Nasal Reconstruction

Question 1

The subunit concept is critical to consider in nasal
reconstruction.

Answer 1

T

Question 2

bilobed flaps are used on tip and ala, not the dorsum

Answer 2

T

Question 3

forehead flap is the workhouse for large and composite
defect.

Answer 3

T

Question 4

Active smoking history is a relative contraindication to certain forms of
nasal reconstruction

Answer 4

T

Question 5

For larger defects, such
as a total rhinectomy, a nasal prosthesis can be constructed for temporary or permanent use

Answer 5

t

Question 6

The extent of ambient light as well as patient positioning can
impact the delineation of the borders of each subunit

Answer 6

T

Question 7

if more than 50% of a given subunit is involved in a nasal
defect, the entire subunit should be excised prior to any reconstruction.

Answer 7

T

Question 8

replacement of a partial subunit rather than a complete subunit
is considered less ideal

Answer 8

T

Question 9

application of the subunit principle in this manner is universal for all patients and defects.

Answer 9

F application of the subunit principle in this manner is not universal for all patients and defects.

Question 10

The subunit principle should be utilized as an absolute rule

Answer 10

F The subunit principle should be utilized as a tool to guide the
reconstructive surgeon, rather than an absolute rule

Question 11

The pincushioning phenomenon can actually
improve the final reconstructive contour in the alar or tip subunits

Answer 11

T

Question 12

the nasal dorsum and sidewall subunits are almost always replaced with grafts
from the nasal septum or rib

Answer 12

T

Question 13

Why Nasal lining defects present distinct challenges?

Answer 13

limited availability of remaining native nasal lining

Question 14

septa! mucosa from the contralateral nasal vault can be used as a turnover flap based on columella art

Answer 14

F septa! mucosa from the contralateral nasal vault can be used as a turnover flap based on anterior
ethmoidal artery branches

Question 15

The draw back of local
mucosa! flaps

Answer 15

are technically challenging and can potentially be distorting to the remaining intact nasal anatomy. They also do not provide a sufficient amount of tissue for the closure of largest lining defects

Question 16

lining-based flaps, these have been more recently replaced by the use of the folded forehead flap

Answer 16

T

Question 17

Options of small- to moderate-sized defect

Answer 17

emaining external skin as
a turnover flap
use of a nasolabial or facial artery musculomucosal (FAMM) flap
forehead flap

Question 18

delayed reconstruction, this may require recreating the original defect

Answer 18

T

Question 19

Flaps should be made too small, to minimize the donor site

Answer 19

F Flaps should not be made too small, to minimize the donor site

Question 20

, missing tissue should be replaced in the
exact amount that has been lost or removed

Answer 20

T

Question 21

small- to medium-sized defects (1-2 cm) option of reconstruction

Answer 21

primary, skin graft,
or local flap closure

Question 22

exceed the 1.5 to 2-cm size mark,
local flaps beyond the forehead flap are more difficult to utilize

Answer 22

T

Question 23

small, superficial defect of nose closed by secondary intension

Answer 23

T

Question 24

Limitation of the secondary intension healing?

Answer 24

secondary healing should be avoided in wounds
in which vital deep structures are exposed
Delayed healing can also be unpredictable with regards to the
amount of contraction seen, which can distort surrounding anatomy
quality
of the resultant scar, which can be depressed or shiny in appearance

Question 25

secondary healing of wounds near the nasal tip or ala can result in esthetically unappealing nasal tip elevation

Answer 25

T

Question 26

Secondary intention give better result over concave surface

Answer 26

T. imperceptible in flat or concave areas or within sun- or radiation-damaged skin

Question 27

medial canthal region and upper nasal sidewall are areas that generally have good outcomes using secondary intension method

Answer 27

T

Question 28

defects that are less than 5 to 6 mm in size.can closed primarily especially in the upper two-thirds of the nose,

Answer 28

T

Question 29

Primary closure at the tip of the nose is recommended

Answer 29

Attempts at primary closure in this region can lead to wide, depressed scars as well unacceptable amounts of anatomic distortion

Question 30

what are the privilege of full-thickness graft in nose reconstruction

Answer 30

no additional scars are added to the area surrounding the defect locally available tissue is not a limiting factor it is relatively quick and easy for the patient

