Skin Lesions And Craniofacial Flashcards
1
Q
Where Do melanocytes originate from?
A
Neural Crest cells
2
Q
When is the risk of malignant transformation of a congenital melanocytic Nieves greatest in childhood?
A
Before age 9
3
Q
What is the typical margin for atypical or dysplastic Nieves?
A
2 mm margins
4
Q
What is a Nevus spilus ?
A
And irregularly shaped light brown spot with darkly, pigmented, macules, or papules distributed in the lesion
5
Q
Puetz jeghers syndrome
A
AD; multiple lentigines and GI polyps
6
Q
What is a halo Nevus
A
A melanocytic Nieves, surrounded by an area of depigmentation, usually found on the trunk of teenagers
7
Q
Most common vascular neoplasm of childhood
A
Hemangioma
8
Q
What is a port wine stain?
A
Capillary malformation that presents at birth and grows proportionate to gross and has normal endothelial cell turnover
9
Q
How to treat a port wine stain
A
Pulsed dye laser of 585 wavelength and short duration
10
Q
What is the inheritance pattern of a disease that presents with multiple glomus tumors?
A
Autosomal dominant
11
Q
What syndrome has telangiectasia on the face lips, tongue, ears, hands feet G.I. GU pulmonary CNS and liver
A
Ozler Weber Renu syndrome, hereditary hemorrhagic. Telangiectasia
12
Q
True or false pyogenic granulomas often develop as rapidly growing bleeding papules during pregnancy
A
True
13
Q
What is PHACE syndrome?
A
Posterior fossa abnormalities, hemangiomas, arterial lesions, coarctation of the aorta, cardiac malformations, eye abnormalities
14
Q
What is a solitary firm hyperkeratotic sometimes pedunculated papule frequently found on the digits overlying and IP joint, but can be found anywhere on the hands and feet
A
Acquired digital fibrokeratoma
15
Q
What is a lesion that is skin colored or red found on the lateral or dorsal surface of a digit on an infant or young child
A
Infantile, digital fibromatosis
16
Q
Most common side effects of using steroids for the treatment of keloids
A
Dermal atrophy and hypo pigmentation
17
Q
Most common malignant tumor that can arise in a Nieves sebaceous
A
Basal cell carcinoma
18
Q
Which reddish brown lesion exhibits Darier’s sign meaning urticates upon stroking
A
Cutaneous mastocytoma
19
Q
What are treatment modalities for actinic keratosis?
A
Excision, curettage, 5FU, laser, ablation, dermabrasion, chemical, peels, cryosurgery
20
Q
What is actinic cheilitis
A
Scaly fissure lesion in the lower lip, which is secondary to chronic ultraviolet light exposure. Squamous cell carcinoma can develop from this.
21
Q
What are the high-risk HPV types?
A
16 and 18
22
Q
Most common subcutaneous soft tissue tumors
A
Lipomas
23
Q
What are angiolipomas
A
Painful subcutaneous nodules that are otherwise similar to lipomas
24
Q
What are the cutaneous findings in Gardner syndrome?
A
Epidermal, inclusion cyst, osteomas, fibromas, lipomas, Leo myomas, Desmo, tumors, fibrosarcoma
APC mutation
25
What is the most carcinogenic ultraviolet light?
UVB
26
Other than some exposed sites, what are the most common locations of basal cell carcinoma?
Old scars, thermal burns, or at the site of Nevus sebaceous
27
What are some of the clinical types of basal cell carcinoma?
Superficial, nodular, ulcerative, pigmented, morpheaform.
28
What are the treatment options for basal cell carcinoma?
Curettage and electro dissection, excision, cryotherapy, photodynamic therapy, 5FU, emit, imiquimod; vismodegib
29
What are the contraindications to curettage an electro dissection?
