Term
| Where should botox be injected to maximize eyebrow elevation? |
|
Definition
| Injection into depressors (corrugator supercilii/glabella, depressor supercilii/glabella, procerus and orbicularis oculi) |
|
|
Term
| When is it better to choose a bilobe vs. paramdedian forehead flap for nasal defects after MOHS? |
|
Definition
Paramedian for >1.5cm
Can also consider melolabial advancement if limited to lateral alar subunit (ala and nasal sidewall) |
|
|
Term
| When should cleft lip be repaired? |
|
Definition
10s (10 weeks old/3 months, 10 pounds, 10 Hgb). At this time, also perform tip rhinoplasty, and closure of nasal floor with BMT.
Palate you repair at 1 year |
|
|
Term
| What changes occur with aging skin? |
|
Definition
Epidermal and dermal thinning
Increased dermal connective tissue matrix
Decreased elastin |
|
|
Term
| What are the changes in wound tensile strength at 1) 1 week, 2) 1-3 weeks, 3) 3 weeks, 4) 6 weeks |
|
Definition
1) 1 week= 3%
2) 1-3 weeks= 10%
3) 3 weeks= 30%
4) 5 weeks= 50%
5) 6-12 weeks= 70-80% |
|
|
Term
Which muscles of the face are responsible for each wrinkle?
1) Horizontal rhytids over glabella
2) Vertical rhytids of the glabella
3) Deep horizontal rhytids over forehead |
|
Definition
1) Procerus
2) Corrugator supercilli
3) Frontalis |
|
|
Term
What are the benefits of each type of brow lift?
1) Direct
2) Indirect
3) Pretrichial
4) Coronal
5) Endoscopic |
|
Definition
1) Direct: just above brow, good for asymmetric brow and won't help forehead
2) Good for prominent forehead rhytids
3) Pretrichial: Good for brow lift with high forehead and good hairline (lowers hairline). Low facial nerve risk.
4) Minimizes scars, elevates hair line though
5) Risk to facial nerve, but otherwise hides incision in temporal tuft. |
|
|
Term
| What are the Dedo grades of cervical abnormality? |
|
Definition
1) Minimal
2) Lax cervical skin
3) Fat accumulation
4) Platysmal banding
5) Retrognathia
6) Low hyoid |
|
|
Term
| What type of fracture of the mandible would create a contralateral open bite, shortened vertical height of ipsilateral side and premature molar and swing to the ipsilateral side? |
|
Definition
|
|
Term
| What are the three main phases of wound healing and their timelines? |
|
Definition
1) Inflammation (2-3 days): PMNs outnumber macrophages
2) Proliferation (2-3 weeks): fibroblasts lay down type 3 collagen
3) Maturation: type 3 collagen replaced by type 1 collagen. Wounds reach 80% of normal tissue |
|
|
Term
| What are the major risk factors for hematoma formation after face lift? |
|
Definition
| Male, BMI> 30, smoking, anterior platysmaplasty, SBP>150, ASA use |
|
|
Term
What Z plasty angles change scar lenbth by the following %?
1) 25%
2) 50%
3) 75% |
|
Definition
1) 30 degrees
2) 45 degrees
3) 60 degrees |
|
|
Term
| What is the blood supply of the trapezius? |
|
Definition
| Transverse cervical, dorsal scapular, occipital |
|
|
Term
| What is the appropriate order of facial laser and botox treatment? |
|
Definition
| Botox, wait 2 weeks then laser |
|
|
Term
| What cartilage is used in the autospreader technique for INV widening in SRP? |
|
Definition
| Upper lateral cartilage infolding. |
|
|
Term
| What are the appropriate standard nasolabial and nasofacial angles? |
|
Definition
1) Nasolabial= 90-115
2) Nasofacial= 30-40
Ideal nasal projection 3-4-5 triangle (Crumley) |
|
|
Term
| When are the Karapandzic, Estlander and Abbe flaps useful? |
|
Definition
1) Karapandzic: large defects 1/2-2/3 without philtrum involved
2) Estlander: lesions that involve commisure
3) Abbe: good for philtral defect |
|
|
Term
| Describe the findings of a unilateral cleft lip deformity |
|
Definition
1) Columella, caudal septum and nasal tip are deviated to non-cleft side
2) Elongated ala leading to horizontal configuration of nostril
3) Posterior cartilaginous and bony septum deviated towards cleft side
4) Retrodisplacement of the lower lat on the involves side |
|
|
Term
| What methods can be used to increase length of a PMMF? |
|
Definition
1) Bring medial incision more inferior than lateral
2) Orient flap more obliquely
3) Carry flap into hair bearing skin |
|
|
Term
What are the major methods to decrease nasal tip projection in rhinoplasty?
