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ENT Specialties MAIN > Plastic Surgery > Flashcards

Plastic Surgery Flashcards

1
Q

What is the appropriate ratio of the long and short axes for elliptical incisions?

A

0.167361111111111

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2
Q

Generally, what size defects of the lower lip can be closed primarily?

A
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3
Q

What is the most common reason for rhinoplasty revision?

A

Polly beak deformity or supratip swelling.

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4
Q

What is the primary blood supply of the deltopectoral flap, temporal, forehead, and nape of neck cutaneous flaps?

A
  • DeltopectoralInternal mammary arteries.
  • Temporal-Superficial temporal artery.
  • Forehead-Supraorbital and supratrochlear arteries
  • Nape of neck-Random (postauricular, occipital vertebral arteries).
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5
Q

What are five lower lid blepharoplasty techniques that help prevent postoperative retraction?

A
    1. Horizontal alignment of lower lid incisions.
    1. Preservation of a strip of orbicularis attached to the tarsal plate.
  • 3•Draping of the flap medially and superiorly.
  • 4• Placement of a suspension suture between the deep surface of the orbicularis and the orbital periosteum.
  • 5•Triamcinolone injection into plane of orbital septum.
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6
Q

What are the five stages in the repair of third-degree microtia?

A
  • I-Auricular reconstruction.
  • II-Lobule transposition.
  • III-Atresia repair.
  • IV-Tragal construction.
  • V-Auricular elevation.
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7
Q

What are the reconstructive options when the mandibular condyle must be removed during tumor resection?

A
  • Incompletely reconstruct the ramus so that it does not extend as high as the glenoid fossa.
  • Attach a prosthetic condyle to the flap.
  • Shape the end of the flap to simulate the condyle.
  • Use the resected condyle as a nonvascularized graft mounted onto the end of the flap with a miniplate.
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8
Q

At what age is cleft palate repair performed?

A

>6 months.

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9
Q

What do “microplates” refer to?

A

1.0 mm screw applications.

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10
Q

How long does it take for hair to start growing after transplantation?

A

10-16 weeks.

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11
Q

How many hairs are contained in a micrograft?

A

1-2.

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12
Q

Where should subperiosteal undermining begin during brow lift?

A

2.5 cm above the lateral orbital rim to avoid injury to the supraorbital nerve.

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13
Q

What is the best method of reconstruction for defects between 1/2 and

A

2/3 of the lower lip, not involving the oral commissure? Abbe-Sabattini flap.

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14
Q

What postorbital fracture visual acuity scores are associated with a return to normal acuity after treatment?

A

20/400 or better.

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15
Q

At what age is lip adhesion performed?

A

2-4 weeks of age.

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16
Q

‘What is the typical long-term interincisal opening after surgical correction of TMJ ankylosis?

A

25-28 mm.

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17
Q

What percent of patients develops herpes simplex virus (HSV) despite antiviral prophylaxis?

A

2-7%.

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18
Q

What is the incidence of positive responses to skin tests for injectable collagen?

A

3%.

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19
Q

What percent of patients develops postinflammatory hyperpigmentation?

A

33% (more for darker skin types).

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20
Q

Where should dissection of the tarsoconjunctival flap begin in relation to the eyelid margin?

A

3-4 mm superior to the lid margin.

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21
Q

How long does injectable collagen remain in the tissue?

A

3-6 months.

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22
Q

How many hairs are contained in a minigraft?

A

3-8.

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23
Q

How much time should be allotted between transplantation sessions?

A

4 months.

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24
Q

At what age is pharyngoplasty typically performed?

A

4 years.

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25
Q

How far posterior should dissection proceed when placing a porous polyethylene implant for defects of the posterior convex orbital floor?

A

4cm.

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26
Q

When does hypopigmentation after laser skin resurfacing present?

A

6-12 months after treatment.

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27
Q

What are the indications for endoscopic optic nerve decompression after facial trauma?

A

66% reduction in amplitude of the visual-evoked response, loss of red color vision, bony impingement on the optic canal, and afferent papillary defect.

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28
Q

What percent of patients develops contact dermatitis after laser resurfacing?

A

6s%.

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29
Q

What is the average gain in soft-tissue projection after implant placement?

A

70% of the size of the implant.

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30
Q

How is infection managed after chin implantation?

A

A 10-day course of antibiotics is given, and if the infection does not resolve, the implant should be removed. If a microporous implant is used, the implant is removed without delay.

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31
Q

What complication will occur if the above ratio is not met?

A

A dog-ear deformity.

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32
Q

What are the key features of the Millard cleft lip repair?

A

A medial rotation flap to align the vermillion, a triangular C flap to lengthen the columella, and an advancement flap to close the upper lip and nostril sill.

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33
Q

What is lip adhesion?

A

A preliminary step in cleft lip repair where a complete cleft lip is converted into an incomplete cleft.

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34
Q

What should be incorporated into the flap to promote viability of the skin paddle?

A

A small cuff of soleus and flexor hallucis longus muscle.

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35
Q

What is the most common cause of lower lid retraction after blepharoplasty?

A

Accumulation of small amounts of blood in the middle lamellar plane.

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36
Q

When should micro- and minigrafts be placed in relation to flap or reduction procedures?

A

After the flap or reduction procedures have healed.

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37
Q

What is the ideal age for unilateral microtia correction?

A

Age 6.

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38
Q

What is the most important factor in the aesthetic outcome of lip reconstruction?

A

Alignment of the vermillion border.

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39
Q

What is the safest plane of dissection in the malar region?

A

Along the superficial surface of the elevators of the upper lip (zygomaticus major and minor).

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40
Q

Where in the midface is the facial nerve most vulnerable during SMAS undermining?

A

Anterior to the parotid gland.

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41
Q

What does the converse technique attempt to reconstruct during surgery for the prominent ear?

A

Antihelix of the auricle.

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42
Q

What are the contraindications to primary closure of bites?

A

Any human bite; animal bites seen after 5 hours of injury; all avulsion injuries from any animal bite.

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43
Q

On average, how much skin is perfused by the peroneal artery in the Fibular free flap?

A

Approximately 10 x 21 cm.

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44
Q

Where should the vascular pedicle lie on the new mandible?

A

As close as possible to the new mandibular angle.

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45
Q

How much time should be allotted before removing an implant due to improper size?

A

At least 3 months.

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46
Q

How much cartilage should be preserved during a complete strip procedure?

A

At least a 4-5 mm strip or 75% of the original cartilage volume.

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47
Q

Where are inferiorly positioned plates placed?

A

At the inferior border of the mandible to avoid the neurovascular bundle.

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48
Q

Which major tip support mechanism is violated by the inter- and transcartilaginous incisions?

A

Attachment of the caudal edge of the upper lateral cartilages to the cephalic edge of the alar cartilages.

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49
Q

Which major tip support mechanism is violated by the complete transfixion incision?

A

Attachment of the medial crura to the caudal septum.

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50
Q

Which reconstructive options when the mandibular condyle must be removed during tumor resection is optimal?

A

Autologous condyle transplantation as it preserves occlusion, TMJ function, and vertical facial height without increasing morbidity.

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51
Q

How wide are the Burrow’s triangles designed?

A

Bases are equal in width to 1/2 of the lip defect.

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52
Q

What is the treatment for a nondisplaced posterior table fracture with a CSF leak?

A

Bed rest with head elevation +I- lumbar drain; cranialization considered if not resolved after 5-7 days.

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53
Q

What is the general approach for repair of panfacial fractures?

A

Begin laterally, work medially, and correct NOE and nasal septal fractures last; frontal fractures should be repaired before midface fractures.

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54
Q

What is the general approach to repair LeFort III fractures?

A

Begin stabilization at the cranium then work caudally.

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55
Q

When is alveolar bone grafting typically performed in patients with cleft palate?

A

Between ages 9 and 11.

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56
Q

In what region is division of the frontalis muscle prohibited?