Aggressive types, such as morphia form, sclerosing, infiltrative, recurrent, and micronodular basal cell carcinoma. Anatomic areas that are rich in Pylos sebaceous units like the nose and scalp. Deeply invasive tumors that have invaded through the dermis. Areas with soft skin texture, like the eyelid and lip.
30
What is the metastatic risk for squamous cell carcinoma?
Overall risk of metastasis is 2% to 6%. Mary tumors have a 5% metastatic risk while recurrent tumors have a 30% risk. Lesions less than 2 cm have a 9% risk and lesions greater than 2 cm have a 30% risk. Lesions that invade more than 4 mm have a metastatic risk of 45%.
31
Most common metastatic location for squamous cell carcinoma
Regional lymph nodes, lungs, liver
32
What kind of mutations increase the risk of developing melanoma?
XP, CDKN2A, CDK4, TERT
33
What are the indications for a Sentinel lymph node biopsy in melanoma patients?
If the depth is greater than one millimeter, and there is no evidence of metastatic disease or clinical lymph node involvement. It should also be discussed with patients that have lesions that are .76 to 1 mm thick with either ulceration or mitotic rate greater than one per millimeter squared.
34
What is the surgical management for metastatic melanoma to the lymph nodes identified clinically or on sentinel node biopsy?
Complete lymph node dissection in patient with positive sentinel lymph node biopsy, and those patients with stage three clinical disease
35
What are the limits to a complete axillary node dissection
Superior is the subclavius muscle.
Inferior is the insertion of the Thoracodorsal nerve into the Latus muscle.
Medial is the first rib to the edge of the pec minor muscle, and including the tissue above the pec major and in between Pec major and minor.
Lateral is the edge of the Lat muscle
36
What are the limits of a complete inguinal lymph node dissection
Superior is 5 cm above the inguinal ligament.
Inferior is the confluence of the sartorius and the adductor longus
Medial Is the adductor longus and pubic tubercle
Lateral is a Sartorius muscle and the anterior superior iliac spine.
37
Saethre- chotzen
TWIST
AD
Bilateral coronal synostosis
Brachycephaly
Ptosis
Maxillary hypoplasia.
Low hairline.
Prominent ear crust along concha
Strabismus
Cleft or high arched pallet
Vertebral, anomalies line normal intelligence
38
How many types of Pfeiffer syndrome are there?
Type one is craniosynostosis with broad, thumbs and toes they have near normal intelligence.
Type two has a cloverleaf skull severe CNS involvement, elbow, synostosis, and early death.
Type three is like type two without the clover leaf skull next line
Include FGFRone and FGFRtwo
AD
Craniosynostosis.
Wide, thumbs and great toes.
Maxillary hypoplasia.
Normal intelligence usually
39
Apert syndrome
FGFR2
AD
Bilateral coronal synostosis
Brachycephaly
Maxillary, hypoplasia with cleft palate and anterior open bite
Hypertelorism; exorbitant, paresis
Send act of all fingers and toes.
Course skin and acne
Enlarged earlobes.
Variable intelligence
40
Crouzon
FGFR2
AD
Bilateral coronal synostosis
Exophthalmus
Maxillary hypoplasia
Parrot beak nose
Micrognathia.
Normal hands and feet
41
Muenke
FGFR3
42
What craniosynostosis syndrome has an autosomal recessive pattern of inheritance?
Carpenter syndrome
43
Which craniosynostosis syndrome has an X linked pattern of inheritance
Craniofrontonasal dysplasia
44
What kind of mutation happens with FGF receptors and craniosynostosis syndrome?
Gain of function
45
What is the most common cleft pattern scene with Robin sequence?
Wide U shape cleft?
46
Which cleft associated syndrome is associated with progressive blindness
Stickler syndrome
47
Nager syndrome
Malar hypoplasia and variable thumb and upper extremity hypoplasia
SF3B4
typically AD
48
Treacher Collins
AD
TOCF1
49
Goldenhar
Epi-bulbar dermoids and vertebral abnormalities
50
What are the contraindications for tongue, lip, adhesion, or mandibular distraction in the robin sequence?