Question 31

full-thickness grafts can do well in the thin-skinned areas of the dorsum or nasal sidewalls

Answer 31

T

Question 32

rafts on the front of the nose on or near the nasal tip will often appear as depressed, off-colored patches that do not blend well with the surrounding skin

Answer 32

T

Question 33

The dorsal nasal flap, glabellar, Rieger, and miter are useful option to reconstruct any defect in the nose

Answer 33

F. take advantage of the relative excess of tissue present in glabella and nasal dorsum regions and are useful for closure of defects in the proximal and middle third of the nose

Question 34

The bilobed flap is a workhorse flap for defects of the thick, stiff skin of the distal third of the nose that are up to 1.5 cm in size.

Answer 34

T

Question 35

The bilobed flap base should be positioned laterally and medially for tip and alar defects

Answer 35

T

Question 36

If needed bilobed flap can extend to check and lower lid skin

Answer 36

It should not extend onto cheek or lower lid skin

Question 37

Bilobed flap include subcutaneous tissue and skin only

Answer 37

F. These flaps are elevated with muscle immediately superficial to the periosteum or perichondrium with wide undermining of the adjacent skin to enable closure of the secondary and tertiary defects

Question 38

postoperative distortion as well as a pincushioning appearance to the Bilobed flap is not uncommon

Answer 38

T

Question 39

In the middle part of the nose, lateral defects that are vertically oriented can use a V-Y flap from the remaining sidewall extending onto the medial cheek

Answer 39

T

Question 40

V-Y flap based on the perforator of the angular art

Answer 40

T

Question 41

small alar defects sparing the nasal rim can be repaired with a V-Y advancement

Answer 41

T

Question 42

Nasolabial flaps can be utilized for resurfacing defects of the nasal sidewall and ala

Answer 42

T

Question 43

anatomic distortion is significant with nasolabial flap

Answer 43

F Because tissue is recruited from outside the the nose itself, anatomic distortion is minimized enabling the closure of larger nasal defects

Question 44

Nasolabial flap can performed in One or Two stage

Answer 44

T

Question 45

In the nasolabial flap Removal of intervening tissue is better tolerated at the ala of the nose

Answer 45

F Removal of intervening tissue is better tolerated at the nasal sidewall subunit whereas defects of the ala, alar crease, and hairless triangle it is preferential to keep the intervening tissue with plans for division and inset 3 weeks later

Question 46

The width of the flap along the nasolabial crease has dimensions equal to the height of the defect.

Answer 46

T

Question 47

Nasolabial flap include muscle

Answer 47

F elevated above the facial mimetic musculature to include small perforating branches of the facial artery.

Question 48

The principal limitation of nasolabial flaps

Answer 48

The principal limitation of nasolabial flaps is the nature of pincushioning or trapdoor healing that occurs at the location of the ala

Question 49

superior portion of forehead flap can be closed primarily or be allowed to heal secondarily through wound contracture and reepithelialization with good results

Answer 49

T

Question 50

the donor site of forhead flap can be grafted

Answer 50

F Skin grafting of the donor site should be avoided

Question 51

The paramedian forehead flap based on the ipsilateral pedicle

Answer 51

T

Question 52

Indications for forehead flap reconstruction

Answer 52

Defects larger than 1.5-cm multiple subunits. Composite defects

Question 53

When performing the reconstruction in three stages, there is no added benefit to thinning the flap during the initial stage

Answer 53

T

Question 54

flap necrosis can be seen in three-stage reconstructions

Answer 54

F flap necrosis can be seen in two-stage reconstructions particularly in smokers

Question 55

The width of the forehead flap

Answer 55

1.2 to 1.5 cm wide at its base

Question 56

The forehead flap should not extend to the orbital rim

Answer 56

F Extending the flap base inferiorly across the orbital rim can be performed to gain additional flap length

Question 57

Major complications following nasal reconstruction are generally rare.

