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Plastic Surgery Royal College > Nose > Flashcards

Nose Flashcards

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1
Q

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.

A
  1. Pressure, volume, type
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2
Q

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
1.Nommer 4 options pour la reconstruction du lining.

A
  1. Septal mucoperichondrial flap
    Folded paramedian
    Nasolabial
    FAMM
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3
Q

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 ?

A
  1. Neurovasc compromise, compartment pressure, entry wound
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4
Q

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

A
  1. X ray, compartment pressures
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5
Q

High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
4. Nommer 3 elements de la prise en charge

A
  1. Immediate OR for debridement +/- fasciotomies, tetanos, broad spectrum antibiotics
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6
Q

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

  1. Nommer 2 sites donneurs pour la reconstruction du support.
A

SEPTUM
SPLIT CALVARIAL BONE GRAFT
CHONCHA
RIB

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7
Q

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

  1. Nommer 3 vaisseaux qui vascularisent le lambeau paramédian ipsilatéral.
A

Suptratrochlear
Supraorbital
Dorsal Nasal

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8
Q

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

  1. Nommer les repères de surface anatomique où se situe le point de pivot du lambeau frontal.
A

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

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9
Q

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

A
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10
Q

What condition if associated with rhinophyma

A

Acne rosacea

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11
Q

Name two medical treatments for rhinophyma

A

Accutane PO
Metronidazole topic
Tetracycline PO

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12
Q

Name 3 surgical treatments for rhinophyma

A

Cold knife excision
Dermaplanning
Dermabrasion
CO laser

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13
Q

3 malignant transformations of rhinophyma

A

BCC (15-30 %)
SCC
Sebaceous carcinoma
Angiosarcoma

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14
Q

2 ways to close a rhinophyma deficit

A

Let granulate with dressings
Paramedian flap
Skin grafts

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15
Q

Name three characteristics of the aging nose

A

Shorter and more brittle nasal bones
Drooping tip (more acute nasolabial angle)
Thinner 2/3 superior and thicker, more sebaceous tip
Increased nasal length

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16
Q

Name 3 treatments for internal nasal valve collapse, and where we anatomically will put the grafts

A

Spreader grafts
Autospreader flaps from ULC
-place between the septum and the ULC, submucoperichondreal
Inferior turbinate outfracture or resection
Septoplasty

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17
Q

Name 2 donor sites for spreader grafts

A

Costal cartilage
Septal cartilage

18
Q

What vascularizes the nasal tip after open rhinoplasty?

A

Lateral nasal artery from the angular artery

19
Q

What muscle causes the droopy nose

A

Depressor septi nasi

20
Q

Name three valves of the nose

A

internal
external
velopharyngeal sphincter??

21
Q

2 approaches to the septum and briefly describe them

A

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

22
Q

What deformation can result from an aggressive caudal septum resection ?

A

Short nose deformity and increased nasolabial angle

23
Q

What medication can we topically apply to reduce risk of recurrence post surgery of rhinophyma

A

(no source)
Metronidazole

24
Q

What percentage of family history is positive in rhinophyma?

A

21% (PRS 2002 article)
43% 2010 article from maisonneuve-rosemont

25
Q

Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez.
1. Nommer deux option de lambeau local + leur vascularization

A
  1. Paramedian - supratrochlear
  2. Washio (retro-auricular temporal flap) - superficial temporal vessels
  3. Scalping flap (converse) - superficial temporal vessels
26
Q

Paramedian flap : Nommer 3 façons de prélever une longueur suffisante pour une reconstruction étendue ad columelle.

A
  1. Diagonal design
  2. Design into hairline
  3. Lower base of flap below medial eyebrow
  4. Pre-expansion
27
Q

Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez.

2 ways to reconstruct lining

A

Turn in free flap
Pre-laminated paramedial forehead flap
Septal pivot flap with mucoperichondral fold overs

28
Q

What is the structural defect in a saddle nose?
Name 2 causes

A

Loss of dorsal support through loss of septum, ULC and/or nasal roof

  1. Over-resection of the septum
  2. Trauma
  3. Weigner’s granulomatosis
  4. Cocaine
  5. Infx : syphilis, TB)
29
Q

2 ways to reconstruct a saddle nose

A

Dorsal reconstruction with onlay graft + columellar strut grafting (moderate)

Cantilever dorsal graft and tip support (severe)

30
Q

Name 2 causes of nasal obstruction

A
  1. Septal deviation
  2. Turbinate hypertrophy
  3. Rhinitis
  4. External or internal valve collapse
31
Q

Why would a cartilage graft of an asian patient from the nose be insufficient ?

A

Asian nose has less septal cartilage

32
Q

Name one autogenic + alloplastic option for nasal augmentation and 4 complications of alloplastic

A

Autogenic : septal cartilage, choncal cartilage, rib cartilage, SCBG
Allplastic : silicone, medpor (porous polyethylene), gortex (polytetrafluoroethylene)

  1. migration
  2. infection
  3. extrusion
  4. resporption
  5. visability
33
Q

Grafts used for nasal tip to increase projection?

A
  1. columellar strut
  2. septal extension
  3. Tip onlay (supra tip)
  4. Shield (infra-tip)
  5. Combination (supra + infratip)
34
Q

Name the 4 sides of the internal nasal valve

A
  1. septum
  2. ULC
  3. inferior turbinate
  4. nasal floor
35
Q

What impact does the internal valve have on the airway resistance ?

A

50-60%

36
Q

2 clinical signs of internal nasal valve collapse

A

positive cottle test
on speculum exam, <15 degrees
inverted V

37
Q

3 causes for internal valve collapse

A

septal deviation
age
trauma
post-rhinoplasty (overaggressive septal or ULC resection, no dorsal reconstitution)

38
Q

Name the dissection planes for paramedian flap

A

Subcutaneous for 1-2 distal flap
Subfrontalis
Subperiostal starting 1cm above superior orbital rim

39
Q

Name 3 reasons why we would delay a paramedian flap

A

Smoker
Radiation
Old scar lies in the flap territory
Complex extension of flap design

40
Q

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.

A
  1. Retraction
  2. Color match
  3. Step off
  4. Texture
41
Q

1.5x1.5 nasal tip deficit, what flap do you want to use, draw it

A

Marchac or Reiger (axial frontonasal)

42
Q

2 principles of reconstruction for nasal alae and soft triangle

A

Reconstruct all three layers
Maintain airway patency
Optimize aesthetics
Decrease donor site morbidity

Plastic Surgery Royal College (3 decks)

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