A

Between the lateral brow and the temporal hairline.

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57
Q

Between which layers of the scalp are tissue expanders placed?

A

Between the periosteum and the loose areolar tissue.

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58
Q

How is contact dermatitis after laser resurfacing treated?

A

Bland emollients (avoid topical antibiotics), topical class I corticosteroids, cool and wet compresses.

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59
Q

Which injectable fillers require a skin test prior to use?

A

Bovine collagen fillers (Zyplast and Zyderm).

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60
Q

What is the best method of reconstruction for defects involving 2/3 or more of the upper lip?

A

Burrow-Dieffenbach +I- Abbe-Sabattini flap.

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61
Q

What if the skull is involved?

A

Can use a split calvarial, split rib, or methyl methacrylate plus latissimus dorsi flap.

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62
Q

Reduction of what structure accomplishes the majority of profile changes in patients requesting reduction rhinoplasty?

A

Cartilaginous dorsum.

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63
Q

What is the one way to improve the stability of a columellar strut?

A

Carve the base into a V or fork or rest a large strut on a cartilage platform (plinth).

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64
Q

What are the major adjunctive procedures for tip rotation?

A

Caudal septal shortening, upper lateral cartilage shortening, high septal transfixion with septal shortening, and reduction of convex caudal medial crura.

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65
Q

Why should a rhomboid flap not be used to close a scalp defect?

A

Causes improper orientation of the hair.

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66
Q

What is the most feared complication of otoplasty?

A

Chondritis.

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67
Q

What is a V-Y advancement flap?

A

Closure of a rectangular defect by incising an adjacent triangle of tissue and advancing it into the defect.

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68
Q

What are the complications of radical septal resections?

A

Columellar retraction, dorsal saddling, airway collapse, increased nasal width, loss of tip support, and septal perforation.

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69
Q

What is a pixie or satyr earlobe?

A

Common complication of rhytidectomy where the earlobe is elongated and directly attached to the facial cheek skin.

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70
Q

What are the minor adjunctive procedures for tip rotation?

A

Complete transfixion incision, wide skin sleeve undermining, excision of excessive vestibular skin, proper tip taping, plumping grafts, columellar strut, division of the septi depressor muscle.

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71
Q

What are the different approaches used in septoplasty?

A

Complete, partial, hemi- and high transfixion incisions.

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72
Q

Which mandible fractures require ORIF with bicortical screws?

A

Complex open fractures that are displaced, comminuted, or infected.

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73
Q

Rigid fixation is based on what two means of stabilization?

A

Compression and splinting.

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74
Q

Why should compression plates be overcontoured by 3 degrees to 5 degrees?

A

Compression at the buccal surface tends to produce spreading on the lingual side; overcontouring will overcome this.

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75
Q

What problems can occur if a lateral mandibular defect is not reconstructed?

A

Contour deformity of the lateral lower 1/3 of the face, displacement of residual mandible toward the side of the defect, malocclusion.

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76
Q

What is the “workhorse” for exposure of the nasoethmoidal region?

A

Coronal approach.

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77
Q

What can be done for trismus that does not respond to brisement force?

A

Coronoidectomies.

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78
Q

What is the indication for surgical treatment of isolated anterior table fractures?

A

Cosmetic deformity.

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79
Q

How does release of the arcus marginalis affect eye contour?

A

Creates a more convex, youthful eye contour.

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80
Q

What is the primary disadvantage of lip adhesion?

A

Creates scar tissue that can interfere with definitive repair.

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81
Q

What are the potential complications of endoscopic optic nerve decompression?

A

CSF leak, carotid artery injury, transection of the ophthalmic artery, and orbital fat herniation.

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82
Q

What technique is ideal for repair of large full-thickness defects of the upper lid?

A

Cutler Beard or Bridge procedure.

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83
Q

What is a potential complication of this approach?

A

Damage to the temporal fat pad, resulting in temporal wasting.

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84
Q

What effect does the complete transtlxion incision have on tip projection and rotation?

A

Decreases tip projection and increases tip rotation (resulting in nasal shortening).

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85
Q

What vessels is the iliac crest free flap based on?

A

Deep circumflex iliac vessels.

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86
Q

What vessels is the rectus abdominus free flap based on?

A

Deep inferior epigastric vessels.

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87
Q

Which approach to rhytidectomy improves the nasolabial folds?

A

Deep plane rhytidectomy.

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88
Q

What is the primary blood supply to the temporalis muscle flap?

A

Deep temporal artery.

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89
Q

What is the proper plane of dissection during rhinoplasty?

A

Deep to the subcutaneous tissue and SMAS layers.

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90
Q

What effect does SMAS suspension have on the nasolabial folds?

A

Deepens them.

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91
Q

What are the two major approaches to tip surgery?

A

Delivery and nondelivery.

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92
Q

What other factors increase the risk of scarring?

A

Development of wound infection or contact dermatitis, recent use of isotretinoin, history of radiation therapy, and history of keloids.

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93
Q

What is the significance of the position of the hyoid bone in rhytidectomy?

A

Dictates the maximum improvement possible in the cervicomental angle; ideal position is high and posterior.

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94
Q

What is the major limit of microsurgical reconstruction in this area?

A

Difficult to restore normal contour.

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95
Q

What are the three approaches to zygomatic arch fractures?

A

Direct percutaneous, temporal (Gillies), and hemicoronal approaches.

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96
Q

What is the treatment of choice for an edentulous 40-year-old epileptic man who sustains a LeFort I fracture during a seizure?

A

Direct wiring of the zygomaticomaxillary buttresses.

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97
Q

What is the most likely cause of dimpling of the skin following liposuction of the jowls?

A

Directing the opening of the extractor toward the skin.

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98
Q

When is cranialization required for treatment of frontal sinus fractures?

A

Displaced posterior table fractures with a CSF leak or significantly comminuted posterior table fractures.

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99
Q

What are the indications for frontal sinus obliteration in the presence of a fracture?

A

Displaced posterior table fractures with involvement of the nasofrontal duct.

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100
Q

What is the most likely cause of cyclovertical diplopia following repair of a NOE fracture?

A

Disruption of the trochlea.

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101
Q

What can be done for the patient whose lateral crura are concave?

A

Dissect lateral crura completely free and reverse them 180 degrees.

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102
Q

When approaching the frontozygomatic buttress through the hemicoronal incision, how is the temporal branch of the facial nerve avoided?

A

Dissection begins just superficial to the superficial layer of the deep temporal fascia; 2 cm above the zygomatic arch, the dissection is carried deep to the superficial layer of the deep temporal fascia.

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103
Q

What is the plane of dissection with the Gillies approach?

A

Dissection is carried out between the temporalis muscle and its overlying fascia.

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104
Q

What is the significance of the timing of palatal repair on midfacial growth and speech?

A

Earlier repair is associated with better speech but midface retrusion; later repair is associated with worse speech but minimal midface retrusion. More evidence exists to support the importance of timing on speech than on midface retrusion.

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105
Q

What are the only plates that can bear the stress of mastication during healing?

A

Eccentric dynamic compression plates.

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106
Q

Patients who have previously undergone blepharoplasty are at increased risk for which complication after laser skin resurfacing?

A

Ectropion.

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107
Q

The greater omentum axial flap is based on what vessels?

A

Either the right or the left gastroepiploic artery.

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108
Q

What is the most common complication after orbital reconstruction?

A

Enophthalmos.

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109
Q

Which rotation flap is best suited for lateral defects of the lower lip?

A

Estlander flap.

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110
Q

What is the best flap for defects of the oral commissure?

A

Estlander flap.

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111
Q

What is the most common complication of submental liposuction?

A

Excessive submental wrinkling.

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112
Q

What are the four ways to correct hypertrophic or wide scars?

A

Excision/undermining, Z-plasty or W-plasty, geometric broken line closure, and dermabrasion.

