Focused Review Flashcards
What is better for posterior expansion, 2-piece lefort or SARPE?
2-piece lefort, more relapse
What is the max expansion you can get with a SARPE?
For around 7 mm
What is your SARPE protocol?
-5-7 days latency
-0.5 mm / day within 4 weeks
-4 months consolidation
What do you do if you have a dusky maxilla?
-Concerned for avascular necrosis
-Remove any splints/IMF
-Consider OR to return maxilla back to original position
What is the normal intercanthal and interpupillary distance?
-Intercanthal: 32 mm
-Interpupillary: 60 mm
What is the goal MIO s/p ankylosis?
35 mm
What is the Kaban protocol?
-Resect bony ankylosis
-Ipsilateral coronoidectomy
-Contralateral coronoidectomy prn
-Temporalis flap
-Mobilization after 10 days
-Aggressive PT
What imaging do you obtain for a TMJ ankylosis?
CT Face with contrast (see pterygoid plexus and other vasculature
What are your landmarks for a TMJ arthrocentesis?
-Holmund-Hellsing line.
-10 mm ahead and 2 mm below
-20 mm ahead and 10 mm below
What do you use for your arthrocentesis?
-LR 300 mL
-Kenalog 40 mg/mL
What inflammatory mediators are you attempting to reduce in TMJ?
TNF-a
IL1
IL6
Describe your costochondral graft approach?
-Rib 6 on right side
-5 cm incision along inframammary crease
-Skin, subQ, fascia, plane between pectoralis major and rectus abdominus
-Harvest 1-3 cm of cartilaginous cap
-Check for PTX
Where is most likely bleeding during TMJ surgery?
-Middle meningial: 31 mm medial to zygomatic arch and 2.4 mm anterior to height of glenoid fossa
-Masseteric
-Pterygoid plexus
What is the course of the facial nerve?
-Branch 1.5-2.8 cm anterior to EAC
-Crosses zygomatic arch 8-35 mm anterior to EAC in temporoparietal fascia layer
Describe steps of carotid cutdown.
-Neck incision 5 cm in length, 2 cm below inferior border of mandible over SCM
-Retract SCM posteriorly
-Identify carotid sheath
-Retract IJV posteriorly
-Dissect to carotid bifurcation (ID hypoglossal nerve)
-Ligate above facial (third anterior branch)
What is TMJ concepts made out of?
-Fossa: High molecular weight polyethylene, unalloyed titanium mesh
-Condyle: Cobalt/chronium/molybendum, titanium alloy body
What is Frey’s syndrome, how is it treated?
-Aberrent innervation of parasympathetic and sympathetic fibers of auriculotemporal and glossophrayngeal nerves
-Demarcate area with starch iodine test
-Scopolamine patch or botox 16 units
How is OSA classified?
AHI:
Normal: 0-4
Mild: 5-15
Moderate: 15-30
Severe: 30+
What is apnea?
-Cessation of airflow x10 seconds
What is hypopnea?
-Reduction of airflow resulting in O2 reduction of 3-4%
What is RERA?
-Respiratory event related arousal
What is STOP BANG and how is it interpreted?
-Snoring, tiredness, observed apnea, pressure, BMI, age, neck, gender
-High risk 5-8, intermediate 3-4
What is Epworth sleepiness scale and how is it interpreted?
-Questions likelihood of dozing off during specific tasks
-11-24 excessive, 6-10 higher than normal daytime sleepiness
What is PAS?
Posterior airway space (measured along line B to angle of mandible)
-Less than 11 may indicate base of tongue obstruction