Plastics Flashcards
When to remove sutures in the HandN
Face: 3-7d
Scalp: 7-10d
What are the rungs on the reconstructive ladder?
Secondary intention Primary closure Delayed closure STSG FTSG Tissue expansion Random flap Local pedicled flap Free flap
What are the Fitzpatrick skin types?
I: Redhead, blue eyes II: Redhead/Blonde, blue/green eyes III: Brunette IV: Mediterranean V: Indian VI: African
Which skin types should get adjunctive therapy when undergoing CO2 resurfacing?
Fitzpatrick skin types III and above should get Hydroquinone gel to prevent hyperpigmentation
What two incisions compose an open approach for rhinoplasty?
Marginal and transcolumellar
Marginal is at the bottom of the LLC
What is the most common recipient vein in the H&N?
EJ
What form the major tip support of the nose?
Size and strength of lower lateral cartilage
Medial crura attaching to the septum
Scroll region (attachment of upper & lower lateral)
What is the scroll region of the nose?
Where the LLC overlies the ULC
What is the keystone area of the nose?
Where the nasal bones overly the ULC
What is a normal nasofrontal angle?
~120 degrees
What is a normal collumelar-labial angle?
Male 90-105 degrees
Female 5 more degrees
What divides the facial thirds?
Trichion (hair peak)
Glabella
Subnasale
Menton
What divides the facial fifths?
Lateral auricle Lateral canthus Medial canthus Medial canthus Lateral canthus Lateral auricle
What angle determines tip rotation?
Columellar-labial angle
What is the 3-4-5 rule of rhinoplasty?
Columella-Base-Dorsum
What is a normal columellar show?
2-3mm
What are the rhinoplasty incisions?
Intercartilaginous
Marginal
Trans/Intracartilaginous
Transcolumellar
What incisions are made for open septorhinoplasty?
Marginal & transcolumellar
What is nasal rotation?
Over-rotated = up Under-rotated = down
What artery is the pedicle for the supraclavicular island flap?
Supraclavicular artery
From where does the supraclavicular artery arise?
Transverse cervical artery (93%) Suprascapular artery (7%)
Where is the angiosome for the supraclavicular flap?
Anterolateral deltoid skin
Submental artery relationship to digastric
Deep to it in 70% (lying on the mylohyoid)
Superficial to it in 30%
What defects is the submental island useful for?
Intraoral
Lower face
Preauricular
What defects is the FAMM flap useful for?
OC & OP Palate defects Floor of mouth Ventral tongue Upper & lower lips
Which mimetic muscles are innervated on their superficial side?
Buccinator
Levator anguli oris
Mentalis
Where does the facial artery course over the face?
2nd mandibular molar to nasal ala
Venous drainage of the FAMM flap
Random
More an arterialized flap than an axial flap
What is the dominant artery in a PMMC flap?
Pectoral artery (thoracoacromial trunk)
What secondary arteries contribute to the PMMC blood supply?
Lateral thoracic artery
Internal mammary branches
Are abx indicated in mandible fractures?
Body/Ramus: Injury through periop period
Isolated condyle: Periop only
Are abx indicated in midface fractures?
Periop only
What is the difference in outcomes between an oblique ridge Champy plate and a lateral plate?
Lateral plate has lower infection rate. No difference in mechanics.
Indications for two fixation plates for mandible ORIF?
Unfavorable fracture line (tension plate)
Symphyseal fracture
ORIF or closed reduction and MMF for condylar neck/subcondular fractures?
ORIF
Data supports better long-term functional outcomes
Indications for orbital fracture repair
Over 50% of the orbital floor
EOM entrapment
Enophthalmos
How long is the gracilis muscle?
25cm
What is the arterial supply of the gracilis muscle?
The adductor branch of profunda femoris
Also, occasionally the medial circumflex artery
Venous supply of the gracilis free flap
Two vena comitantes running with the artery
Where does the artery come in for the gracilis FF?