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113
Q

What is the primary advantage of the eyelid margin graft?

A

Eyelash replacement.

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114
Q

What four composite grafts can provide both rigidity and a mucosal surface for eyelid reconstruction?

A

Eyelid margin graft, tarsoconjunctival graft, nasal chondromucosal graft, and hard palate mucoperiosteal graft.

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115
Q

To which vessels can the peroneal artery be anastomosed?

A

Facial or external carotid artery.

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116
Q

What is the best material for dural reconstruction?

A

Fascia lata.

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117
Q

What materials can be used to obliterate the frontal sinus?

A

Fat, muscle, fascia, or cancellous bone; can also allow spontaneous osteogenesis after burring the inner cortices.

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118
Q

What is the optimal flap for reconstruction of anterior mandibular defects?

A

Fibular free flap (FFF).

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119
Q

When do most major hematomas occur after rhytidectomy?

A

First 12 hours postoperatively.

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120
Q

Your patient has a fracture of the mandibular body and a comminuted midface fracture. How do you approach reconstruction?

A

First MMF, then ORIF the mandible, then ORIF the midface.

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121
Q

Your patient has a fracture of the condylar head and mandibular body and a comminuted midface fracture. How do you approach reconstruction?

A

First ORIF the midface, then place the patient into MMF, then ORIF the mandibular body fracture.

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122
Q

What are the best flaps for through-and-through cheek or oral cavity defects?

A

Folded Fibular free flap or double paddle scapula flap.

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123
Q

When should lag screws be used to reduce a fracture?

A

For an oblique fracture with an intact inner fragment where the length of the fracture is at least twice the thickness of the bone.

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124
Q

When are serial explorations indicated after penetrating injuries to the face?

A

For high-energy gunshot or rifle (>1200 ft/s) injuries, shotgun injuries, and high-energy avulsion injuries.

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125
Q

For which types of clefts is the double reversing Z-plasty best?

A

For narrow soft palate clefts and submucous clefts.

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126
Q

‘What is brisement force?

A

Forced jaw opening under anesthesia; usually successful for treatment of trismus that does not respond to physiotherapy.

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127
Q

How many stages are required for completion of the Juri flap?

A

Four stages.

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128
Q

What are the absolute indications for surgical repair of frontal sinus fractures?

A

Fractures involving the nasofrontal duct and significantly displaced posterior table fractures with or without dural tear and CSF leak.

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129
Q

What is the primary advantage of using a soft tissue free flap over a pectoralis major flap in conjunction with a mandibular plate?

A

Free flap results in a much lower rate of plate exposure.

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130
Q

What flaps are ideal for reconstruction of extensive scalp defects?

A

Free latissimus dorsi surfaced with nonmeshed split-thickness skin graft; if entire scalp is involved, latissimus dorsi with serratus anterior.

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131
Q

What material is used for grafting?

A

Fresh autogenous particulate marrow.

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132
Q

Alopecia in which area of the scalp is not improved by scalp reduction?

A

Frontal.

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133
Q

Reduction of which buttresses is essential to restore upper facial width?

A

Frontozygomatic buttresses.

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134
Q

What happens to the position of the globe when 2.5 cc of fat is removed?

A

Globe moves 1mm inferiorly and 2 mm posteriorly.

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135
Q

What is the most commonly injured nerve during rhytidectomy?

A

Greater auricular nerve.

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136
Q

How wide should the Abbe-Sabattini flap be?

A

Half the width of the defect.

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137
Q

What is the most common complication of rhytidectomy?

A

Hematoma.

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138
Q

What are the three approaches to the frontozygomatic buttress?

A

Hemicoronal, lateral brow, and the upper blepharoplasty incisions.

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139
Q

Which of these is preferred when the anatomy of the tip-infratip lobule and related structures is ideal?

A

High septal transfixion with septal shortening.

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140
Q

What technique is ideal for reconstruction of large posterior lamella defects of the lower eyelid?

A

Hughes tarsoconjunctival flap.

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141
Q

Which type of injectable fillers can be diminished with hyaluronidase in the case of over augmentation?

A

Hyaluronic acid derivatives (Restylane, Juvederm, Captique).

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142
Q

What treatments can be used to help this problem?

A

Hydroquinone or retinoic acid plus a topical class I corticosteroid, glycolic acid.

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143
Q

What is the best method of reconstruction for defects involving 2/3 or more of the lower lip?

A

If centered in the midline, the Webster modification of the Bernard-Burrow repair.

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144
Q

When is diplopia likely to persist after orbital reconstruction?

A

If diplopia occurs within 30 degrees of the primary position.

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145
Q

What is the significance of the labiomental fold in chin implantation?

A

If the fold is high, implantation can enlarge the entire lower face.

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146
Q

Which types of osseous free flaps allow enosseous dental implants?

A

Iliac crest, scapula, fibula, and radius.

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147
Q

What is the difference between SMAS imbrication and SMAS plication?

A

Imbrication involves undermining and cutting the SMAS prior to suspension; plication involves folding the SMAS on itself.

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148
Q

Why is the gain reduced?

A

Implant settling, bone resorption, and soft-tissue compression.

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149
Q

In which patients are sliding genioplasty indicated?

A

In patients with excess or insufficient vertical mandibular height, extreme microgenia, hemifacial atrophy, or mandibular asymmetry and in those who fail alloplastic chin augmentation.

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150
Q

When can the transcartilaginous incision not be used?

A

In patients with widely divergent intermediate crura where the domes need exposure for narrowing.

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151
Q

When does midface retrusion present in children with cleft palate?

A

In the teenage years when the growth spurt occurs.

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152
Q

How does the facelift incision differ between men and women?

A

In women, the incision runs along the posterior margin of the tragus (posttragal); in men, the incision is placed in the preauricular crease (pretragal) so that facial hair does not grow on the tragus postoperatively. Also, a margin of non-hair-bearing skin is preserved around the inferior attachment of the earlobe in men.

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153
Q

What is the most common complication of otoplasty?

A

Inadequate correction.

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154
Q

What is the most common cause of loss of vision after reduction of facial fractures?

A

Increased intraorbital pressure, usually secondary to venous congestion.

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155
Q

What are the disadvantages of the retroseptal approach?

A

Increased risk of injury to the inferior oblique muscle and prolapse of orbital fat into the surgical field.

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156
Q

What are the most common causes of delayed healing and nonunion after repair of mandible fractures?

A

Infection and noncompliance.

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157
Q

The “zone of compression” refers to which area of the mandible?

A

Inferior border of the mandible.

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158
Q

Identification of what structure is essential in safely exposing the medial and central fat pads during a transconjunctival lower eyelid blepharoplasty?

A

Inferior oblique muscle.

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159
Q

Which anatomic areas are more prone to scarring after laser treatment?

A

Infraorbital area, mandible, and anterior neck.

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160
Q

What is isolagen?

A

Injectable autologous soft tissue material derived from cultured human fibroblasts.

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161
Q

What are the contraindications to orbital exploration after orbital trauma?

A

Injury to an only-seeing eye; presence of hyphema, globe injury, or retinal tear; and medical instability.

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162
Q

Which incisions can be used for exposure and delivery of the alar cartilages?

A

Intercartilaginous and marginal incisions.

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163
Q

What are the three primary incisions used in tip surgery?

A

Intercartilaginous, transcartilaginous, and marginal incisions.

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164
Q

Which technique results in greater cephalic tip rotation: interrupted or complete strip?

A

Interrupted strip.

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165
Q

What is the Goldman technique for increasing tip projection?

A

Interrupted strip; borrowed cartilage from the lateral crus is sutured into the medial crus, resulting in elongation of the medial crura.

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166
Q

What are the indications for pharyngoplasty after cleft palate repair?

A

Intractable VPI not responsive to speech therapy.

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167
Q

What can be used to treat scarring after laser skin resurfacing?

