OMS Flashcards
1
Q
What percentage of disc recapture occurs following arthroscopy?
A
0-10%
2
Q
What is the most common long term complication of costochondral grafts?
A
asymmetric growth
3
Q
What form of TMJ noise has the best prognosis?
A
Early opening & late reciprocal click
4
Q
How is pain felt when you have a disc perforation?
A
Capsular nociceptors
5
Q
If done incorrectly, a high condylotomy may cause damage to what nerve?
A
Auriculotemporal nerve
6
Q
A diagnostic aid for Rheumatoid Arthritis is?
A
ANA
7
Q
Why is there an increased incidence of TMJ ankylosis in children vs. adults?
A
thin cortical bone
8
Q
Tricyclic antidepressants work by:
A
Blocking reuptake of norepinephrine
9
Q
Which STD can cause arthritis?
A
gonorrhea
10
Q
There is damage to the articular cartilage in the TMJ, what is the cause of pain?
A
Prostaglandin E2, leukotriene B4
11
Q
How does damaged articular cartilage heal?
A
by forming fibrocartilage
12
Q
What happens to the synovial fluid in the TMJ in a patient with RA?
A
Decreased viscosity
13
Q
What type of occlusal splint will cause more loading on the TMJ?
A
anterior primary contact
14
Q
What is the thickness of the superior tarsal plate?
A
1mm thick, 10mm in height, 25mm length
15
Q
What is the position of the upper eyelid, at primary gaze, in relation to limbus?
A
2-3mm inferior
16
Q
Where do you make the lateral orbital osteotomy for a Lefort III?
A
Frontozygomatic suture extending into the inferior orbital fissure
17
Q
What is the most common site for A-V malformation following Lefort I osteotomy?
A
Descending palatine artery
18
Q
What area of the maxilla is most resistant to RPE?
A
midpalatal
19
Q
What causes immediate relapse following BSSRO?
A
Proximal segment distraction during fixation
20
Q
Patients with VME have?
A
Decreased masticatory force (by EMG measurement)
21
Q
What is the complication of placing the medial cut of a BSSO too high?
A
The medial pole of the condyle remains with the distal segment
22
Q
SARPE should be considered in which patient?
A
Adults (>18 years) with greater than 5mm of transverse deficiency
23
Q
What is the most common “bad split” during a BSSO?
A
Buccal plate fracture
24
Q
Where does the mentallis muscle insert?
A
Dermis of skin
25
Best age for hard tissue manipulation in cleft patients is?
9-11
26
What palatal muscle is not involved in speech?
Tensor veli palatine
27
What is the function of the hamulus?
Pully point for the tensor veli palatini
28
Patients with congenital micrognathia may also have defects in which bones?
Malleus & Incus (1st pharyngeal arch)
29
What muscle acts to close the eustacian tube?
No muscle acts to close the tube, it is closed by relaxation of the levator veli palatine and the tensor veli palatine, which both actually aid in opening the tube
30
Describe how you would use a tongue flap to close an alveolar cleft defect?
anteriorly based
31
Parents without clefts have a child with a cleft, what is the chance that they will have another cleft child?
4%
2 children: 9% for 3rd
1 parent: 4-6% child
1 parent and 1 child: 17%
32
What is the ideal time for lip adhesion?
6-8 weeks, completed by 3 months, brings palatal segments together, not muscles
33
What palatal muscle is most responsible for speech?
Levator veli palatini
34
What is the etiology of hemifacial microsomia?
Intrauterine damage of the stapedial artery
35
What is the most important muscle to close for VP competence?
Levator veli palatine
36
What is the average preferred distance of the upper brow to the pupil center?
25mm
37
What is Romberg’s syndrome?
Progressive hemifacial atrophy, coup de gras defect
38
What is the relationship of the malar eminence to the lateral canthus?
10 mm lateral and 15-20 mm inferior
39
What is the normal dimension for the palpebral fissure?
8-12mm women, 7-10mm men
40
Likely causes of 100 degree neck-chin angle?
normal (105-120)
41
What is the relationship of the medial and lateral canthus?
Lateral is 4mm superior to medial
42
Which muscle is not affected by brow lift?
rizorius
43
What muscle insert into the Nasolabial fold?
levator labii superirois aleque nasi
44
What is the blood supply to a genioploasty segment?
periosteum
45
Ramsey Hunt syndrome is?
Involves auditory canal & nerve, caused by Herpes zoster virus, causes facial paralysis due to CN VII involvement, deafness, vertigo and pain. Triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle
46
The least predictable area of soft tissue change with mandibular movements is?
lower lip
47
The least predictable area of soft tissue change with mandibular movements is?