Undersurface of the proximal 1/3 of the muscle
Between the adductor longus and adductor brevis
8-10cm inferior to the pubic tubercle
What nerve innervates the gracilis FF?
Anterior branch of the obturator nerve
Why is a two-stage gracilis preferable?
Better symmetry at rest
allows for axonal regrowth prior to placing gracilis
When is a temporary cranial nerve substitution procedure indicated for FN paralysis
Paralysis less than 2y old
prevents mimetic muscle atrophy
Where is the incision for a sural nerve harvest
2cm posterior and 2cm superior to lateral malleolus
What is the length of a harvested sural nerve?
25-35cm
How can you test if a CFNG has undergone axonal regeneration?
Tinel sign
tapping it causes tingling
Which side should be harvested for gracilis?
Contralateral to the FN paralysis
for ease of inset
How long should a gracilis FF be?
From oral commissure to temple
Which muscles of facial expression are innervated on their superficial side?
MLB: Mentalis, Levator anguli oris, Buccinator
To what is the gracilis muscle attached in a gracilis FF?
Oral commisure/nasolabial fold Temporoparietal fascia (TPF) just above zygoma
When will a pt begin to see contraction of a gracilis FF?
4-6mo postop
Continues to strengthen for 12-24mo
What nerve can accompany a RFFF?
Lateral antebrachial cutaneous nerve
What are the limiting anatomic factors to bone in RFFF?
Prox: Insertion of pronator teres
Dist: Insertion of brachioradialis
How long of bone can be harvested with a RFFF?
10-12cm
What circumference of the radius can be harvested with a RFFF?
40%
Which palmar arches are supplied by which arteries in the arm?
Radial: Deep palmar arch
Ulnar: Superficial palmar arch
What is the dominant fasciocutaneous branch off of the radial artery in the proximal forearm?
Inferior cubital artery
What limits the arterial length of a RFFF?
The takeoff of the radial recurrent artery
What marks the course of the lateral antebrachial cutaneous nerve?
It runs with the cephalic vein
What pressure for the RFFF tourniquet?
250 mmHg
What two muscles border the intermuscular septum?
Brachioradialis
Flexor carpi radialis
What is the endpoint when laser treating vascular lesions?
Transient purpura
What laser best treats photodamage?
Broad band light
What is the limit in defect size for primary closure of the auricular helix?
1.5cm
What are the predominant methods to close helical defects too large to close primarily?
Helical chondrocutaneous advancement flaps
Pre/postauricular tubed interpolated flaps
FTSG
What is the ideal defect size for helical chondrocutaneous advancement flaps?
1.5-2.5cm
What is the ideal defect for pre/postauricular interpolated tube flaps?
> 2.5cm and limited to the helix
What is the best method to close a full thickness defect of the superior auricle with an intact helical rim?
Postauricular subcutaneous island flap
What are the two general types of skin flaps?
Random cutaneous flaps
Arterial cutaneous flaps (axial flaps)
What are the four types of skin flaps?
Random
Arterial cutaneous
Fasciocutaneous
Musculocutaneous
What is the blood supply of the ALT flap?
Descending branches of the lateral circumflex femoral artery
Indications for ND following parotidectomy
Clinical nodes
Tumor over 4cm
High grade tumors: SCC, adenoCa, high-grade mucoep)
What does the Frankfort horizontal connect?
Porion (superior EAC) to orbitale (inferior orbital rim)
What is the most commonly injured motor nerve during facelift surgery?
Frontal branch
What is the most commonly injured nerve during facelift surgery?
Great auricular
In unilateral cleft lip, tip/columella deviates toward
Normal side
In unilateral cleft lip, caudal septum deviates toward
Normal side
In unilateral cleft lip, cartilaginous/bony septum deviates toward
Cleft side
What is the visual effect of the lateral crural steal technique?
Increases rotation and projection
What is the visual effect of the lateral crural overlay technique?
Increases rotation, decreases projection
What muscle causes nasal tip ptosis when smiling?
Depressor septi
What is seen in the tension nose deformity?
