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Golden Guide > THE Omsite > Flashcards

THE Omsite Flashcards

1
Q

Dermatochalasis

A

Excess upper lid skin

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2
Q

Blepharochalasis

A

Inflammatory condition of the upper lid redundancy when edema resolved d/t weakened structures and some fat herniation through orbital septum
- steatoblepharon

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3
Q

Pseudoptosis

A

Brow droop that displaces lid vs ptosis due to levator m or sympathetic defect

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4
Q

MRD1 normal

A

4-5 mm
>5 mm = thyrotoxicosis
2 mm or less = ptosis

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5
Q

Normal MRD2

A

5-6 mm

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6
Q

What is the ballotment test

A

Application of digital pressure to globe
- bulging = fat pad prolapse, not edema (upward gaze may produce same result)

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7
Q

What is the snap test (eyes)

A

Test skin laxity and risk of ectropion
Normal = 1-3 s

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8
Q

Lid distraction test

A

Test for laxity of lid ligaments (pull lid away)
- normal <6mm

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9
Q

Arcus marginalis

A

Where orbital septum meets orbital bone (localized rim of thickening where the eyelid’s orbital septum attaches to the orbital bone)

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10
Q

Cause of upper eyelid crease

A

Attachment of levator aponeurosis attaching through orbicularis into dermis

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11
Q

Does blepharoplasty incise through mueller’s muscle

A

No

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12
Q

Appropriate face prep in blepharoplasty

A

Povidone-iodine
- DO NOT USE CHLOROHEXIDINE - lyses corneal epithelium

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13
Q

Appropriate brow position

A

F: 8-10 at arch, 10-15 tail
M: 1-2 mm above superior orbital rim, straight

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14
Q

Supratrochlear n. And supraorbital n. Location

A

Supratrochlear: 1.7-2.2 cm from midline
Supraorbital: 2.7-3.0 cm from MSP

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15
Q

Where is the fat of the eye

A

Upper: 2 fat pads + lacrimal gland laterally
Lower: 3 fat pads
ROOF: retro-orbicularis oculi fat
SOOF: suborbicularis oculi fat
Fibro-fatty tissue

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16
Q

Bleph incision placement

A

> 10 mm from lower border of brow
20 mm of lid skin must remain to prevent lagophthalmous
Inferior incision in supratarsal crease (F: 8-10 mm above lid margin; M: 7-8 mm above lid margin
Superior incision extent dictated by pinch test

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17
Q

Blepharoplasty complications

A
  1. Inferior oblique m. Injury during lower bleph
    located between nasal and middle fat pads
    -torsional diplopia
  2. Ptosis - injury to levator
  3. Lagophthalmous - excess skin reduction (wait 12 weeks)
  4. Xerophthalmous - damage to lacrimal gland
  5. Diplopia - more common in lower lid bleph
  6. Chemosis - disruption of lymphatics
  7. Retrobulbar hematoma
18
Q

Endoscopic brow lift - 5 incisions

A

1 midline, 2 lateral brow, 2 temporal
- medial subperiosteal until 2 cm superior to brow then combine with lateral subgaleal at conjoint tendon

19
Q

How many cm of scalp must be excised for every 1 cm of brow elevation

A

2 cm

20
Q

SMAS is continuous with

A

SMAS extends from platysma to the galea aponeurotica
Continuous with TP fascia and galea
Connects to the dermis via vertical septa

21
Q

Different coronal incisions and who they’re indicated for

A

Coronal: medium forehead, non-balding male
Trichophytic - beveled just within hairline
Pretrichial - does NOT lengthen forehead, good for high foreheads

22
Q

Proper location of malar eminence

A

1 cm lateral and 1.5-2 cm inferior to lateral canthus = Hinderer’s point

23
Q

When placing malar implants, anterior maxillary sinus wall fracture with tear of sinus membrane. Still enough bone. What do you do

A

Continue to place malar implants

24
Q

Ratio of bizygomatic width to facial height in M vs. F

A

F: 0.86
M: 0.88

25
Q

Where is Webster’s triangle and its significance

A

The most caudal aspect of the pririform crest: head of inferior turbinate, nasal floor, lateral nasal sidewall
- start lateral osteotomies above inferior turbinate
- Preserve this to prevent airway collapse

26
Q

What forms the supratip break

A

Downward descent of cartilaginous dorsum and diverging lower lateral cartilages

27
Q

What causes a bulbous tip

A

Excessive V of lower lateral cartilages

28
Q

Normal nasolabial angle in F vs m

A

F: 90-105
M: more acute

29
Q

Tripod concept of rhinoplasty

A

Medial crura combine to form one leg and and 2 lateral crura form R and L legs of tripod

30
Q

Degrees of internal nasal valve and how do we test patency

A

10-15 deg
Cottle’s test - pull to side when pt breathes in
- treat collapse with spreader graft

31
Q

Major mechanisms of nasal tip support

A
  1. Medial crura and caudal septum
  2. Attachment between U/LLC (scroll; most commonly interlocked)
  3. Size, shape, strength of LLC
32
Q

Closed rhinoplasty incisions

A
  1. Intercartilaginous (between U/L laterals) combined with some form of trans fixation
    - only dissect one side of septum to preserve blood supply and close with quilting sutures to prevent septal hematoma
    - hemitransfixation preserves tip support better than complete transfixation
33
Q

How do you prevent open roof deformity

A

Avoid by doing osteotomies after dorsal hump removal
- correct open roof with lateral osteotomies

34
Q

Tip support achieved with what graft

A

Shield graft
- cephalic trim will cause upward rotation of tip
- during cephalic trimming, to avoid alar notching —> leave 5-7 mm of cartilage width

35
Q

How to achieve tip support with SRP

A

Columellar strut

36
Q

What happens if you have poor nasal tip definition and poor tip support for SRP

A

Umbrella graft (shield + columellar strut)

37
Q

Manage external nasal valve collapse with SRP how

A

Alar batten

38
Q

How to prevent rocker deformity

A

Avoid extending lateral osteotomies to radix to prevent rocker deformity
- may do intermediate lateral osteotomy on long side of nose to correct significant asymmetries

39
Q

Septal hematoma can cause what deformity

A

Saddle nose deformity

40
Q

Ideal auriculocephalic angle

A

25-35 degrees

Golden Guide (3 decks)

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