A

Intralesional or topical corticosteroids, 585 nm pulsed-dye laser (two to three treatments at 6-8 weeks intervals).

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168
Q

What is the term for repair of the levator veli palatini muscle during cleft palate repair?

A

Intravelar veloplasty.

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169
Q

What are the major advantages of the Millard repair?

A

It preserves cupid’s bow and the philtra! dimple, and by placing the tension of closure under the alar base, it reduces flare and promotes improved molding of the underlying alveolar process.

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170
Q

Why is the Fibular free flap optimal for reconstruction of mandibular defects?

A

It provides enough length to reconstruct any size defect, can be harvested in the supine position and in tandem with tumor resection, has low donor site morbidity, and provides soft tissue for intraoral defects.

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171
Q

What transposition flap restores the frontal hairline?

A

Juri flap.

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172
Q

Where is the frontal branch of VII most vulnerable during brow lift?

A

Just above the lateral brow, 1-2 em from the orbital rim.

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173
Q

What sort of plates should be used in the severely atrophic mandible?

A

Large reconstruction plates.

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174
Q

What sort of plates should be used with comminuted mandible fractures?

A

Large reconstruction plates.

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175
Q

In cases ofpanfacial fractures, when should NOE fractures be repaired?

A

Last.

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176
Q

What is the primary complication of the temporal advancement flap for reconstruction of the anterior lamella of the eyelid?

A

Lateral canthal droop.

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177
Q

For full-thickness defects of the eyelid that cannot be closed primarily, what technique is attempted prior to using any flaps?

A

Lateral cantholysis.

178
Q

What can be done to improve exposure with the transconjunctival approach?

A

Lateral canthotomy with cantholysis.

179
Q

What are the various interrupted strip techniques?

A

Lateral division, medial division, multiple vertical interrupting cuts, both medial and lateral division with a resection of a lateral segment, and rotation of a segment of lateral crus into medial crus.

180
Q

Where should the medial incision be placed when raising the pectoralis major flap?

A

Lateral to the perforating branches of the internal mammary artery to preserve the blood supply of a deltopectoral flap should it be needed in the future.

181
Q

Which musculocutaneous flap has the largest area of skin available for transfer to the head and neck?

A

Latissimus dorsi.

182
Q

What is the primary blood supply of the latissimus dorsi flap?

A

Latissimus dorsi-Thoracodorsal artery.

183
Q

What procedure is normally performed prior to extensive scalp reductions?

A

Ligation of the occipital vessels 2-6 weeks before the reduction.

184
Q

What are miniplates?

A

Lightweight, compression-neutral plates designed to be used with self-tapping screws (2.0 mm, 1.5 mm, or 1.3 mm).

185
Q

What is the consequence of overly aggressive resection of upper eyelid skin?

A

Loss of crease definition.

186
Q

What are the relative contraindications to the coronal forehead lift?

A

Male-pattern baldness in men and high hairlines in women.

187
Q

How is midface retrusion treated?

A

Maxillary advancement through LeFort osteotomies.

188
Q

Which technique is ideal for patients with an overprojected tip due to overdeveloped alar cartilages?

A

Medial and lateral division with resection of lateral segment.

189
Q

What techniques can be used to augntent the effects of the complete strip, without sacrificing tip projection?

A

Medial triangle excision, alternating incomplete incisions, crosshatching, gentle morselization, and transdomal suture narrowing.

190
Q

Which patients are good candidates for the midforehead lift?

A

Men with deep rhytids in whom a coronal lift is contraindicated.

191
Q

What is the primary complication of this flap?

A

Microstomia.

192
Q

What are the two most common complications of dermabrasion?

A

Milia and hypopigmentation.

193
Q

What types of screws are used to secure superiorly positioned plates?

A

Monocortical to prevent damage to tooth roots.

194
Q

What are the advantages of the subciliary approach?

A

More direct, requires less understanding of orbital anatomy, and provides more exposure than the transconjunctival approach.

195
Q

How do chin implants used in women differ from those used in men?

A

More oval in women, squarer and larger in men.

196
Q

What is the advantage of leaving a small amount of soft tissue on the auricular graft?

A

More rapid host bed fixation.

197
Q

What technique involves placing several horizontal mattress sutures along the scapha to create an antihelical sulcus?

A

Mustarde technique.

198
Q

What is the role of angiography prior to fibula free flap?

A

Necessary to confirm the presence of the peroneal artery and to confirm that it is free of disease and not the dominant source of blood supply to the distal leg.

199
Q

What is the difference in outcome between these approaches?

A

No significant difference in outcome.

200
Q

When should lid malposition after blepharoplasty be corrected?

A

No sooner than 6 months after the initial surgery.

201
Q

What are the advantages of the Gillies approach?

A

No visible scar, protects the temporal branch of the facial nerve, and allows bimanual reduction.

202
Q

What are the advantages and disadvantages of the intraoral approach to chin implantation?

A

No visible scars; increased potential for contamination; suture line irritation; requires larger incision than the external approach; unable to stabilize the implant internally.

203
Q

What should be done if bony resorption occurs under the implant?

A

Nothing.

204
Q

4 weeks after ORIF of a mandibular body fracture, your patient presents with an exposed plate and purulent drainage. The reduction is grossly intact. ‘What do you do?

A

Open wound, remove involved tooth if applicable, remove hardware, and assess union; if nonunion is present, most patients will heal with MMF; other option is plate and bone graft (external approach).

205
Q

10 days after ORIF of a mandibular body fracture, your patient presents with an exposed plate and purulent drainage. The reduction is grossly intact. What do you do?

A

Open wound, remove involved tooth if applicable; if hardware is loose, replace it with a new plate; if hardware is rigid, continue drainage, wound care.

206
Q

What is the primary advantage of the Karapandzic circumoral rotation flap?

A

Orbicularis oris muscle is preserved.

207
Q

What would be the optimal treatment for a 25-year-old man with a LeFort I fracture, bilateral dislocated subcondylar fractures, and a comminuted left parasymphyseal fracture?

A

ORIF of the parasymphyseal fracture, ORIF of one subcondylar fracture, and MMF for 3 weeks.

208
Q

What is the preferred donor site for bone grafting in the repair of nasoethmoidal (NOE) fractures?

A

Outer or inner table of the parietal skull.

209
Q

What is the most common cause of alar margin elevation?

A

Overaggressive resection of the lateral crus.

210
Q

‘What problem may arise in the edentulous, denture-wearing patient after mandible fracture with mental nerve disruption?

A

Patients who wear a complete mandibular denture require gingival sensation; in the presence of bilateral mental nerve paresthesia, it may be impossible for the patient to tolerate a mandibular denture.

211
Q

What is the primary blood supply to the Fibular free flap?

A

Peroneal artery.

212
Q

What is the most effective treatment for entropion that fails to resolve with massage?

A

Placement of a spreader graft (i.e., palatal mucosal graft) in the posterior lamella.

213
Q

What is the most common complication of segmental mandibulectomy defect reconstruction with plates?

A

Plate exposure.

214
Q

‘What is the most common complication of segtnental mandibulectomy defect reconstruction with plates?

A

Plate exposure.

215
Q

What is the primary blood supply of the pectoralis major muscle (PMM) flap?

A

PMM-Thoracoacromial, lateral thoracic arteries.

216
Q

Which injectable filler is approved by the FDA for treatment of lipoatrophy in HIV patients?

A

Poly-L-lactic acid (Sculptra).

217
Q

What is the most common cause of infection after ORIF?

A

Poor plating technique.

218
Q

Where should the point of attachment of the medial canthal tendons be directed?

A

Posterior and superior to the lacrimal fossa to avoid telecanthus and blunting of the medial canthal area.

219
Q

In which plane is the neck dissected during deep plane rhytidectomy?

A

Preplatysmal.

220
Q

What are the two transconjunctival approaches?

A

Preseptal and retroseptal.

221
Q

In what direction are the flaps pulled during SMAS suspension?