Shortened upper lip (gingival show)
Narrowed nostrils
Under-rotation
Increased collumellar show
What is seen in Polybeak deformity?
Supratip fullness
A more pronounced nasal dorsum with relative underprojection of the tip
What is seen in inverted V deformity?
Narrow middle vault compared to upper dorsum, shows a true inverted V due to pyriform aperture
With 30 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 45 degrees
Lengthen 25%
With 45 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 60 degrees
Lengthen 50%
With 60 degree Z-plasty arms, the scar will rotate how many degrees and lengthen how much?
Rotate 90 degrees
Lengthen 75%
What eye drop can be used to mask ptosis?
Apraclonidine
Stimulates Muller’s muscle & dilates the iris
Where is the nasion?
It is at the midline nasofrontal suture
Where is the sellion?
It is the deepest point of the nasofrontal angle
Where is the radix?
It is the root of the nose.
Where is the pogonion?
Most anterior portion of the mandible
Where is the gonion?
The most posteroinferior aspect of the mandible
Where is the menton?
The most inferior portion of the chin
What muscle is responsible for bunny lines?
Transverse nasalis
What is the visual effect of the tongue-in-groove stitch?
Increases rotation (MC up on septum)
Can decrease projection (MC posterior on septum)
Decreases collumellar show
What are techniques to increase tip rotation?
columellar strut (increases projection)
tip grafting (increases projection)
lateral crural steal (increases projection)
lateral crural overlay (decreases projection)
tongue-in-groove (decreases projection)
What is the ideal collumellar show?
2-4mm
What kind of toxicity can be seen with a chemical peel?
Phenol toxicity = cardiac arrhythmias
When does hair regrow following telogen effluvium?
3mo
What are the approaches to the orbital rim?
Transconjunctival (pre or post-septal) Subciliary Orbical rim (lower) Brow Lid crease (upper) Bicoronal
Which chemical peel requires neutralization?
Glycolic acid
Can use water or 5% sodium bicarb
Where is the rhinion?
Where the ULC and nasal bones meet
What types of collagen are formed in a scar?
Type III –> Type I
What are the risk factors for hematoma following rhytidectomy?
Smoking Aspirin Males HTN Platysmaplasty
What are the steps of skin graft nutrition during healing?
Days 0-2 = plasmatic imbibition
2-4 = Inosculation
4-7 = Angiogenesis
What are the phases of hair follicles?
Anagen (growth)
Catagen (involution)
Telogen (rest)
Exogen (shedding)
How long is the anagen phase of hair follicles?
3-4y
How long is the telogen phase of hair follicles?
3-4mo
What is the landmark for when FN injuries should be repaired via anastomosis?
Lateral to the lateral canthus should be explored and repaired
What side is microtia more commonly found on?
Microtia (Mike right)
What side is cleft lip more commonly found on?
cLeft
What is the Karapandzic flap used for?
Lower lip defects 1/2 to 2/3
What is the Abbe flap used for?
Lip defects 1/3-1/2, not involving commisure
What is the Gillies fan flap used for?
Lower lip defects over 2/3
What is Dedo class I? What is the suggested intervention?
Normal skin
No intervention
What is Dedo class II? What is the suggested intervention?
Neck skin laxity
Rhytidectomy
What is Dedo class III? What is the suggested intervention?
Submental and submandibular adiposity
Cervical liposuction
What is Dedo class IV? What is the suggested intervention?
Platysmal banding
Rhytidectomy and platysmaplasty
What is Dedo class V? What is the suggested intervention?
Microgenia or retrognathia
Chin augmentation or mandibular advancement
What is Dedo class VI? What is the suggested intervention?
Low hyoid
Division of suprahyoid musculature, chin augmentation
What is done if a tissue expander is found to be extruded?
If still early in expansion: abort and remove
If near the end of expansion: continue and monitor for infection
Where are split calvarial bone grafts taken from?
2cm lateral to sagittal suture
What is suitable for primary closure on the lower eyelid?
Under 25%
What is a Tenzel flap used for?