Subglottic obstruction
51
What are the most common Tessier clefts?
Seven, three, 11
52
What are the commonly encountered diagnosis associated with hypertelorism.?
Encephalocele, frontier, nasal dysplasia, atypical facial clefting, crouzon syndrome, bilateral cleft lip and palette
53
Which way is the nasal root deviated and uni coronal craniosynostosis?
Toward the fuse side
54
Binder syndrome
Absent anterior nasal spine
55
CHARGE
ColoBoma of the eye.
Heart defects.
Atresia of the nasal choanae
Retardation of growth
Genital and or urinary abnormalities.
Ear abnormalities and deafness
56
What study should be conducted for a patient presenting with an ear anomaly associated with syndrome appearing facial features
Renal sound because there is a higher incidence in syndrome associated with ear abnormalities
57
True or false facial sutures fuse before cranial sutures
False
58
What is the cause of head tilting and uncorrected unilateral synostosis?
Strabismus secondary to paresis of the ipsilateral superior oblique muscle
59
True or false torticollis is most commonly ipsilateral in deformational forehead plagiocephaly
True.
Torticollis is usually contralateral with synostotic forehead plagiocephaly
60
Which form of synostosis is most frequently associated with abnormalities of the corpus callosum and increased incident of developmental delay
Metopic suture
61
Which cranial synostosis syndrome is associated with kleeblatschadel
Pfeiffer
62
Carpenter
AR
Craniosynostosis of single or multiple sutures
Deafness
Mental retardation
Brachy Datyly
Syndactlyl
Poly Dactyly
63
Jackson Weiss
Craniosynostosis.
Hyper tourism
Midface, hypoplasia
broad great toes
Syndactly toes
Medial deviation, tarsal, metatarsal coalescence
AD
FGFR2
64
Baller- Gerhold
Craniosynostosis.
Radial aplasia
Anal anomalies
urologic defects
Cardiac deformity
CNS abnormalities
Vertebral defects
AR
RECQL4
65
Antley Bixler
Craniosynostosis
Midface hypoplasia
Depressed nasal bridge
Proptosis
Cho anal stenosis
DysPlastic ears
Radio humeral synostosis
Joint contractors
Renal defects
High incidence of respiratory compromise
66
Which muscles control the velum
Levator veil palatine, tensor veil palatine, palatopharyngeus, palatoglossus, musculus uvula
67
Which of the paired Velar muscles is innervated by the mandibular branch of the trigeminal nerve
Tensor veil palatini
68
What is the motor innervation of the VR muscles except for the tensor?
Vagus
69
What is the blood supply of the soft palate
Ascending palatine
70
Which muscles formed the anterior and posterior tonsillar pillars
Palataoglossus and palatopharyngeus
71
At what point in gestation is the error likely to occur for cleft palette, and cleft lip
Weeks 5 to 6 for the lip.
Week 7 to 8 for the pallet
72
What is the theoretical purpose of the intravelar veloplasty
To detach from the hard pallet and re-orient the levator muscle and optimize function
73
Gingivoperiosteoplasty
Surgical procedure that treats, cleft lip and palette by creating a bridge across the alveolar cleft. The procedure uses the child’s periosteum to heal the cleft without the need for bone grafting.
74
What is the incident of VPI after cleft palette repair?
It ranges from 7 to 25%
75
What is the most important muscle regarding closure of the Velo pharyngeal space for speech?
Levator veli palatini
76
What muscle forms the basis for a successful sphincter pharyngoplasty
Palatopharyngeus, two flaps are elevated from the poster, tonsillar pillars, and suture to each other and to the posterior pharyngeal wall
77
What is a pharyngeal flap?
My mucosal flap based on the superior constrictor muscle, which is elevated from the posterior pharyngeal wall and attached the soft pallet
78
What artery supply the soft pallet?
