO2 5%
○ Beta-bloqueur topique (betoptic)

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26
Q

Qu’est-ce qu’un A-frame deformity?

A

Déformation au-dessus du pli supra-tarsien secondaire à la résection trop grande de graisse nasal et central au-dessus du septum inter-pad. Tu as encore tes glandes lacrimales en latérale

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27
Q

Nommez des tests pour diagnostiquer un œil sec

A
  • Shirmer’s 1 (N = >1cm after 5mm)
  • Shirmer’s 2 (<40% S1)
  • Rose bengal stain
  • Tear breakup time
  • Tear lysozyme electrophoresis
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28
Q

Qu’est-ce qu’un snap back test normal?

A

Tirer sur la paupière inférieure et permettre la rétraction

N = <1s (N’a pas le temps de cligner des yeux)

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29
Q

Qu’est-ce qu’un pinch test normal?

A

< 6mm

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30
Q

3 approches bleph inf

A

transconj
sous-ciliaire
directe

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31
Q

Facteurs de risque pour faire un ectropion? (4)

A

approche sous-ciliaire
laxité cutané importante
proptose
dysthyroidie
myopie unilatérale haute

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32
Q

PEC aigue d’un ectropion

A

Taping
Suture de Frost
Massage
Injection stéroides

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33
Q

PEC tardif d’un ectropion

A

Si perte de peau : Midface lift ou FTSG

Si hypotonie : Wedge excision de la portion inadéquate ou canthopexie
i
Si perte de lamelle postérieure : Spacer graft

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34
Q

Quelles sont les complications de la blépharoplastie (10)

A
  • Asymétrie
  • Hématome rétro-bulbaire
  • Cécité (0.04%)
  • Ectropion
  • Lagophtalmos
  • Ptose
  • Yeux secs
  • Dommage cornéen
  • Chemosis
  • Abcès de point, kyste, infection granulome
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35
Q

Pourquoi le LASER augmente le risque d’œil sec?

A

Endommage les nerfs cornéen terminaux avec lambeau de cornée

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36
Q

5 Facteurs de risque pour les yeux secs

A
  • Yeux sec pré-op
  • LASER
  • Vecteur négatif du globe
  • Laxité paupière inférieure
  • Proptose
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37
Q

Muscle le plus communément endommagé lors d’une blépharoplastie

A
  • Oblique inférieur (#1)
  • Oblique supérieur
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38
Q

décrire la ligne de Pitanguy

A

0.5cm sous le tragus à 1.5 cm latéral au sourcil

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39
Q

4 caractéristiques d’un front vieillissant

A

Ride transverse du front
Ride glabellaire verticales et obliques
Ptose de sourcil
Dyschromie

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40
Q

Buts du brow lift (3)

A

Resuspendre le sourcil
Resuspendre la peau de la paupière
Atténuer les rides

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41
Q

3 techniques de manipulation des graisses

A

Loeb’s procedure: Medial fat slid out of compartment into tear trough, sutured to angular muscles

Libération du arcus marginalis: lower compartment fat redraped over rim

Septal reset: Graisse du compartiment inférieur redrapée sur rebord avec repositionnement des septum orbitaire en le suturant au périoste

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42
Q

3 techniques d’affaiblissement des muscles?

A
  • Scarification
  • Excision
  • Paralysie chimique
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43
Q

Liste des + et – du brow lift coronal

A

+ : Cicatrice cachée, bien pour les lignes de cheveux basses (1.5cm = 1mm d’élévation), bonne exposition

    • : Alopécie, anesthésie du scalp, dysesthésies, longue cicatrice, recul de la ligne des cheveux
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44
Q

Liste des + et – du brow lift directe?

A

+ : Simple, ratio 1 :1 prédictible, correction de l’asymétrie, bien pour les hommes chauves

  • : Cicatrice visible, hyperesthésie
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45
Q

Liste des + et – du brow lift transpalbébral?