Lower lid reconstruction of 1/3 to 2/3
What is a Hughes tarsoconjunctival flap used for?
Lid reconstruction 50-100%
What is the blood supply to the temporalis muscle flap?
Deep temporal artery (ant and post)
How long does re-epithelialization take following dermabrasion?
5-7d
Which injectable fillers are used for deeper injections?
Poly-l-lactic acid (Sculptra) Calcium hydroxyapatite (Radiesse)
What must be administered to pts with a history of herpesvirus infections when undergoing peels or laser resurfacing?
Prophylactic antivirals
When are cleft lips repaired?
10, 10, 10
What is responsible for a shortened upper lip?
Depressor septi
What incisions make up the midfacial degloving approach?
Sublabial
Full transfixion
Intercartilaginous
How wide should the bony nose be compared to alar base width?
75%
What is in a Baker-Gordon peel?
Phenol
Tap water
Liquid soap
Croton oil
What are the approaches to browlift?
Direct Indirect Pretrichial Coronal Endoscopic
What is a normal MRD1?
3-5mm
What is a normal MRD2?
5mm
What is the correct plane for an endoscopic browlift?
Subperiosteal
What is the correct plane for a coronal browlift?
Subgaleal
What is the correct plane for an indirect browlift?
Subcutaneous
What is the correct plane for a direct browlift?
Subcutaneous
What is Crumley’s method?
3-4-5 of nasal triangle
What is Goode’s method?
Nasal tip to alar-facial crease
Nasion to nasal tip
Ratio should be 0.55-0.6
What is Hering’s law?
Law of equal innervation
Repair of ptosis or blepharoptosis may unmask ptosis in the other eye
What is the necessary size for a scalp tissue expander?
2.5x the size of the defect
What plane are scalp tissue expanders placed in?
Subgaleal
When after implantation can tissue expanders begin inflation?
2w postop
What are the specific risks to the preseptal vs postseptal approach to lowe lid blepharoplasty?
Preseptal: Can cause scarring of anterior lamella
Postseptal: Puts inferior oblique at more risk
What type of BCC is the most difficult to excise?
Sclerosing aka Morpheaform
It has tentacles and skip lesions
What is the treatment for post-inflammatory hyperpigmentation?
It is seen after laser skin rejuvenation.
Treatment is hydroquinone, sunblock, and exfoliants.
What does the facial plane connect?
The glabella and pogonion
What constitutes the nasofrontal angle?
Dorsum of nose to nasion
Nasion to glabella
It’s the angle between the two lines
What is the ideal nasofrontal angle?
115-135 degrees
Where are the local anesthetics metabolized?
Amides = 2 i's, liver Esters = 1 i, plasma
How quickly is the onset of Botox?
Botox A = 2-5d
Botox B = 24h
How long does Botox last?
3-4mo
What allergies are a contraindication to Botox?
Albumin
Cow’s milk protein allergy
What muscle can be denervated with Botox to treat marionette lines?
Depressor anguli oris
What bacterium is associated with leech therapy?
Aeromonas hydrophila
What is seen in Stickler syndrome?
Myopia SNHL Hypermobile joints Cleft palate Flattened midface
What can EMLA cream cause?
Methemoglobinemia
What peel causes perifollicular frosting?
Salicylic acid
What is the appropriate length-width ratio for a fusiform excision?
1:3
What does the Converse technique treat?
Prominauris
Incise on either side of planned antihellix, suture skin together
What does the Hatch technique treat?
Prominauris
Suture the helical root to the temporalis fascia
What does the Furnas technique treat?
Prominauris
Suture the conchal cartilage to the mastoid periosteum
What are the methods to correct prominauris?
Hatch
Converse
Furnas
Mustarde
How long must a pt wait after LASIK before getting a blepharoplasty?
6 months
To account for impaired corneal sensation
What in Baker’s solution changes the depth of peel?
Croton oil
What is in Jessner’s solution?
Resorcinol
Salicylic acid
Lactic acid
Ethanol
How long before dermabrasion can be repeated?