Lesser palatine artery, ascending palatine branch of facial artery, Palatine branches of ascending pharyngeal artery
79
Rhinolalia aperta
Hypernasal speech due to inadequate closure of velopharyngeal portal
80
What is the advantage of video fluoroscopy?
Ability to defined the level of below, vp closure in the sagittal plane. This test requires less cooperation than nasal endoscopy.
81
What is the advantage of nasal endoscopy?
Ability to visualize the entire VP mechanism during speech. This allows characterization of the closure pattern.
82
The retropharyngeal space lies between what two facial planes
Buccopharyngeal fascia and prevertebral fascia
83
What is the innovation of the muscle included in the sphincter pharyngeal plasty?
Cranial part of accessory nerve 11 and pharyngeal branch of Vegas via the plexus
84
How is new bone formed during distraction osteogenesis
Intra-membranous ossification because there is no c cartilage intermediate
85
What growth factor is currently thought to play a key role in the process of distraction osteogenesis
Transforming growth, factor beta one
86
At what age should you use distraction osteogenesis with caution?
Before 18 months of age. It is usually used in 22 years of age or as young as 18 months.
87
When can you not perform distraction osteogenesis of the mandible. Meaning, what stage?
Grade 3 mandibular hypoplasia is unable to undergo distraction because there is absence of the ramus
88
What is the blood supply of the Maxilla following osteotomy?
Ascending pharyngeal artery and the ascending palatine branch of the facial artery
89
How can you determine if a patient has achieved, skeletal maturity?
You look at serial lateral cephalometric x-rays, and wrist x-rays
90
When what teeth are present is there a higher incidents of unfavorable mandibular fractures with a sagittal split osteotomy?
The third molar is present. It is recommended that the third molar is removed to 12 months prior to osteotomy.
91
What structure is developed from the helix of the first brachial arch
Tragus helical crust and helical root
Be drained to the parotid lymph nodes
92
What structures come from the three helix of the second brachial arch
Helix, scapha, concha, anti-helix, anti-tragus, lobule.
These will drain to the posterior auricular nodes
93
What is normal ear growth?
85% of year development is done by three years of age with full development achieved between six and 15 years
94
Describe the Venous drainage of ear
Anterior ear is drained by the superficial temporal and Retro mandibular veins.
Posterior ear is drained by posterior auricular Regular, veins draining into the external jugular vein
95
What is the proposed pathogenesis of microtia
Obliteration of the stapedial artery
96
For a Microtia patient when should they undergo total ear reconstruction
Traditionally, it should be by 6 to 7 years old, but you need sufficient rib cartilage to create a new year so you can wait until 9 to 10 so that you have a lower rate of a revision
97
When should bone anchored hearing aids be placed in patients
Should be placed after ear reconstruction has been completed
98
What are the characteristics of a prominent ear?
Hypertrophy of the concha and effacement of the anti-helical fold
99
What is the effect of mustardy sutures?
Permanent conchoscaphal sutures to re-create the anti-helical fold
100
What is stahls ear
Third crus for abnormal angulation of the superior crus projecting the rim upward or outward
101
What happens to the epidermis during expansion?
It thickens
102
What is the most common visceral location of an infantile hemangioma?
Liver
103
What are the disadvantages of propanolol therapy for a hemangioma?
Monitoring for bradycardia, hypotension, hyperkalemia, hypoglycemia
104
Which type of hemangioma is positive for GLUT1
Infantile
105
How do you treat kapsiform hemangioendothelioma
VinChristine or Rep myosin
106
What mutation causes a port wine stain
GNAQ
107
What is a lymphatic malformation?
Due to a mutation in PIK3A
Can be macros, cystic, or micro, cystic, or combined
Macro cystic lesions can be treated with sclerotherapy
Micro cystic are treated with resection or carbon dioxide laser
108
What is a Venus malformation
Due to a mutation inTIE2
Can have phleboliths
Can treat with sclerotherapy
109
What is the key sell involved in wound remodeling?