A

+ : Blépharoplastie en même temps, bien pour les hommes chauves, cicatrice minime, bien pour accéder à la glabella, innervation préservée

  • : Élévation limitée, difficile
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46
Q

Liste des + et – du brow lift temporal?

A

+ : Sensation préservée, cicatrice cachée, bonne élévation latérale

  • : Alopécie, accès difficile à la glabelle, pas d’élévation médiale , risque lésion. nerf facial
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47
Q

Quels sont les + et les – d’un brow lift dans la ligne des cheveux?

A

+ : Peut avancer la ligne des cheveux, approche sous-cutanée, sous-galéal et sous-périosté possible

  • : Risque de visibilité de la cicatrice
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48
Q

Quels sont les + et les – d’un brow lift endoscopique?

A

Quels sont les + et les – d’un brow lift endoscopique?

+ : Cicatrice minime, magnification, bonne exposition, bonne vision de la glabelle

  • : Difficile, $, Accès limité aux rides profonds
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49
Q

Nommez des façons de sécuriser l’élévation du sourcil (9

A
  • Excision cutanée
  • Sutures
    –>Tunnel cortical
    –>Sutures de suspension
  • Vis percutanée ou interne
  • K-Wire
  • Mitek
  • Endotine
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50
Q

5 causes de ptose

A

Congéniale
Involutionnelle / sénile
Traumatique
Neurogénique (horner, paralysie 3, MG)
Mécanique (dermatochalasis, tumeur, tose sourcil)

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51
Q

comment classifier la fonction du levator

A

mauvaise: 0-5mm
acceptable: 5-10mm
bon: >10mm

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52
Q

Pseudoptoses: 5 causes extrinsèques

A

Grave’s: retraction paupière unilat donne impression de ptose controlat

Enophtalmie post trauma: plus grand contenant = rétraction du globe

Exophtalmie controlatérale: fausse impression de ptose controlat

Hypotropie: rotation vers le bas du globe

Blépharospasme essentiel

dermatochalasis

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53
Q

4 signes cliniques d’une ptose congénitale

A

diminution ouverture palpébrale, reduced margin to light reflex, diminution de l’excursion du levator, lagophtalmos on downward gaze: #1

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54
Q

anomalies associées à une ptose congénitale

A
  • Strabisme
  • Amblyopie
  • Anophtalmie ou microphtalmie
  • Hamartome
  • Syndrome de Marcus-Gunn (Connections III-V3 (moteur))
  • Syndrome blepharophimosis (Ptose, télécanthus, blepharophimosis)
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55
Q

Quelle sont des degrés de ptose?

A
  • Légère 1-2mm
  • Modérée 3mm
  • Sévère >4mm
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56
Q

Pourquoi cela cause un problème d’utiliser de l’épinéphrine dans la correction de ptose?

A

Stimule le muscle de Muller, donc a risque de sous-correction, doit avoir l’air SUR-corriger sur la table

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57
Q

Complications d’une correction de ptose?

A

Sous correction
Sur-correction
Exposition cornéenne, kératite, yeux secs
Anomalies de contour
Asymétrie
Anomalies des cils
Entropion, ectropion
Débalancement des EOM (Diplopie)
Prolapsus de la conjonctive

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58
Q

en quoi gras orbitaire est physiologiquement différent du gras normal

A

Cellules plus petites
Gras plus saturé
Moins de lipoprotéine lipase
Moins actif métaboliquement
Moins affecté par la diète

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59
Q

4 fonction des larmes

A

-Lubrification pour mouvement des paupières
-Antibactérien
-Oxygénation de l’épithélium cornéen
-Maintient une surface de globe réfractive lisse

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60
Q

How do you differentiate an injury to the marginal madidubular nerve vs injury to cervical branch

A

Eversion of the lower lip is still possible with injury to cervical branch but not with marginal mandibular injury (mentalis paralysis)

