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PRS RC 2020 > Head & neck recon > Flashcards

Head & neck recon Flashcards

1
Q

Best flaps for Tongue recon?

A
  1. RFFF, ALT
  2. RAM, DIEP, gracilis
  3. Salvage: pec major MC flap
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2
Q

Best flaps for FOM recon?

A
  1. RFFF, ALT

2. Salvage: deltopectoral, PMMC, FAMM, nasolabial

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3
Q

Best flaps for buccal mucosa?

A
  1. RFFF, ALT

2. Platysma

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4
Q

Recon options for pharynx?

A
  1. Tubed ALT, RFFF
  2. Free jejunum or colon, gastric pull-up
  3. Salvage: deltopectoral, IMAP
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5
Q

Recon options for esophagus?

A 
Type 0 (small defect): primary closure
Type 1 (partial, <50% circum): ALT, RFFF
Type 2 (circum, >50%): tubed ALT, jejunum
Type 3 (extensive non circum defects, multiple anatomic levels): Rectus, ALT
Type 4 (thoracic esophagus): gastric pull-up, pedicled (supercharged) jejunum flap
Salvage: deltopectoral
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6
Q

Goals for upper aerodigestive tract?

A

Passage of food
Facilitate airflow
Speech

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7
Q

Goals of tongue recon?

A

Airway protection
Speech/articulation
Swallowing
Protective sensation

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8
Q

Recon options for tongue?

A

15-25% - primary closure, STSG, FAMM
25-60% (hemiglossectomy) - ALT/RFFF (+lateral arm, dorsalis pedis)
>70% (total glossectomy) - ALT (+TRAM, LD, gracilis)

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9
Q

Goals for esophageal recon?

A

prevent stenosis
dysphagia
obstruction

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10
Q

Goals of nasopharynx recon?

A

provide lining

obliterate dead space

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11
Q

Goals of oropharynx reco?

A 
Soft palate: functional velum
Closure of oronasal communication
Airway protection
Aspiration protection
unrestricted swallowing
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12
Q

4 phases of swallowing?

A

Oral preparatory
Oral propulsive
Pharyngeal (airway protection)
Esophageal

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13
Q

Principles of esophageal reconstruction?

A

Anchor flap to pre-vertebral fascia to prevent sagging
Flap monitoring: bowel out to surface, skin paddle to surface, implantation doppler
Salivary bypass tubes

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14
Q

Goals of cranial base defects?

A 
Watertight dural seal
Obliterate dead space
Re-establish orbital + oropharyngeal cavities
Well-vascularized soft tissue cover
Reconstruction bony + ST defects
Cover exposed vessels
Optimal cosmesis
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15
Q

What are the 3 regions of cranial base defects? (Gullane, Irish et al 1994)

A

Region I – anterior cranial fossa, down the clivus to foramen magnum
Region II – middle cranial fossa (mainly infratemporal & pterygopalatine fossa)
Region III – posterior cranial fossa (incl. petrous temporal bone)

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16
Q

Principles of reconstruction of cranial base defects?

A

Multidisciplinary approach
Dural repair
Bone reconstruction (controversial)

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17
Q

Options for dural recon?

A

Primary closure preferred
Pericranial flap
Temporalis muscle flap
Patch (cadaver dura, bovine pericardium, fascial graft)

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18
Q

Local or regional flaps for skull base reconstruction?

A

Temporalis
Peicranial
Glabellar
Galeo-occipitalis

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19
Q

Pedicled flaps for skull base recon?

A

Pec major
Trapezius
Lat dorsi
SCM

20
Q

Free flap options for skull base recon? (most often first choice)

A 
RFF
Gracilis
VRAM
TRAM
LD
21
Q

What is the classification for forehead defects?

A

Zone 1: supraorbital brow
Zone 2: pre-hairline forehead
Zone 3: post-hairline forehead

22
Q

What are the recon options for Zone 1 forehead defect?

A

split calvarial
rib graft
vascularized bone graft

23
Q

Recon options for Zone 2 forehead?

A

alloplastic

split calvarium

24
Q

Recon options for Zone 3 forehead?