Answer 57

T

Question 58

In case of infectin depridement of the effected cartilage with delay in replacement of any cartilage for at least 4 to 6 weeks

Answer 58

T

Question 59

Biloped flap for tip lateraly base

Answer 59

T

Question 60

Subunit concept not used any more

Answer 60

T

Question 61

Nasopalatine nerve supply the upper part of the philtrum

Answer 61

T

Question 62

Secondary intension of the nasal tip lead to elevation of the columella

Answer 62

T

Question 63

bilobed flaps are used on tip and ala, not the dorsum

Answer 63

T

Question 64

defects as small as a few millimeters on the nasal tip or ala can significantly distort a patient's appearance if closed without the recruitment of tissue from outside the area

Answer 64

T

Question 65

it is recommended that the relevant subunit anatomy be marked with the patient upright in the preoperative area rather than supine on the operating room table

Answer 65

T

Question 66

bipedicle bucket handle flap from high in the nasal vault may be used for small ala or alar margin lining defects.

Answer 66

T

Question 67

For mid-vault defects, the ipsilateral or contralateral septa! lining can provide a large amount of mucosa for lining replacement

Answer 67

T

Question 68

When harvested from the ipsilateral nose, the lining flap is based anteriorly off of the labial artery via its columella branches

Answer 68

T

Question 69

Finally, for larger heminasal or subtotal lining defects, free tissue transfer such as a free radial or ulnar forearm flap is typically required

Answer 69

T

Question 70

Delayed healing can also be unpredictable

Answer 70

T with regards to the amount of contraction seen, which can distort surrounding anatomy

Question 71

flat or concave areas or within the sun- or radiation-damaged skin. we leave the wound with secondary healing

Answer 71

T

Question 72

Primary closure of defects is particularly true in the upper twothirds of the nose

Answer 72

T

Question 73

The dorsal nasal flap, glabellar, Rieger, and miter flaps Supplied by the angular artery

Answer 73

T

Question 74

The dorsal nasal flap, glabellar, Rieger, and miter flaps are muscular flap

Answer 74

these flaps are elevated as skin and subcutaneous tissue with or without muscle and rotated and/or advanced inferiorly toward the nasal tip

Question 75

One common disadvantage of these flaps is the depressed transverse scar that is often apparent at the flap junction with the tip subunit

Answer 75

t

Question 76

Bilobed flap rotation in 180 degrtee

Answer 76

F Traditionally, flaps were designed to require a 180° rotation, which created large dogears and later Zitelli,25 developed the aforementioned design to decrease the flap's rotation to 90° to 100°.

Question 77

The V-Y flap can be used in in convex surface

Answer 77

F in a natural crease or concavity.

Question 78

In the proximal third of the nose, vertically oriented defects centrally can be reconstructed with V-Y flap from the nasal sidewall

Answer 78

T

Question 79

nasal dorsum tissue can be utilized for more lateral defects

Answer 79

T

Question 80

In the middle part of the nose, lateral defects that are vertically oriented can use a V-Y flap from the remaining sidewall extending onto the medial cheek.

Answer 80

T

Question 81

The goal for inset should be that the flap is completely on the nose instead of straddling the nasal-cheek junction so as to not efface this natural crease.

Answer 81

T

Question 82

The principal limitation of nasolabial flaps is the nature of pincushioning or trapdoor healing that occurs at the location of the nasal side wall

Answer 82

F The principal limitation of nasolabial flaps is the nature of pincushioning or trapdoor healing that occurs at the location of the ala

Question 83

midline nasal defects can be resurfaced using flaps based on either the left or right pedicle, whereas unilateral defects are reconstructed by flaps based on the ipsilateral pedicle to shorten the distance between the pivot point and the defect, assuming no previous scars in the area in forehead flap

Answer 83

T

Question 84

Approximately l to 2 cm cephalad to the eyebrow, the plane of dissection proceeds deep to the periosteum to capture the supratrochlear vessels

Answer 84

t

Question 85

The secondary or intermediate stage the forehead flap is elevated off of its nasal bed at a superficial subcutaneous level of 2 to 3 mm in thickness, leaving the supratrochlear pedicle intact

Answer 85

t

Question 86

The residual excess subcutaneous fat and frontalis muscle left on the nasal substance are sculpted and thinned to create the desired contour. Cartilage grafts are placed

Answer 86

T