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61
Q

Discuss the differences between intrinsic aging and extrinsic aging

ici: intrinsic

A

Epidermis
-less keratinocytes and melanocytes,
-stratum corneum is more compact

Dermis
- atrophy
-loss of elastic fibers
-increase in type III collagen
-larger and less functional fibroblasts

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62
Q

Discuss the differences between intrinsic aging and extrinsic aging

ici: extrinsic

A

Epidermis
- atrophy, thin membrane basale, change in pigmentation
Dermis
- increase in elastic fibers, dermoelastosis,

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63
Q

Describe the histological changes of wrinkles

A
  • loss of dermo-epidermal pappilaes
  • reduction in melanocytes/langherans
  • reduction in collagen
  • atrophic dermis
  • thinning of ground substance
  • increase in sebaceous gland size
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64
Q

List 4 main mechanisms of aging in the soft tissue

A
  • descent from gravitational forces
  • deflation/volume loss
  • fat accumulation in lower third of face
  • radial expansion (soft tissue expands away from the face due to repeated animation that stretches retaining ligaments
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65
Q

List bony changes that occur with age

A
  • Retrusion of the intraorbital rim and anterior maxilla
  • Inferolateral and superomedial expansion of the orbit
  • reduction of facial height to due loss of alveolar bone in the maxilla and mandible
  • downward and inward rotation of facial structures
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66
Q

What are the goals of facelift

A
  • rejuvenation of the face
  • correction of ptosis
  • augment volume
  • correct muscle laxity
  • augment zones with bone loss
67
Q

Name 4 types of incisions that can be used for facelifts

A
  1. Temporal
  2. Pre-auricular (pre or retro-tragal)
  3. Post auricular
  4. Occupital (pre or post hairline)
68
Q

What are the vectors for the skin and SMAS in facelift

A

Skin: posterior and vertical (perpendicular to the mandible body)

SMAS: vertical and diagonal on the platysma

69
Q

Name 4 types of facelifts

A
  • Subcutaneous
  • Deep subcutaneous
  • Sub-periosteal
  • Skoog
  • Endoscopic
70
Q

What are some advantages and disadvantages of subcutaneous facelift

A

Advantages
- simple and quick
- facial nerve is protected
- good for patients with only skin laxity

Disadvantages
- increased risk of skin necrosis
- only on vector for traction
- persistance is shortened

71
Q

What are the advantages and disadvantages of deep subcutaneous facelift

A

Advantages
- robust flap, SMAS is not penetrated, superficial fat compartments are captured, allows defatting

Disadvantages
- Unidirectional vector
- fixation depends on sutured tension

72
Q

Name 3 variations of the sub-cutaneous facelift

A
  • minimal access cranial suspension
  • imbrication
  • plication
73
Q

What are the advantages of subcutaneous facelift with imbrication

A

Advantages
- safe and rapid compared to subsmas
- can reshape deeper structures (2 vectors)
- removes tension from skin closure

Disadvantages
- risk of suturing branch of facial nerve
- less scar formation (less kong term results)
- deep palpable sutures

74
Q

What is the ideal patient to undergoe SMASectomy

A
  • patients with more subcutaneous fat
75
Q

In SMASectomy where is the SMAS excised

A
  • region overlying anterior edge of the parotid gland and parallel to the naso-labial fold
76
Q

Describe the Skoog facelift

A

SMAS elevated as a single unit with the skin

77
Q

What are the advantages and disadvantages of Skoog faclift

A

Advantages
- flap is thick and robust
- more durable result

Disadvantages
- more risk for facial nerve
- naso-labial fold cannot be improved
- single vector of pull

78
Q

List the different variations of the subcutaneous and sub-SMAS dissection

A
  • Low SMAS
  • High SMAS
  • Composite lift
  • Lamellar lift
  • Fondation lift
79
Q

What is a low SMAS technique

A

lift inferior to zygomatic arch that treats lower face only. No effect on midface, perioral or infraorbital areas