A

Primarily superiorly and partially posterior.

222
Q

What are the mild complications of laser skin resurfacing?

A

Prolonged erythema, acne or milia, contact dermatitis, and pruritus.

223
Q

What factors predispose to lid malposition after lower lid blepharoplasty?

A

Proptosis or unilateral high myopia; preexisting scleral show; malar hypoplasia; lower lid laxity from previous surgery; and females > 65 years and all males.

224
Q

What are the advantages to the preseptal approach?

A

Protection of the inferior oblique muscle and periorbita.

225
Q

What is the most important surgical component of the septum?

A

Quadrangular cartilage-provides midline support and can significantly influence the external appearance of the nose.

226
Q

What is the optimal flap for oral cavity soft tissue defects?

A

Radial forearm free flap (RFFF).

227
Q

What factors significantly increase the risk of plate exposure?

A

Radiation therapy and extensive soft-tissue resection.

228
Q

How is stabilization by splinting performed?

A

Reconstruction plates with bicortical screws.

229
Q

What if the skull base is involved?

A

Reconstruction requires microsurgery with a latissimus dorsi, rectus abdominus, or free omental flap.

230
Q

What are the advantages of lateral interruption techniques?

A

Reduced likelihood of uneven tip-defining points becoming evident months after surgery; faster symmetrical healing; less loss of projection; avoidance of notching and pinching.

231
Q

What are two major limitations of the transconjunctival approach to lower lid blepharoplasty?

A

Redundant skin cannot be removed and orbicularis hypertrophy cannot be treated.

232
Q

What factors increase the risk of prolonged erythema?

A

Regular use of tretinoin or glycolic acid, rosacea, multiple passes, inadvertent pulse stacking, aggressive intraoperative rubbing.

233
Q

What is the treatment for infected extraoral mandibular ORIF?

A

Removal of the tooth and the failed plate, debridement of dead bone, placement of a large reconstruction plate, and primary grafting if inadequate bone contact exists.

234
Q

How can one repair a floating palate when the anterior and lateral walls of the maxilla are severely comminuted?

A

Replace the comminuted bone with a bone graft fixed to the alveolar ridge and infraorbital rim.

235
Q

What are the advantages of using a nondelivery approach?

A

Requires minimal dissection ensuring more symmetric and predictable healing; resists cephalic rotation; single incision; preserves existing tip projection; and resists tip retrodisplacement and postoperative tip ptosis.

236
Q

What is the primary disadvantage of this procedure?

A

Requires 6-8 weeks of ocular occlusion.

237
Q

What are the two types of lower lid malposition after blepharoplasty?

A

Retraction and ectropion.

238
Q

What is the difference between retraction and ectropion?

A

Retraction is vertical lid shortening due to fibrosis in the middle lamellar plane; ectropion is lid eversion caused by shortening of the anterior lamella, skin, and orbicularis oculi.

239
Q

Which is more common?

A

Retraction.

240
Q

What is the most severe, yet rarest, complication of blepharoplasty?

A

Retrobulbar hemorrhage-incidence 0.04%.

241
Q

Which of these involves an incision in the fornix directly into the orbital fat?

A

Retroseptal.

242
Q

What problem can occur with overzealous tightening of the superior and inferior third of the ear?

A

Reverse telephone ear.

243
Q

What are the best reconstructive options for total lip defects?

A

RFFF, groin flap, or scapular flap.

244
Q

What is usually the last surgery performed in children with clefts?

A

Rhinoplasty.

245
Q

Which of these techniques is best for thick-skinned patients with abundant soft tissue and a wide, underprojected tip?

A

Rotation of a segment of lateral crus into the medial crus.

246
Q

What techniques can be used to decrease tip projection?

A

Sacrifice of major tip support mechanisms, reduction of a large nasal spine, resection of a small amount of cartilage from the lateral alar crus, softening the domes by serial crosshatching, reduction of overdeveloped cartilaginous dorsum.

247
Q

What is the primary blood supply of the sternocleidomastoid myocutaneous (SCM) flap?

A

SCM-Random (occipital, superior thyroid, transverse cervical arteries).

248
Q

What must be done prior to autologous condyle transplantation?

A

Scrapings of the marrow cavity at the cut end should be sent for frozen section to confirm that it is free of tumor.

249
Q

What is the primary advantage of AlloDerm?

A

Semipermanent (20-50% persistence beyond 1year).

250
Q

In the delivery approach, what are the indications for using a complete, rather than hemi-, transfixion incision?

A

Severely deviated caudal septum; when access to the nasal spine is necessary; when tip rotation and nasal shortening are desired.

251
Q

What factors are associated with decreased skin paddle survival?

A

Short skin island, short bone graft, use of the skin paddle intraorally.

252
Q

What is the primary disadvantage to the preseptal approach?

A

Slightly higher risk of lower-lid entropion.

253
Q

When should a posterior incision be used to harvest auricular cartilage?

A

Small grafts and when epithelial and soft tissues are to be incorporated with the graft.

254
Q

What are the three techniques most often used for unilateral cleft lip repair?

A

Straight line repair, Tennison triangular flap repair, and Millard rotation advancement flap.

255
Q

In which plane is the midface dissected during deep plane rhytidectomy?

A

Subcutaneous for 2-3 em anterior to the tragus, then immediately superficial to the orbicularis and zygomaticus muscles.

256
Q

What is the plane of dissection in the coronal forehead lift?

A

Subgaleal.

257
Q

What are the approaches to ORIF of condylar fractures?

A

Submandibular or retromandibular (most common); intraoral; preauricular facelift incision

258
Q

What is the major vascular pedicle for the platysma myocutaneous flap?

A

Submental branch of the facial artery.

259
Q

In which plane is the lower face dissected during deep plane rhytidectomy?

A

Sub-SMAS plane.

260
Q

What should be used to prevent this problem?

A

Sunscreen (pretreatment regimens have not been proven to help).

261
Q

What is the blood supply to this flap?

A

Superficial temporal artery.

262
Q

The “zone of tension” refers to which area of the mandible?

A

Superior border of the mandible.

263
Q

What muscle is primarily responsible for preventing velopharyngeal insufficiency (VPI)?

A

Superior constrictor muscle.

264
Q

What are the two techniques for pharyngoplasty?

A

Superior-based pharyngeal flap and sphincter pharyngoplasty.

265
Q

A patient presents to you with TMJ ankylosis after repair of a condylar fracture. ‘What should be done?

A

Surgical correction (interpositional arthroplasty, costochondral grafting, total joint prosthesis) followed by vigorous physical therapy.

266
Q

How should an outbreak of HSV be treated?

A

Switch to a different antiviral and administer the maximum dose.

267
Q

What technique is ideal for reconstruction of posterior lamellar defects of the upper lateral eyelid?

A

Tarsal rotation flap.

268
Q

What are the disadvantages of using a nondelivery approach?

A

Technically more difficult if inexperienced.

269
Q

What are the indications for extraction of teeth in mandibular fracture lines?

A

Teeth that are grossly mobile, have fractured roots, have advanced dental caries and periapical pathology, have soft-tissue pathology, or that hinder fracture reduction.

270
Q

What complication is caused by too much flexion of the midportion of the antihelix and inadequate flexion at the superior and inferior poles?

A

Telephone ear.

271
Q

In what region of the face can transection of the SMAS directly injure a branch ofVII?

A

Temporal region.

272
Q

Where should the chin implant lie in relation to the lower incisors?

A

The anterior surface should not lie beyond the labial surface of the lower incisors.

273
Q

What is the basic method of the converse technique?

A

The antihelix is created using an island of cartilage.

274
Q

What should be done if the distal portion of the canaliculus is resected?

A

The cut end should be marsupialized and stented for at least 3 weeks.

275
Q

How much auricular cartilage can be harvested without affecting the structural integrity of the ear?

