Plastics Flashcards
Name common benign lacrimal gland tumor
Pleomorphic adenoma
Aka benign mixed tumor
What % of pple have a common caniliculus?
90%
Whats the most common type of melanoma on the face?
Lentigo maligna
whats kassabach merrit syndrome?
thrombocytopenia in capillary hemangioma 2/2 plt sequestration
whats a hemangiopericytoma?
round encapsulated within cone needs to be excised completely can be benign or malignant and can look like cav hemangioma
lacrimal gland tumors: 50% inflammatory (painful) and 50% tumors- what are the 2 types of epithelial tumors?
adenoid cystic ca
benign mixed cell tumor
how do you treat benign mixed tumor of lac gland?
complete excision including capsule. Why not incisional biopsy? bc it has malignant potential
what are the causes of inflammation of the lacrimal gland?
sarcoid- painful
IOI- painful
Lymphoma- NOT painful
whats the most important consideration in chosing a ptosis surgery?
amount of levator fxn
whats a fasanaella?
remove mullers and top 1/3 of tarsus
in both TAO, and CC fistula there are angry conj vessels How do the 2 presentations differ?
CC fistula the mad vessels go right up to limbus. In TAO theres a clear zone w no angry vesses between muscle and K
what are the symptoms of IOI?
Deep pain, EOM restriction, chemosis, pain w eom,
whats the first part of the orbit to be affected by IOI?
Lacrimal gland
whats the next step in rx if steroids fail for IOI?
Radiation
how does sarcoid usually present in the orbit? uni or bilateral?
bilateral lacrimal gland swelling
whats the cause of a CC fistula?
basal skull fracture
whats a dural cavernous fistula, who gets it, whats the cause?
1) menigeal artery commun w cav sinus
2) old pple
3) htn, atherosclerosis
does a varix present w proptosis or enophthalmos?
both!
proptois upon valsalva and enophthalmos upon rest
how do you treat optic n glioma?
complete excision
what does a meningioma arise from?
arachnoid villi
meningioma is described as “fusiform tumor” what does that mean?
fusiform = tapered on the ends (as opposed to gliom which is not)
what does a sphenoid wing meningoma look like on ct?
hyperostosis of the surrounding bone
how do you treat sphenoid wing meningioma?
observe till visually significant. If so, then debulk tumor. Complete excision is impossible
how do you treat a optic nerve meningioma that is visually significat?
radiation
whats “fibrous dysplasia”
benign condiition of hyperostotic bone in face. Need to debulk.
how does neuroblastoma present besides horners?
abrupt eccymotic protosis
whas a CDCR?
Connect carucle into middle meatus w pyrex tube. it completely bipasses the canalicular system
if youre doing a DCR and find abnormal tissue what do you do?
frozen section of the specimen
what do you connect in a dcr?
lacrimal sac to middle meatus (bypass lower portion of lacrimal system that drains into inferior meatus)
2-8-12-15mm
punctum- canaliculus-lac sac- NL duct
2-8-12-15mm
punctum- canaliculus-lac sac- NL duct
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
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
where do the frontal, ethmoidal, and maxillary sinuses drain?
middle meatus
Bones of orbital roof
Frontal
Lesser wing of sphenoid
Lateral orbital wall bones
Zygomtic
Greater wing of sphenoid
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
ASPERGILLUS CELLULITIS CAUSES WHAT LAB ABNORMAILTY
Hgh IgE
what % of pple with hyperthyroid get TAO?
30%
whats more common primary meningioma (ie arising from the ON) or secondary orbital meningioma?
secondary orbital meningioma
what does ON meningioma arise from
what does secondary orbital meningioma arise from?
1) arachnoid villi
2) intracrainial site like sphenoid or clinoid
Developing lymphoma in which part of the eye confirs the greatest risk of systemic non-hodgkins lymphoma?
eyelid
what causes involutional LL entropion?
disinsertion of retractors
horizontal laxity
Whats a synonym of blue nevus
nevus of ota
whats the cell of origin in kaposis sarcoma?
endothelial! (lymphatic endothelium forming vascular channels)
What 2 structures does the IO separate?
medial and central fat pads of LL
Where does CN7 run in the upper face?
IN the SMAS
where does cn7 run in the lower face
deep to smas
name layers of face
epidermis dermis subQ fat smas deep facial facia
where does levator aponeurosis insert?
into pretarsal orbicularis and skin (makes the crease)
why Asian eyelid the way it is?
bc septum fuses w levator aponuerosis lower down allows fat to have lower positioning
whats a normal LF?
12-15mm
whats a normal mrd1
4mm
where does superior septum arise from and where does it insert?
superior periosteum
fuses w levator aponeurosis above tarsus
where does inf septum arise from and where does it insert?
inferior periosteum
fuses w capsulopalpebral fascia below inferior tarsus
where does levator originate from
lesser wing of sphenoid
what does whitnall ligament do?
transitions from levator muscle to aponeurosis
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)
what does the lateral horn of the levator do?
divided lacrimal gland
where does mullers insert?
sup border of tarsus
where does medial canthal tendon insert?
ant and post lacrimal crest
wheres the peripheral arcade?
above tarsus
wheres marginal arcade?
2mm above lid margin
where does medial face lymph drain into?
submandibular
where does lateral face lymph drain into?
pre-auricular
whats the triad of blepahrophimosis and inher?
AD
- telecanthus
- epicanthi inversus
- ptosis
in what systemic dz can you see congenital eyelid eversion?
ichthyosis
wheres epicanthus inversus
inferior/lower lid
wheres epicathus tarsalis?
tarsalis= top (upper lid)
wheres epicanthus palpebralis?
equal upper and lower
where epicanthus supraciliaris?
eyebrow
whats epiblepharon
Asian kid w eyelashes up
when eyelid coloboma is isolated finding where is it usually located?
upper eyelid
when lid coloboma is in the lower lid, its ass w?
goldenhaar
whats the soft yellow things josh has below his lid?
syringoma (benign eccrine gland papule)
when do eccrine hidrocystomas enlarge?
warm weather/sweating
if defect is 33% or less
direct closure
if defect is 33-50%
semicircular flap
if defect >50%
cutler beard
modified hughs
how to correct mild ptosis
fasanella
how to correct ptosis if LF is 4-8mm
levator resection
if levator fxn is <4mm how to correct?
sling
how to correct aponurotic ptosis
levator advancement
whats blepharochalasis
rare inflammatory dz in young females lids become thin
when does the lacrimal gland start working?
6 wks
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
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)
most common INFECTIOUS cause of dacryoadenitis
EBV
Mumps = #2 and will be bilateral!
whats a “direct” fracture?- think baseball bat to face
naso-orbital-ethmoid fracture
epistaxis
rounding of medial canthal angle
telecanthus
whats Lefort 1?
?
whats lefort 2?
?
whats lefort 3?
?
Most common cause of pre-septal 2/2 a scratch?
s. aureus
whats the weakest part of the maxilla?
posterior-medial
whats a stye?
external hordeolum (infection of zeiss gland)
whats an internal hordeolum?
infection of meibom gland oricifes
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
whats another name for apaneurotic ptosis?
involutional ptosis
how much ptosis can you repair w a fasanella
2
if theres more ptosis than 2, you have to touch the levator