What about increase |
|
Definition
Decrease: Complete transfixion incision. Reduction of nasal septum. Complete strip
Increase: lateral crural steal, shield grafting, interdomal sutures, tongue in groove, collumellar strut grafting |
|
|
Term
| How long to wait for dermabrasion after PMMF for nasal tip defect? |
|
Definition
| 6-8 weeks is optimal time to wait for dermabrading scars |
|
|
Term
| Why use contralateral side for PMMF for nasal tip reconstruction? |
|
Definition
Reduces angle of rotation and reduces rotational shortening.
Remember, supratrochlear artery supplies flap. Runs superficially the more distal in its course (can thin flap distally) |
|
|
Term
| What percentage of people have an incomplete superficial palmar arch that would preclude use of a RFFF in free flap reconstruction? |
|
Definition
| 12%. Need modified Allen's test |
|
|
Term
| Which free flap options have potential for sensory reinnervation and what is the supply? |
|
Definition
1) RFFF, antebrachial cutaneous
2) ALT/PLT: lateral femoral cutaneous
3) Lateral arm fasciocutaneous: posterior cutaneous |
|
|
Term
| What are the stages of skin graft taking? |
|
Definition
1) Imbibition: 24-48h
2) Inoscultation: 48h-72h
3) Angiogenesis: 3-7 days
4) after 1 week, complete graft take occurs |
|
|
Term
| Which Fizpatrick skin types are most sensitive to hyperpigmentation following CO2 laser skin resurfacing? |
|
Definition
| III and up. Darker skin, higher chance. III and up give hydroquinone gel before to prevent this. |
|
|
Term
| What are the changes to the lower lateral cartilage on the cleft side of a unilateral cleft deformity? |
|
Definition
Shortened medial crus
Elongated lateral crus
Blunted dome
Posteriorly, laterally and inferiorly displaced alar base |
|
|
Term
| Where should botox injections into the corrugator be done? |
|
Definition
Forehead and glabellar rhytids
Extend laterally enough to encpompass length of muscle without passing mid-pupillary line and staying 1cm above orbital rim (prevent levator weakness and resulting ptosis) |
|
|
Term
| What incisions are used for external approach to rhinoplasty? |
|
Definition
| Marginal and transcolumellar |
|
|
Term
| What order do you perform gold weight, brow lift and canthoplasty in for facial nerve surgery? |
|
Definition
Brow lift->gold weight-> canthoplasty
Brow lift is for brow ptosis
Gold weight is for incomplete closure
Canthoplasty is for ectroprion |
|
|
Term
Blepharoplasty:
1) Brow lift first or second
2) Schirmer's test appropriate level
3) Period graves must be stable prior to surgery |
|
Definition
1) Brow lift first (avoid over resection of lid)
2) Normal 10-155, 5 or less is severe dry eye
3) 1 year |
|
|
Term
| Common superficial chemical peels |
|
Definition
1) 10-25% RCA
2) Jessner (resorcinol, ethanol, salicyclic acid, lactic acid)
3) 40-70% glycolic acid
4) 5-15% salicylic acid |
|
|
Term
| Common deep chemical peel |
|
Definition
| Gordon-Baker phenol peel composed of phenol 88%, septisol, liquid soap, croton oil (depth), distilled water |
|
|
Term
| Over-resection of doral hump leading to inferior displacement of upper lateral cartilages leading to INV collapse is called |
|
Definition
| Inverted V- occurs when upper lats are not re-attached to septum |
|
|
Term
| During rhinoplasty, nasal bone inferior to osteotomy sinks relative to bone superior to cut, creating "step off" |
|
Definition
|
|
Term
| Dorsal hump corrections leaving a gap between the dorsal septum and lateral nasal wall. How is this repaired? |
|
Definition
Open roof:
Lateral osteotomies, spreader grafts or dorsal onlay grafts can correct.
Make sure to make the osteotomies NOT extend superiorly to the m edial canthus or you may end up with a rocker deformity |
|
|
Term
| When do you repair microtia with medpore vs. cartilage? |
|
Definition
|
|
Term
| What are the appropriate planes of dissection of coronal, endoscopic, direct, indirect brow lifts? |
|
Definition
1) Coronal: sub-galeal
2) Endoscopic: sub-periosteal
3) Indirect and direct: subcutaneous |
|
|
Term
| Why perform a pre-septal instead of post-septal transconj lower lid bleph? |
|
Definition
Better visualization of fat pad to protect inferior oblique.
