Surgical Approaches

Question 1

Transconjunctival Approach

Answer 1

Forced duction test. Lubricated corneal shields. Local anesthetic injected at lateral canthal area and around inferior orbital rim. Scissors then used to perform lateral canthotomy, then turned vertically to perform cantholysis and release the inferior branch of the tendon. Needle tip cautery used to dissect through conjunctiva over the orbital rim, stop at level of the puncta. Can continue this dissection into a retro-caruncular incision to expose medial portion of the orbit. Subperiosteal dissection used to expose defect. Can then place orbital floor implant or explore areas to remove infection.

Question 2

Temporal space infection

Answer 2

Gilles - 2.5 cm superior and anterior to the helix within the hairline 2 cm in length. Care to avoid superficial temporal artery. Dissect through skin, subq, superficial temporal down to deep portion of deep temporal fascia, then expose the temporalis muscle then advance until it is medial to the zygomatic arch.
Keen incision -

Question 3

Retropharyngeal space approach

Answer 3

Incision made parallel to anterior border of SCM inferior to the hyoid bone. SCM and carotid sheath are retracted laterally. Loose connective tissue bluntly dissected between carotid sheath and esophagus to gain access to the retropharyngeal space

Question 4

Uvulopharyngopalatoplasty UPPP

Answer 4

Done normally in conjunction with palatine tonsillectomy. Reduction, tightening and reposition the soft palate and oropharyngeal structures

Question 5

Rhinoplasty

Answer 5

Open and endonasal methods.
Open - Transcolumellar incision, deglove nose in subperichondral and subperiosteal fashion, removal of cartilaginous septum leaving a minimum of 1 cm. Dorsal hump reduction, place spreader grafts as needed for internal nasal valve, lateral and medial osteotomies as needed, columellar strut graft for tip support, cephalic trim to rotate the nasal tip, alar batten grafts to support external nasal valve, shield grafts to provide tip support

Question 6

Rhytidectomy

Answer 6

Temporal hair tuft sparing incision 45 degree hockey stick incision, preauricaular incision, extend under earlobe and posteriorly into hair bearing region of scalp. Skin, Subcutaenous, SMAS and dissection to subSMAS, undermine to the anterior border of parotid then place superior lateral traction on SMAS and the excess is excised and sutured in place.