Rhinoplasty Flashcards

1
Q

What are the two clinically significant muscles affecting the nose mentioned in the passage?
A) Levator labii alaeque nasi and transverse nasalis
B) Depressor septi nasi and orbicularis oris
C) Levator labii alaeque nasi and depressor septi nasi
D) Nasalis and orbicularis oculi

A

C) Levator labii alaeque nasi and depressor septi nasi

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2
Q

What is the role of the levator labii alaeque nasi in relation to the external nasal valve?
A) Shortening the upper lip
B) Assisting in keeping the external nasal valve open
C) Decreasing tip projection
D) Interdigitation with the orbicularis oris

A

B) Assisting in keeping the external nasal valve open

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3
Q

How does the contraction of lip elevators affect the nasal airway patency?
A) It shortens the upper lip
B) It distracts the upper lateral cartilages, opening the internal valve
C) It causes alar flaring
D) It decreases tip projection

A

B) It distracts the upper lateral cartilages, opening the internal valve

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4
Q

What are the three types of depressor septi muscles identified in the cadaver study?
A) Type I, Type II, and Type III
B) Type A, Type B, and Type C
C) Visible, Identifiable, and Rudimentary
D) Levator, Depressor, and Orbicularis

A

Back: A) Type I, Type II, and Type III

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5
Q

How does transection of the depressor septi muscles benefit rhinoplasty patients with a drooping nasal tip and shortened upper lip?

A) Shortens the upper lip
B) Maintains tip rotation/projection on animation
C) Causes alar flaring
D) Decreases tip projection

A

Back: B) Maintains tip rotation/projection on animation

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6
Q

What is the primary goal achieved by transection of the depressor septi muscles in rhinoplasty patients?
A) Enhancement of the tip-lip relationship
B) Shortening of the upper lip
C) Decrease in tip rotation
D) Alar flaring

A

A) Enhancement of the tip-lip relationship

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7
Q

: How long is the follow-up period mentioned for patients who underwent transection of the depressor septi muscles in rhinoplasty?

A) Up to 6 months
B) Up to 1 year
C) Up to 2 years
D) Up to 5 years

A

C) Up to 2 years

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8
Q

What is the consequence of impaired alar flaring in the levator labii alaeque nasi muscle?

A) Shortening of the upper lip
B) Functional nasal obstruction with facial paralysis
C) Decrease in tip projection on animation
D) Opening of the internal valve

A

B) Functional nasal obstruction with facial paralysis

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9
Q

What effect does the depressor septi nasi have when clinically significant?

A) Shortening the upper lip
B) Decreasing tip projection on animation
C) Alar flaring
D) Opening the external nasal valve

A

B) Decreasing tip projection on animation

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10
Q

In the cadaver study, what characterizes Type II depressor septi muscles?
A) Little or no interdigitation with the orbicularis oris
- B) Full interdigitation with the orbicularis oris
- C) Visibility and identifiability
- D) No muscle or only rudimentary muscle visible

A

A) Little or no interdigitation with the orbicularis oris

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11
Q

What is the primary method of identifying rhinoplasty patients who may benefit from transection of depressor septi muscles?
A) Radiographic imaging
- B) Smiling during a preoperative examination
- C) Nasal endoscopy
- D) Palpation of nasal cartilages

A

B) Smiling during a preoperative examination

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12
Q

What aesthetic results are mentioned as achieved by transection of the depressor septi muscles in rhinoplasty?
- A) Alar flaring
- B) Decrease in tip rotation
- C) Shortening of the upper lip
- D) Well-maintained tip rotation/projection on animation

A

D) Well-maintained tip rotation/projection on animation

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13
Q

What is the concern associated with the transcolumellar incision in rhinoplasty?
- A) Impaired alar flaring
- B) Functional nasal obstruction
- C) Compromised blood supply to the nasal tip
- D) Decreased tip projection

A

C) Compromised blood supply to the nasal tip

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14
Q

What are the contributions to the blood supply of the nose mentioned in the passage?
- A) Internal carotid artery only
- B) External carotid artery only
- C) Both internal and external carotid arteries
- D) Vertebral artery

A

C) Both internal and external carotid arteries

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15
Q

Which arteries primarily supply the proximal portion of the nose?
- A) Facial artery
- B) Ophthalmic artery
- C) Superior labial and angular vessels
- D) Dorsal nasal artery

