Plastics Flashcards
Detail an approach through the facial bone sCT
Start at frontal sinuses/skull apex Zygomatic complex Nasal bones Orbital walls Ethmoid sinuses Pterygoids Maxillary sinus Mandible TMJ
Look for fluid in sinuses
Displacement
LeFort classification
What is common to all LeFort fractures?
Involvement of the pterygoid plates
What are 3 practical points to classifying LeFort fractures?
- if the anterolateral margins of the nasal fossa are intact it excludes a type 1 fracture
- if the infraorbital rims are intact it excludes a type 2 fracture
- if the zygomatic arch is intact it excludes a type 3 fracture
What structures are involved in a tripod fracture
Zygoma
Maxilla
Lateral orbit
What are important physical exam findings to look for in facial trauma
Diplopia Entrapment V2 anesthesia Malar flattening Enopthalamos Proptosis Malocclusion Intraoral bleeding Ocular depression or elevation Displacement of medial canthal tendon Facial asymmetry Facial instability/movement
Describe LeFort I
horizontal maxillary fracture, separating the teeth from the upper face
fracture line passes through the alveolar ridge, lateral nose and inferior wall of maxillary sinus
(above roots of teeth)
Describe LeFort II
pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex
fracture arch passes through posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim and nasal bones
Describe LeFort III
craniofacial disjunction
fracture line passes through nasofrontal suture, maxillo-frontal suture, orbital wall and zygomatic arch
What are 3 pathophysiologic contributions to diabetic ulcers?
Neuropathy (sensory, motor, autonomic)
Peripheral vascular disease
Immunosuppression
What are 5 risk factors for impaired wound healing?
Infection Peripheral vascular disease Venous insufficiency Diabetes mellitus Malnutrition Smoking Immunosuppression therapy Chemo/Radiation Immobility Wound contamination
What are the most important features in an orbital floor injury that may require surgical fixation?
enopthalamos
persistent entrapment after swelling has decreased
How should you splint a volar PIP injury?
Dorsal blocking splint
~20 degrees of flexion
Leave DIP and PIP the ability to flex (avoid stiffness)
How should you splint after an extensor tendon repair?
MCP in hyperextension
PIP/DIP in full extension
Need to include D2-5 as they have combined movements
How to examine for a distal peripheral nerve injury in the upper extremity?
Think anatomically: Cervical roots Trunks Cords Peripheral nerves Examine all muscle movements (all directions) - neck, shoulder, elbow, wrist, fingers Check sensory throughout arm Include neck
Management of closed traumatic brachial plexus injuries?
Most likely neuropraxia
Observation, physio to maintain strength and range of motion
EMG (may be delayed)
What are 5 causes of brachial plexus injuries?
Transection Traction Direct compression (ie. malignancy) Metabolic (ie. diabetes mellitus) Ischemic Radiation
Where is the limit of where plastics will repair the facial nerve if lacerated?
medial to the lateral canthus
Where should you place finger splints?
On the volar side
Dorsal skin much thinner with less padding - prone to breakdown
What is released in carpal tunnel surgery?
transverse carpal ligament (more distal from flexor retinaculum)
What are the contents of the carpal tunnel?
median nerve
flexor pollicus longus
tendons of FDS (4)
tendons of FDP (4)
What are indications for more urgent surgical intervention for carpal tunnel?
fixed parasthesias/sensory loss (no relief during day/night)
motor weakness
thenar atrophy
What are 6 risk factors for carpal tunnel syndrome?
pregnancy obesity female gender hypothyroidism diabetes rheumatoid arthritis connective tissue disease occupational factors aromatase inhibitor use
Why does CTS usually spare the thenar eminence?
palmar sensory cutaneous branch breaks off before the median nerve goes under the flexor retinaculum - often spared
What does the transverse carpal ligament attach to?
Ulnar: pisiform, hamate
Radial: scaphoid, trapezium
What are 3 management options for carpal tunnel syndrome?
Splinting, activity modification
Steroid injection
Surgical release
What are 4 contraindications to botox therapy?
pregnancy
known hypersensitivity (for one formulation, cow’s milk protein allergy)
neuromuscular disorders (myasthenia, Lambert-Eaton, ALS)
use of succinylcholine, non-depolarizing blockers, cholinesterase inhibitors