But takes a little longer |
|
|
Term
| When do you use Furnas vs. Mustarde stitches for prominaurus? |
|
Definition
1) Furnas: stitch conchal bowl back to mastoid periostium, does not create antihelical fold. Used when cocho-mastoid angle is increased.
2) Mustarde (more common), places suture across estimated position of anti-helical fold (good for underdeveloped anti-helical fold).
Sutures placed 2mm apart across a 16mm distance with a 1cm bite width. |
|
|
Term
| What are the major differences between CO2 and Er-YAG laser? |
|
Definition
1) CO2
- Photothermal, wider zone of coagulative necrosis (good hemostasis), greater depth of penetration
2) Er-YAG
- Photomechanical, Higher water coeficcient with greater skin absorption (thinner, more precise tissue removal with less adjacent tissue injury) |
|
|
Term
| Which incision is necessary for a retrograde approach to the nasal tip? |
|
Definition
|
|
Term
| What are the incisions used in a midfacial degloving for lefort fracture? |
|
Definition
| Full transfixion, bilateral intercartilagenous, sublabial |
|
|
Term
| What techniques in nasal surgery can effect external nasal valve obstruction? |
|
Definition
1) Septoplasty (caudal septum)
2) Onlay batten graft (for overexcised lower lateral cartilages)
3) Spreader grafts
4) Traction sutures |
|
|
Term
How much larger should the size of a tissue expander base be than the desired size of the defect?
What is the cumulative gain across the expander dome when it is full be to cover the spot? |
|
Definition
2.5 x size
Cumulative gain should be equal to width across empty base plus width of defect to be removed.
4mm defect would need 10mm expander and 14mm cumulative gain |
|
|
Term
| What are the incisions for an endonasal rhinoplasty using a delivery approach? |
|
Definition
Marginal, intercartilaginous and full transfixion.
This differs from external which uses marginal and transcolumellar. |
|
|
Term
| What are the options for lower lip reconstruction depending on amount of loss? |
|
Definition
1) <25% primary
2) 25-50% without commisure= abbe
3) 25-50% with commisure= Estlander
4) 50-66%= karapandzic
5) >2/3 Bernard Burrow, Gilles fan |
|
|
Term
|
Definition
A is most commonly used for cosmetic purposes.
A should not be given with cow milk allergy
A takes longer to act and provides longer duration effects |
|
|
Term
| What skin levels are injured with light, medium and deep chemical peels? |
|
Definition
1) Light is epidermis injury and inflammatory in papillary dermis
2) Medium is damage through papillary dermis with inflammation of reticular dermis
3) Deep (phenol, croton oil) is damage through reticular dermis. |
|
|
Term
| What are the phases of hair growth? |
|
Definition
ACTE
1) Anagen (growth)- 90% of follicles, 3-4 years
2) Catagen (involution)
3) Telogen (rest)- 10%, 3-4 months, introduction of proteolytic enzymes
4) Exogen (shedding) |
|
|
Term
| How does minoxidil work for hair loss? |
|
Definition
| Increases diameter of existing hair follicles and the % of follicles in anogen phase. |
|
|
Term
| What is the most common and the most aggressive forms of BCC? |
|
Definition
1) Common is nodular (telangiectatic pearly papule with rolled borders and frequent ulceration).
2) Aggressive is sclerosing/morpheaform (white or pink plaque with unpredictable arms and skip lesions). |
|
|
Term
| What are the syndromes associated with cleft lip and palate? |
|
Definition
1) Van der woude: AD IRF6 gene, lower lip pits
2) PRS: micrognathia drives cleft palate and glossoptosis
3) Stickler: AD, hearing loss, cartilage issues
4) 22q11.2 delection (Digeorge): AD |
|
|
Term
| In what sequence and timeline should cleft lip and palate be repaired? |
|
Definition
1) NAM if needed 1-3 months
2) Cleft lip, BMT, primary rhino at 10 weeks (1-9 months)
3) Cleft palate at 6-18 months |
|
|
Term
| What changes to the lower lateral cartilage occurs in unilateral cleft? |
|
Definition
Same length on both sides, but medial crura on cleft side is shorter and lateral crura are longer. This leads to lateral crural steal).
The lower lateral cartilage is displaced inferiorly, posteriorly and laterally on the cleft side. |
|
|
Term
| What type of repair is the Millard technique for cleft lip? |
|
Definition
|
|
Term
| What are the vertical fifths and horizontal thirds of facial analysis? |
|
Definition
1) Vertical fifths
- Lateral auricle, lateral canthus, medial canthus, medial canthus, lateral canthus, auricle.