A

: B) Ophthalmic artery and its branches

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16
Q

What vessels primarily supply the nasal tip area?
- A) Superior labial and angular vessels
- B) Facial artery and dorsal nasal artery
- C) Lateral nasal branch and columellar branches
- D) Ophthalmic artery and its branches

A

C. Lateral nasal branch and columellar branches

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17
Q

What does the angiographic study in cadaver heads confirm about the lateral nasal vessels?
- A) They arise superficially at the nasal tip
- B) They consistently identify the alar groove
- C) They provide collateral supply to the nasal tip
- D) They are absent in 10% of cases

A

C) They provide collateral supply to the nasal tip

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18
Q

What is the clinical relevance of the study mentioned in the passage?
- A) Excessive defatting is recommended for nasal tip procedures
- B) The nasal tip can be safely defatted without risk
- C) Collateral blood supply enters the nose via the alar arcades
- D) Transcolumellar incisions are necessary for proper blood flow

A

C) Collateral blood supply enters the nose via the alar arcades

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19
Q

According to the passage, what is the clinical recommendation for nasal tip procedures concerning blood supply?
- A) Excessive defatting is advisable for better outcomes
- B) Nasal tip should be defatted to avoid complications
- C) Surgeons should reconstruct the underlying framework instead of defatting
- D) Transcolumellar incisions are crucial for proper blood flow

A

Surgeons should reconstruct the underlying framework instead of defatting

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20
Q

: In the angiographic study, what is the percentage of cases where the lateral nasal artery was consistently present?
A) 68.2%
- B) 100%
- C) 50%
- D) 22%

A

: B) 100%

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21
Q

What is the consequence of prior incisions in the alar region according to the passage?
- A) Improved blood supply to the nasal tip
- B) No effect on collateral blood supply
- C) Jeopardizing collateral supply to the nasal tip in secondary procedures
- D) Increased risk of alar flaring

A

C) Jeopardizing collateral supply to the nasal tip in secondary procedures

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22
Q

What artery provides collateral supply to the nasal tip via the nasal arcades, as mentioned in the passage?
- A) Facial artery
- B) Ophthalmic artery
- C) Infraorbital artery
- D) Dorsal nasal artery

A

C) Infraorbital artery

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23
Q

What is the primary concern related to the blood supply of the nasal tip in the context of surgical procedures?
- A) Lack of arterial supply
- B) Excessive bleeding
- C) Compromised vascularization due to excessive defatting
- D) Occlusion of the external carotid artery

A

C) Compromised vascularization due to excessive defatting

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24
Q

How many nasal vaults are there, and what are they named?
- A) Two - Upper and Lower
- B) Three - Bony, Upper Cartilaginous, and Lower Cartilaginous
- C) Four - Bony, Lateral Cartilaginous, Medial Cartilaginous, and Lower
- D) One - Bony Vault

A

B) Three - Bony, Upper Cartilaginous, and Lower Cartilaginous

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24
Q

What makes up the bony vault of the nose?
- A) Nasal bones only
- B) Ascending frontal process of the maxilla only
- C) Nasal bones and the ascending frontal process of the maxilla
- D) Upper lateral cartilages

A

C) Nasal bones and the ascending frontal process of the maxilla

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25
Q

Why are osteotomies rarely indicated above the canthal level in the bony vault?
- A) Thin bone and wide structure
- B) Thick bone and narrow structure
- C) Thick bone and wide structure
- D) Thin bone and narrow structure

A

B) Thick bone and narrow structure

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25
Q

What defines the keystone area in the upper cartilaginous vault?
- A) Medial crural ligaments
- B) Junction of upper lateral cartilages with nasal bones and septum
- C) Lower lateral cartilages
- D) Nasal bones

A

B) Junction of upper lateral cartilages with nasal bones and septum

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25
Q

What is the consequence of the loss of intricate relationships in the keystone area of the upper cartilaginous vault?
A) Inverted-V deformity
- B) Dorsal hump
- C) Loss of nasal tip projection
- D) Thickening of the nasal bones

A

A) Inverted-V deformity

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26
Q

What are the components of the lower lateral cartilaginous vault?
- A) Upper lateral cartilages and septum
- B) Medial, middle, and lateral crura
- C) Fibrous connections and anterior septal angle
- D) Piriform abutment and dorsal hump

