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2. Written > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

The facial skeleton (viscerocranium) form from what type of ossification

A

Intramembraneous - perisoteal blood supply.

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2
Q

Antia-Buch max defect size?

A

2.5cm defect

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3
Q

Helical rim defects >3cm

A

Converse tunnel. Cartilage strut under post auricular skin. 3 weeks strut lifted on anteriorly based flap and inset.

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4
Q

Options for conceal bowl

A

Secondary
SG
Excise bare cartilage and SG

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5
Q

Max size of Tanzer

A

2cm

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6
Q

Options for middle 1/3 ear

A

Rim: Antia-Buch
Wedge <2cm
Cart graft - Dieffenbach (cart sutured to defect covered by flap) or converse
Contralateral chondrocutaneous composite flap.

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7
Q

Rim Recon Options

A

Small:
contralat composite, AB, Condrocut rotation.
Large:
-Cart graft and local flap (Converse 2 stage tunnel and lift)
-Tubed-pedicle (3 stage tub, inferior, superior)

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8
Q

Superior Third

A

Small:
-Tanzer excision
Large:
-C/l cart graft and flap (preaur banner)
- condrocut flap (Davis root +sg, OC helix based)
-Valise handle (3stage+sg) defect attached and elevated
- CC graft +TF flap

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9
Q

Middle third

A

Small: Tanzer
Large:
-Chonchal - flip flap (inc down to fascia)
-C/l composite graft/ Converse/ Dieff (2 stage st 1 sutured to defect)

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10
Q

Ear Recon:

A

Auto
Auto/ Allo
Pros
Coverage TE or free or ped TPF flap+SG.
C/l 6-8 costal synchondrosis.

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11
Q

Benign Ear Diff

A

granuloma pyogenicum,
beryllium granuloma,
verruca contagiosa,
verruca senilis,
cylindroma,
nevus,
papilloma,
lipoma,
lymphangioma,
leiomyoma, and
chondroma,

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12
Q

Upper eyelid recon
FULL THICKNESS

A

<25:
- direct closure
25-50:
- DC+ lat canthotomy
- Tenzel semicircular MC + comp
- Sliding Tarsoconj + FTSG or MC flap
> 50:
- Composite graft + MC flap (frick, FH)
- Cutler-Beard bridge (LL inf based rectangle composite) w=w
- central: (Mustarde lower lid switch) based on inf. arcade.

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13
Q

Lower Lid
Partial thickness

A

<50%
-Local cutaneous/MC flaps
>50%
-FTSG
-Tripier flap
-Fricke flap
-Mustarde Cheek rotation flap

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14
Q

Lower Lid
Full thickness

A

25-50%
- DC + lat cantotomy or inf C’lysis
- Deep: Tenzel SC +lysis
Tenzel–> McGregor–> Mustarde
- Unilat Tripier MC+ Composite
- Shallow: Hughes Tarsoconj adv + FTSG or MC

>50%
Shallow: Hughs TC Adv+ FTSG or MC
(bio Trip, Must, Frick, FH)
Deep: Septal CondMuc graft + mustarde
-McGregor temp z-plasty flap

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15
Q

Lower Lid
Full thickness

A

25-50%
- DC + lat cantotomy or inf C’lysis
- Deep: Tenzel SC +lysis
Tenzel–> McGregor–> Mustarde
- Unilat Tripier MC+ Composite
- Shallow: Hughes Tarsoconj adv + FTSG or MC

>50%
- Shallow: Hughs TC Adv+ FTSG or MC
(bio Trip, Must, Frick, FH)
- Deep: Septal CondMuc graft + mustarde
-McGregor temp z-plasty flap
-Composite + MC

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16
Q

What are the degrees of levator function?

