Face Flashcards
Name the branches of the facial artery in the neck
Ascending palatine – supplies the soft palate and palatine tonsils.
Tonsillar – supplies the palatine tonsils.
Submental – supplies the floor of the mouth and sublingual gland.
Glandular – supplies the submandibular gland.
Name the branches of the facial artery in the face
Superior and inferior labial artery – supply the upper and lower lips.
Lateral nasal artery – supplies the external nose.
Angular artery – supplies the external nose, lower eyelid, orbicularis oculi and lacrimal sac.
Describe the course of the facial artery
The facial artery arises from the external carotid artery within the carotid triangle of the neck.
It travels superiorly and obliquely, underneath the digastric and stylohyoid muscles, and closely associated with the posterior surface of the submandibular gland (it can pass through the gland itself in some individuals).
It gives rise to several branches in the neck – ascending palatine, tonsillar, submental, and glandular.
The facial artery then curves upwards, passing over the body of the mandible and along the inferior border of the masseter, deep to the platysma muscle.
It then takes a tortuous course towards the angle of the mouth, supplying superior and inferior labial branches to the lips. It terminates by ascending along the side of the nose in the nasolabial fold, as the angular artery.
What are the reconstructive options in the lip?
Direct closure
Up to a third of the lip can be closed primarily
Excise with a V, pentagon or W
Microstomia is a potential complication.
FTSG
Partial thickness defects.
Local flaps
What is the anterior lamella composed of?
Skin
Orbicularis oculi
What is the middle lamella composed of?
Pre-septal fat
Orbital septum
Post-septal fat
What is the posterior lamella composed of?
Tarsal plate
Upper eyelid retractors
Conjunctiva
What is the blood supply to the eyelid?
Facial artery and Angular Artery at the medial canthus
Superficial temporal artery at the lateral canthus
Infra-orbital artery at the lower eyelid
What local flaps can be used in eyelid reconstruction?
Tenzel semicircular flap is a workhorse – involves a lateral canthotomy and a rotation of skin lateral to the eyelid
Semicircle goes above canthus
Suboblicularis plane (musculocutaneous flap)
2cm diameter
Upper and lower lid
McGregor flap has similar concept to Tenzel but it extends posteriorly making it a transposition advancement flap. Good for large v-shaped defects of the lower eyelid. (similar to a Tenzel, but incorporates a Z-plasty).
Blasius flap – transposition flap
Imre flap – rotational flap
Lid sharing procedures:
Modified Hughes flap - advancement of tarsal plate and conjunctiva from ipsilateral upper eyelid to defect in lower eyelid
Cutler-Beard – advancement of a full thickness flap (excluding tarsus) from the ipsilateral lower eyelid to repair defect of upper eyelid
How can defects >75% be reconstructed?
MUSTARDE CHEEK advancement flap for the lower eyelid.
Excision – lateral canthal edge, up to temple, anterior to ear, down to mandible
Dissect beneath oblicularis oris to inferior orbital rim
Subcutaneous beyond this to avoid facial muscle
What are the goals of scalp reconstruction?
Tension free closure of defect
Maintenance of motor and sensory function where possible
Maintenance of contour
Maintenance of brow symmetry and hairline
Protection of cranium/dura/brain
What is stress relaxation?
The property of skin that decreased the amount of fore necessary to maintain a fixed amount of skin stretch over time
What is creep?
Skin property whereby skin gains surface area when a constant load is applied
As force is applied to the leading skin edge, tissue thickness decreased from extrusion of fluid and mucopolysaccharides, realignment of dermal collagen bundles, elastic fibre microfragmentation and mechanical stretching of the skin
Describe some reconstructive options for the nose
Direct closure
<1cm defects
Dorsum or sidewall
Undermining may be required
May result in dog ears which require excision
FTSG
If concerned about margins
Preauricular/post auriclular/clavicular donor sites
Local flaps
Transposition flap
Defects <1cm in thin skin zones e.g. cephalic nasal sidewalls and dorsum
V-Y flaps
Small defect (<1.5cm) in anterior alar groove
Dorsal nasal flap
Defects <2.5cm located centrally on the dorsum of the nose
Bilobe flap
<1.5 cm defect located on the sidewall at least 5mm from margin of nostril.
Preferably based laterally
What is a pinnaplasty?
A surgical process to reshape and correct prominent or asymmetrical ears
What is a specific complication for pinnaplasty?
Cauliflower ear
A blood clot forms around the ear cartilage causing it to die, resulting in fibrous tissue forming