A

B) Medial, middle, and lateral crura

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27
Q

According to the fresh-cadaver study by Adams et al, what was the mean loss of tip projection for open rhinoplasty versus closed rhinoplasty?
A) 1.98 mm for open, 3.43 mm for closed
- B) 3.43 mm for open, 1.98 mm for closed
- C) No significant difference
- D) 0.001 mm for open, 0.001 mm for closed

A

B) 3.43 mm for open, 1.98 mm for closed

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28
Q

What structures were manipulated in the fresh-cadaver study by Adams et al to assess nasal tip support in open and closed rhinoplasty?
- A) Nasal bones
- B) Lower lateral cartilages
- C) Nasal septum
- D) All of the above

A

D) All of the above

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29
Q

What was the primary reason for the larger loss of tip projection in open rhinoplasty in the study by Adams et al?
- A) Cephalic trim
- B) Interruption of the lower lateral cartilages
- C) Ligamentous disruption
- D) Septum removal

A

C) Ligamentous disruption

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30
Q

According to the passage, what is emphasized concerning the relationship of upper lateral cartilages to the septum in the keystone area?
A) T-shaped contour
- B) U-shaped contour
- C) S-shaped contour
- D) L-shaped contour

A

A) T-shaped contour

31
Q

What is the primary support factor for tip projection in the lower lateral cartilaginous vault?
- A) Length and strength of the nasal bones
- B) Fibrous connections between upper and lower lateral cartilages
- C) Medial crural ligaments
- D) Nasal hump

A

B) Fibrous connections between upper and lower lateral cartilages

32
Q

What is the consequence of manipulating the septum in terms of tip support in both open and closed rhinoplasty approaches?
- A) Increased tip support
- B) Greater loss of tip projection
- C) Improved nasal symmetry
- D) No impact on tip support

A

B) Greater loss of tip projection

33
Q

What combination of structures provides tip support according to the passage?
- A) Skin, bones, and ligaments
- B) Ligaments, cartilage, and muscles
- C) Skin, ligaments, and cartilage
- D) Bones, muscles, and cartilage

A

C. Skin, ligaments, and cartilage

34
Q

How does progressively disrupting skin, ligaments, and cartilage affect tip projection?
- A) Increases tip projection
- B) Has no impact on tip projection
- C) Decreases tip projection
- D) Improves nasal symmetry

A

C) Decreases tip projection

35
Q

According to Sheen, what forms the angle of divergence in the lower lateral cartilage?
- A) Medial crura
- B) Middle crus
- C) Lateral crura
- D) Supratip area

A

: B) Middle crus

36
Q

What is the significance of the angle of divergence in the lower lateral cartilage, as per Sheen’s classification?
- A) Determines the shape of the nasal bones
- B) Influences the length of the nasal septum
- C) Affects the type of nasal tip (bulbous or boxy)
- D) Determines the position of the nasal columella

A

C) Affects the type of nasal tip (bulbous or boxy)

37
Q

What are the tip-defining points mentioned in the passage, which are important for assessing tip definition and identifying tip asymmetries?
- A) Nasal bones and supratip area
- B) Columellar lobule angle and nasal septum
- C) Domes and nasal columella
- D) Supratip area, apex of the domes, and columellar lobule angle

A

D) Supratip area, apex of the domes, and columellar lobule angle

38
Q

How can a classification system based on the angle of divergence of the middle crura and the width of the domes aid in the diagnosis and treatment of nasal tip deformities?
- A) By determining the length of the nasal septum
- B) By assessing the thickness of the nasal bones
- C) By influencing the position of the nasal columella
- D) By providing guidance on the type and treatment of nasal tip deformities

A

D) By providing guidance on the type and treatment of nasal tip deformities

39
Q

According to the passage, what does Sheen’s classification system consider for diagnosing and treating nasal tip deformities?
- A) Length of the nasal septum
- B) Thickness of the nasal bones
- C) Angle of divergence of the middle crura and width of the domes
- D) Position of the nasal columella

A

C) Angle of divergence of the middle crura and width of the domes

40
Q

In the context of tip support, what is the consequence of disrupting progressively more of the skin, ligaments, and cartilage?
- A) Increased tip projection
- B) No impact on tip projection
- C) Decreased tip projection
- D) Improved nasal symmetry