12 months
What is the youngest that hair restoration procedures should be attempted?
30-35
What is the ideal upper eyelid crease height?
Men: 6-9mm
Women: 8-11mm
What scores on the Jahrsdorfer scale indicated they are a candidate for surgery?
6-10
Scale to evaluate presence of normal structures in congenital aural atresia.
What is the argon laser used for?
Vascular anomalies
Port wine stains, hemangiomas, telangiectasias
What is the extinction length of the CO2 laser?
0.03mm
It doesn’t penetrate very deeply
What are the types of YAG lasers and what are they most similar to?
Nd:YAG is similar to Argon (absorbed by Hgb)
Ho:YAG is similar to CO2 (absorbed by water)
What vessels supply the inferior trapezius island flap?
Occipital
Transverse cervical
Dorsal scapular
What vessels supply the superior trapezius island flap?
Occipital
Paraspinal perforators
What vessels supply the lateral trapezius island flap?
Transverse cervical artery branches
What is a normal Shirmer’s test?
Greater than 10-15mm of tears in 5 minutes
What mutation is associated with Alport syndrome?
COL4A5
What mutation is associated with the most common type of non-syndromic hearing loss?
GJB2
What mutation is associated with non-syndromic HL with intact OAE’s?
Otoferlin mutations
DBFN9
What mutation is associated with syndromic hearing loss and euthyroid goiter?
PDS gene
Pendred syndrome
What is seen in Pendred syndrome
Syndromic HL
Euthyroid goiter
EVA
Mondini deformity
What test is used to diagnose Pendred syndrome?
Perchlorate discharge test
Now genetic testing
What mutation is associated with Jervell and Lange-Nielsen syndrome?
KVLQT1
What is seen in Jervell and Lange-Nielsen syndrome?
Syndromic deafness
QT prolongation
How is JLNS inherited?
AR
How is Pendred syndrome inherited?
AR
What flap is used when the philtrum is involved?
Abbe flap to reconstruct philtrum
Can be used in conjunction with perialar crescenteric advancement flaps if the defect is large.
What can be changed with the incisions for a PMFF to help with rotation of the flap?
Carry medial incision more inferiorly
How are traumatic FN injuries medial to the lateral canthus treated?
Either not explored, or explored and tagged for later elective anastomosis (within 30d)
How are Stensen’s duct injuries treated?
Proximal: ligation of both ends
In general: re-anastomosed
What is the optimal time to dermabrade following surgery?
6-8w postop
What incisions describe the delivery approach in rhinoplasty?
Intercartilaginous & marginal
What incision is used for the retrograde approach to rhinplasty?
Intercartilaginous
What can be approached via the retrograde approach to rhinoplasty?
Upper lateral cartilages
Lateral crus of lower lateral cartilages
What lesion is caused by petroleum based ointments in a postoperative nose?
Paraffinoma
What is the ideal alar-lobule ratio?
1:1
What is the ideal collumellar-lobule ratio?
2:1
When is best to fix mandible fractures
Within 1w of injury
When is nasal septal growth greatest?
It’s bimodal. Age 0-5 then puberty.
When is best for closed reduction of nasal fractures?
Kids: within 4 days
Adults: within 10 days
Flaps based in which direction are more likely to develop trap door deformity?
Superiorly-based flaps
Lymphatics drain downward
What is a normal auriculocephalic angle?
25-35 degrees
How are apart are the medial and lateral limbs of a Mustarde stitch?
16mm
What is the position of the superior orbital rim in synostotic frontal plagiocephaly?
Elevated on the affected side
What is the position of the superior orbital rim in deformational frontal plagiocephaly?
Normal or depressed
What contributes to prominauris?
Unfolded antihelical fold (73% contribution)
Large conchal bowl
When must ear molding begin?
Within 3w of life
What measurements qualify as prominauris?
Auriculocephalic angle over 40 degrees
or
Helix-scalp distance over 2.5cm
What is the necessary cumulative gain for a tissue expander?
