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ENT > Plastics > Flashcards

Plastics Flashcards

1
Q

When to remove sutures in the HandN

A

Face: 3-7d
Scalp: 7-10d

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2
Q

What are the rungs on the reconstructive ladder?

A 
Secondary intention
Primary closure
Delayed closure
STSG
FTSG
Tissue expansion
Random flap
Local pedicled flap
Free flap
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3
Q

What are the Fitzpatrick skin types?

A 
I: Redhead, blue eyes
II: Redhead/Blonde, blue/green eyes
III: Brunette
IV: Mediterranean
V: Indian
VI: African
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4
Q

Which skin types should get adjunctive therapy when undergoing CO2 resurfacing?

A

Fitzpatrick skin types III and above should get Hydroquinone gel to prevent hyperpigmentation

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5
Q

What two incisions compose an open approach for rhinoplasty?

A

Marginal and transcolumellar

Marginal is at the bottom of the LLC

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6
Q

What is the most common recipient vein in the H&N?

A

EJ

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7
Q

What form the major tip support of the nose?

A

Size and strength of lower lateral cartilage
Medial crura attaching to the septum
Scroll region (attachment of upper & lower lateral)

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8
Q

What is the scroll region of the nose?

A

Where the LLC overlies the ULC

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9
Q

What is the keystone area of the nose?

A

Where the nasal bones overly the ULC

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10
Q

What is a normal nasofrontal angle?

A

~120 degrees

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11
Q

What is a normal collumelar-labial angle?

A

Male 90-105 degrees

Female 5 more degrees

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12
Q

What divides the facial thirds?

A

Trichion (hair peak)
Glabella
Subnasale
Menton

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13
Q

What divides the facial fifths?

A 
Lateral auricle
Lateral canthus
Medial canthus
Medial canthus
Lateral canthus
Lateral auricle
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14
Q

What angle determines tip rotation?

A

Columellar-labial angle

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15
Q

What is the 3-4-5 rule of rhinoplasty?

A

Columella-Base-Dorsum

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16
Q

What is a normal columellar show?

A

2-3mm

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17
Q

What are the rhinoplasty incisions?

A

Intercartilaginous
Marginal
Trans/Intracartilaginous
Transcolumellar

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18
Q

What incisions are made for open septorhinoplasty?

A

Marginal & transcolumellar

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19
Q

What is nasal rotation?

A 
Over-rotated = up
Under-rotated = down
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20
Q

What artery is the pedicle for the supraclavicular island flap?

A

Supraclavicular artery

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21
Q

From where does the supraclavicular artery arise?

A 
Transverse cervical artery (93%)
Suprascapular artery (7%)
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22
Q

Where is the angiosome for the supraclavicular flap?

A

Anterolateral deltoid skin

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23
Q

Submental artery relationship to digastric

A

Deep to it in 70% (lying on the mylohyoid)

Superficial to it in 30%

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24
Q

What defects is the submental island useful for?

A

Intraoral
Lower face
Preauricular

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25
Q

What defects is the FAMM flap useful for?

A 
OC & OP
Palate defects
Floor of mouth
Ventral tongue
Upper & lower lips
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26
Q

Which mimetic muscles are innervated on their superficial side?

A

Buccinator
Levator anguli oris
Mentalis

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27
Q

Where does the facial artery course over the face?

A

2nd mandibular molar to nasal ala

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28
Q

Venous drainage of the FAMM flap

A

Random

More an arterialized flap than an axial flap

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29
Q

What is the dominant artery in a PMMC flap?

A

Pectoral artery (thoracoacromial trunk)

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30
Q

What secondary arteries contribute to the PMMC blood supply?

A

Lateral thoracic artery

Internal mammary branches

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31
Q

Are abx indicated in mandible fractures?

A

Body/Ramus: Injury through periop period

Isolated condyle: Periop only

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32
Q

Are abx indicated in midface fractures?

A

Periop only

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33
Q

What is the difference in outcomes between an oblique ridge Champy plate and a lateral plate?

A

Lateral plate has lower infection rate. No difference in mechanics.

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34
Q

Indications for two fixation plates for mandible ORIF?

A

Unfavorable fracture line (tension plate)

Symphyseal fracture

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35
Q

ORIF or closed reduction and MMF for condylar neck/subcondular fractures?