A

C) Decreased tip projection

41
Q

What are the three primary components of the septum?
- A) Quadrangular cartilage, perpendicular plate of the ethmoid, and vomer
- B) Quadrangular cartilage, cribriform plate, and vomer
- C) Perpendicular plate of the ethmoid, nasal spine, and vomer
- D) Quadrangular cartilage, cribriform plate, and turbinates

A

A) Quadrangular cartilage, perpendicular plate of the ethmoid, and vomer

42
Q

What comprises the bony septum, and what should be done during septal reconstruction to prevent cerebrospinal fluid rhinorrhea?
- A) Nasal spine; sidewise fracture of the premaxilla
- B) Perpendicular plate of the ethmoid; removal of the bony part of the perpendicular plate
- C) Nasal spine; removal of the cribriform plate
- D) Quadrangular cartilage; alteration of the caudal portion of the septum

A

B) Perpendicular plate of the ethmoid; removal of the bony part of the perpendicular plate

43
Q

What is the most projecting part of the premaxilla, and why does it need to be altered infrequently?
- A) Nasal spine; rarely interferes with septal reconstruction
- B) Vomer; rarely contributes to nasal obstructions
- C) Cribriform plate; infrequently needs adjustment
- D) Quadrangular cartilage; rarely causes alar–columellar discrepancy

A

A) Nasal spine; rarely interferes with septal reconstruction

44
Q

What part of the septum is the most protruding part of the columella, and under what circumstances might it need alteration?
- A) Nasal spine; in cases of nasal valve collapse
- B) Cribriform plate; in cases of cerebrospinal fluid rhinorrhea
- C) Quadrangular cartilage; in cases of turbinates hypertrophy
- D) Caudal portion of the septum; in cases of alar–columellar discrepancy

A

D) Caudal portion of the septum; in cases of alar–columellar discrepancy

45
Q

What is the internal nasal valve defined as?
- A) Junction between the septum and the caudal border of the upper lateral cartilage
- B) Nasal spine
- C) Cribriform plate
- D) Quadrangular cartilage

A

A) Junction between the septum and the caudal border of the upper lateral cartilage

46
Q

What is the typical angle range that must be preserved or reconstructed with a spreader graft in rhinoplasty?
- A) 5° to 10°
- B) 15° to 20°
- C) 10° to 15°
- D) 20° to 25°
- Back: C) 10° to 15°

A

C) 10° to 15°

47
Q

In primary or secondary rhinoplasty, what is the recommended action regarding the angle mentioned in the previous statement?
- A) It should be increased for better aesthetic outcomes
- B) It should be ignored for simplicity
- C) It should be left to natural changes
- D) It should be preserved or reconstructed with a spreader graft

A

D) It should be preserved or reconstructed with a spreader graft

48
Q

Among the three turbinates (nasal conchae), which is considered the most significant functional component in nasal airway breathing?
- A) Superior turbinates
- B) Middle turbinates
- C) Inferior turbinates
- D) Anterior turbinates

A
  • Back: C) Inferior turbinates
49
Q

What procedure is indicated for airway correction and yields excellent functional results related to the turbinates?
- A) Turbinate augmentation
- B) Turbinate relocation
- C) Submucous resection of the turbinate
- D) Turbinate removal

A

C) Submucous resection of the turbinate

50
Q

Following the open rhinoplasty approach, where is the blood supply to the nasal tip primarily derived from?
- A) Internal carotid artery
- B) External carotid artery
- C) Lateral nasal arteries 2 to 3 mm above the alar groove
- D) Dorsal nasal artery

A

C) Lateral nasal arteries 2 to 3 mm above the alar groove

51
Q

what is the most common cause of functional nasal airway obstruction?
- A) Septal deviation
- B) External nasal valve abnormalities
- C) Internal nasal valve abnormalities
- D) Inferior turbinate hypertrophy

A
  • Back: D) Inferior turbinate hypertrophy
52
Q

Besides inferior turbinate hypertrophy, what other factors must be considered as potential causes of functional nasal airway obstruction?
- A) External nasal valve abnormalities only
- B) Septal deviation only
- C) Internal nasal valve abnormalities only
- D) Septal deviation and internal or external nasal valve abnormalities