Macrophage
110
How does platelet derived growth factor affect wound healing?
released my platelets in the inflammatory phase and attracts macrophages
111
How does transforming growth factor beta affect wound healing?
It is released by the macrophages which attract fibroblasts and are involved with collagen projection
112
Type one collagen
Most common in skin bone and tendon and ligament
113
Type two collagen
Hyaline cartilage
114
Type three collagen
Vessels, intestine, skin, early scar formation
115
Type four collagen
Basement membrane
116
How much pressure is required to create a pressure sore
Above 32 can lead to ischemia and pressure sores
117
What are the steps of frostbite management?
Resuscitation, rapid rewarming, thrombolytic therapy, waiting
118
What antibiotics should you give in a patient being treated with leeches
Cipro, bactrim, tetracycline
119
What is the mechanism of action of acticoat
Contains silver ions that are directly bactericidal
Efficacious against pseudomonas, MRSA, VRE, some species of yeast
120
When is hyperbaric oxygen therapy beneficial?
Osteomyelitis, necrotizing, fasciitis, lower extremity, diabetic wounds, ischemia reperfusion injuries
121
What happens to the epidermis with tissue expansion?
Thickens, especially the stratum spinosum
122
What is the effect of tissue expansion on hair growth?
It decreases the telogen phase
123
What conditions associated with impaired wound healing preclude elective surgery
Ehlers Danlos syndrome and progeria
124
Progeria
Autosomal, recessive, arterial, sclerosis, premature, aging, poor wound healing
125
What is Whitnell’s tubercle?
It is the bony prominence on the lateral inner aspect of the orbital rim. That is the bony insertion point of the lateral canthak tendon.
126
What structure helps identify Whitnell tubercle
Eslers‘s fat pad is a minor fat pad located superficial to and immediately above the tubal under the orbital septum. It helps find the insertion of the lateral tendon.
127
How many fat pads are in the upper and lower eyelid
There are two in the upper eyelid and three in the lower eyelid. They are located superficial to levator
128
What divides the medial from central fat pad in the lower eyelid
The inferior oblique muscle
129
What is the most commonly injured muscle in upper lid blepharoplasty
Superior oblique it resides deep and medial to the medial fat pad
130
Hewes vs Hughes
Hewes: conjunctival lead sharing flap from the upper eyelid that includes a portion of the tarsal plate. They are best for wide and deep, lower lead defects. It preserves an attachment to the lateral can tendon which is best for defects that include the lateral aspect of the lower lid.
Hughes: similar to above, but does not preserve the lateral canthal tendon
Both will require coverage by either a rotational flap or a skin graft
131
What is a Cutler beard flap?
Full thickness, flap of skin, muscle and conjunctiva, and or cartilage from the lower lid used to reconstruct a large, full thickness, upper lid defect
132
Dorsal nasal flap
Supplied by the angular artery and best for midline dorsal defects less than 2 cm
133
134
What are the major risk factors of reconstruction plate extrusion
Anterior location and radiation
135
Osteoradionecrosis of the mandible
Typically occurs for three years after radiation therapy and most cases occur, radiation doses, greater than 60 gy
136
What is the minimum width of bone required for dental implants?
6 mm at least 1 mm of healthy bone must surround the implant
137
What is the minimum vertical height for bone for dental implants?
7 to 10 mm
138
What nerve can be included to provide sensation to the skin paddle of a fibula flap?
Lateral sural cutaneous nerve
139
How much proximal and distal fibula should be preserved
4 to 6 cm from the head and 6 to 8 proximal to the lateral malleolus
140
Peronea arteria magna
Single dominant arterial inflow to the distal lower extremity that comes from the perineal artery
141
What is the blood supply to the iliac crest bone flap?