Supraorbital nerve –has a deep division that is not easily identified
48
The open sky approach in the bleph, the following structure is exposed?
Septum
49
The ability to distract the lower lid more than ___ mm indicates the need for a lower eyelid shortening procedure?
8mm
50
What 2 anatomic factors are implicated for their movement having an effect on the soft tissues after Lefort I osteotomies?
ANS and upper incisor
51
How do you treat VPI with poor elevation of soft palate?
Superior based flap
52
Mueller’s muscle is under what type of control?
Sympathetic
53
What is the location of the nasal portion of the Lefort II osteotomy?
Inferior to the nasofrontal suture
54
What is the vascular supply to the inferior turbinate?
Spenopalatine artery (internal max)
55
After a Lefort I osteotomy, a patient has a strange aura and diplopia, what is the cause?
Cavernous sinus thrombosis
56
What is the correct pressure setting of CPAP for a patient with OSA?
7-15
57
What artery does not contribute to the frontal flap to the nose?
Superficial Temporal (Supratrochlear, supraorbital, dorsal nasal do)
58
What separates the fat pads in the lower lid?
Inferior oblique separates medal & central pads
59
What is the pathway of dissection for an open rhinoplasty?
Over perichondrium, under Periosteum
60
What is the relationship of the lateral nasal cartilage to the nasal bones?
Cartilage fits under the bones
61
What is the minimum that is required on the lower lateral cartilages for tip support?
5-7mm (at the dome)
62
Where do you place bone grafts for Lefort III?
Tuberosity, Zygomatic/temporal, orbital
63
What muscle opens the Eustachian tube?
Tensor veli palatine
64
What is the length of the nares, when compared to the columella?
2:3
65
Where does the maxillary sinus exit in the nose?
middle meatus
66
What is the pollybeak deformity?
Convexity of nasal supratip, relative to rest of nose
Complication following rhinoplasty – inadequate reduction of the superior septal angle, a transfixation incision that is not adequately reconstructed and/or postoperative scarring in the supratip region
Also called Parrot’s beak deformity
67
Distraction osteogenesis Advantage over BSSO or difference is:
higher rate of condylar resorption and nerve injury w/ BSSO
68
Which type of BSSO movement would cause most condylar resorption?
High mandibular plane advancement
69
When would DO be more beneficial over BSSO?
Short posterior face height
70
Wilkes classification, what characteristics of stage IV?
Bony remodeling
71
What do you do to minimize relapse of B point after mand OGS surgery?
2 superior border and one inferior border screw
72
What is Bolton analysis?
The overall ratio known to be 91.3%
The Anterior analysis measures the sum of Mesio-distal width of front 6 mandibular teeth and compares them to maxillary teeth. The anterior ratio is known to be 77.2%
73
Physical findings in chondromatosis of the TMJ.
loose radiodense bodies within the joint. These loose bodies are formed by metaplastic synovial tissues (joint mice)
74
Muscle not important in velopharyngeal competence
Superior pharyngeal constrictor.
75
Path of Hypoglossal nerve in relation to hyoglossus and mylohoid muscle?
Lateral to hyoglossus, medial to mylohyoid
76
Innervation of Deltoid, Bicep, Tricep
Deltoid C4-5
Bicep C5-6
Tricep C6-7
77
Which of the following is an accessory TMJ ligament?
Sphenomandibular and stylomandibular
78
Mueller’s muscle but called it the superior tarsus muscle innervation
innervated form the cervical sympathetics and will still have a superior lid crease if it’s out because the crease is caused by the levator
79
Deficit in frontalis vs Deficit procerus and corrugator
Deficit in frontalis: brows drop
| Deficit procerus and corrugator: brow raises
80
Least helpful to evaluate disc position:
tomogram
81
ee increased what in inflammed TMJ
prostaglandins e2, leukotrienes b4
82
When do palatal shelves fuse-related to tongue dropping down
8 week is when tongue drops and the palatal shelves are completley fuses at week 12
83
Innervation of posterior and anterior digastric
anterior belly - mandibular division (V3) of the trigeminal (CN V) via the mylohyoid nerve;
posterior belly - facial nerve (CN VII)
84
Muscles that open jaw.
