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ABOMS (Johnston) > Orthognathic/Craniofacial/OSA > Flashcards

Orthognathic/Craniofacial/OSA Flashcards

1
Q

Describe APGAR score

A

Apgar scores of 0-3 are critically low, especially in term and late-preterm infants

Apgar scores of 4-6 are below normal, and indicate that the baby likely requires medical intervention

Apgar scores of 7+ are considered normal (1, 3)

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3
Q

Incidence of CLP per 1000

A
  • Asian 3.2
  • Caucasian 1.4
  • African 0.43
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4
Q

What gestational age can CLP be diagnosed

A

16 weeks via ultrasound

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5
Q

What screening tool should be employed for infant with CLP

A

Echocardiogram

R/o valve disease or great vessel transposition

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6
Q

CLP laterality prevalence

A

2:1 on left

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7
Q

When does cleft lip (CL) develop

A

During 3rd-7th weeks

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8
Q

When does cleft palate form?

A

During 5th-12th weeks

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9
Q

What processes fail to fuse in CL?

A

CL = failed fusion of medial nasal and maxillary processes

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10
Q

What fails to attach / align in CP?

A

CP = failed attachment and alignment of levator veli, tensor veli palatini, uvular, palatopharygeus, and palatoglossus muscles

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11
Q

What forms primary palate? Secondary Palate?

A

Primary palate = premaxila = lip, alveolar arch, palate anterior to incisive foramen

Secondary palate = hard and soft palates posterior to incisive foramen

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12
Q

Rule of ten’s for safe infant anesthesia

A
  • 10 weeks old
  • >10lbs
  • Hg >10
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13
Q

When is primary lip repair performed?

Advantages for later repair?

A

10-14 weeks

  1. More prominent landmarks
  2. Easier
    1. Better esthetic outcome
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14
Q

When is CP repair done?

What developmental milestone guides timing?

What are advantages for later repair?

A

9-18 months

Speech development. If child has mental delay and speech is anticipated much later, than CP repair should be delayed

  1. Decreased incidence of maxillary hypoplasia
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15
Q

What is incidence of VPI following CP repair?

A

20% VPI

diagnosed 3-5 years old

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16
Q

When is alveolar grafting performed?

A

Mixed dentition age 8-11

Canine root 2/3 formed

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17
Q

When is orthognathic surgery performed

A

If needed it is done age 14-18

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18
Q

When is lip and nasal revision surgery done?

A

After age 5 and only for severe deformities

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19
Q

What is most common technique for unilateral CL repair?

A

Millard rotation-advancement technique

  • 3 layers
  • Orbicularis oris muscle is made to form continous sphincter
  • Incisions lie in natural contours

https://www.youtube.com/watch?v=kVZ0vlW3c7Y

20
Q

When is rhinoplasty done?

A

6-12 months after orthognathic surgery, if needed. This is because maxillary advacement often improves nasal esthetics.

22
Q

What can be done during CL repair to lengthen columella or create nasal sill?

A

C-flap

https://www.youtube.com/watch?v=eZfQXT_A8Jo

23
Q

Upper facial 1/3 exam

  • Female eyebrow form/dimensions
  • Superior orbital rim relation to cornea
A
  • Female eyebrows slope upward, peaking about 10 mm above the supraorbital rims
  • The superior orbital rims should project about 10 mm in front of the cornea
24
Q
  • Normal nasolabial angle
  • Lateral orbital rim relation to cornea
A
  • 100 +/- 10. Greater in females
  • 10mm posterior to cornea
25
Q
  • Upper incisor show at rest
  • Racial variance on incisor show
  • Changes with age on incisor show
  • What percent of lower facial heigh is occupied by upper lip?
  • Lower lip?
  • Ratio of Bizygomatic width to Bigonial width?
  • Chin throat angle?
A
  • 5mm Females>males
  • Whites show more than > Asians > Blacks
  • Decreases with age
  • Upper lip 30% lower facial height
  • Lower lip 25% lower facial height
  • Bigonial width 30% less than bizygomatic width
  • Chin throat angle 110
26
Q

Steiner analysis

  • What assesses maxilla position? Normal range
  • Mandible position? Normal range
  • Max - Mand relationship? Normal range
A
  • What assesses maxilla position - SNA 79-84 deg
  • Mandible position - SNB 76-82 deg
  • Max - Mand relationship - ANB 4-0 deg
27
Q

Ricketts Analysis

  • What assesses maxilla position?
  • Normal range
A
  • What assesses maxilla position? NA - FH
  • 86-94 deg
28
Q