A

ORIF

Data supports better long-term functional outcomes

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36
Q

Indications for orbital fracture repair

A

Over 50% of the orbital floor
EOM entrapment
Enophthalmos

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37
Q

How long is the gracilis muscle?

A

25cm

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38
Q

What is the arterial supply of the gracilis muscle?

A

The adductor branch of profunda femoris

Also, occasionally the medial circumflex artery

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39
Q

Venous supply of the gracilis free flap

A

Two vena comitantes running with the artery

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40
Q

Where does the artery come in for the gracilis FF?

A

Undersurface of the proximal 1/3 of the muscle
Between the adductor longus and adductor brevis
8-10cm inferior to the pubic tubercle

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41
Q

What nerve innervates the gracilis FF?

A

Anterior branch of the obturator nerve

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42
Q

Why is a two-stage gracilis preferable?

A

Better symmetry at rest

allows for axonal regrowth prior to placing gracilis

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43
Q

When is a temporary cranial nerve substitution procedure indicated for FN paralysis

A

Paralysis less than 2y old

prevents mimetic muscle atrophy

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44
Q

Where is the incision for a sural nerve harvest

A

2cm posterior and 2cm superior to lateral malleolus

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45
Q

What is the length of a harvested sural nerve?

A

25-35cm

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46
Q

How can you test if a CFNG has undergone axonal regeneration?

A

Tinel sign

tapping it causes tingling

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47
Q

Which side should be harvested for gracilis?

A

Contralateral to the FN paralysis

for ease of inset

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48
Q

How long should a gracilis FF be?

A

From oral commissure to temple

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49
Q

Which muscles of facial expression are innervated on their superficial side?

A

MLB: Mentalis, Levator anguli oris, Buccinator

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50
Q

To what is the gracilis muscle attached in a gracilis FF?

A 
Oral commisure/nasolabial fold
Temporoparietal fascia (TPF) just above zygoma
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51
Q

When will a pt begin to see contraction of a gracilis FF?

A

4-6mo postop

Continues to strengthen for 12-24mo

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52
Q

What nerve can accompany a RFFF?

A

Lateral antebrachial cutaneous nerve

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53
Q

What are the limiting anatomic factors to bone in RFFF?

A

Prox: Insertion of pronator teres
Dist: Insertion of brachioradialis

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54
Q

How long of bone can be harvested with a RFFF?

A

10-12cm

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55
Q

What circumference of the radius can be harvested with a RFFF?

A

40%

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56
Q

Which palmar arches are supplied by which arteries in the arm?

A

Radial: Deep palmar arch
Ulnar: Superficial palmar arch

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57
Q

What is the dominant fasciocutaneous branch off of the radial artery in the proximal forearm?

A

Inferior cubital artery

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58
Q

What limits the arterial length of a RFFF?

A

The takeoff of the radial recurrent artery

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59
Q

What marks the course of the lateral antebrachial cutaneous nerve?

A

It runs with the cephalic vein

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60
Q

What pressure for the RFFF tourniquet?

A

250 mmHg

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61
Q

What two muscles border the intermuscular septum?

A

Brachioradialis

Flexor carpi radialis

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62
Q

What is the endpoint when laser treating vascular lesions?

A

Transient purpura

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63
Q

What laser best treats photodamage?

A

Broad band light

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64
Q

What is the limit in defect size for primary closure of the auricular helix?

A

1.5cm

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65
Q

What are the predominant methods to close helical defects too large to close primarily?

A

Helical chondrocutaneous advancement flaps
Pre/postauricular tubed interpolated flaps
FTSG

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66
Q

What is the ideal defect size for helical chondrocutaneous advancement flaps?

A

1.5-2.5cm

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67
Q

What is the ideal defect for pre/postauricular interpolated tube flaps?

A

> 2.5cm and limited to the helix

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68
Q

What is the best method to close a full thickness defect of the superior auricle with an intact helical rim?

A

Postauricular subcutaneous island flap

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69
Q

What are the two general types of skin flaps?

A

Random cutaneous flaps

Arterial cutaneous flaps (axial flaps)

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70
Q

What are the four types of skin flaps?

A

Random
Arterial cutaneous
Fasciocutaneous
Musculocutaneous

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71
Q

What is the blood supply of the ALT flap?