A

Excursion of lid margin from full down to full up.
Excellent >10mm
Good 8-10mm (Min - FS/ MM Conj resec’n)
Fair 5-7mm. (Mod - Lev adv)
Poor 1-4mm (brow/front suspension)

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17
Q

Asian lid

A

Epicanthal folds
Lack pretarsal show
Lower lid crease (4-6 vs 8-10)
Lower insertion of orbital septum relative to tarsus (lower periorbital fat)

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18
Q

Chemosis Tx

A

Ointment/Lube/patching
Topical steroid drops, tarsorraphy
Conjunctiectomy

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19
Q

Retrobulbar Hematoma
Symptoms
Tx

A

Compression of Central Retinal Artery, Optic nerve.
Sudden onset:
Pain
Proptosis
Decreased visual acuity

Tx:
Admit, Ortho consult
Release sutures, canthotomy,
IV corticosteroids, acetazolimide
OR exploration

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20
Q

lymph drainage lips

A

Upper and lateral lower = summand
central lower = submental

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21
Q

RF for reoccurrence

A

Size, location
Depth, Grade, Perineural Inv., Marjolin
LN
Clinical RF

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22
Q

Vermillion Recon Options?

A
  • Verm Adv or switch
  • Mucosal Adv. VY, Biped
  • Goldstein MC flap?
  • Tongue, FAMM (Incas Bucc for vermillion recon only), Buccal
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23
Q

Commissure

A

Rhomboid mucosal
Double Skin flap and mucosal rhomb/ tongue
Zisser

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24
Q

Lower Lip Recon Options?

A

<1/3: Wedge, 1o
1/4-1/2: Johansson Adv (w=1/2defect) h=8-10mm, Reverse Abbe only lateral (1/2w) start at mid point, Eslander

1/2-2/3: Karapanzic preserves facian nerve for functional recon (Central),
Uni Gilles fan,
DAO

2/3 to total: Bilat Gilles fan,
Web-Bernard Burow, Fujimoro gate, recional/free

General Kara or BB if no lip.

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25
Q

Upper Lip Recon Options?

A

By unit
Philtrum: 1o, SG, Abbe, Peri alar
White lip: NL

Phil and lateral <1/4:
b/l perialar cres+abbe,
Rev Kara

Phil and lateral >2/3:
b/l NL + Abbe
Rev Kara + Abbe
WBB
Reg, free

Lateral:
1o,
A-T, Peri Alar Cres Adv,
NL, Abbe, Rev Est

Abbe or slander if comm, large do BB + Cres excision

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26
Q

Karapanzic

A

U incise skin in mental crease parallel to free margin and continue into melolabial crease,

  • ID NVB release Ris to advance,
  • back cut mucosa, or burow at commissure

Preserves sensation/orb function.
Dis: micro, asym, under proj.

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27
Q

Uni Gillies

A

Full thickness
No preservation of OO innervation, lacks sensory

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28
Q

WBB

A

Incise in labiodental and NL crease
Burows skin and sc only to preserve OO.
Narrow as possible to prevent puckering
(NEEDS Verm flap)

Adv: SS, local, complete LL
Dis: no function, insensate, Microstom. income.

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29
Q

Lip recon regional:
Indications for free:

A

Pec Mj, DP, Tubed neck, FC scalp
Large, Rads, composite, failed

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30
Q

Chin

A

Boardering on verm: A-T
Adv flap with burow triangle in parental crease
Modified limberg with scar in vertical midline (not crossing inf boarder of mind)

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31
Q

Lip Development

A

Upper: two medial nasal prom fuse with maxillary prom
Lower Mandibular pro

32
Q

Lip Subunits

A

Lateral:
Phil col
Nasal sił
Alar base
NL fold
Med: Phil

33
Q

Lip: Sensory Innervation

A

Fifth CN:
Upper: Infraorbital - Max Nerve, (Sidewall/ala, col, med cheek)
Lower: Mental (Mandibular)

34
Q

Mental foramen landmark

A

Second mand bicusp

35
Q

Most common lip cancer
Excision Recommendation

A

90% SCC 95% LL, lip is 1/4 of oral ca.
Diff:
Sebacious ca
Adenoid cystic
Acinic cell
Merkel Cell

“Full thickness 3-5mm hard for 90% with 2-3% RR at 5 year”

36
Q

Eslander
Gillies
Kara
WB

A

Triangular based on superior lab artery
Gillies: rat advancement flap, upper cheek to close large centra LL >50% Flap l= Defect w, w=h
-Kara: composite flap with innervated OO. Midline Upper and lower defects. uni = 50%, bi for total/
WB- >80% Medial advancement of cheek (need ver recon - mucosal adv).