A

The entire concha can be removed as long as the antihelix is kept intact.

276
Q

What tissues are included in the posterior thigh fasciocutaneous flap?

A

The fascia lata, subcutaneous tissue, and the descending branch of the inferior gluteal artery.

277
Q

What is the difference between the hemitransfixion incision and the Killian incision?

A

The hemitransfixion incision is made unilaterally at the junction of the caudal septum and the columella, whereas the Killian incision is made unilaterally 2-3 mm cephalic to the mucocutaneous junction.

278
Q

In a Millard repair, which part of the lip is rotated and which is advanced?

A

The medial segment is rotated inferiorly, and the lateral segment is then advanced medially.

279
Q

After MMF for a condylar fracture, your patient complains of deviation ofhisjaw on opening. ‘What should be done?

A

The patient should look in the mirror while opening the jaw and practice forcing himself to open without deviation. The deviation can be overcome with these exercises.

280
Q

How is closed reduction achieved in edentulous patients?

A

The patient’s dentures are wired to his or her jaws using circummandibular and circumzygomatic wires or screws. Gunning splints are used if dentures are not available.

281
Q

When dissecting from the temporal region to the zygomatic arch, where does the deep temporal fascia divide into superficial and deep layers?

A

The temporal line of fusion at the level of the superior orbital rim.

282
Q

What happens to the fascia as dissection continues toward the zygomatic arch?

A

The temporoparietal fascia and the superficial layer of the deep temporal fascia fuse 1cm above the zygomatic arch.

283
Q

What are the two most common methods of secondary cleft palate repair?

A

The V-Y advancement and the double reversing Z-plasty.

284
Q

Which is best for clefts extending into the hard palate?

A

The V-Y advancement.

285
Q

What are the risk factors for developing bossae or horns after rhinoplasty?

A

Thin skin, strong cartilages, and bifidity.

286
Q

Which patients are good candidates for direct brow lift?

A

Those with brow asymmetries (i.e., from facial nerve paralysis) and marked ptosis of the lateral eyebrow.

287
Q

Between which muscles does the peroneal artery run?

A

Tibialis posterior and soleus muscles.

288
Q

What are THORPs?

A

Titanium hollow screw reconstruction plates.

289
Q

What are AOs?

A

Titanium or steel fixation plates that are more malleable than THORPs.

290
Q

Why should extra caution be taken during lateral dissection of the upper eyelid?

A

To avoid prolapsing the lacrimal gland.

291
Q

What is the purpose of lip adhesion?

A

To facilitate definitive repair by decreasing the tension across the wound.

292
Q

What is the purpose of IMF after Fibular free flap placement?

A

To minimize movement near the vascular pedicle.

293
Q

What are the two types of nondelivery approaches?

A

Transcartilaginous and retrograde.

294
Q

What are the disadvantages of the open approach?

A

Transcolumellar external scar; risk of disturbing normal anatomy in the infratip lobule and caudal aspects of the alar cartilages; prolonged edema in thick-skinned patients; potential for excess trauma to the tip and dorsal skin flap; increased operative time; increased difficulty in judging the exact tip-supratip relationship after skin flap replacement; grafts must be suture fixated.

295
Q

What are the three approaches to the inferior orbital rim/orbital floor?

A

Transconjunctival, subciliary, and rim incisions.

296
Q

Which approach to the inferior orbital rim involves cutting the capsulopalpebral fascia?

A

Transconjunctival.

297
Q

What maneuver can be done to help prevent this complication?

A

Transdomal suture to narrow the tip.

298
Q

What is the primary blood supply of the trapezius flap?

A

Trapezius-Occipital or transverse cervical arteries.

299
Q

What is the indication for reduction of coronoid process fractures?

A

Trismus secondary to impingement of the fractured fragment on the zygoma.

300
Q

True/False: After mental nerve injury, sensation usually returns even without repair.

A

True.

301
Q

True/False: Auricular cartilage grafts can be used to reconstruct the posterior lamella of the lower eyelid but should not be used in the upper eyelid.

A

True: Placement in the upper lid can cause corneal abrasions.

302
Q

What is the optimal flap for reconstruction of pharyngoesophageal defects?

A

Tubed RFFF or free jejunal (RFFF is better for base of tongue or oropharynx, free jejunal flap is better for total pharyngoesophagectomies).

303
Q

Which of these has a potentially higher fistula rate?

A

Tubed RFFF.

304
Q

What is the most common repair for complete unilateral cleft palate?

A

Two flap palatoplasty, described by Bardach and Slayer.

305
Q

What does “dynamic compression” refer to?

A

Two-plate system (compression and tension plates).

306
Q

What are the disadvantages of the Abbe-Sabattini flap?

A

Two-staged procedure, risk of patient injuring the flap by opening the mouth too widely, and risk of microstomia.

307
Q

What percent of patients pharyngoplasty to reduce VPI?

A

Up to 20%. with cleft palate eventually require pharyngoplasty

308
Q

How long does Sculptra last?

A

Up to 3 years.

309
Q

What is the most appropriate approach for exposure of the inferior maxillary buttresses?

A

Upper labial buccal sulcus incision.

310
Q

What are the advantages and disadvantages of medial interruption techniques?

A

Useful in more extreme anatomic situations to normalize tip projection but almost always result in a moderate to major loss of tip projection and have the potential for notching and pinching.

311
Q

What are the indications for surgical exploration after ZMC injury?

A

Visual compromise, EOM entrapment, globe displacement, significant orbital floor disruption, displaced or comminuted fractures.

312
Q

When is stabilization by splinting performed?

A

When compression is impossible (e.g., inadequate fracture surface area, atrophic edentulous fractures, comminuted fractures, and defect fractures).

313
Q

When are bone grafts used in the repair of anterior table fractures?

A

When gaps >4-S mm are present.

314
Q

After high-energy avulsion injuries to the face, when is reconstruction of missing bone and soft tissue initiated?

A

When no further necrosis is seen at reexploration of the wound.

315
Q

When is a cleft lip normally repaired?

A

When the child is 10 weeks old, weighs 10 lbs, and has a hemoglobin of 10 (“rule of 1os”); this is delayed 4 months if lip adhesion is first performed.

316
Q

What complication results from pulling too far posteriorly?

A

Widening and flattening of the oral commissure.

317
Q

What are the advantages to the open approach?

A

Wider exposure, allowing the use of binocular vision, bimanual dissection, and microcautery for hemostasis; enables direct vision of the domes and the nasal profile; and can secure tip grafts directly with suture and approach the septum from above-down as well as from below-up.

318
Q

What are the advantages of using miniplates over wires in reducing fractures of the ZMC?

A

Wires only stabilize in the x plane, whereas miniplates add stabilization in all three spatial planes (x) y, z); wires are difficult to place in free-floating pieces of bone; wires require exposure of the deep surface of the bone.

319
Q

How can extensive midface defects involving the orbit and/or maxilla be reconstructed?

A

With a prosthesis or latissimus dorsi flap with multiple skin paddles.

320
Q

What is the difference in the mechanism of healing between facial fractures repaired with MMF and fractures repaired with ORIF?

A

With MMF, a callus, formed via micromovement of the fractured ends, bridges the fractured ends together; with ORIF, no callus is formed, and the fracture heals via direct bone growth.

321
Q

What is the proper plane of dissection in the temporal region to avoid injury to VII?

A

Within the subaponeurotic plane (deep to the temporoparietal fascia).

322
Q

What is the safest plane of dissection in the temporal region when exposure of the zygomatic arch is necessary?

A

Within the superficial temporal fat pad deep to the superficial layer of the deep temporal fascia.

323
Q

Which patients are good candidates for the pretrichial forehead lift?

A

Women with a high hairline and long vertical height to the forehead.

324
Q

Which patients are not good candidates for endoscopic brow lift?

A

Women with high hairlines, patients with male-pattern baldness or tight, thick skin with extensive bony attachments (more common in Asians and native Americans).