A

Descending branches of the lateral circumflex femoral artery

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72
Q

Indications for ND following parotidectomy

A

Clinical nodes
Tumor over 4cm
High grade tumors: SCC, adenoCa, high-grade mucoep)

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73
Q

What does the Frankfort horizontal connect?

A

Porion (superior EAC) to orbitale (inferior orbital rim)

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74
Q

What is the most commonly injured motor nerve during facelift surgery?

A

Frontal branch

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75
Q

What is the most commonly injured nerve during facelift surgery?

A

Great auricular

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76
Q

In unilateral cleft lip, tip/columella deviates toward

A

Normal side

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77
Q

In unilateral cleft lip, caudal septum deviates toward

A

Normal side

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78
Q

In unilateral cleft lip, cartilaginous/bony septum deviates toward

A

Cleft side

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79
Q

What is the visual effect of the lateral crural steal technique?

A

Increases rotation and projection

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80
Q

What is the visual effect of the lateral crural overlay technique?

A

Increases rotation, decreases projection

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81
Q

What muscle causes nasal tip ptosis when smiling?

A

Depressor septi

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82
Q

What is seen in the tension nose deformity?

A

Shortened upper lip (gingival show)
Narrowed nostrils
Under-rotation
Increased collumellar show

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83
Q

What is seen in Polybeak deformity?

A

Supratip fullness

A more pronounced nasal dorsum with relative underprojection of the tip

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84
Q

What is seen in inverted V deformity?

A

Narrow middle vault compared to upper dorsum, shows a true inverted V due to pyriform aperture

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85
Q

With 30 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?

A

Rotate 45 degrees

Lengthen 25%

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86
Q

With 45 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?

A

Rotate 60 degrees

Lengthen 50%

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87
Q

With 60 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?

A

Rotate 90 degrees

Lengthen 75%

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88
Q

What eye drop can be used to mask ptosis?

A

Apraclonidine

Stimulates Muller’s muscle & dilates the iris

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89
Q

Where is the nasion?

A

It is at the midline nasofrontal suture

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90
Q

Where is the sellion?

A

It is the deepest point of the nasofrontal angle

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91
Q

Where is the radix?

A

It is the root of the nose.

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92
Q

Where is the pogonion?

A

Most anterior portion of the mandible

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93
Q

Where is the gonion?

A

The most posteroinferior aspect of the mandible

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94
Q

Where is the menton?

A

The most inferior portion of the chin

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95
Q

What muscle is responsible for bunny lines?

A

Transverse nasalis

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96
Q

What is the visual effect of the tongue-in-groove stitch?

A

Increases rotation (MC up on septum)
Can decrease projection (MC posterior on septum)
Decreases collumellar show

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97
Q

What are techniques to increase tip rotation?

A

columellar strut (increases projection)
tip grafting (increases projection)
lateral crural steal (increases projection)
lateral crural overlay (decreases projection)
tongue-in-groove (decreases projection)

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98
Q

What is the ideal collumellar show?

A

2-4mm

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99
Q

What kind of toxicity can be seen with a chemical peel?

A

Phenol toxicity = cardiac arrhythmias

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100
Q

When does hair regrow following telogen effluvium?

A

3mo

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101
Q

What are the approaches to the orbital rim?

A 
Transconjunctival (pre or post-septal)
Subciliary
Orbical rim (lower)
Brow
Lid crease (upper)
Bicoronal
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102
Q

Which chemical peel requires neutralization?

A

Glycolic acid

Can use water or 5% sodium bicarb

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103
Q

Where is the rhinion?

A

Where the ULC and nasal bones meet

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104
Q

What types of collagen are formed in a scar?

A

Type III –> Type I

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105
Q

What are the risk factors for hematoma following rhytidectomy?

A 
Smoking
Aspirin
Males
HTN
Platysmaplasty
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106
Q

What are the steps of skin graft nutrition during healing?

A

Days 0-2 = plasmatic imbibition
2-4 = Inosculation
4-7 = Angiogenesis

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107
Q

What are the phases of hair follicles?

A

Anagen (growth)
Catagen (involution)
Telogen (rest)
Exogen (shedding)

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108
Q

How long is the anagen phase of hair follicles?

A

3-4y

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109
Q

How long is the telogen phase of hair follicles?

