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0
Q

Name common benign lacrimal gland tumor

A

Pleomorphic adenoma

Aka benign mixed tumor

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1
Q

What % of pple have a common caniliculus?

A

90%

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2
Q

Whats the most common type of melanoma on the face?

A

Lentigo maligna

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3
Q

whats kassabach merrit syndrome?

A

thrombocytopenia in capillary hemangioma 2/2 plt sequestration

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4
Q

whats a hemangiopericytoma?

A

round encapsulated within cone needs to be excised completely can be benign or malignant and can look like cav hemangioma

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5
Q

lacrimal gland tumors: 50% inflammatory (painful) and 50% tumors- what are the 2 types of epithelial tumors?

A

adenoid cystic ca

benign mixed cell tumor

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6
Q

how do you treat benign mixed tumor of lac gland?

A

complete excision including capsule. Why not incisional biopsy? bc it has malignant potential

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7
Q

what are the causes of inflammation of the lacrimal gland?

A

sarcoid- painful
IOI- painful
Lymphoma- NOT painful

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8
Q

whats the most important consideration in chosing a ptosis surgery?

A

amount of levator fxn

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9
Q

whats a fasanaella?

A

remove mullers and top 1/3 of tarsus

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10
Q

in both TAO, and CC fistula there are angry conj vessels How do the 2 presentations differ?

A

CC fistula the mad vessels go right up to limbus. In TAO theres a clear zone w no angry vesses between muscle and K

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11
Q

what are the symptoms of IOI?

A

Deep pain, EOM restriction, chemosis, pain w eom,

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12
Q

whats the first part of the orbit to be affected by IOI?

A

Lacrimal gland

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13
Q

whats the next step in rx if steroids fail for IOI?

A

Radiation

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14
Q

how does sarcoid usually present in the orbit? uni or bilateral?

A

bilateral lacrimal gland swelling

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15
Q

whats the cause of a CC fistula?

A

basal skull fracture

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16
Q

whats a dural cavernous fistula, who gets it, whats the cause?

A

1) menigeal artery commun w cav sinus
2) old pple
3) htn, atherosclerosis

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17
Q

does a varix present w proptosis or enophthalmos?

A

both!

proptois upon valsalva and enophthalmos upon rest

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18
Q

how do you treat optic n glioma?

A

complete excision

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19
Q

what does a meningioma arise from?

A

arachnoid villi

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20
Q

meningioma is described as “fusiform tumor” what does that mean?

A

fusiform = tapered on the ends (as opposed to gliom which is not)

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21
Q

what does a sphenoid wing meningoma look like on ct?

A

hyperostosis of the surrounding bone

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22
Q

how do you treat sphenoid wing meningioma?

A

observe till visually significant. If so, then debulk tumor. Complete excision is impossible

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23
Q

how do you treat a optic nerve meningioma that is visually significat?