37
Q

75% UL Defect

A

B/l Kara (innervated lip )+Abbe

38
Q

Lateral lower lip defect + comm

A

Estlander

39
Q

Mentalis function

A

Elevates central lower lip.

40
Q

Tongue Recon Options

A

<25 = 1o, STSG, FAMM
20-60% = ALT, RFFF, Lateral Arm, Dorsalis Pedis (ALT MC for larger defect)
>70% ALT, TRAM, LD, Grac

41
Q

Floor of mouth

A

Stage 1 <2cm local flap or STSG
Stage 2: 2-4cm local or free flap

Anterior:
Local: NL, Temp, FAMM, Tongue
Distant: PM, DP, Lat
Free: Rad/Ulnar FA, ALT, Fib if bone

Posterior:
Local: NL, FAMM
Distant: PM, DP
Free: RFFF, ALT, LA, DP, Fib

42
Q

Buccal

A

Local: plat, FAMM, TPF +SG, Tongue
Distant: Pm (Bulky), DP
Free: RFFF, Ulnar, ALT thin

43
Q

Cordeiro Classification

A

1- limited (1 or 2 walls) - FC

2- Subtotoal Orbit preserved

a) <50% transverse palate - FC/ obturator
b) >50% - OC required

3- Total - all 6 incl floor
a) orb contents preserved
Double (Fib+ RA + NVBG/ allo for Orbital floor), Temporalis for poor candidate.
b) resected - RA 3 paddle + fib for dental

4- Orbitomaxillectomy - RA

44
Q

Test

A
45
Q

Blood & Nerve Supply of Nose

A

Ext Carotid

Facial A –> Angular–> lateral nasal

–> Superior Lab –> columellar

Internal Max –> Infraorb

Internal Carotid

Opthalmic –> Anterior ethmoidal A –> External Nasal Br

Opthalmic –> Dorsal nasal (anast to lateral nasal)

Nerve:

External: Infratroch (radix), IO (sidewalls), Ant Ethmoid -External Br. (tip, alae)

Internal: Ant Ethmoid - Internal Br, Nasopalatine, Lesser Palatine

46
Q

Nasal Recon Max Local flap?

Bilobe Design.

NL design and blood supply

A

1.5cm

Bilobe: lower third laterally based for tip, and vv.

NL: Medial edge in NL crease. Options: superior or inferior, one stage island or 2 stage pedicled.

Blood supply = perforators Inferior = facial artery ( Nasal ala, dorsum and sidewall) 1.5-2.5cm

Superior based = angular (random pattern) for lipa and oral.

47
Q

Blood supply of Fronto nasal advancement, Rieger, dorsal nasal or miter

Defect?

Glabellar?

A

Angular artery.

Middline lower or middle third.

Glabellar–> medial canthi

48
Q

Anatomy of Paramed FH flap

Ways to lengthen?

A

Supratroch travels on PO becoming SC at hairline.

49
Q

Nasal Lining:

A

SG

Infold flap

Vestibular lining.

Septal Muco Pericondrial

Facial artery musculo mucosal

Free

50
Q

Describe Submental Artery Flap

Indications/ CI

A

MC Platysma Flap (laterally based).

Submental br of facial artery parallel to ant belly of diagastic.

Indications:

Extra oral (lower and midface), Oral (up to palate posterior tongue)

Combined, hair bearing.

CI: Ips neck dissection.

51
Q

Juri cervicofacial flap

A

Continue lateral from defect alon Zygomatic arch, preauriclar fold, retro auricular hairline.

Ped: Facial and submental artery.

52
Q

Safe zone of frontal branch of facial Nerve.

A

>3.5 cm anterior to external auditory canal.

53
Q

Cervicopectoral flap

A

MC based on Anterior thoracic perforators off the internal mammery artery.

Defect: lower lateral cheek (line from trag to commissure)

Steps: Extend defect posteriorly inferior to ear , retroauricular hairline, parallel to anterior border of trapezius crosses clav at DP groove then extended inferior PRN. SubCut in face , sub platy in neck deep to anteriro pectoral fascia on chest.