A

3-4mo

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110
Q

What is the landmark for when FN injuries should be repaired via anastomosis?

A

Lateral to the lateral canthus should be explored and repaired

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111
Q

What side is microtia more commonly found on?

A

Microtia (Mike right)

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112
Q

What side is cleft lip more commonly found on?

A

cLeft

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113
Q

What is the Karapandzic flap used for?

A

Lower lip defects 1/2 to 2/3

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114
Q

What is the Abbe flap used for?

A

Lip defects 1/3-1/2, not involving commisure

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115
Q

What is the Gillies fan flap used for?

A

Lower lip defects over 2/3

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116
Q

What is Dedo class I? What is the suggested intervention?

A

Normal skin

No intervention

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117
Q

What is Dedo class II? What is the suggested intervention?

A

Neck skin laxity

Rhytidectomy

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118
Q

What is Dedo class III? What is the suggested intervention?

A

Submental and submandibular adiposity

Cervical liposuction

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119
Q

What is Dedo class IV? What is the suggested intervention?

A

Platysmal banding

Rhytidectomy and platysmaplasty

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120
Q

What is Dedo class V? What is the suggested intervention?

A

Microgenia or retrognathia

Chin augmentation or mandibular advancement

121
Q

What is Dedo class VI? What is the suggested intervention?

A

Low hyoid

Division of suprahyoid musculature, chin augmentation

122
Q

What is done if a tissue expander is found to be extruded?

A

If still early in expansion: abort and remove

If near the end of expansion: continue and monitor for infection

123
Q

Where are split calvarial bone grafts taken from?

A

2cm lateral to sagittal suture

124
Q

What is suitable for primary closure on the lower eyelid?

A

Under 25%

125
Q

What is a Tenzel flap used for?

A

Lower lid reconstruction of 1/3 to 2/3

126
Q

What is a Hughes tarsoconjunctival flap used for?

A

Lid reconstruction 50-100%

127
Q

What is the blood supply to the temporalis muscle flap?

A

Deep temporal artery (ant and post)

128
Q

How long does re-epithelialization take following dermabrasion?

A

5-7d

129
Q

Which injectable fillers are used for deeper injections?

A 
Poly-l-lactic acid (Sculptra)
Calcium hydroxyapatite (Radiesse)
130
Q

What must be administered to pts with a history of herpesvirus infections when undergoing peels or laser resurfacing?

A

Prophylactic antivirals

131
Q

When are cleft lips repaired?

A

10, 10, 10

132
Q

What is responsible for a shortened upper lip?

A

Depressor septi

133
Q

What incisions make up the midfacial degloving approach?

A

Sublabial
Full transfixion
Intercartilaginous

134
Q

How wide should the bony nose be compared to alar base width?

A

75%

135
Q

What is in a Baker-Gordon peel?

A

Phenol
Tap water
Liquid soap
Croton oil

136
Q

What are the approaches to browlift?

A 
Direct
Indirect
Pretrichial
Coronal
Endoscopic
137
Q

What is a normal MRD1?

A

3-5mm

138
Q

What is a normal MRD2?

A

5mm

139
Q

What is the correct plane for an endoscopic browlift?

A

Subperiosteal

140
Q

What is the correct plane for a coronal browlift?

A

Subgaleal

141
Q

What is the correct plane for an indirect browlift?

A

Subcutaneous

142
Q

What is the correct plane for a direct browlift?

A

Subcutaneous

143
Q

What is Crumley’s method?

A

3-4-5 of nasal triangle

144
Q

What is Goode’s method?

A

Nasal tip to alar-facial crease
Nasion to nasal tip
Ratio should be 0.55-0.6

145
Q

What is Hering’s law?

A

Law of equal innervation

Repair of ptosis or blepharoptosis may unmask ptosis in the other eye

146
Q

What is the necessary size for a scalp tissue expander?

A

2.5x the size of the defect

147
Q

What plane are scalp tissue expanders placed in?

A

Subgaleal

148
Q

When after implantation can tissue expanders begin inflation?

A

2w postop

149
Q

What are the specific risks to the preseptal vs postseptal approach to lowe lid blepharoplasty?

A

Preseptal: Can cause scarring of anterior lamella

Postseptal: Puts inferior oblique at more risk

150
Q

What type of BCC is the most difficult to excise?