A 
Split calvarium
vascularized BG
Alloplastic
Free flap (lat dorsi) + split rib
Composite serratus + rib free flap
25
Q

What does the superficial and deep leaflets of the DTF before inferiorly

A

Superficial: parotidomasseteric fascia
Deep: posterior masseteric fascia

26
Q

Goals of recon of zygoma?

A

Facial width
Orbital volume
projection

27
Q

Definition of Le Fort I?

A

Nasal septum
Anterior + lateral maxilla walls
Pyramidal process of palatine bone
Pterygoid plates

28
Q

Definition of Lefort II

A 
Nasofrontal suture
Medial orbital wall
Orbital floor
Inferior orbital rim
ZM suture
Pterygoid plates
29
Q

Definition of Lefort III

A 
Craniofacial dysjunction
Nasofrontal suture
Medial orbital walls
Orbital floor
ZF suture
Zygomatic arch
Pterygoid plates
30
Q

What are 5 pediatric considerations in CMF trauma?

A

Faster healing (early/immediate treatment)
Erupting teeth (MMF difficult - use circummandibular or pyriform drop down wires)
Avoid subperiosteal undermining (growth disturbances)
Plates: either removal or bioabsorbable
Short period of MMF

31
Q

In Champy system, when do 1 line become 2

A

Posterior to 1st premolar

32
Q

Principles of mandible surgery?

A

Anatomic reduction of fragements
Functionally stable fixation of fragments
Atraumatic operating technique
Early active pain free mobility

33
Q

What is load-sharing stability?

A

Functional stability achieved by fixation system with anatomic abutment of fragments

34
Q

What is load-bearing stability?

A

Functional stability achieved by fixation system only

35
Q

Indications of ORIF of condyle?

A

In middle cranial fossa
Bilateral condylar fractures + midface fracture
Interferes with translation
Unable to achieve occlusion

36
Q

What are advantages of locking plate?

A

No pressure on bone
Perfect adaptation of plate not needed
Less screw loosening
“Internal external fixator”

37
Q

What are adv/disav (3) of internal and external approaches to the mandible?

A

Internal
- Adv: Hidden scar, immediate occlusion assessment
- Disad: mental nerve, angle and ramus fracture, witch chin deformity
External
- Adv: wide exposure, can inspect lower border for reduction
- Disad: visible scar, MM branch

38
Q

What is ORN?

A

Non-vital bone in area of previous radiation therapy without recurrence of cancer

39
Q

What are 2 theories of pathophysiology of ORN?

A
  1. Hypoxic theory: progressive endarteritis, not enough blood supply for bone healing
  2. Bone turnover theory: osteoblast suppression that impedes healing
40
Q

Risk factors for ORN?

A

Patient: poor oral hygiene, poor nutrition, state of dentition, ill-fitting dentures
Cancer: brachytherapy, high dose radiation, posterior defects, advanced stage tumors
Treatment: radiation >60Gy, acute trauma of surgical procedures of the jaw

41
Q

What are the indications for HBO?

A

Infectious: OM, Nec fasc
Ischemia; ORN, flap necrosis, skin necrosis after filler injection, decompression sickness, inhalational injury
Wounds: chronic wounds

42
Q

What is the pathophysiology of HBO?

A
  • hyperoxygenation
  • oxidative killing
  • toxin inhibition
  • fibroblast proliferation
  • angiogenesis
43
Q

Absolute and relative contraindications to HBO?

A

Absolute: tension pneumothorax, chemotherapy (cisplatin, bleomycin, doxorubicin)
Relative: claustrophobia, seizure, COPD, URTI, pregnacy, pacemaker

44
Q

Complications of HBO?

A

Common: claustrophobia, barotrauma, vision changes
Rare: seizure, cataract, pulmonary toxicity, finger numbness

45
Q

Define fibrous dysplasia?

A

Replacement of bone with fibro-osseous connective tissue and poorly formed trabecular bone

46
Q

What is cherubism?

A

Familial fibrous dysplasia

Characterized by fibrous dysplasia of the lower face, giving the face a rounded appearance

47
Q

Hypopharyngeal cancers is associated with which syndrome?

A 
Plummer-Vinson
Splenomegaly
Esophageal stenosis
Glossitis
Anemia (iron deficiency)

PRS RC 2020 (6 decks)

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