Lateral pterygoid, digastric, mylohyoid, geniohyoid
85
a delta vs c nerve
```
A Delta: sharp Pain (mechanical and thermal), mylenated, large (1-5micrometers)
fast conduction (5-40m/s)
```
C-fiber: dull pain (mechanical, thermal, and chemical), unmylenated, small (0.2-
1.5micrometers), slow (0.5-2 m/s)
86
Innervation of Palatoglossus
vagus
87
What happens to the bone of the condyle when it gets eroded through. How does it repair and would MMF help ?
bony thickening and marginal osteophyte formation in the mandibular condyle –MMF does not help
88
What joins maxillary vein to form retromandibular vein:
superficial temporal vein
89
Characteristics of Cluster headache: onset:
severe, unilateral orbital, supraorbital, temporal pain lasting 15-180 minutes accompanied by ipsilateral lacrimation, rhinorrhea, eyelid edema, miosis, 1 to 8 attacks per day.
90
What RDI is indication for treatment in child with craniofacial anomaly?
10
91
After birth what part of the mandible shows the least growth?
symphysis
92
Muscle of facial expression that does not attach to bone?
rizorius
93
What percentage of lingual nerves rise above the level of the alveolar crest at the area of the thrid molar?
14%
94
Alveolar bone comes from what brachial arch? And is it ecto or endomesenchyme?
1st arch and ectomesenchyme
95
How long does cememtum take to repair in weeks?
4-6
96
SARPE area most likely to cause orbital and sphenoid bone fractures?
Pterygomaxillary junction
97
Lefort unrepaired causes elongation of the midface due to what muscle?
medial pterygoid
98
What nerve provides sensory to cutaneous nasal tip?
Anterior ethmoidal
99
How does the mandible /maxilla form?
First arch with mesoderm
100
After lefort surgery, notice a septal deviation with alar aspect of nose disformed, what do you do?
Put the septum back in the clinic or in the OR.
101
difference between myofascial pain and myositis
Myofacial pain: repepetive strain: unilateral, dull, aching pain; limited mouth opening, pts often complain of frequent
headache and earache; soft end-feel; pain increases with function. LOCALIZED, REPRODUCIBLE TENDERNESS with trigger points. Sensation of acute malocclusion
(not verifiable clinically). Complaints of frequent temporal headaches
Myositis: injury or infection: swelling and inflammation secondary to direct trauma or infection; trismus. Localized CONTINUOS PAIN IN MUSCLE WITH DIFFUSE TENDERNESS AND SWELLING OF THE ENTIRE LENGTH OF THE AFFECTED MUSCLE
102
Epker modification with BSSO
dissection carried out, only as needed, avoiding excessive stripping of the masseter and medial pterygoid muscles. This causes less swelling and postoperative discomfort as well as preservation of blood supply
103
how many seconds are considered an apnic event
10 seconds
104
During arthrocentesis develop Retro-discal bleeding
retrude the condyle
105
Palatal cleft affects which dimensions of growth
transverse, A-P and vertical
106
multiple alveolar cleft repair failures results in recurrent oronasal fistula, best closed with what flap?
anterior tongue
107
Supraorbital rim position
5-8 mm in front of cornea
108
What makes stable brow lift
Trancutaneous bone screws at each parasag. Location – removed after 1 week
109
In Endoscopic brow lift, which muscles cut?
Procerus and corrugator
110
Best way to prevent skin dimpling following submental SAL
keep cannula toward platysma
111
Where is temporal branch of VII?
contined within its undersurface
112
Why is there a risk of going subplatysmal
because many people have a natural midline dehiscence
113
What is the action of the hypoglossal nerve:
n 12-motor to all tongue muscles except palatalglossus (9, 10)
114
What med do you give TMJ patient with GI disease that can’t take nsaids?
choline magnesium trisalicylate or salsalate
115
columellar double break is formed by:
olumellar double break marks the transition between the intermediate crus of the lower lateral cartilage and the medial crus
116
Submentoplasty contraindications
```
retrogenia/micrognathia, cherubic face
low and anterior hyoid bone (ideal high and posterior hyoid bone)
ptotic submandibular glands
loss of cervical skin elasticity
platysmal banding/laxity
little to no cervical subcutaneous fat
```
117
Glogau classification of wrinkles
- Category I: young, with “no wrinkles” and minimal photoaging and are best managed with cosmoceutical agents and superficial resurfacing procedures such as light chemical peels and microdermabrasion
- Category II patients: in their thirties, with early to moderate signs of photoaging and characterized by wrinkles in motion
- Category III patients: moderate to advanced photoaging with static wrinkles requiring more significant ablative resurfacing techniques
- Category IV patients are the oldest, with more severe photoaging changes and wrinkles significant enough to justify deep resurfacing and other surgical techniques