A

Sclerosing aka Morpheaform

It has tentacles and skip lesions

151
Q

What is the treatment for post-inflammatory hyperpigmentation?

A

It is seen after laser skin rejuvenation.

Treatment is hydroquinone, sunblock, and exfoliants.

152
Q

What does the facial plane connect?

A

The glabella and pogonion

153
Q

What constitutes the nasofrontal angle?

A

Dorsum of nose to nasion
Nasion to glabella
It’s the angle between the two lines

154
Q

What is the ideal nasofrontal angle?

A

115-135 degrees

155
Q

Where are the local anesthetics metabolized?

A 
Amides = 2 i's, liver
Esters = 1 i, plasma
156
Q

How quickly is the onset of Botox?

A

Botox A = 2-5d

Botox B = 24h

157
Q

How long does Botox last?

A

3-4mo

158
Q

What allergies are a contraindication to Botox?

A

Albumin

Cow’s milk protein allergy

159
Q

What muscle can be denervated with Botox to treat marionette lines?

A

Depressor anguli oris

160
Q

What bacterium is associated with leech therapy?

A

Aeromonas hydrophila

161
Q

What is seen in Stickler syndrome?

A 
Myopia
SNHL
Hypermobile joints
Cleft palate
Flattened midface
162
Q

What can EMLA cream cause?

A

Methemoglobinemia

163
Q

What peel causes perifollicular frosting?

A

Salicylic acid

164
Q

What is the appropriate length-width ratio for a fusiform excision?

A

1:3

165
Q

What does the Converse technique treat?

A

Prominauris

Incise on either side of planned antihellix, suture skin together

166
Q

What does the Hatch technique treat?

A

Prominauris

Suture the helical root to the temporalis fascia

167
Q

What does the Furnas technique treat?

A

Prominauris

Suture the conchal cartilage to the mastoid periosteum

168
Q

What are the methods to correct prominauris?

A

Hatch
Converse
Furnas
Mustarde

169
Q

How long must a pt wait after LASIK before getting a blepharoplasty?

A

6 months

To account for impaired corneal sensation

170
Q

What in Baker’s solution changes the depth of peel?

A

Croton oil

171
Q

What is in Jessner’s solution?

A

Resorcinol
Salicylic acid
Lactic acid
Ethanol

172
Q

How long before dermabrasion can be repeated?

A

12 months

173
Q

What is the youngest that hair restoration procedures should be attempted?

A

30-35

174
Q

What is the ideal upper eyelid crease height?

A

Men: 6-9mm
Women: 8-11mm

175
Q

What scores on the Jahrsdorfer scale indicated they are a candidate for surgery?

A

6-10

Scale to evaluate presence of normal structures in congenital aural atresia.

176
Q

What is the argon laser used for?

A

Vascular anomalies

Port wine stains, hemangiomas, telangiectasias

177
Q

What is the extinction length of the CO2 laser?

A

0.03mm

It doesn’t penetrate very deeply

178
Q

What are the types of YAG lasers and what are they most similar to?

A

Nd:YAG is similar to Argon (absorbed by Hgb)
Ho:YAG is similar to CO2 (absorbed by water)

179
Q

What vessels supply the inferior trapezius island flap?

A

Occipital
Transverse cervical
Dorsal scapular

180
Q

What vessels supply the superior trapezius island flap?

A

Occipital

Paraspinal perforators

181
Q

What vessels supply the lateral trapezius island flap?

A

Transverse cervical artery branches

182
Q

What is a normal Shirmer’s test?

A

Greater than 10-15mm of tears in 5 minutes

183
Q

What mutation is associated with Alport syndrome?

A

COL4A5

184
Q

What mutation is associated with the most common type of non-syndromic hearing loss?

A

GJB2

185
Q

What mutation is associated with non-syndromic HL with intact OAE’s?

A

Otoferlin mutations

DBFN9

186
Q

What mutation is associated with syndromic hearing loss and euthyroid goiter?

A

PDS gene

Pendred syndrome

187
Q

What is seen in Pendred syndrome

A

Syndromic HL
Euthyroid goiter
EVA
Mondini deformity

188
Q

What test is used to diagnose Pendred syndrome?

A

Perchlorate discharge test

Now genetic testing

189
Q

What mutation is associated with Jervell and Lange-Nielsen syndrome?