Deep circumflex iliac artery
Approximately 14 to 16 cm of bone can be harvested
You can also harvest the internal oblique muscle using the ascending branch
142
Scapula flap
Circumflex scapular artery branches from the subscapular artery travels through the triangular space
The angular branch of the thoracodorsal artery supplies, the scapular angle or tip
143
Where should the osteotomy be made between what muscles on the radius?
BR and PT
144
What are the bones the calvarium and how are they formed during development?
Frontal parietal and temporal bones are formed by inter-membrane ossification
Occipital and sphenoid bones are formed by endochondral ossification
145
How is galeal scoring performed?
Perpendicular to the line of maximal tension
Each score allows for 1.67 mm advancement
146
What is the blood supply to the pericranium?
Middle meningeal and intracranial circulation to the calvarial bone
147
Where does the inferior labial artery branch from the facial artery?
2.6 cm lateral and 1.5 cm inferior to theoral com Icher
148
What is the lymphatic drainage pattern of the lips?
The upper and lateral lower drain to the sub mandibular and the remaining lower drain to the submental
149
What nerve block to numb the central chin
Inferior alveolar nerve
150
What is the minimal functional diameter of the oral stoma?
3 centimeters
151
What nerve provides general sensation to the tongue
The lingual nerve provide sensation to the oral
Glossopharyngeal nerve provides sensation to the pharyngeal portion
152
What is the lymphatic drainage of the tongue?
Level two nodes are most commonly affected, but level one and three are also at high-risk
I selective neck dissection from levels 123 is usually performed with tongue cancer
153
How much of the tongue is required to maintain tongue function
A portion of at least 20 to 30%
154
155
156
What nerve is at risk when excising a brachial cleft fistula
Hypoglossal nerve because the fistula follows the carotid sheath, super superiorly, and crosses the hypoglossal nerve
157
What is the deformity in an open lock deformity?
Condyle slips into position anterior to the articular eminence
158
What are the layers of the epidermis and dermis?
Corneum
Lucidum
Granulosum
Spinosum
Basale
159
What does the dermis contain?
Adnexal structures and vascular
160
When does net collagen production peak after an injury?
One to two weeks
161
What are the biological effects of FGF?
Fibroblast and epithelial proliferation
Collagen product
Potent angiogenic factor
162
What happens in vitamin C deficiency?
Scurvy because it is required for proline and lysine hydroxylation, which is important for collagen cross-linking
163
What happens does colchicine do in collagen synthesis?
Inhibits secretion of Tropocollagen
164
What does copper deficiency and penicillamine do in collagen synthesis?
Prevent lysing oxidation, which is necessary for intra and intermolecular bonding
165
How do tendons heal?
Intrinsic with minimal inflammation with the Epitenon cells, producing collagen, and extrinsic, which produces adhesions and is increased with immobilization
166
What adult tissues are able to heal without scarring?
Bone and liver
167
Describe the order of prevalence for pressure ulcers
Ischial tuberosity
Trochanter
Sacrum
Calcaneus
Occiput
Scapula
168
What animals can potentially transmit rabies
Carnivores
169
What wounds are tetanus prone?
Open more than six hours
Deeper than 1 cm
Contain devitalized tissue
Contaminated
170
What are the contraindications to radiation therapy for keloids?
Pregnant women
Pediatrics
Tissue with underlying visceral structures
171
172
What is the mechanism of intralesional steroid therapy for keloids?
Inhibits, fibroblast proliferation and collagen production by inhibiting phospholipase A2
Stimulates collagenase production
Normalizes collagen organization
173
Describe the mechanism of action of Acticoat
Contain silver ions that are directly bactericidal
Efficacious against pseudomonas MRSA VRE and some yeast
174
In what situations is hyperbaric oxygen therapy helpful
Necrotizing fasciitis
Diabetic wounds of the foot
Osteomyelitis
Ischemia reperfusion injury
175
What growth factor is responsible for increased vascularity in expanded tissue
VEGF
176
What effect does tissue expansion have on hair growth?