80
Q

What is a high SMAS technique

A

lift that goes superior to the zygomatic arch that treats the midface and periorbital region with the lower face

81
Q

What is a composite facelift

A

includes the lower lid orbicularis with the platysma and subcutanous fat as a single unit

82
Q

What is a lamellar SMAS facelift

A

lift where skin and SMAS are mobilized but dissected as two seperate planes. Lifted at different degrees and in different vectors

83
Q

What is a subperiosteal face lift

A

Lift where midface periosteum is elevated as a single plane.The skin and SMAS are not dissected

84
Q

Which patients are not candidates for sub-periosteal facelifts

A
  • skin redundancy of nasolabial folds
  • redudancy of skin at jawline or neck
85
Q

What are the advantages and disadvantages of subperiosteal facelift

A

Advantages
- facial nerve is protected
- visible scarring is minimized

Disadvantages
- steep learning curve
- skin and SMAS move as single unit

86
Q

What are 4 particularities for male facelifts

A
  • pre-tragal incision
  • incision transserve in sideburn
  • higher rates of hematoma (8%)
  • avoid incision in the occipital region of hairline
87
Q

6 Contrindications au facelift

A
  • Maladie du collagène
  • HTN non contrôlé
  • Maladie systémique sévère
  • Attentes non réalistes
  • Tabac
  • Anticoagulants
    relatif: DB, obésité
88
Q

What adjunct can be used in combination of facelift

A
  • fat grafting
  • release of dermal attachements around nasolabial fold
  • lip rejuvenation (fillers/lip lift)
  • Malar augmentation
  • resuspension of chin or insertion of chin implant
89
Q

What is the advantage of using fibrine glue in facelifts

A
  • reduction of postoperative drainage at 24 hrs
  • reduction of ecchymosis
90
Q

How can you improve hypertension in patients undergoing facelift procedure

A
  • clonidine preop
  • hydralazine (BCC)
  • adequate pain control
  • Beta-blocker (labetalol)
  • chlorpromazine
91
Q

Quels changements (3) apporter a votre technique pour un facelift chez un fumeur (à ne pas faire!!)

A
  • Lambeau plus épais
  • Peu de tension
  • Peu de dissection
92
Q

Which branch of facial nerve is most often injured during facelifts

A

Buccal branch

93
Q

What is most common location for skin necrosis following facelift

A

retro-auricular region

94
Q

Nommer les 10 complications les plus fréquentes du facelift

A

-Hématome #1 -> 2-3% femmes, 8% hommes (Comprends 70% des complications)
- Œdème
- Ecchymose
- Dommage nerfs (GAN 7%, Moteur <1%)
- Nécrose/épidermolyse
- Sérome
- Infection
- Asymétrie
- Cicatrice hypertrophique
- Insatisfaction

Autre: alopécie, déformation ligne des cheveux

95
Q

What is Frey Syndrome

A

Abberant reinnervation of the skin by parasympathetic nerve fibers of the auriculoteporal nerve leading to gustatory sudation.

96
Q

How do you manage Frey syndrome

A

Conservative
- botox
- scopolamine

Surgical
- re-elevation and interposition of the flap
- Jacobson neurectomy

97
Q

How do you diagnose Frey Syndrome

A

Starch-Iodine test (amidon is added to dry iodine. If sweating is present, the iodine will become blue)

98
Q

Where is the greater auricular nerve most at risk?

A
  • 6.5cm below the external auditory canal at midline of sternocleidomastoid muscle
    (McKinney’s point)
99
Q

What nerves come out at Erbs point

A
  • greater auricular
  • transverse cervical
  • lesser occipital
  • supra-clavicular
100
Q

Name 5 stigmata of facelifts

A
  • Lateral sweep
  • Commissural distortion
  • Joker’s line
  • Smile blocks
  • Flat facial contours
  • Pixie ear
101
Q

How can restore youthful appearance of the lips

A
  • subalar/collumelar excision
  • vermillion advancement
  • volume enhancement (fat injection, fillers)
  • dermabrasion
102
Q

What is Erbs point

A

Landmark along the posterior border of the SCM at the junction between the upper and middle 3rd where multiple nerve emerge

103
Q

What is a pixie ear deformity

A

Inferior migration and axis distortion of the ear lobule

104
Q

Where does the accessory nerve run?