McNamara Analysis

  • What assesses maxilla position? Normal range
  • Mandible position? Normal range
  • Max - Mand relationship? Normal range
A
  • What assesses maxilla position? N perpendicular to A
    • Normal range 0-1mm
  • Mandible position? N perpendicular to Pog
    • Normal range mixed dentition -7mm
    • Normal range female -4 to 0
    • Normal range male -2 to +2
  • Max - Mand relationship?
    • Midface length (Condylion to A) - mandible length (Condylion to Pog)
    • Normal range mixed dentition 19-21mm
    • Normal range female 25-27mm
    • Normal range male 30-33mm
29
Q

Downs Analysis

  • Mandibular position reference points
  • Normal range
  • Similar to what analysis scheme for maxillary AP position
A
  • FH to N-Pog
  • 86-94 deg
  • Rickets uses FH to N-A point for maxilla
30
Q

Steiner Facial Type Analysis

  • How to assess facial type with Steiner
  • Normal range
A
  • Intersection of Mandibular Plane with SN
  • 30-34 deg
31
Q

Panorex findings of Long face

A
  1. Vertical growth, mandible rotated open, short ramus height, obtuse gonial angle
32
Q

Panorex findings of Short face

A

Long ramus, acute gonial angle, horizontal growth, over-closed mandible, decreased lower facial height.

33
Q

Growth cessation

  • C-spine findings on lateral ceph
A
  • Mature C-spine
    • Rectangular shape (instead of triangular)
    • Inferior body curved (instead of flat)
34
Q

Lefort Measurements

  • Incision distance above MGJ
  • Distance from piriform rim to DPA
A
  • Incision 3-5mm superior to MGJ
  • DPA 34mm posterior to piriform
35
Q

Advantages of interdental cuts between 2s/3s

Advantes of interdental cuts between 3s/4s

A

2s/3s

  • Less chance for root injury (2 single roots)
  • Often don’t need ortho to separate roots
  • Can manage inclination of incisors

3s/4s

  • Larger segment with blood suppy
36
Q

SARPE

  • Indications
  • Used when which suture has closed?
  • What does expansion start?
  • Rate of expansion?
A
  • >10mm transverse deficiency
  • Midpalatal suture
  • 5-7 days postop
  • 0.5mm day
37
Q

LeFort Complications

  • What can cause blindness during LeFort?
  • What can be done to minimize bleeding?
  • What can limit anterior movement of maxilla?
A

Blindness

  • Skull base fracture
  • Optic artery hypoperfusion
  • Arterial aneurysm

Bleeding

  • Hypotension
  • Afrin
  • Reverse Trendelenburg

Limited Anterior Movement

  • Horizontal fracture through pterygoid plates leaving medial pterygoid m. attached. Manage by separating tuberosity from pterygoid plates
38
Q

3 reasons for mandibular surgery first

A
  1. Unable to place patient in CR for planning purposes (micrognathia, condylar erosion, muscular dystonia)
  2. Clockwise mandible movement is beyond pure rotation (planning software can’t account for translation)
  3. Thin maxillary bone (if maxilla is cut and plated first, the plates may weaken during mandibular surgery due to bite blocks)
39
Q

2 reasons for maxilla first surgery

A
  1. Thin ramus, other concerns that make a bad split likely (unstable mandible puts maxilla in wrong position)
  2. If planning a VRO
40
Q

Idiopathic Condylar Resorption

Management options

Advantages/Disadvantages

A
41
Q

OSA Prevalence

A

2-4%

42
Q

What number is abnormal Epworth Sleepiness Scale

A

Score of 9 or greater

43
Q

RDI numbers / AHI numbers

Mild

Moderate

Severe

A
44
Q

Airway Eval with Lateral Ceph

  • List 3 areas
  • Average dimensions
A
  1. Soft palate length 35mm
  2. Posterior airway space: 11mm
  3. Hyoid to Mandibular plane <15mm
45
Q

Fujita Classification

List 3 types

A
  1. Narrow oropharynx: large tonsils/uvula, pillar webbing
  2. Oral and hypopharyngeal obstruction: flat palate, large tongue
  3. Hypopharyngeal obstruction: retrognathia, floppy epiglottis, large lingual tonsils
46
Q

Prevalence of Fujita Classifications

  • Percent of OSA with discrete Type II (Oro/Hypopharyngeal)
  • Percent of OSA with discrete Type I (Oropharynx)
A
  • 20% discrete Type II
  • 10% discrete Type I

ABOMS (Johnston) (8 decks)

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