Decreases the telogen phase
177
Werner syndrome
Mutation in WRN
Graying of hair
Horse voice
Thicken skin
Diabetes
Arthrosclerosis
Cataracts
Surgery is not recommended, but has been reported for temporary improvements
178
Lathyrogens
Prevent cross-linking of collagen which decreases tensile strength
Possible use for decreasing scar tissue
179
Honey
Antibacterial against pseudomonas, E. coli. Staph. And Haemophilus influenza.
180
181
What muscles help close the mouth
Masseter temporalis and medial pterygoid muscles close the mouth
182
What muscles open the mouth
Lateral pterygoid, digastric, mylohyoid, genial, hyoid, and genioglossus
183
What is the Andi Gump deformity?
Resection of the anterior segment of the mandible which leads to loss of oral competence difficulties with speech and mastication and loss of chin projection
184
What is the minimal length of an osteotomized segment of the mandible?
At least 1.5 cm to ensure adequate blood supply
185
What muscle can be harvested with the iliac crest
Internal oblique supplied by the ascending branch of the DCIA
186
How do you find the angular artery for the tip of the scapula?
It arises from the Thoracodorsal artery, usually the LD branch, but occasionally from the serratus anterior travels deep to the muscle within a fat pad
187
188
What is superior orbital Fissure syndrome?
Disruption of the foreign nerves 34V1 and six leading to extra ocular muscle paralysis ptosis a fixed dilated pupil with normal consensual response and numbness of the forehead eyebrow and upper eyelid
189
What are the four extensions in a tetrapod fracture?
Inf orbital rim,
zygomofrontal suture, or the lateral orbit
Lateral buttress, which is these zygomatic maxillary buttress
Zygomatic arch
190
Why do condylar neck fractures usually displace medial?
The lateral teratoid attaches into the condylar neck. It displays the neck immediately when acting unopposed.
191
What is the blood supply to the facial nerve?
Stylo mastoid artery branch of the posterior auricular artery
Greater superficial petrosal artery from the middle meningeal artery
192
Where does the temporal branch cross the zygomatic arch?
Halfway between the lateral canthus and the root of the helix near McGregor’s patch
193
Between what layers does the temporal branch of the nerve course as it crosses the zygomatic arch?
Deep to the SMAS and immediately superficial to the superficial layer of the deep temporal fascia
194
What layer does the marginal mandibular nerve lay deep to as it crosses the mandible?
The nerve lie is immediately beneath the superficial layer of the deep cervical fascia
195
Most common cause of bilateral facial paralysis
GBS
196
Where is the site of lesion leading to crocodile tears?
At proximal to the geniculate ganglion as the greater petrosal nerve segregates from the facial nerve at that point
Leads to nerves that were originally destined for the submandibular gland, going to the lachrymose gland, instead which leads to tearing during eating
197
Most common cause of facial paralysis and children
Bell’s palsy
198
Most common cause of facial paralysis in the neonate
Birth trauma
199
What are polyphasic potentials on EMG?
Recorded from nearby nerve fibers and signify renovation of the muscle earliest sign of nerve regeneration
200
201
Cul-de-sac test
When sound resonates in a cavity, however, cannot get out due to the obstruction
To test you ask the patient to repeat a word like bat or boot twice and the second time you pinch the nose close if the resonance is different the oral and nasal cavities are coupled meaning there is inadequate, velopharyngeal function
202
What are the indications for a palatal obturator
Extremely wide cleft with little or no velar movement neuromuscular deficit or surgical candidate or surgical failure
203
Incident of VPI after standard palato plasty and intra-Velar plasty
20%
204
What can be done to prevent contracture and rolling of a PPF?
