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Plastics Flashcards

1
Q

Orbit dimensions

A

40-45 mm deep
45 mm wide (max width ~1 cm behind rim)
35 mm high
30 cc volume

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2
Q

Bones and structures of SOF

A

Greater and lesser sphenoid wings

Transmits CN 3, 4, v1 and 6; SOV, symp fibers to iris dilator

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3
Q

Bones and structures of optic canal

A

Within lesser wind of sphenoid

Transmits optic nerve, ophthalmic artery and sympathetic nerves to blood vessels

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4
Q

Bones and structures of the inferior orbital fissure

A

Bordered medially by maxillary bone, anteriorly by zygomatic bone and laterally by greater wing of sphenoid, palatine
Transmits CN V2, zygomatic nerve, inferior ophthalmic vein, venous comm. btwn ophth vein & pterygoid/sphenopalatine plexus

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5
Q

Foramen ovale, rotundum, lacerum

A

Ovale: V3
Rotundum: v2
Lacerum: ICA
Spinosum: MMA

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6
Q

Central retinal artery entry into optic nerve

A

13 mm posterior to globe

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7
Q

Ant/post ethmoidal foramen

A

Jxn of frontal and ethmoid bones

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8
Q

SOF structures inside/outside annulus

A

In: CN 3 (sup/inf), nasociliary, CN 6,
Out: lacrimal n, frontal n, trochlear n, SOV

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9
Q

Parasympathetic and sympathetic innervation pathways

A

Parasympathetic via short ciliary nerves through ciliary ganglion
sympathetic via long ciliary nerves

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10
Q

Pre tarsal orbicularis heads

A

Superficial: extends from ant lac crest to form part of MCT then inserts on zygomatic bone

Deep: extends from post lac crest to surround canaliculi (horners muscle), forms part of LCT, then inserts onto lat orbital tubercle

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11
Q

Preseptal orbicularis

A

Anterior limb from MCT & post lac crest/lac sac fascia (Surrounds sac), then continues to lat palpebral raphe

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12
Q

Orbital orbicularis

A

Inserts at medial canthal tendon and interdigitates with frontalis muscle superiorly at brow

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13
Q

Forehead muscles and functions

A
  1. Frontalis: moves scalp anterior and post; raises eyebrows; innervated by CN 7; independent muscle
  2. Corrugator: pulls medial eyebrow inf/med producing vertical glabellar wrinkle; Originates from nasal process of frontal bone; innervated by CN 7; part of orbital orbicularis
  3. Procerus: pulls forehead and medial brow inferiorly producing horizontal lines in nose; interdigitates with inf edge of frontalis
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14
Q

LPS horns

A

Muscular portio (40 mm), aponeurotic (15-20 mm; 2 horns)

Lateral: Inserts into lateral orbital tubercle; divides lacrimal gland

Medial: Inserts onto posterior lacrimal crest; inserts onto lower half of Tarsus to form eyelid crease

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15
Q

Whitnalls ligament

A

10 mm above superior edge of tarsus
Attachments: medially to trochlea; laterally to lacrimal gland and lateral wall 10 mm ABOVE Whitnall’s tubercle
Origin of Mullers muscle
Peripheral arterial arcade found between aponeurosis and mullers muscle

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16
Q

Muscle Analogous to mullers in LL

A

Inf tarsal muscle; symp innervation; arises from CPF at level of lockwood’s ligament

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17
Q

Capsulopalpebral fascia

A 
Analogous to levator apo.
Originates from inferior rectus sheath
Encircles inferior oblique muscle 
joins to form Lockwood ligament 
fuses c septum and inserts into inf Tarsus
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18
Q

Lockwood’s ligament

A

analogous to Whitnall’s ligament

Medial and lateral horns attached to retinacula forming suspensory hammock

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19
Q

Dimensions of Tarsus

A

29 mm long
1 mm thick
superior tarsal plate: 10 mm in height
Inf: 4 mm in height

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20
Q

Medial canthal tendon

A

Attaches to tarsal plates; fusion of tendinous insertions of pretarsal and preseptal orbicularis

Anterior limb: attaches to frontal process of maxillary bone; passes anterior to lacrimal sac; origin of superficial head of precursor orbicularis; attaches to anterior lacrimal crest

Posterior limb attaches to posterior lacrimal crest; passes behind lacrimal sac. More important than anterior limb for lid apposition

21
Q

Lateral canthal tendon

A

Originates from lat borders of upper and lower tarsal plates
inserts onto tubercle of Whitnall
3 mm superior to MCT insertion

22
Q

Vascular supply to eyelids

A

UL: ICA to ophthalmic to superior marginal arcade
LL: ECA to facial artery to angular artery to inf marginal arcade