A

KVLQT1

190
Q

What is seen in Jervell and Lange-Nielsen syndrome?

A

Syndromic deafness

QT prolongation

191
Q

How is JLNS inherited?

A

AR

192
Q

How is Pendred syndrome inherited?

A

AR

193
Q

What flap is used when the philtrum is involved?

A

Abbe flap to reconstruct philtrum

Can be used in conjunction with perialar crescenteric advancement flaps if the defect is large.

194
Q

What can be changed with the incisions for a PMFF to help with rotation of the flap?

A

Carry medial incision more inferiorly

195
Q

How are traumatic FN injuries medial to the lateral canthus treated?

A

Either not explored, or explored and tagged for later elective anastomosis (within 30d)

196
Q

How are Stensen’s duct injuries treated?

A

Proximal: ligation of both ends

In general: re-anastomosed

197
Q

What is the optimal time to dermabrade following surgery?

A

6-8w postop

198
Q

What incisions describe the delivery approach in rhinoplasty?

A

Intercartilaginous & marginal

199
Q

What incision is used for the retrograde approach to rhinplasty?

A

Intercartilaginous

200
Q

What can be approached via the retrograde approach to rhinoplasty?

A

Upper lateral cartilages

Lateral crus of lower lateral cartilages

201
Q

What lesion is caused by petroleum based ointments in a postoperative nose?

A

Paraffinoma

202
Q

What is the ideal alar-lobule ratio?

A

1:1

203
Q

What is the ideal collumellar-lobule ratio?

A

2:1

204
Q

When is best to fix mandible fractures

A

Within 1w of injury

205
Q

When is nasal septal growth greatest?

A

It’s bimodal. Age 0-5 then puberty.

206
Q

When is best for closed reduction of nasal fractures?

A

Kids: within 4 days
Adults: within 10 days

207
Q

Flaps based in which direction are more likely to develop trap door deformity?

A

Superiorly-based flaps

Lymphatics drain downward

208
Q

What is a normal auriculocephalic angle?

A

25-35 degrees

209
Q

How are apart are the medial and lateral limbs of a Mustarde stitch?

A

16mm

210
Q

What is the position of the superior orbital rim in synostotic frontal plagiocephaly?

A

Elevated on the affected side

211
Q

What is the position of the superior orbital rim in deformational frontal plagiocephaly?

A

Normal or depressed

212
Q

What contributes to prominauris?

A

Unfolded antihelical fold (73% contribution)

Large conchal bowl

213
Q

When must ear molding begin?

A

Within 3w of life

214
Q

What measurements qualify as prominauris?

A

Auriculocephalic angle over 40 degrees
or
Helix-scalp distance over 2.5cm

215
Q

What is the necessary cumulative gain for a tissue expander?

A

Uninflated width + length needed for defect = cumulative gain

216
Q

Is convexity or concavity better for recipient of a FTSG?

A

Concavity

217
Q

What is considered early vs. late complications of injectable fillers?

A

2 weeks is the cutoff

218
Q

What should be done for late complication of injectable fillers?

A

Triamcinolone injection

Can help with granulomas, nodules, and migration

219
Q

What is seen in Binder syndrome?

A

AKA Maxillo-Nasal dysplasia

Absent anterior nasal spine
Midface hypoplasia
Class III occlusion

220
Q

What inhaled anesthetic is associated with improved flap survival?

A

Isoflurane

221
Q

What is the starting dose for propranalol for infantile hemangioma?

A

0.33 mg/kg Q6h

Increases based on tolerability and age

222
Q

What negative pressure is required for cervicofacial liposuction?

A

1 atm

223
Q

What is the ideal nasofacial angle?

A

30-40 degrees

224
Q

What is a Mathes and Nahai class I musculocutaneous flap?

A

Single dominant pedicle

225
Q

What is a Mathes and Nahai class II musculocutaneous flap?

A

One dominant pedicle and multiple minor pedicles that can’t support the flap

226
Q

What is a Mathes and Nahai class III musculocutaneous flap?

A

Dual dominant pedicles

227
Q

What is a Mathes and Nahai class IV musculocutaneous flap?

A

Multiple segmental pedicles

228
Q

What is a Mathes and Nahai class V musculocutaneous flap?