A

radiation

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24
whats "fibrous dysplasia"
benign condiition of hyperostotic bone in face. Need to debulk.
25
how does neuroblastoma present besides horners?
abrupt eccymotic protosis
26
whas a CDCR?
Connect carucle into middle meatus w pyrex tube. it completely bipasses the canalicular system
27
if youre doing a DCR and find abnormal tissue what do you do?
frozen section of the specimen
28
what do you connect in a dcr?
lacrimal sac to middle meatus (bypass lower portion of lacrimal system that drains into inferior meatus)
29
2-8-12-15mm
punctum- canaliculus-lac sac- NL duct
30
2-8-12-15mm
punctum- canaliculus-lac sac- NL duct
31
whats the bick procuedure whats it used for?
LL ectropion- cut full thickness flap out of lateral lower lid and close primarily- may cause "rounding" of canthal angle if heals like shit
32
whats the medial spindle procedure whats it used for?
medial LL ectropion or LL punctum turned out- excise conj and retractors medially in a diamond configuration (ie posterior lamella) and close
33
where do the frontal, ethmoidal, and maxillary sinuses drain?
middle meatus
34
Bones of orbital roof
Frontal | Lesser wing of sphenoid
35
Lateral orbital wall bones
Zygomtic | Greater wing of sphenoid
36
where are glands of Krause and where are wolfring?
Krause- superior fornix wolfring- NON-MARGINAL tarsal border Julie Krause has to be superior to everyone else
37
ASPERGILLUS CELLULITIS CAUSES WHAT LAB ABNORMAILTY
Hgh IgE
38
what % of pple with hyperthyroid get TAO?
30%
39
whats more common primary meningioma (ie arising from the ON) or secondary orbital meningioma?
secondary orbital meningioma
40
what does ON meningioma arise from | what does secondary orbital meningioma arise from?
1) arachnoid villi | 2) intracrainial site like sphenoid or clinoid
41
Developing lymphoma in which part of the eye confirs the greatest risk of systemic non-hodgkins lymphoma?
eyelid
42
what causes involutional LL entropion?
disinsertion of retractors | horizontal laxity
43
Whats a synonym of blue nevus
nevus of ota
44
whats the cell of origin in kaposis sarcoma?
endothelial! (lymphatic endothelium forming vascular channels)
45
What 2 structures does the IO separate?
medial and central fat pads of LL
46
Where does CN7 run in the upper face?
IN the SMAS
47
where does cn7 run in the lower face
deep to smas
48
name layers of face
``` epidermis dermis subQ fat smas deep facial facia ```
49
where does levator aponeurosis insert?
into pretarsal orbicularis and skin (makes the crease)
50
why Asian eyelid the way it is?
bc septum fuses w levator aponuerosis lower down allows fat to have lower positioning
51
whats a normal LF?
12-15mm
52
whats a normal mrd1
4mm
53
where does superior septum arise from and where does it insert?
superior periosteum | fuses w levator aponeurosis above tarsus
54
where does inf septum arise from and where does it insert?
inferior periosteum | fuses w capsulopalpebral fascia below inferior tarsus
55
where does levator originate from
lesser wing of sphenoid
56
what does whitnall ligament do?
transitions from levator muscle to aponeurosis
57
where does the anterior portion of levator aponeurosis insert? where does posterior insert?
anterior- pretarsal skin and orbicularis | posterior- anterior surface of lower half of tarsus (dehiscence=ptosis but LF remains normal bc ant portion still ok)
58
what does the lateral horn of the levator do?
divided lacrimal gland
59
where does mullers insert?
sup border of tarsus
60
where does medial canthal tendon insert?
ant and post lacrimal crest
61
wheres the peripheral arcade?
above tarsus
62
wheres marginal arcade?
2mm above lid margin
63
where does medial face lymph drain into?
submandibular
64
where does lateral face lymph drain into?
pre-auricular
65
whats the triad of blepahrophimosis and inher?
AD 1. telecanthus 2. epicanthi inversus 3. ptosis
66
in what systemic dz can you see congenital eyelid eversion?
ichthyosis
67
wheres epicanthus inversus
inferior/lower lid
68
wheres epicathus tarsalis?
tarsalis= top (upper lid)
69
wheres epicanthus palpebralis?
equal upper and lower
70
where epicanthus supraciliaris?
eyebrow
71
whats epiblepharon
Asian kid w eyelashes up
72
when eyelid coloboma is isolated finding where is it usually located?
upper eyelid
73
when lid coloboma is in the lower lid, its ass w?
goldenhaar
74
whats the soft yellow things josh has below his lid?
syringoma (benign eccrine gland papule)
75
when do eccrine hidrocystomas enlarge?
warm weather/sweating
76
if defect is 33% or less
direct closure
77
if defect is 33-50%
semicircular flap
78
if defect >50%
cutler beard | modified hughs
79
how to correct mild ptosis
fasanella
80
how to correct ptosis if LF is 4-8mm
levator resection
81
if levator fxn is <4mm how to correct?
sling
82
how to correct aponurotic ptosis
levator advancement
83
whats blepharochalasis
rare inflammatory dz in young females lids become thin
84
when does the lacrimal gland start working?
6 wks
85
if you have to remove puncta 2/2 sebaceous cell do you do dcr at same time?
no. observe bc don't want to spread the cancer. do dcr at later time
86
How long before surgery should each of these drugs be stopped NSAID Coumadin ASA
NSAID- 3 days Coumadin- 4 days ASA 5 days (reverse alphabetical order)
87
most common INFECTIOUS cause of dacryoadenitis
EBV | Mumps = #2 and will be bilateral!
88
whats a "direct" fracture?- think baseball bat to face
naso-orbital-ethmoid fracture epistaxis rounding of medial canthal angle telecanthus
89
whats Lefort 1?
?
90
whats lefort 2?
?
91
whats lefort 3?
?
92
Most common cause of pre-septal 2/2 a scratch?
s. aureus
93
whats the weakest part of the maxilla?
posterior-medial
94
whats a stye?
``` external hordeolum (infection of zeiss gland) ```
95
whats an internal hordeolum?
infection of meibom gland oricifes
96
when a kid w congenital ptosis looks down, why is there lagophthalmos and lid is high?
bc lid is fatty and doesn't go all the way down
97
whats another name for apaneurotic ptosis?
involutional ptosis
98
how much ptosis can you repair w a fasanella
2 | if theres more ptosis than 2, you have to touch the levator

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