54
Q

Deltopectoral Flap

A

Blood supply: IMA, and TA (axial flap)

55
Q

Temporalis Flap:

A

Blood Supply:

Internal Max Artery –> Deep temportal branches (anterior and posterior)

STA - Middle temporal Artery

Indications: Turnover - posteriro oral, nasopharyns, orit, ear,

Lenthening: disinsert from corinoid, remove arch.

56
Q

Trapezius

A

Blood Supply:

Upper: Occipital

Middle: Transverse Cerv–> Superficial Cerv

Lower: Deep br or TCA (dorsal scap) + IC

57
Q

Frontal Br of facial nerve

Galea continuation

Scalp PO continuation

A

RUNS IN Superficial temporal fascia

STF laterally, smas in face, frontalis, occipitalis

Deep temporal fascia (at fusion line seprate and envelope ST fat pad)

58
Q

Extending Scalp flap

A

Score PERPENDICULAR to axis

59
Q

Facial Nerve Landmarks?

A
  1. Tragal pointer 0.5-1cm deep and inferior
  2. Deep to dephalad boarder of Posterior belly of diagastic
  3. Tampanomastoid suture 6-8mm deep to inferior end of suture line.
  4. Retrograde dissection
60
Q

Salivary Tumors: When Rads?

A

Close or microscopically positive margins.

Proximity to facial nerve

Perineural/Lymphovascular invasion

Cervical Mets

61
Q

Gustatory Sweating? Tx

A

Cross innervation post surgery disruction AT nerve. Cholenergic parasympathetic fibers ( GP CN9 via otic ganglion) innervate sympathetic skin sweat gland.

Observaation if mild, botox, alloderm or fascia graft.

62
Q

Most common salivary tumors?

Benign (1, 2nd)

Malig?

Mets?

A

Benign: Plemorpic adenoma 80% of benign tumors, Warthins (papillary cystadenoma)

Children: hemangioma

Mucoepidermoid (in parodid), Adenoid cystic in other glands

Mets: Melanoma, SCC (heme spread of Breast, lung prost, kid, GI)

63
Q

History of Salivary Gland tumor

A
64
Q

First Branch Arch

A

Nerve: Trigem

Art: Maxillary

Cart: Mandible, Malleus & incus

Muscles: Temporalis, mass, Pter, TTym/VP, MH ABD.

65
Q

Second Branch Arch

A

Facial nerve

Stapedial artery

Reicherts Cart: Mall (man), incus (proces), stapes, styloid process, styloid hyoid lig.

Muscles of facial expression, plat, stylohyoid, hyoid

66
Q

Third Arch

A

GP nerve

Internal carotid

Hyoid (body, cornu)

Stylopharyngeus

67
Q

4th Arch

(5th Arch = Nothing)

A

Sup Laryngeal nerve

Left: Aortic arch, Right: SC artery

Thyroid, cuneform

Pharyngeal construction, cricopharyngeal. Cricothyroid

68
Q

6th Arch

A

Recurrent laryngeal

Pulmonary artery

Cricoid, arytenoids, corniculate

Intrinsic larynx muscles

69
Q

Midface Embryo

A

Maxillary,

Med (tip, phil, UL) & lat Nasal (ala),

Frontonasal (dorsem)

Prominances fuse to form nose and upper lip.

(1st branchial arch)

70
Q
A
71
Q

Congen ML Mass Diff?

A

Dermoid

Gliomas - firm, nonpulse from lateral nasal wall

Encepaloceles - blue, pulsatile, compressibl emass or intrasasal mass at crib plate.

Furstenberg test (compression of Int jug)

72
Q

Primary Palate?

Secondary Palate?

A

MNP

Shelves of max prominences.

73
Q

Tongue Embryo

A

1st pharngeal arch (lingual nerve = branch of trigeminal , nerve to 1st.)

Posterior (GP nerve to 3rd)

74
Q

Thyroglossal Duct Cyst

A

Asym Midline mass at hyoid - elevate with swallow.

Mgmt: Sustronk- excision and central hyoid

75
Q

Frontal Sinus

A

Appears at 5-6 adult size by 12-20.

76
Q

PHACE

A

Post Fossa

Hemangioma

Arterial lesions

Cardiac mal/ Corarctation

Eye

2. Written (31 decks)

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