THE Omsite Flashcards
Dermatochalasis
Excess upper lid skin
Blepharochalasis
Inflammatory condition of the upper lid redundancy when edema resolved d/t weakened structures and some fat herniation through orbital septum
- steatoblepharon
Pseudoptosis
Brow droop that displaces lid vs ptosis due to levator m or sympathetic defect
MRD1 normal
4-5 mm
>5 mm = thyrotoxicosis
2 mm or less = ptosis
Normal MRD2
5-6 mm
What is the ballotment test
Application of digital pressure to globe
- bulging = fat pad prolapse, not edema (upward gaze may produce same result)
What is the snap test (eyes)
Test skin laxity and risk of ectropion
Normal = 1-3 s
Lid distraction test
Test for laxity of lid ligaments (pull lid away)
- normal <6mm
Arcus marginalis
Where orbital septum meets orbital bone (localized rim of thickening where the eyelid’s orbital septum attaches to the orbital bone)
Cause of upper eyelid crease
Attachment of levator aponeurosis attaching through orbicularis into dermis
Does blepharoplasty incise through mueller’s muscle
No
Appropriate face prep in blepharoplasty
Povidone-iodine
- DO NOT USE CHLOROHEXIDINE - lyses corneal epithelium
Appropriate brow position
F: 8-10 at arch, 10-15 tail
M: 1-2 mm above superior orbital rim, straight
Supratrochlear n. And supraorbital n. Location
Supratrochlear: 1.7-2.2 cm from midline
Supraorbital: 2.7-3.0 cm from MSP
Where is the fat of the eye
Upper: 2 fat pads + lacrimal gland laterally
Lower: 3 fat pads
ROOF: retro-orbicularis oculi fat
SOOF: suborbicularis oculi fat
Fibro-fatty tissue
Bleph incision placement
> 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
Blepharoplasty complications
- Inferior oblique m. Injury during lower bleph
located between nasal and middle fat pads
-torsional diplopia - Ptosis - injury to levator
- Lagophthalmous - excess skin reduction (wait 12 weeks)
- Xerophthalmous - damage to lacrimal gland
- Diplopia - more common in lower lid bleph
- Chemosis - disruption of lymphatics
- Retrobulbar hematoma
Endoscopic brow lift - 5 incisions
1 midline, 2 lateral brow, 2 temporal
- medial subperiosteal until 2 cm superior to brow then combine with lateral subgaleal at conjoint tendon
How many cm of scalp must be excised for every 1 cm of brow elevation
2 cm
SMAS is continuous with
SMAS extends from platysma to the galea aponeurotica
Continuous with TP fascia and galea
Connects to the dermis via vertical septa
Different coronal incisions and who they’re indicated for
Coronal: medium forehead, non-balding male
Trichophytic - beveled just within hairline
Pretrichial - does NOT lengthen forehead, good for high foreheads
Proper location of malar eminence
1 cm lateral and 1.5-2 cm inferior to lateral canthus = Hinderer’s point
When placing malar implants, anterior maxillary sinus wall fracture with tear of sinus membrane. Still enough bone. What do you do
Continue to place malar implants
Ratio of bizygomatic width to facial height in M vs. F
F: 0.86
M: 0.88
Where is Webster’s triangle and its significance
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
What forms the supratip break
Downward descent of cartilaginous dorsum and diverging lower lateral cartilages
What causes a bulbous tip
Excessive V of lower lateral cartilages
Normal nasolabial angle in F vs m
F: 90-105
M: more acute
Tripod concept of rhinoplasty
Medial crura combine to form one leg and and 2 lateral crura form R and L legs of tripod
Degrees of internal nasal valve and how do we test patency
10-15 deg
Cottle’s test - pull to side when pt breathes in
- treat collapse with spreader graft
Major mechanisms of nasal tip support
- Medial crura and caudal septum
- Attachment between U/LLC (scroll; most commonly interlocked)
- Size, shape, strength of LLC
Closed rhinoplasty incisions
- 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
How do you prevent open roof deformity
Avoid by doing osteotomies after dorsal hump removal
- correct open roof with lateral osteotomies
Tip support achieved with what graft
Shield graft
- cephalic trim will cause upward rotation of tip
- during cephalic trimming, to avoid alar notching —> leave 5-7 mm of cartilage width
How to achieve tip support with SRP
Columellar strut
What happens if you have poor nasal tip definition and poor tip support for SRP
Umbrella graft (shield + columellar strut)
Manage external nasal valve collapse with SRP how
Alar batten
How to prevent rocker deformity
Avoid extending lateral osteotomies to radix to prevent rocker deformity
- may do intermediate lateral osteotomy on long side of nose to correct significant asymmetries
Septal hematoma can cause what deformity
Saddle nose deformity
Ideal auriculocephalic angle
25-35 degrees