Uninflated width + length needed for defect = cumulative gain
Is convexity or concavity better for recipient of a FTSG?
Concavity
What is considered early vs. late complications of injectable fillers?
2 weeks is the cutoff
What should be done for late complication of injectable fillers?
Triamcinolone injection
Can help with granulomas, nodules, and migration
What is seen in Binder syndrome?
AKA Maxillo-Nasal dysplasia
Absent anterior nasal spine
Midface hypoplasia
Class III occlusion
What inhaled anesthetic is associated with improved flap survival?
Isoflurane
What is the starting dose for propranalol for infantile hemangioma?
0.33 mg/kg Q6h
Increases based on tolerability and age
What negative pressure is required for cervicofacial liposuction?
1 atm
What is the ideal nasofacial angle?
30-40 degrees
What is a Mathes and Nahai class I musculocutaneous flap?
Single dominant pedicle
What is a Mathes and Nahai class II musculocutaneous flap?
One dominant pedicle and multiple minor pedicles that can’t support the flap
What is a Mathes and Nahai class III musculocutaneous flap?
Dual dominant pedicles
What is a Mathes and Nahai class IV musculocutaneous flap?
Multiple segmental pedicles
What is a Mathes and Nahai class V musculocutaneous flap?
One dominant and multiple segmental pedicles, any of which can support the flap
What component determines the depth of a Baker-Gordon peel?
Croton oil
What donor material resist absorption best in rhinoplasty?
Split calvarial bone
What portion of people have an incomplete superficial palmar arch?
12%
What are the x-rays of choice for assessing mandible fractures?
Panorex and reverse Townes view
Progression of local anesthetic toxicity
CNS excitation
+/- seizures
CNS depression
Cardiorespiratory depression
Local anesthetic toxicity CNS excitation symptoms
Agitation Muscle twitching HTN Lightheadedness Lip tingling Tinnitus Metallic taste
Treatment of local anesthetic toxicity
Seizures - Benzos (5mg Ativan)
Oxygen +/- airway control
+/- vasopressor support
Lidocaine toxic dosage
4.5 mg/kg plain
7 mg/kg with Epi
Which local anesthetic can cause methemoglobinemia?
Prilocaine
Mechanisms of cocaine
Sodium channel inhibitor
NE reuptake inhibitor
Contraindications to cocaine
Pseudocholinesterase deficiency
HTN
Arrhythmias
Cocaine toxicity Tx
Oxygen
Alpha blockade (phentolamine)
Calcium channel blocker
Sublingual nitroglycerin
V1 blocks
Supraorbital and supratrochlear
Nasociliary (superomedial orbital wall)
External branch of ant. ethmoidal n. (inferomedial border of nasal bone)
V2 blocks
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
V3 blocks
V3 block (sigmoid notch, post to lateral pter plate, 6cm depth, 5cc) Inf alveolar intraoral block Mental block (intraoral, btwn 1st and 2nd premolars)
Cervical plexus block
Erb’s point (1/3-1/2 way from mastoid tip to SC joint along post. SCM)
10cc injected 3cm deep
Which opiate can cause serotonin syndrome?
Demerol (meperidine)
When given to pts on SSRI or MAOI
Serotonin syndrome symptoms
HTN
Seizures
Coma
Pyrexia
What receptor do opiates work on?
Opiate receptors (Mu, Sigma, Kappa)
What receptor do benzos work on?
Benzodiazepine receptor potentiates GABA
Side effects of opiates
N/V Constipation Hypotension Respiratory depression Pinpoint pupils
Four goals of sedation
Anxiolysis
Hypnosis
Amnesia
Anesthesia
Ketamine contraindications
Patients <3mo Questionable airway Cardiopulmonary disease Head injury or ^ICP Psychosis
Which sedative can cause laryngospasm?
Ketamine (especially in kids)
S/S of malignant hyperthermia
Tachycardia Tachypnea ^End-tidal CO2 Masseter spasm Acidosis/Hyperkalemia
Treatment for malignant hyperthermia
2.5 mg/kg IV dantrolene
Repeat Q5m until stabilized
What is the airway fire triad?