325
Q

Reduction of which buttresses is essential to restore the midfacial length?

A

Zygomaticomaxillary and nasomaxillary buttresses.

326
Q

Generally, what size defects of the lower lip can be closed primarily

A

< 1/2 the lip.

327
Q

When is the risk of thrombosis highest after microsurgical reconstruction

A

15 - 20 minutes after closure.

328
Q

Where does the common tibial-peroneal trunk originate in relation to the head of the fibula

A

2 - 7 em distal.

329
Q

If IMF is used, when is it removed

A

2 weeks postoperatively.

330
Q

How long does it take for complete regeneration of the endothelium across a microvascular anastomosis

A

2 weeks.

331
Q

What is the average length of the fibula

A

25 em.

332
Q

What is the maximum size of graft that can safely be obtained in-situ

A

3 - 4 em wide.

333
Q

Where should dissection of the tarsoconjunctival flap begin in relation to the lid margin

A

3 - 4 mm superior to the lid margin.

334
Q

What is the maximum length to width ratio for local flaps

A

3: I.

335
Q

What is the most common complication from microsurgical reconstruction

A

36% suffer medical complications (pulmonary problems, prolonged ventilatory support, acute ethanol withdrawal).

336
Q

What antibiotics is this organism sensitive to

A

3rd -generation cephalosporins, ciprotloxacin, aminoglycosides, sulfa drugs, and tetracycline.

337
Q

In institutions performing high volume microsurgical reconstruction, what is the success rate? Re-exploration rate

A

98%; 2%.

338
Q

What should be incorporated into the flap to promote viability of the skin paddle

A

A small cuff of soleus and flexor hallicus longus muscle.

339
Q

What is the best method of reconstruction for defects between 112 to 2/3 of the lower lip, not involving the oral commissure

A

Abbe-Sabattini flap.

340
Q

What organism lives in the gut of leeches and is the most common organism associated with wound infections when leeches are applied

A

Aeromonas hydrophila.

341
Q

What is the minimum age at which the calvarium can be split

A

Age 4 or 5 (layers of the skull are not defined until then).

342
Q

On average, how much skin is perfused by the peroneal artery in the FFF

A

Approximately I 0 x 2 I em.

343
Q

What are the contraindications to leech use

A

Arterial insufficiency, severe immunocompromise, allergic reaction to previous leech application.

344
Q

Where should the vascular pedicle lie on the new mandible

A

As close as possible to the new mandibular angle.

345
Q

Which method is optimal

A

Autologous condyle transplantation as it preserves occlusion, TMJ function, and vertical facial height without increasing morbidity.

346
Q

How wide are the Burow’s triangles designed

A

Bases are equal in width to I /2 of the lip defect.

347
Q

What is the best method of reconstruction for defects involving 2/3 or more of the upper lip

A

Burow-Dieffenbach +/Abbe-Sabattini flap.

348
Q

What if the skull is involved

A

Can use a split calvarial, split rib, or methyl methacrylate plus latissimus dorsi flap.

349
Q

Why should a rhomboid flap not be used to close a scalp defect

A

Causes improper orientation of the hair.

350
Q

What is a V-Y advancement

A

Closure of a rectangular defect by incising an adjacent triangle of tissue and advancing it into the defect.

351
Q

How is the diploic layer of the skull recognized during in-situ harvesting

A

Color changes from yellow-white to red and increased bleeding occurs.

352
Q

How does delaying (elevating the flap in 2 stages 2-3 weeks apart) improve flap survival

A

Conditions tissue to ischemia, closes A-V shunts, and increases blood flow by sympathectomy.

353
Q

What problems can occur if a lateral mandibular defect is not reconstructed

A

Contour deformity of the lateral lower 1 /3 of the face, displacement of residual mandible toward the side of the defect, malocclusion.

354
Q

Why do cranial bone grafts have superior resistance to resorption when compared to other donor sites (eg, rib or iliac bone)

A

Cranial bone originates from membranous bone whereas the other donor sites originate from endochondral bone; cranial bone revascularizes more quickly.

355
Q

What technique is ideal for repair of large full-thickness defects of the upper lid

A

Cutler Beard or Bridge procedure.

356
Q

What vessels is the iliac crest free flap based on

A

Deep circumflex iliac vessels.

357
Q

What vessels is the rectus abdominus free flap based on

A

Deep inferior epigastric vessels.

358
Q

What is the primary blood supply to the temporalis muscle flap

A

Deep temporal artery.

359
Q

What is the primary blood supply of the deltopectoral, temporal, forehead, and nape of neck cutaneous flaps

A

Deltopectoral - internal mammary arteries. Temporal - superficial temporal artery. Forehead - supraorbital and supratrochlear arteries. Nape of neck - random (postauricular, occipital vertebral arteries).

360
Q

What finding on inspection of a flap signifies venous thrombosis

A

Development of a sharp line of color demarcation.

361
Q

What is the major limit of microsurgical reconstruction in this area

A

Difficult to restore normal contour.

362
Q

What are the major limitations of microsurgical reconstruction in the head and neck

A

Difficult to restore texture/color of facial skin, soft tissue/bony contour of maxilla, functional mobility of tongue/lower lip, and sensation of oral cavity.

363
Q

What complications are specific to the cranial bone harvest

A

Dural exposure, meningitis, CSF leak, sagittal sinus injury, and brain injury.

364
Q

The greater omentum axial flap is based on what vessels

A

Either the right or the left gastroepiploic artery.

365
Q

Which rotation flap is best suited for lateral defects of the lower lip

A

Estlander flap.

366
Q

What is the best flap for defects of the oral commissure

A

Estlander flap.

367
Q

What is the primary advantage of the eyelid margin graft

A

Eyelash replacement.

368
Q

What 4 composite grafts can provide both rigidity and a mucosal surface for eyelid reconstruction

A

Eyelid margin graft, tarsoconjunctival graft, nasal chondromucosal graft, hard palate mucoperiosteal graft.

369
Q

To which vessels can the peroneal artery be anastomosed

A

Facial or external carotid artery.

370
Q

What is the best material for dural reconstruction

A

Fascia lata.

371
Q

What is the optimal flap for reconstruction of anterior mandibular defects

A

Fibular free flap (FFF).

372
Q

What are the best flaps for through-and-through cheek or oral cavity defects

A

Folded RFFF or double paddle scapula flap.

373
Q

What is the primary advantage of using a soft tissue free flap over a pectoralis major flap in conjunction with a mandibular plate

A

Free flap results in a much lower rate of plate exposure.

374
Q

What flaps are ideal for reconstruction of extensive scalp defects

A

Free latissimus dorsi surfaced with non-meshed split thickness skin graft; if entire scalp is involved, latissimus dorsi with serratus anterior.

375
Q

What are the different types of cranial bone grafts

A

Full thickness calvarium, split thickness calvarium, bone chips, and bone dust.

376
Q

What factor is most essential to the success of a vascularized bone graft to the mandible

A

Good immobilization.

377
Q

What is the most potent natural inhibitor of thrombin

A

Hirudin.

378
Q

What technique is ideal for reconstruction of large posterior lamella defects of the lower lid

A

Hughes tarsoconjunctival flap.

379
Q

How wide should the Abbe-Sabattini flap be

A

I /2 the width of the defect.

380
Q

What is the best method of reconstruction for defects involving 2/3 or more of the lower lip

A

If centered in the midline, the Webster modification of the Bemard-Burow repair.

381
Q

If a free flap fails, what is the best option for reconstruction

A

If medical condition allows, a second free flap should be performed instead of a locoregional flap.

382
Q

Which of these is most reliable? least reliable

A

Iliac crest, radius, respectively.

383
Q

Which types of osseous free flaps allow enosseous dental implants

A

Iliac crest, scapula, fibula, and radius.