A
  • Back: D) Septal deviation and internal or external nasal valve abnormalities
53
Q

Front: Who popularized the concept of the “Gorney-Gram,” and what is its purpose?
- A) Mark Gorney; to assess postoperative happiness
- B) Mark Gorney; to identify potential red flag patients
- C) Dr. Rhinoplasty; to assess surgical outcomes
- D) Dr. Happiness; to plot patient’s overall satisfaction

A
  • Back: B) Mark Gorney; to identify potential red flag patients
54
Q
A
54
Q

Front: What does “SIMON” stand for in the context of a red flag patient?
- A) Simple Image Modification Outcomes
- B) Single, Immature, Male, Overly Narcissistic
- C) Surgical Improvement and Modification Outcomes
- D) Sophisticated Imaging and Measurement Outcomes

A

Back: B) Single, Immature, Male, Overly Narcissistic

55
Q

According to the passage, what is a characteristic of the “Debbie Downer” type of red flag patient?
- A) Excessive concern for minimal findings
- B) Extreme narcissism
- C) Chronic dissatisfaction during office visits
- D) Aggressive behavior toward the surgeon

A
  • Back: C) Chronic dissatisfaction during office visits
56
Q

Who is often regarded as the father of modern rhinoplasty due to his contributions to the analysis, classification, and repair of various nasal deformities?
- A) Carl von Graefe
- B) Johann Friedrich Dieffenbach
- C) John Orlando Roe
- D) Jacques Joseph
-

A

Back: D) Jacques Joseph

57
Q

What is a distinct advantage of the open rhinoplasty approach mentioned in the passage?
- A) Binocular visualization
- B) Rapid operative time
- C) Limited options with original tissues
- D) Indirect control of bleeding

A
  • Back: A) Binocular visualization
58
Q

What is mentioned as a potential disadvantage of the open rhinoplasty approach in the passage?
- A) Rapid operative time
- B) Limited options with original tissues and cartilage grafts
- C) Delayed wound healing
- D) Precise diagnosis and correction of deformities

A
  • Back: C) Delayed wound healing
59
Q

What is a potential disadvantage of the open rhinoplasty approach related to incisions, as mentioned in the passage?
- A) Limited diagnosis and correction of deformities
- B) Transcolumellar scar (external nasal incision)
- C) Rapid operative time
- D) Minimal nasal tip edema
-

A

Back: B) Transcolumellar scar (external nasal incision)

60
Q

What is a potential disadvantage of the open rhinoplasty approach related to operative time, as mentioned in the passage?
- A) Protracted nasal tip edema
- B) Suture stabilization of grafts
- C) Rapid operative time

A
  • D) Prolonged operative time
61
Q

Front: How does the thickness, mobility, and sebaceous character of the nasal skin vary along its length?
- A) The upper two-thirds are thicker, less mobile, and more sebaceous.
- B) The inferior third is thinner, less mobile, and less sebaceous.
- C) The upper two-thirds are thinner, more mobile, and less sebaceous.
- D) The inferior third is thicker, more mobile, and more sebaceous.

A
  • Back: C) The upper two-thirds are thinner, more mobile, and less sebaceous.
62
Q

Front: What is the average thickness of the nasal dorsum?
- A) Approximately 1.3 mm
- B) Approximately 2.4 mm
- C) Approximately 3.5 mm
- D) Approximately 4.6 mm

A
  • Back: A) Approximately 1.3 mm
63
Q

What is the importance of noting the vascularity to the nasal tip in an open rhinoplasty approach using a transcolumellar incision?
- A) It helps in controlling bleeding during the procedure.
- B) It ensures proper cartilage grafting.
- C) It prevents damage to the nasal septum.
- D) It helps avoid compromising blood flow to the nasal tip.

A
  • Back: D) It helps avoid compromising blood flow to the nasal tip.
64
Q

Front: What is the significance of the keystone area in the upper cartilaginous vault?
- A) It is the narrowest part of the nose.
- B) It is where the nasal bones overlap the upper lateral cartilages.
- C) It is the widest part of the dorsum.
- D) It is composed of the medial, middle, and lateral crura.