A

1cm above Erbs point

105
Q

Name 4 particularities of secondary face lifts

A
  • SMAS layer is thinner
  • less skin can be excised
  • increased risk of facial nerve injury due to scaring
  • skin flaps may be more robust (delayed phenomenon)
106
Q

Name 3 signs of the aging lip

A
  • increased distance between collumellar base and upper vermillion border
  • less exposed vermillion (thin lip)
  • loss of volume in the vermillion (pout)
107
Q

How long before faceift shoud patients discontinue NSAIDs

A

2 weeks

108
Q

How long before facelift should patients discontinue supplents (garlic, fish oils, ginkgo)

A

2 weeks

109
Q

What is the most important factor to adress in the postoperative period after a facelift

A

Hematoma prevention

110
Q

What are the 3 types of platysma decussation

A

Type 1 (75%): medial fiber decussation 1-2cm below chin. Sperate muscle bellies in suprahyoid

Type 2 (15%): medial fiber decussation all the way to thyroid cartillage and covers submentum

Type 3 (10%): seperate medial bellies that insert directly on the chin

111
Q

Options non-chirurgicales pour le cou? (5)

A

-Belkyra : Acide déoxycholique (lyse adipocytaire)
-Fillers
-Botox
-LASERS
-Microfocused ultrasound
-IPL

112
Q

Indications for neck liposuction

A
  • young patients
  • good dermal quality
  • localized fat
113
Q

Describe the course of the marginal mandibular nerve

A

Posterior to the facial artery
81% above the mandible border
19% up to 1cm below

Anterior to the facial artery
All branches above inferior border of the mandible

114
Q

What would patients complain of if they had an injury to the greater auricular nerve

A

Paresthesia/anesthesia of the lower 2/3 of the ear and adjacent neck/cheek skin

115
Q

How can you differenciate subcutaneous and preplatysmal fat

A

pinch sub-mental area at rest and after contraction of the platysma muscles

116
Q

What would be the most likely cause of persistant buldging at the inferior border of the mandible after fat removal form the neck?

A

Prominence of the digastric muscles

117
Q

Name 4 surgical approaches for neck rejuvenation

A
  • suction lipectomy
  • submental cervicoplasty
  • short-scar facelift WITHOUT submental incision (lateral pull)
  • short-scar facelift WITH submental incision
  • full-scar facelift WITHOUT submental incision
  • full-scar facelift WITH submental incision
118
Q

Name non-surgical options for neck rejuvination

A
  • Fillers
  • Botox
  • Laser
  • Belkyra
119
Q

Name 3 types of incisions for neck lifts

A

Full scar
Sub-mental
Short scar

120
Q

What are the indications for submental neck lift

A
  • platysmal banding
  • undermining required to contour neck
121
Q

What are the indications for short scar face and necklift

A
  • no excess neck skin
  • presence of jowling
  • aged neck-face interface
122
Q

What surgical procedures can be performed to address the platysma? (4)

A
  • platysmal flap cervical rhytidoplasty
  • platysma suspension sutures
  • platysma muscle sling
  • corset platysmaplasty
  • closed percutaneous platysma myotomy
122
Q

What are the indications for full-scar facelift

A

Aging changes in the face and neck with inelastic and excess lower posterior neck skin

123
Q

What is a Rocker deformity

A

Deformity from osteotomies into the nasal bones above the medial canthus causing fragment lateralization of the superior nasal bones. Inferior nasal bones are medialized

124
Q

What is the most common nerve injure during neck lift

A

Marginal mandibular nerve

125
Q

Qu’est-ce qui cause un « Inverted V deformity »?