A

One dominant and multiple segmental pedicles, any of which can support the flap

229
Q

What component determines the depth of a Baker-Gordon peel?

A

Croton oil

230
Q

What donor material resist absorption best in rhinoplasty?

A

Split calvarial bone

231
Q

What portion of people have an incomplete superficial palmar arch?

A

12%

232
Q

What are the x-rays of choice for assessing mandible fractures?

A

Panorex and reverse Townes view

233
Q

Progression of local anesthetic toxicity

A

CNS excitation
+/- seizures
CNS depression
Cardiorespiratory depression

234
Q

Local anesthetic toxicity CNS excitation symptoms

A 
Agitation
Muscle twitching
HTN
Lightheadedness
Lip tingling
Tinnitus
Metallic taste
235
Q

Treatment of local anesthetic toxicity

A

Seizures - Benzos (5mg Ativan)
Oxygen +/- airway control
+/- vasopressor support

236
Q

Lidocaine toxic dosage

A

4.5 mg/kg plain

7 mg/kg with Epi

237
Q

Which local anesthetic can cause methemoglobinemia?

A

Prilocaine

238
Q

Mechanisms of cocaine

A

Sodium channel inhibitor

NE reuptake inhibitor

239
Q

Contraindications to cocaine

A

Pseudocholinesterase deficiency
HTN
Arrhythmias

240
Q

Cocaine toxicity Tx

A

Oxygen
Alpha blockade (phentolamine)
Calcium channel blocker
Sublingual nitroglycerin

241
Q

V1 blocks

A

Supraorbital and supratrochlear
Nasociliary (superomedial orbital wall)
External branch of ant. ethmoidal n. (inferomedial border of nasal bone)

242
Q

V2 blocks

A

V2 block (sigmoid notch, ant/deep to lateral pter plate, 1.5cm more depth)
Sphenopalatine block (greater pal. forament)
Infraorbital n.
Zygomaticotemporal (posterolateral orb rim)
Zygomaticofacial (ant malar eminence

243
Q

V3 blocks

A 
V3 block (sigmoid notch, post to lateral pter plate, 6cm depth, 5cc)
Inf alveolar intraoral block
Mental block (intraoral, btwn 1st and 2nd premolars)
244
Q

Cervical plexus block

A

Erb’s point (1/3-1/2 way from mastoid tip to SC joint along post. SCM)
10cc injected 3cm deep

245
Q

Which opiate can cause serotonin syndrome?

A

Demerol (meperidine)

When given to pts on SSRI or MAOI

246
Q

Serotonin syndrome symptoms

A

HTN
Seizures
Coma
Pyrexia

247
Q

What receptor do opiates work on?

A

Opiate receptors (Mu, Sigma, Kappa)

248
Q

What receptor do benzos work on?

A

Benzodiazepine receptor potentiates GABA

249
Q

Side effects of opiates

A 
N/V
Constipation
Hypotension
Respiratory depression
Pinpoint pupils
250
Q

Four goals of sedation

A

Anxiolysis
Hypnosis
Amnesia
Anesthesia

251
Q

Ketamine contraindications

A 
Patients <3mo
Questionable airway
Cardiopulmonary disease
Head injury or ^ICP
Psychosis
252
Q

Which sedative can cause laryngospasm?

A

Ketamine (especially in kids)

253
Q

S/S of malignant hyperthermia

A 
Tachycardia
Tachypnea
^End-tidal CO2
Masseter spasm
Acidosis/Hyperkalemia
254
Q

Treatment for malignant hyperthermia

A

2.5 mg/kg IV dantrolene

Repeat Q5m until stabilized

255
Q

What is the airway fire triad?

A

Ignition source
Fuel
Oxygen

256
Q

Treatment of CNS excitation due to lidocaine overdose

A

Administer benzodiazepine

257
Q

What are the four levels of sedation?

A

Minimal sedation/Anxiolysis
Moderate sedation
Deep sedation
General anesthesia

258
Q

What four factors define level of sedation?

A

Responsiveness
Airway function
Spontaneous ventilation
Cardiovascular status

259
Q

Abx for dog/cat bites

A

Augmentin

260
Q

Three phases of wound healing

A

Inflammatory
Proliferative
Maturation

261
Q

Length of inflammatory phase of wound healing

A

<7d

262
Q

Length of proliferative phase of wound healing

A

3d-3w

263
Q

Length of maturation phase of wound healing

A

3w-1y

264
Q

How long is the cycle of a skin cell from generation to shedding?

