Nose Flashcards
High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
1. Nommer 3 éléments du questionnaire spécifiques à ce type de blessure.
- Pressure, volume, type
Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
1.Nommer 4 options pour la reconstruction du lining.
- Septal mucoperichondrial flap
Folded paramedian
Nasolabial
FAMM
High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
2. Nommer 2 signes clinic a rechercher a l’examen physique ?
- Neurovasc compromise, compartment pressure, entry wound
High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
3. Nommer 1 investigation qui vous aidera dans la prise en charge de ce patient
- X ray, compartment pressures
High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
4. Nommer 3 elements de la prise en charge
- Immediate OR for debridement +/- fasciotomies, tetanos, broad spectrum antibiotics
Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
- Nommer 2 sites donneurs pour la reconstruction du support.
SEPTUM
SPLIT CALVARIAL BONE GRAFT
CHONCHA
RIB
Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
- Nommer 3 vaisseaux qui vascularisent le lambeau paramédian ipsilatéral.
Suptratrochlear
Supraorbital
Dorsal Nasal
Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
- Nommer les repères de surface anatomique où se situe le point de pivot du lambeau frontal.
Rotation point is 1.7-2 cm lateral from the midline at the level of the superior orbital border. Flap width is 12 mm wide minimum, line is tangental to the medial border of the brow
Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
What condition if associated with rhinophyma
Acne rosacea
Name two medical treatments for rhinophyma
Accutane PO
Metronidazole topic
Tetracycline PO
Name 3 surgical treatments for rhinophyma
Cold knife excision
Dermaplanning
Dermabrasion
CO laser
3 malignant transformations of rhinophyma
BCC (15-30 %)
SCC
Sebaceous carcinoma
Angiosarcoma
2 ways to close a rhinophyma deficit
Let granulate with dressings
Paramedian flap
Skin grafts
Name three characteristics of the aging nose
Shorter and more brittle nasal bones
Drooping tip (more acute nasolabial angle)
Thinner 2/3 superior and thicker, more sebaceous tip
Increased nasal length
Name 3 treatments for internal nasal valve collapse, and where we anatomically will put the grafts
Spreader grafts
Autospreader flaps from ULC
-place between the septum and the ULC, submucoperichondreal
Inferior turbinate outfracture or resection
Septoplasty
Name 2 donor sites for spreader grafts
Costal cartilage
Septal cartilage
What vascularizes the nasal tip after open rhinoplasty?
Lateral nasal artery from the angular artery
What muscle causes the droopy nose
Depressor septi nasi
Name three valves of the nose
internal
external
velopharyngeal sphincter??
2 approaches to the septum and briefly describe them
transfixion - continuation of the intercartilaginous incision, separating the caudal septum from the membranous septum and the medial crura (through and through)
partial transfixion - attachments of the medial crural footplates and caudal septum are preserved
hemitransfixion- unilaterally at the juntion of hte caudal septum and the membranous septum
killian - high septal transfixion incision, does not violate the junction of the caudal septum and the medial crura or membranous septum
What deformation can result from an aggressive caudal septum resection ?
Short nose deformity and increased nasolabial angle
What medication can we topically apply to reduce risk of recurrence post surgery of rhinophyma
(no source)
Metronidazole
What percentage of family history is positive in rhinophyma?
21% (PRS 2002 article)
43% 2010 article from maisonneuve-rosemont
Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez.
1. Nommer deux option de lambeau local + leur vascularization
- Paramedian - supratrochlear
- Washio (retro-auricular temporal flap) - superficial temporal vessels
- Scalping flap (converse) - superficial temporal vessels
Paramedian flap : Nommer 3 façons de prélever une longueur suffisante pour une reconstruction étendue ad columelle.
- Diagonal design
- Design into hairline
- Lower base of flap below medial eyebrow
- Pre-expansion
Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez.
2 ways to reconstruct lining
Turn in free flap
Pre-laminated paramedial forehead flap
Septal pivot flap with mucoperichondral fold overs
What is the structural defect in a saddle nose?
Name 2 causes
Loss of dorsal support through loss of septum, ULC and/or nasal roof
- Over-resection of the septum
- Trauma
- Weigner’s granulomatosis
- Cocaine
- Infx : syphilis, TB)
2 ways to reconstruct a saddle nose
Dorsal reconstruction with onlay graft + columellar strut grafting (moderate)
Cantilever dorsal graft and tip support (severe)
Name 2 causes of nasal obstruction
- Septal deviation
- Turbinate hypertrophy
- Rhinitis
- External or internal valve collapse
Why would a cartilage graft of an asian patient from the nose be insufficient ?
Asian nose has less septal cartilage
Name one autogenic + alloplastic option for nasal augmentation and 4 complications of alloplastic
Autogenic : septal cartilage, choncal cartilage, rib cartilage, SCBG
Allplastic : silicone, medpor (porous polyethylene), gortex (polytetrafluoroethylene)
- migration
- infection
- extrusion
- resporption
- visability
Grafts used for nasal tip to increase projection?
- columellar strut
- septal extension
- Tip onlay (supra tip)
- Shield (infra-tip)
- Combination (supra + infratip)
Name the 4 sides of the internal nasal valve
- septum
- ULC
- inferior turbinate
- nasal floor
What impact does the internal valve have on the airway resistance ?
50-60%
2 clinical signs of internal nasal valve collapse
positive cottle test
on speculum exam, <15 degrees
inverted V
3 causes for internal valve collapse
septal deviation
age
trauma
post-rhinoplasty (overaggressive septal or ULC resection, no dorsal reconstitution)
Name the dissection planes for paramedian flap
Subcutaneous for 1-2 distal flap
Subfrontalis
Subperiostal starting 1cm above superior orbital rim
Name 3 reasons why we would delay a paramedian flap
Smoker
Radiation
Old scar lies in the flap territory
Complex extension of flap design
Pt avec déficit 16mm x 15mm nasal tip post-Moh’s. Le dermato suggère greffe de peau d’épaisseur partielle.
1. Nommer 3 désavantages de reconstruire avec une greffe cutanée d’épaisseur partielle.
- Retraction
- Color match
- Step off
- Texture
1.5x1.5 nasal tip deficit, what flap do you want to use, draw it
Marchac or Reiger (axial frontonasal)
2 principles of reconstruction for nasal alae and soft triangle
Reconstruct all three layers
Maintain airway patency
Optimize aesthetics
Decrease donor site morbidity