384
Q

What are the reconstructive options when the mandibular condyle must be removed during tumor resection

A

Incompletely reconstruct the ramus so it doesn’t extend as high as the glenoid fossa. Attach a prosthetic condyle to the flap. Shape the end of the flap to simulate the condyle. Use the resected condyle as a nonvascularized graft mounted onto the end of the flap with a miniplate.

385
Q

What complications are specific to the iliac crest donor site

A

Injury to abdominal contents or the ilio-femoral joint, detachment of the inguinal ligament, interference with tensor fascia lata function, or damage to nearby peripheral nerves.

386
Q

What is the term for a flap that is raised from a nearby region and moved to a defect across intact skin

A

Interpolation flap.

387
Q

Why is the FFF optimal for reconstruction of mandibular defects

A

It provides enough length to reconstruct any size defect, can be harvested in the supine position and in tandem with tumor resection, has low donor site morbidity, and provides soft tissue for intraoral defects.

388
Q

What is the primary complication of the temporal advancement flap for reconstruction of the anterior lamella of the eyelid

A

Lateral canthal droop.

389
Q

For full thickness defects of the eyelid that cannot be closed primarily, what technique is attempted prior to using any flaps

A

Lateral cantholysis.

390
Q

Where should the medial incision be placed when raising the pectoralis major flap

A

Lateral to the perforating branches of the internal mammary artery to preserve the blood supply of a deltopectoral flap should it be needed in the future.

391
Q

Which musculocutaneous flap has the largest area of skin available for transfer to the head and neck

A

Latissimus dorsi.

392
Q

For reconstruction of oropharyngeal defects, what are the advantages of using a free flap over a pectoralis major flap

A

Lower wound complication rate and shorter hospitalization.

393
Q

What is the best way to avoid injury to the superior sagittal sinus during harvesting of calvarial bone

A

Maintain at least a 2 em distance from the sagittal suture.

394
Q

What is the primary complication of this flap

A

Microstomia.

395
Q

Which of these are most numerous

A

Musculocutaneous.

396
Q

What is the role of angiography prior to FFF

A

Necessary to confirm presence of the peroneal artery and to confirm that it is free of disease and not the dominant source of blood supply to the distal leg.

397
Q

What is the primary advantage of the Karapandzic circumoral rotation flap

A

Orbicularis oris muscle is preserved.

398
Q

What is the preferred site for harvesting calvarial bone

A

Parietal bone (anterior for a flat graft; posterior for a curved graft).

399
Q

What is the thickest part of the skull

A

Parietal bone.

400
Q

What is the primary blood supply to the pectoralis major flap

A

Perforating arteries of the thoracoacromial artery.

401
Q

What is the primary blood supply to the deltopectoral flap

A

Perforating branches of the internal mammary artery ( 4 branches, with the 2”d and 3rd branches representing the dominant blood supply).

402
Q

What can be done to minimize the visibility of the bicoronal incision

A

Perform a wavy line incision.

403
Q

What is the primary blood supply to the FFF

A

Peroneal artery.

404
Q

What is the typical order of return of sensation in noninnervated flaps

A

Pinprick, touch, then temperature.

405
Q

What is the most common complication of segmental mandibulectomy defect reconstruction with plates

A

Plate exposure.

406
Q

What is the primary blood supply of the pectoralis major (PMM), trapezius, latissimus dorsi, and sternocleidomastoid myocutaneous (SCM) flaps

A

PM M - thoracoacromial, lateral thoracic arteries. Trapezius - occipital or transverse cervical arteries. Latissimus dorsi - thoracodorsal artery. SCM - random (occipital, superior thyroid, transverse cervical arteries).

407
Q

What complications are specific to the rib donor site

A

Pneumothorax, hemothorax, and intercostal nerve injury.

408
Q

What is the optimal flap for oral cavity soft tissue defects

A

Radial forearm free flap ( RFFF).

409
Q

What are the best reconstructive options for total lip defects

A

Radial forearm free flap, groin flap, or scapular flap.

410
Q

What factors significantly increase the risk of plate exposure

A

Radiation therapy and extensive soft-tissue resection.

411
Q

What if the skull base is involved

A

Reconstruction requires microsurgery with latissimus dorsi, rectus abdominus, or free omental flap.

412
Q

What is the primary disadvantage of this procedure

A

Requires 6 - 8 weeks of ocular occlusion.

413
Q

Considering rotation flaps, myocutaneous flaps, and random flaps, which of these has the strongest blood supply

A

Rotation flap.

414
Q

Where is this substance found in nature

A

Salivary glands of leeches.

415
Q

What must be done prior to autologous condyle transplantation

A

Scrapings of the marrow cavity at the cut end should be sent for frozen section to confirm that it is free of tumor.

416
Q

Which of these supplies the most blood to the skin

A

Septocutaneous.

417
Q

What factors are associated with decreased skin paddle survival

A

Short skin island, short bone graft, use of the skin paddle intraorally.

418
Q

What is the thinnest part of the skull

A

Squamous portion of the temporal bone.

419
Q

What is the major vascular pedicle for the platysma myocutaneous flap

A

Submental branch of the facial artery.

420
Q

What technique is ideal for reconstruction of posterior lamellar defects of the upper lateral eyelid

A

Tarsal rotation flap.

421
Q

What should be done if the distal portion of the canaliculus is resected

A

The cut end should be marsupialized and stented for at least 3 weeks.

422
Q

Through which muscle compartment do the musculocutaneous branches course

A

The deep posterior compartment containing the soleus and flexor hallicus longus muscles.

423
Q

What is the blood supply of a random flap

A

The dermal and subdermal plexuses.

424
Q

What tissues are included in the posterior thigh fasciocutaneous flap

A

The fascia lata, subcutaneous tissue and the descending branch of the inferior gluteal artery.

425
Q

What is the primary blood supply to this flap

A

Thoracodorsa] artery.

426
Q

Between which muscles does the peroneal artery run

A

Tibialis posterior and soleus muscles.

427
Q

What are THORPs

A

Titanium hollow screw reconstruction plates.

428
Q

What are AOs

A

Titanium or steel fixation plates that are more malleable than THORPs.

429
Q

What is the purpose of IMF after FFF placement

A

To minimize movement near the vascular pedicle.

430
Q

What is the term for a flap that is raised and pivoted into a defect, leaving a secondary defect that must be repaired

A

Transposition flap.

431
Q

What is the primary blood supply to the trapezius flap

A

Transverse cervical artery.

432
Q

T/F: Axial flaps are more reliable than random flaps

A

True.

433
Q

T/F: The surviving length of an axial pattern flap remains constant regardless of flap width

A

True.

434
Q

T/F: Sagittally oriented scalp incisions tend to cause less scalp sensory disturbance than do coronally oriented incisions

A

True.

435
Q

T /F: Significant return of sensation to a free flap occurs even in the absence of neural anastomosis. True.

A

True.

436
Q

T/F: Auricular cartilage grafts can be used to reconstruct the posterior lamella of the lower lid but should not be used in the upper lid

A

True; placement in the upper lid can cause corneal abrasions.

437
Q

What is the optimal flap for reconstruction of pharyngoesophageal defects

A

Tubed RFFF or free jejunal (RFFF is better for base of tongue or oropharynx, free jejunal flap is better for total pharyngoesophagectomies).

438
Q

Which of theses has a potentially higher fistula rate

A

Tubed RFFF.

439
Q

What are the disadvantages of the Abbe-Sabattini flap

A

Two-staged procedure, risk of patient injuring the flap by opening the mouth too widely, and risk of microstomia.

440
Q

What are the 3 different types of skin branches off the peroneal artery

A

Type A: musculocutaneous. Type 8: musculocutaneous and septocutaneous. Type C: septocutaneous.

441
Q

How can extensive midface defects involving the orbit and/or maxilla be reconstructed

A

With a prosthesis or latissimus dorsi flap with multiple skin paddles.

ENT Specialties MAIN (17 decks)

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