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OMFS Medicine > Surgical > Flashcards

Surgical Flashcards

1
Q

Canine Space

A

Between levator anguli oris and levator labii superioris

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2
Q

Buccal space

A

Anterior- lips
Posterior- Masticatory Space (parotidomasseteri fascia, buccopharengeal fascia
Superior- Maxilla
Inferior- Platysma
Lateral- skin
Medial- buccinator
Contents
-buccal fat
- Stensons
- Facial artery and Vein
- CV VII and Ix

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3
Q

Masseteric Space
Part of masticatory spaces

A

Anterior- mandible
Posterior- Parotid gland
Medial- lateral pharyngeal space
Superior- temporal space
Lateral- Masseter
Contents
- IMAX and IAN

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4
Q

Pterygomandibular space
Part of masticatory spaces

A

Lateral- mandible
Medial- medial pterygoid
Inferior- medial pterygoid
Posterior- parotid
Anterior- pterygomandibular raphe (buccinator and superior constrictor muscles)
Contents- IAN, Lingual nerve,

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5
Q

Temporal Space
Part of masticatory spaces

A

Superior- temporal line
Anterior- lateral orbit
Inferior- buccal space

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6
Q

Sublingual space

A

Inferior- mylohyoid, geniohyoid, genioglossus
Superior- FOM
Contents- lingual nerve, lingual artery, hypoglossal nerve, glossopharyngeal nerve, whartons duct, sublingual gland, Batholins

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7
Q

Submental space

A

Anterior- symphsis
Lateral- anterior digastric
Superior- mylohyoid
Inferior- Fascia

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8
Q

Submandibular space

A

Anterior- mandible
Lateral - mandible
Inferior - fascia
Superior- mylohyoid
Posterior- buccopharyngeal gap
(Connection between submandibular space and lateral pharyngeal space) along styloglossus muscle

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9
Q

Lateral Pharyngeal Space

A

Superior- skull base
Inferior- hyoid
Posterior- prevertebral fascia
Anterior- raphe of buccinator and constrictors
Lateral by mandible
Anterior- prestyloid
Posterior- retrostyloid (carotid artery, IJ, CN IX, X, XI, XII
Lemierre syndrome- IJ septic thrombosis
Horner Syndrome- CN IX to XII
Airway issues from bulging pharyngeal wall

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10
Q

Retropharyngeal Spaces

A

Anterior- constrictor muscles
Posterior- alar layer of deep cervical fascia
W/ connections to danger space
Fever, stiff neck, dysphagia, drooling, bulging of posterior wall, airway obstruction.
Intubate with head down

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11
Q

Danger space

A

Superior- skull base
Anterior- alar fascia
Posterior- prevertebaral fascia
Inferior- diaphragm
Tract to mediastinum/pericardium - from retropharyngeal through buccopharyngela fascia and alar fascia down danger space

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12
Q

Prevertebral space

A

Superior- skull base
Anterior- prevertebral fascia
Posterior- Transverse process
At C3 normal is 4mm
Abnormal 7mm

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13
Q

Branches of Maxillary Artery

A

From external maxilla
- deep auricular
- anterior tympanic
- middle meningeal/accessory meningeal
- inferior alveolar
- deep temporal
- pterygoid
- masseteric
- buccinator
- posterior superior alveolar
- infraorbital
- descending palatine
- sphenopalatine

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14
Q

Branches of external maxillary artery

A

Superior thyroid
A sending pharyngeal
Lingual
Occipital
Facial
Posterior auricular
Maxillary
Superficial temporal - transverse facial

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15
Q

Branches of facial artery

A

Submental
Inferior labial
Superior labial
Lateral nasal
Angular artery

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16
Q

Kisselbauchs plexus

A

Anterior ethmoidal
Posterior ethmoidal
Sphenopalatine
Superior labial artery

17
Q

Woodruffs plexus

A

Middle turbinate confluence
Sphenopalatine artery
Ascending pharyngeal

18
Q

Artery distances

A

Anterior ethmoidal- 24mm
Posterior ethmoidal- 36mm
IMAX- 20mm below head of condyle

19
Q

Causes of relapse after orthognatic surgery

A
  1. Failure of hardware
  2. Improper seating of the condyle
  3. Unstable movements including maxilla down, maxilla widen and mandible back
  4. Muscle pull
  5. Condylar resorption
20
Q

Pre auricular Approach

A

Pre auricular crease
Root of helix to the lobule-facial junction
0.8cm from external auditory canal
Temporoparital fascia
Glistening layer of superficial layer of temporalis fascia
Incision then parallels the facial nerve

21
Q

Flap Monitoring

A

I. Color
2. Turgor
3. Temperature
4. Capillary refill
5. Arterial external Doppler
6. Venous flow internal doppler

22
Q

Risk factors for avascular necrosis of the maxilla

A
  1. Radiation
  2. Segmental sx
  3. Ligation of DPA
  4. Palatial stripping or trauma
  5. Thrombosis
  6. Infection
  7. Chemotherapy
  8. Long surgical time
  9. Cleft ortho
  10. Systemic conditions (sickle cell, atherosclerosis)
23
Q

Hypotensive anesthesia

A

30% below normal MAP
Never below Map of 50mmHg
MAP = 1/3 (SBP-DBP) + DBP

24
Q

Treatment of avascular necrosis

A

Initial treatment of vascular necrosis should involve good oral hygiene, frequent saline irrigation, hyperbaric oxygen therapy, tocopherol, pentoxyfilline and antibiotics to prevent secondary infection. Although hyperbaric oxygen may not prevent necrosis it may limit the extent of the necrosis. It may also hasten delineation of the necrotic tissue and assist debridement.
Reconstruction may require closure of the defects with soft tissue flaps and bone grafts, while lost teeth may be replaced with a prosthesis or dental implants

25
Q

OSA

A

Apnea- Cessation of breathing for >10s
Hypopneas- 50% decrease in airflow with 4% decrease in Spo2.
Respiratory effort related arousal- limitation of breathing the results in stimulation and arousal
AHI-
Mild 5-15
Mod 15-30
Sev 30-
RDI same
Epworth Sleepiness scale
8 categories- 0-3 point
Score > 10 associated with increased daytime sleepiness
STOPBANG <4 is at risk for mod/severe
Snoring
Tiredness- ESS
Observed apnea
HTN
BMI >35
Age > 50
N- neck >17M, >16F
G- male
Normal Ceph
P-PNS: 36mm
PAS-11mm
H-MOH: <15mm

26
Q

Fillers

A

Collagen- double skin test
Restylane/juvaderm- hyaluronic acid- 6M
Radisse- HA permanent

27
Q

PRP

A

Autologous blood plasma enriched with platelets
Degranulation release cytokines & growth factors
• Platelet-derived growth factor
• Transforming growth factor beta
• Fibroblast growth factor
• Insulin-like growth factors 1 & 2
• Vascular endothelial growth factor
• Epidermal growth factor
• Interleukin 8
• Keratinocyte growth factor
• Connective tissue growth factor

OMFS Medicine (3 decks)

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