Ignition source
Fuel
Oxygen
Treatment of CNS excitation due to lidocaine overdose
Administer benzodiazepine
What are the four levels of sedation?
Minimal sedation/Anxiolysis
Moderate sedation
Deep sedation
General anesthesia
What four factors define level of sedation?
Responsiveness
Airway function
Spontaneous ventilation
Cardiovascular status
Abx for dog/cat bites
Augmentin
Three phases of wound healing
Inflammatory
Proliferative
Maturation
Length of inflammatory phase of wound healing
<7d
Length of proliferative phase of wound healing
3d-3w
Length of maturation phase of wound healing
3w-1y
How long is the cycle of a skin cell from generation to shedding?
28 days
Layers of the epidermis
“Come Let’s Get Sun Burned”
Corneum Lucidum Granulosum Spinosum Basale
What is the predominant collagen type in skin
Type 1
Fitzpatrick I description
Always burns
Pale, freckles
Fitzpatrick II description
Usually burns, sometimes tans
Fair
Fitzpatrick III description
May burn, usually tans
Light brown
Fitzpatrick IV description
Rarely burns, always tans
Olive
Fitzpatrick V description
Moderate constitutional pigmentation
Brown
Fitzpatrick VI description
Marked constitutional pigmentation
Black
What are the retaining ligaments of the face?
Mandibular Masseteric Zygomatic (McGregor's) Platysmal-auricular Orbicularis
Where is Pitanguy’s line?
0.5cm below tragus to 1.5 cm above lateral brow
Tarsal plate heights
Upper 8mm
Lower 4mm
Where does medial canthal tendon attach?
Anterior lacrimal crest
Where does lateral canthal tendon attach?
Whitnall’s tubercle
4mm posterior to lateral orbital rim
Where do the labial arteries run?
At vermillion
Between labial mucosa and orbicularis oris
Lateral pterygoid origin/insertion
Lateral side of lateral pterygoid plate
Coronoid/condyle
Opens the jaw
Medial pterygoid origin/insertion
Medial side of lateral pterygoid plate
Posterior mylohyoid groove
Closes the jaw
Auricle long axis angle
Posteriorly rotated 15 degrees
Roughly parallel to nasal dorsum
Ear height/width
Height 6cm
Width 3.5cm
Ear projection (angle & linear)
20-30 degrees
2-3cm
(Just remember it’s 2-3 for both cm and degrees)
Layers of the upper eyelid
Skin Orbicularis Septum Preaponeurotic fat Levator aponeurosis Muller's muscle Conjunctiva
Layers of the lower eyelid
Skin Orbicularis Pre-CPF fat Lower lid retractors Capsulopalpebral fascia Conjunctiva
Differences in the Asian upper lid
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
What does PICO model stand for?
Problem
Intervention
Comparison
Outcomes
What does nervus intermedius supply?
GSPN –> lacrimal & nasal mucosa
Chorda –> SMG, sublingual, taste
Lacrimation with eating
Bogorad’s syndrome
Similar to Frey’s syndrome but parasympathetics reach lacrimal gland
To what LN’s does this structure drain?
Above brow
Preauricular
Parotid
To what LN’s does this structure drain?
Central face
Submandibular
To what LN’s does this structure drain?
Lateral face
Parotid
What does the superficial cervical fascia envelop?
Platysma, mimetic muscles, SMAS, galea
What does the superficial layer of the deep cervical fascia envelop?
Salivary glands
Masseter
SCM
AKA investing fascia
What does the middle layer of the deep cervical fascia envelop?
Pretracheal fascia
Straps
Larynx
Thyroid
What does the deep layer of the deep cervical fascia envelop?
Prevertebral fascia
What are the horizontal facial buttresses?
Frontal bar
Zygomatic
Maxillary
Mandibular
What are the vertical facial buttresses?
Nasofrontal
Zygomaticomaxillary
Pterygomaxillary
Mandibular ramus