Periph and marginal arcades allow for anastomosis between ICA and ECA

23
Q

Spencer’s Triad

A

Optociliary shunts, optic atrophy, optic nerve meningioma

24
Q

Risk of systemic lymphoma by location in orbit

A
  1. eyelids 67%
  2. orbit 35%
  3. conjunctiva 20%

Location is more important than histopathology

25
Q

Fibrous histiocytoma Characteristics

A

Benign in 90%
distinguished from hemangiopericytoma only on biopsy
pathology: storiform nebular pattern; spindle cell tumor

26
Q

Rule of 50s

A

50% of lacrimal gland lesions are inflammatory or lymphoproliferative
50% of lacrimal grand tumors are of epithelial origin
50% of epithelial tumors are benign pleomorphic adenoma
50% of malignant tumors are adenoid cystic carcinoma

27
Q

Work up of sinus mucocele

A

Must rule out encephalocele and meningocele

Also a/w CF

28
Q

Most common primary source of orbital Mets in adults

A

Women: breast carcinoma – can cause fibrous response, enophthalmos, and ophthalmoplegia

Men: lung carcinoma

29
Q

Lid reconstruction options by size of defect

A

Upper lid
Less than 33%: direct closure
33-50% defect: tenzel flap
greater than 50% defect: Cutler-Beard flap (tarsoconj)

Lower lid
Less than 33%: direct closure
33-50% defect: tenzel flap
greater than 50% defect: Hughes flap flap tarsoconj)

30
Q

DDX hemifacial spasm

A

CPA tumor, MS
2/2 compression of CN 7
Present during sleep

31
Q

Types of ectropion

A
  1. involutional
  2. paralytic
  3. cicatricial number
  4. mechanical
  5. Congenital (ie blepharophimosis)
32
Q

Types of entropion

A
  1. Congenital
  2. Spastic
  3. Involutional
  4. Cicatricial
33
Q

Most common locations for basal cell carcinoma

A

Lower lid (50%)
medial canthus (Worse prognosis)
upper lid
outer canthus

34
Q

Most common location of squamous cell carcinoma

A

Lower lid

35
Q

Tendon of insertion length of recti

A

LR = IR > SR > MR > SO > IO (1 mm)

LR/sr: 7 mm
Mr: 4.5 mm
Sr: 6 mm
Ccw to spiral of tillaux

36
Q

Arc of contact for extraocular muscles

A

IO > LR > SO > MR> SR = IR

15, 12, 7-8, 7, 6.5

37
Q

Blepharophimosis syndrome

A

Blepharoptosis, telecanthus, epicanthus inversus AND ectropion
AD inheritance; can be a/w trisomy 18

38
Q

Location of ostium in DCR surgery

A

Middle turbinate

39
Q

Walls of orbit

A

Roof (FLS): frontal, lesser sphenoid
Medial (SMELs): lesser sphenoid, maxillary, ethmoid, lacrimal
Floor (MoPZ): maxillary, palatine, zygomatic
Lateral (ZiGs): zygomatic, greater sphenoid

40
Q

Location of IO in relation to fat pads

A

Separates medial and central pads

41
Q

Strongest wall of orbit

A

lateral

42
Q

Most frequent site of BCC on eyelids

A

LL > MC > UL > LC

43
Q

Most common cause of conjunctivitis –> cellulitis in kids

A

H flu

44
Q

Systemic conditions associated with blepharophimosis syndrome

A

Premature ovarian failure in BPES Type 1

45
Q

Risk of systemic disease for peri ocular lymphoma

A

Lids: 67%
Orbit: 35%
Conj: 20%

46
Q

Path of NL canal thru lateral nasal wall

A

Downward, posterior, and LATERAL

MEEI peds #33, pg 251

47
Q
  1. Heerfordt Syndrome
  2. Lofgren syndrome
  3. Mikulicz Syndrome
A

All are systemic forms of sarcoidosis

  1. Heerfordt- granulomatous uveitis, parotid swelling, CN VII palsy
  2. Lofgren- bilateral hilar LAD, arthropathy, fever, erythema nodosum
  3. Mikulicz- lacrimal gland enlargement, salivary gland enlargement, KCS
48
Q

optic nerve blood supply

A

Retrolaminar nerve – pial vessels and short posterior ciliary arteries (SPCAs)
Laminar nerve – SPCAs, branches of circle of Zinn-Haller
Prelaminar nerve – SPCAs, recurrent choroidal arteries
Nerve fiber layer – central retinal artery (CRA)
Intraorbital optic nerve – proximally - pial vessels and branches of ophthalmic artery; distally - branches of CRA
Intracanalicular optic nerve – ophthalmic artery
Intracranial optic nerve – ophtalmic artery and internal carotid artery

49
Q

Sinuses and corresponding meatus

A

Sphenoid– sphenoethmoidal recess
Posterior ethmoidal sinus- superior meatus
Frontal, ant/med ethmoidal, maxillary– middle meatus
Nasolacrimal duct- inferior meatus

Plastics (1 decks)

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