A

28 days

265
Q

Layers of the epidermis

A

“Come Let’s Get Sun Burned”

Corneum
Lucidum
Granulosum
Spinosum
Basale
266
Q

What is the predominant collagen type in skin

A

Type 1

267
Q

Fitzpatrick I description

A

Always burns

Pale, freckles

268
Q

Fitzpatrick II description

A

Usually burns, sometimes tans

Fair

269
Q

Fitzpatrick III description

A

May burn, usually tans

Light brown

270
Q

Fitzpatrick IV description

A

Rarely burns, always tans

Olive

271
Q

Fitzpatrick V description

A

Moderate constitutional pigmentation

Brown

272
Q

Fitzpatrick VI description

A

Marked constitutional pigmentation

Black

273
Q

What are the retaining ligaments of the face?

A 
Mandibular
Masseteric
Zygomatic (McGregor's)
Platysmal-auricular
Orbicularis
274
Q

Where is Pitanguy’s line?

A

0.5cm below tragus to 1.5 cm above lateral brow

275
Q

Tarsal plate heights

A

Upper 8mm

Lower 4mm

276
Q

Where does medial canthal tendon attach?

A

Anterior lacrimal crest

277
Q

Where does lateral canthal tendon attach?

A

Whitnall’s tubercle

4mm posterior to lateral orbital rim

278
Q

Where do the labial arteries run?

A

At vermillion

Between labial mucosa and orbicularis oris

279
Q

Lateral pterygoid origin/insertion

A

Lateral side of lateral pterygoid plate
Coronoid/condyle

Opens the jaw

280
Q

Medial pterygoid origin/insertion

A

Medial side of lateral pterygoid plate
Posterior mylohyoid groove

Closes the jaw

281
Q

Auricle long axis angle

A

Posteriorly rotated 15 degrees

Roughly parallel to nasal dorsum

282
Q

Ear height/width

A

Height 6cm

Width 3.5cm

283
Q

Ear projection (angle & linear)

A

20-30 degrees
2-3cm

(Just remember it’s 2-3 for both cm and degrees)

284
Q

Layers of the upper eyelid

A 
Skin
Orbicularis
Septum
Preaponeurotic fat
Levator aponeurosis
Muller's muscle
Conjunctiva
285
Q

Layers of the lower eyelid

A 
Skin
Orbicularis
Pre-CPF fat
Lower lid retractors
Capsulopalpebral fascia
Conjunctiva
286
Q

Differences in the Asian upper lid

A

Levator aponeurosis fuses with septum below the tarsal plate

This means no levator-skin insertion and that orbital fat can lie all the way down in front of tarsal plate

287
Q

What does PICO model stand for?

A

Problem
Intervention
Comparison
Outcomes

288
Q

What does nervus intermedius supply?

A

GSPN –> lacrimal & nasal mucosa

Chorda –> SMG, sublingual, taste

289
Q

Lacrimation with eating

A

Bogorad’s syndrome

Similar to Frey’s syndrome but parasympathetics reach lacrimal gland

290
Q

To what LN’s does this structure drain?

Above brow

A

Preauricular

Parotid

291
Q

To what LN’s does this structure drain?

Central face

A

Submandibular

292
Q

To what LN’s does this structure drain?

Lateral face

A

Parotid

293
Q

What does the superficial cervical fascia envelop?

A

Platysma, mimetic muscles, SMAS, galea

294
Q

What does the superficial layer of the deep cervical fascia envelop?

A

Salivary glands
Masseter
SCM

AKA investing fascia

295
Q

What does the middle layer of the deep cervical fascia envelop?

A

Pretracheal fascia
Straps
Larynx
Thyroid

296
Q

What does the deep layer of the deep cervical fascia envelop?

A

Prevertebral fascia

297
Q

What are the horizontal facial buttresses?

A

Frontal bar
Zygomatic
Maxillary
Mandibular

298
Q

What are the vertical facial buttresses?

A

Nasofrontal
Zygomaticomaxillary
Pterygomaxillary
Mandibular ramus

ENT (10 decks)

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