A
  • Déplacement inférieur des ULC avec accentuation du rebord caudal des os du nez (Overresection du keystone)
126
Q

décrire le open roof deformity

A

espace créé entre les OPN suite à une correction du dorsal hump

127
Q

Name 4 causes of inferior turbinate hypertrophy

A
  • severe contralateral septal deviation
  • smoking
  • rhinitis
  • upper airway infection
128
Q

6 Options pour ouvrir la valve externe? (6)

A
  • Alar batten graft
  • Alar rim/contour graft
  • Alar spreader graft
  • Lateral crural strut graft
  • Lateral crural turnover
  • Scar revision, soft tissue grafting
129
Q

Name 4 techniques to improve internal valve collapse

A
  • spreader graft
  • allar batten
  • auto-spreader flaps
  • Guyuron graft
130
Q

What is the normal Inter-domal angle

A

30o

131
Q

What is the normal nasolabial angle

A

men: 90-95o
women: 95-110o

132
Q

Name graft options for the dorsum of the nose (5)

A
  • dorsal only graft
  • dorsal sidewall graft
  • radix graft
  • spreader graft
  • septal extension graft
133
Q

What is the normal naso-frontal angle

A

men: 120-130o
women: 115-120o

134
Q

Name 5 nasal tip graft options

A
  • Anchor graft
  • Cap graft
  • Columellar strut
  • Subdomal graft
  • Umbrella graft
  • Sheild graft
  • Extended columellar strut-tip graft (extended shield graft)
  • Onlay-tip graft
135
Q

Nommez des greffes de base alaire

A
  • Columellar plumping
  • Alar base graft
  • Pre-maxillary graft
136
Q

What are the advantages and disadvantages of the closed rhinoplasty

A

Advantages
- no external scar
- limited dissection
- less postoperative oedema
- faster recovery
- intact tip graft pocket

Disadvantages
- learning curve
- cannot have simultaneous viewing of other surgeon
- does not allow direct viewing of the nasal anatomy
- difficult dissection of alar cartilages

137
Q

Liste des incisions alaires pour une rhinoplastie fermée (3)

A

-Inter-cartilagineux: entre ULC et LLC
-trans-cartilagineux: a/n LLC
-Marginale: au rim alaire

138
Q

Liste des approches au septum dans une rhinoplastie fermée

A

-Killian: incision plus postérieure
-Hemi-transfixiante
-Transfixiante partielle limitée
-Septale transfixiante haute

139
Q

Liste des + et – d’une rhinoplastie ouverte

A

+
meilleure visualisation
plus options de greffes
accès direct au septum
meilleur contrôle hémostase

-
Cicatrice
Doit fixer les greffes
plus d’œdème post-op et récup
plus longue dissection

140
Q

Façons d’augmenter la projection du bout?

A

Sutures
-Inter-domal
-trans-domal
-medial crural septal

Greffes
-Tip onlay graft
-Shield graft
-Columellar strut graft
-Extended spreader graft
-Septal extension graft

141
Q

Façons de diminuer la projection de la pointe du nez

A

-Relâche des ligaments suspensoirs et attachements avec les LLC
-Cephalic trim des LLC
-Transsection de crus latéral ou médial du LLC
-Alar base resection

  • *** Attention, si diminue la projection >2mm -> Flaring alaire et bowing de la columelle à risque
142
Q

Combien de cartilage cartilage conserer avec un cephalic trim

A

5mm latéral

143
Q

Façons d’augmenter la rotation du nez?

A

Sutures
- Suspension du LLC au septum dorsal

Greffes
-Columellar strut graft

Résection
-Cephalic trim LLC
-résection du septum caudal ANTÉRIEUR
-résection de la portion caudale du crus médial

144
Q

Façons de diminuer la rotation du nez?