Lining this raw surface with nasal mucosal flaps from the soft pallet
205
Risk factors for postop sleep apnea
Less than five years old, micro, retrognathia upper respiratory tract infection, history of perinatal, respiratory dysfunction, tonsillar, or adenoid enlargement
Some recommend tonsillectomy prior to surgery
206
When are chondrocytes present during distraction osteogenesis
When there is excessive motion fibrocartilage non-union occurs
207
What growth factor plays a key role in the process of distraction osteogenesis
TGF beta one
208
How long does it take the bone in the distraction zone to achieve 90% of normal bone structure?
Usually within eight months
209
Even though distraction, osteogenesis failure has not been reported what factors could contribute to it
Ischemic fibrosis without adequate local blood supply fibrous tissue formation without bone formation
Cystic degeneration caused by blockage of Venus outflow the distraction gap fills with cystic cavity
Fibrocartilage nonunion caused by unstable fixation cartilage, fills the distraction gap
Buckling of regenerate bone due to fixation device destabilization or premature removal
210
What is the most important clinical measurement when treatment planning for vertical maxillary change
The amount of maxillary incisor exposure with the lips in a relaxed position
2 to 4 mm is normal
211
What are the osteotomy needed to complete surgically assisted rapid palatal expansion
Horizontal osteotomy from pyriform rim to pterygomaxillary fissure
Midline palatal osteotomy from ANS to posterior nasal spine, then extending interdental between the maxillary incisors pterygoid and nasal septal separation
212
In microtia patients, what must be present for canal and middle ear reconstruction
Good cochlear function, and no imaging evidence of a malformed inner ear
Surgery is deferred if the middle ear and mastoid have failed to aerate
213
Conchomastoid suture are more commonly associated with what complication
Meatus distortion
214
A post oto plasty pinned back appearance is due to what shortcoming
Inadequate resection of the hypertrophic conchal bowl and over accentuation of the anti helix, resulting in loss of visibility of the helical rim
215
Nevi originate from a proliferation of what cells
Melanocytes of Neuro ectodermal origin
216
Compound Nevus
Fully formed nest of cells in the epidermis and newly forming cells in the dermis
217
218
What tissues are affected by infantile hemangioma?
Skin and subcutaneous tissue of the head and neck, trunk and extremity
Liver is the most common visceral location
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What are the risk factors for infantile hemangioma?
More common and females, premature infants, and Caucasians
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What is the significance of multiple infantile hemangioma?
Patient with more than five small dome like tumors are at risk for having a hepatic hemangioma
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What is first line intervention for a small localized problematic infantile hemangioma
Lesions less than 3 cm in diameter can be injected with steroids not to exceed 3 mg per kilogram per injection
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Do congenital hemangioma look like infantile hemangioma’s
No, they are reddish purple have course telangiectasia and a peripheral halo
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What differentiates a congenital hemangioma from a infantile
Congenital hemangiomas are solitary usually on the extremities equal in both sexes average of 5 cm in diameter negative for Glut1
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What is the natural history of capillary malformations?
The stain darken and becomes purple and the skin will thicken
Pyogenic granulomas may develop
Tissue underneath the stain can become overgrown
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What is the natural history of AV malformation?
Quiescence
Expansion
Destruction
Decompensation
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Oropharyngeal cancer
Tonsils fossa most common location
Tongue difficult to detect with higher frequency of bilateral Mets
More midline = more likely to have BL modes
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Hypopharyngeal cancer
Worst prognosis
SCC
Most detected late
Incidence of post cricoid cancer with Plummer Vinson
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Swallowing most important phase
. Pharyngeal
Larynx elevates and closes
Airway protection during this phase
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Problem with tracheostomy
. Can tether the larynx and prevent elevation which is important during pharyngeal phase of swallowing
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Three nerve branches of facial nerve @ mastoid segment
Stapedius is not included in facial nucleus so not affected in Möbius
Nerve to EAM
Chorda tympani goes to anterior 2/3 tongue and parasympathetic to submandibular and sublingual
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Enog
Most reliable test to determine prognosis with facial nerve paralysis
EMG doesn't become positive for 14-21 days
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