2) Horizontal
- Trichion, Glabella, Subnasale, Mention |
|
|
Term
| What are the ideal nasofacial, nasofrontal and nasolabial angles? |
|
Definition
Nasofacial= 30-40 degrees
Nasolabial= 90-105 degrees
Nasofrontal= 115-130 degrees |
|
|
Term
| What are the advantages and disadvantages of a coronal brow/forehead lift? |
|
Definition
Advantages: Good exposure, ability to address different muscle groups, well hidden scar (but elevates hair line)
Disadvantages: Invasive, elevates hairline, scalp hyposthesia |
|
|
Term
| What are the advantages and disadvantages of a pretrichial brow/forehead lift? |
|
Definition
Similar to coronal, but won't elevate hairline.
Can't be done in men because scar will be visible in receeding hairline. Also some issues with scalp hyposthesia |
|
|
Term
| What is the cause of lagopthalmos during upper bleph? |
|
Definition
| Overzealous resection of skin. Usually resolves with time. If not, may require FTSG. |
|
|
Term
| What are the 3 methods of determining Nasal tip projection in nasal analysis? |
|
Definition
1) Goode: distance from tip to alar margin= 2/3 distance from nasion to nasal tip
3:4:5 proportion by columella, nasal height and nasal dorsum.
2) Simmons: Ratio of upper lip should equal base length of nose in 1:1 ratio |
|
|
Term
| What major tip support mechanism is impacted by the delivery approach in endonasal rhinoplasty? |
|
Definition
Connection of upper and lower lateral cartilages.
Uses marginal and intra or intercartilagenous incision |
|
|
Term
| What methods are used to increase tip projection? |
|
Definition
- Transdomal sutures
- Lateral crural steal
- Cartilage grafting
- Columnellar strut or septal extension
- Septocolumellar suture |
|
|
Term
| What are the indications for Furnas vs. Mustarde Otoplasty sutures? |
|
Definition
Furnas= overdeveloped conchal bowl
Mustarde= underdeveloped antihelical fold |
|
|
Term
| What are the contraindications to chemical peeling? |
|
Definition
1) Active herpetic lesions
2) CVDs
3) Pustular acne
4) Prior radiation
5) keloid history |
|
|
Term
| What are the major skin filler substances used? |
|
Definition
1) HA: lasts 6-12 months, no allergy testing required
2) Poly-L-lactic (sculptura), requires multiple doses, can be used in HIV
3) CAHA |
|
|
Term
What is the blood supply of the following flaps?
1) Pec flap
2) Latissimus dorsi
3) SCM
4) Scapular |
|
Definition
1) Pectoral branch of thoracacromial
2) Thoracodorsal artery
3) Occipital (when superior)
4) Circumflex scapular artery off of subscapular artery |
|
|
Term
| What is the blood supply for a Gracilis free flap? What about motor nerve capability? |
|
Definition
Terminal branch of adductor artery, a branch of profunda femoris
Motor is anterior branch of obturator nerve |
|
|
Term
| When is interposition grafting necessary for nerve repair? |
|
Definition
| When distance between ends >1cm. |
|
|
Term
| What are the advantages and disadvantages of cross-facial nerve grafting? |
|
Definition
Advantages: spantaneous and volitional movement
Disadvantages: 2 stages, weaker movements, donor site risk |
|
|
Term
| What are the static procedures performed in facial reanimation? |
|
Definition
1) Slings- elevate oral commisure without volitional movement
2) Brow lift- ptosis
3) Upper eyelid loading
4) Canthoplasty: eleate lax lower eyelid and help tear collection
5) Tarsorrhaphy: indicated for lagopthalmos (more aggressive) |
|
|
Term
| Which tendon is disrupted in NOE fractures and what appearance does this produce? |
|
Definition
Medial canthal tendon disruption leads to lateral displacement causing telecanthus and appearance of hypertelorism.
Type 1: Ligament remains fixed
Type 2: Ligament is attached, but bony fragment is small, needs fixation
Type 3: Complete disruption of ligament, needs fixation contralaterally across nose. |
|
|
Term
| Describe how management of posterior table fractures in determined. |
|
Definition
1) Non-displaced without outflow obstruction- observe
2) Displacement then explore.
3) Can dry DRAF-III, but if doubt exists, should cranialize. |
|
|
Term
| In a orbitozygomatic fracture, which fracture should be fixated first? |
|
Definition
Zygomaticofrontal fixation first
After reduction, work superior to inferior and lateral to medial |
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