A
  • C) It is the widest part of the dorsum.
65
Q

What can overresection during dorsal hump reduction in the keystone area lead to?
- A) Enhanced tip–lip relationship
- B) Inverted-V deformity
- C) Improved dorsal aesthetic lines
- D) Increased tip projection

A

B) Inverted-V deformity

66
Q

Front: What makes up the lower cartilaginous framework in the nasal vaults?
- A) Nasal bones
- B) Upper lateral cartilages (ULCs)
- C) Medial, middle, and lateral crura
- D) Ascending frontal process of the maxilla

A
  • Back: C) Medial, middle, and lateral crura
67
Q

hat is the composition of the internal nasal valve, and what is its typical angle?
- A) It is formed by the intersection of the nasal septum and the caudal margin of the ULC, with a typical angle of 10–15 degrees.
- B) It is a cartilaginous vestibule bounded by the nares and lateral alar sidewalls.
- C) It is the angle formed by the junction of the upper lateral cartilage with the nasal septum.
- D) It is the narrowest segment of the nasal airway, contributing up to 50% of the total airway resistance.

A
  • Back: A) It is formed by the intersection of the nasal septum and the caudal margin of the ULC, with a typical angle of 10–15 degrees.
68
Q

What can contribute up to 50% of the total airway resistance in the nasal airway?
- A) External nasal valve
- B) Inferior turbinate
- C) Internal nasal valve
- D) Nasal septum

A
  • Back: C) Internal nasal valve
69
Q

Front: What structures constitute the septum?
- A) Nasal bones and upper lateral cartilages
- B) Septal cartilage, perpendicular plate of the ethmoid bone, nasal crest of the maxilla, and vomer
- C) Inferior, middle, and superior turbinates
- D) Lower lateral cartilages and dorsal cartilaginous septum

A
  • Back: B) Septal cartilage, perpendicular plate of the ethmoid bone, nasal crest of the maxilla, and vomer
70
Q

What is the primary contributor to the total airway resistance in the nasal airway?
- A) External nasal valve
- B) Internal nasal valve
- C) Inferior turbinate
- D) Upper lateral cartilage

A
  • Back: C) Inferior turbinate
71
Q
  1. Front: What are the “danger signs” identified by Gunter that may suggest underlying psychological issues in rhinoplasty patients?
    - A) Specific facial features
    - B) Unexplained weight loss
    - C) Minimal disfigurement, unrealistic expectations, unresolved grief, etc.
    - D) Age-related concerns
A
  • Back: C) Minimal disfigurement, unrealistic expectations, unresolved grief, etc.
72
Q
  1. Front: According to Gorney, what traits are described by the acronym “SIMO” in the context of rhinoplasty patients?
    - A) Single, immature, male, overly expectant, narcissistic
    - B) Sympathetic, introspective, motivated, organized
    - C) Surgical, informed, meticulous, organized
    - D) Simple, introverted, methodical, observant
A
  • Back: A) Single, immature, male, overly expectant, narcissistic
73
Q
  1. Front: How does Gorney use a plot to identify potential problem patients in rhinoplasty?
    - A) Plots concerns relative to age
    - B) Plots concerns relative to gender
    - C) Plots concerns relative to deformity and patient expectations
A
  • D) Plots concerns relative to socioeconomic status
74
Q

Why is evaluating the patient’s skin type, thickness, and texture important in preoperative surgical planning for rhinoplasty?
- A) It helps determine the patient’s age.
- B) It affects the choice of anesthesia.
- C) Thicker, more sebaceous skin tends to camouflage changes made to the underlying osseocartilaginous framework.

A
  • D) It helps in assessing the patient’s mental health.
75
Q

Front: How is the face divided during facial analysis in rhinoplasty, and why is it important?
- A) Into quarters to assess symmetry
- B) Into halves for a balanced look
- C) Into thirds using horizontal lines to evaluate proportions and relationships
- D) Into eighths to analyze minute details
-

A

Back: C) Into thirds using horizontal lines to evaluate proportions and relationships

76
Q

How is nasal length verified during facial analysis in rhinoplasty?
- A) Measure from the hairline to the nasal tip.
- B) Measure from the nasal base to the oral commissures.
- C) Measure from the radix to the tip and compare it to the stomion-to-menton distance.
- D) Measure the distance between the alar rims.

A
  • Back: C) Measure from the radix to the tip and compare it to the stomion-to-menton distance.
77
Q
A