A
  • Résection du septum caudal POSTÉRIEUR
  • Souminer la peau
  • Relâcher les LLC
145
Q

Options pour comment corriger un boxy tip

A

Suture inter-domales
Sutures trans-domales
Cephalic trim des LLC

146
Q

Types d’implants alloplastique et complications associées dans la rhinoplastie

A
  • Silicone
  • Medpor
  • Goretex
  • Dacron
  • Alloderm

Complications : Déplacement, distortion, résorption, visibilité

147
Q

Indications pour ostéotomies osseuses du nez

A

Wide bony vault
Pour élargir base osseuse
Fermeture open roof
Nez dévié
Rocker deformity

148
Q

Liste des + des ostéotomies percutanées

A
  • Moins d’ecchymose
  • Moins d’œdème
  • Plus de contrôle
  • *Considérer dans les re-do et les nez courts
149
Q

Est-ce qu’on devrait faire les ostéotomies médiales ou latérales en premier

A
  • Médiale (sinon perte de support)
150
Q

Contrindications relatives pour faire des ostéotomies

A
  • Lunettes lourdes
  • Vieux avec os minces
  • Nez ethniques low and broag
  • Os courts avec rebord distal <1cm sous la ligne inter-cantale
151
Q

Liste des types d’ostéotomies latérales

A
  • Low to low
  • Low to high
  • Double level
152
Q

Comment traiter une hypertrophie des cornets?

A
  • Résection sous-muqueuse
  • Morselisation sous-muqueuse
  • Out-fracture
  • Turbinectomie au LASER
153
Q

6 Caractéristiques du nez afro-américain?

A

Wide nose
Low dorsum
Wide bimalar distance
Horizontally oriented nostrils, wide base
Deficient premaxilla
Limited septal cartilage

154
Q

7 Caractéristiques du nez asiatique

A

Thick sebaceous skin
Low dorsum
Weak lower lateral cartilage
Less septal cartilage
Deficient premaxilla
Wide nasal base
Retracted columella

155
Q

5 Caractéristiques du nez middle eastern

A

Long nasal bones
Low radix
Large hump
Hanging columella
Septal deviation

156
Q

Causes de collapse de la valve externe

A

-LLC faibles ou overresection
-Manque de couverture de tissus mous
-Paralysie CN VII
-Sténose vestibulaire
-Ailes pincées
-Masse

157
Q

Caractéristiques du saddle nose?

A

-Perte de support du septum dorsal
-Dépression supra-tip
-Rétraction de la columella
-Perte de la valve externe
-Over-riding deformity (Quand très sévère, le lobule tourne vers le haut)

158
Q

***comment corriger un saddle nose

A

TX : Cantilever graft ou septal L-Strut

159
Q

Qu’est-ce qu’une Polly Beak deformity?

A

-Plénitude de la portion supra-tip
-Entraine une perte de rotation/projection de la pointe

160
Q

Caractéristiques d’un cocaïne nose?

A

-Perforation septale
-Rétraction alaire
-Nez court
-Perte de longueur de la columelle
-Tip dévié vers le côté de l’insufflation (main dominante)
-Synéchies
-Augmentation ou destruction des cornets
-Déviation septale
-V-inversé

161
Q

management d’un epistaxis

A

Léger
-Pression 15min a/n des ULC
-phenyléphrine ou oxymétazoline topique
-élévation de la tête + fléchir cou

Sévère et réfractaire
i. Défaire le pansement, inspection, succion, AgNo3, cauther, paquetage antérieur,
ii. Paquetage postérieur +- angio +- OR pour ligature endoscopique de la sphenopalatine, maxillaire interne ou éthmoïde

162
Q

Stigmates du vieillissement d’un nez

A

-Allongement du nez
-Droopy tip
-Élargissement des cartilages alaires
-Épaississement de la peau
-Bunny lines
- Bulbous tip (?)

questions pratiques de l'université montréal (43 decks)

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