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Head and Neck Flashcards

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1
Q

The facial skeleton (viscerocranium) form from what type of ossification

A

Intramembraneous - perisoteal blood supply.

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2
Q

Antia-Buch max defect size?

A

2.5cm defect

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3
Q

Helical rim defects >3cm

A

Converse tunnel. Cartilage strut under post auricular skin. 3 weeks strut lifted on anteriorly based flap and inset.

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4
Q

Options for conceal bowl

A

Secondary
SG
Excise bare cartilage and SG

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5
Q

Max size of Tanzer

A

2cm

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6
Q

Options for middle 1/3 ear

A

Rim: Antia-Buch
Wedge <2cm
Cart graft - Dieffenbach (cart sutured to defect covered by flap) or converse
Contralateral chondrocutaneous composite flap.

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7
Q

Rim Recon Options

A

Small:
contralat composite, AB, Condrocut rotation.
Large:
-Cart graft and local flap (Converse 2 stage tunnel and lift)
-Tubed-pedicle (3 stage tub, inferior, superior)

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8
Q

Superior Third

A

Small:
-Tanzer excision
Large:
-C/l cart graft and flap (preaur banner)
- condrocut flap (Davis root +sg, OC helix based)
-Valise handle (3stage+sg) defect attached and elevated
- CC graft +TF flap

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9
Q

Middle third

A

Small: Tanzer
Large:
-Chonchal - flip flap (inc down to fascia)
-C/l composite graft/ Converse/ Dieff (2 stage st 1 sutured to defect)

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10
Q

Ear Recon:

A

Auto
Auto/ Allo
Pros
Coverage TE or free or ped TPF flap+SG.
C/l 6-8 costal synchondrosis.

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11
Q

Benign Ear Diff

A

granuloma pyogenicum,
beryllium granuloma,
verruca contagiosa,
verruca senilis,
cylindroma,
nevus,
papilloma,
lipoma,
lymphangioma,
leiomyoma, and
chondroma,

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12
Q

Upper eyelid recon
FULL THICKNESS

A

<25:
- direct closure
25-50:
- DC+ lat canthotomy
- Tenzel semicircular MC + comp
- Sliding Tarsoconj + FTSG or MC flap
> 50:
- Composite graft + MC flap (frick, FH)
- Cutler-Beard bridge (LL inf based rectangle composite) w=w
- central: (Mustarde lower lid switch) based on inf. arcade.

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13
Q

Lower Lid
Partial thickness

A

<50%
-Local cutaneous/MC flaps
>50%
-FTSG
-Tripier flap
-Fricke flap
-Mustarde Cheek rotation flap

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14
Q

Lower Lid
Full thickness

A

25-50%
- DC + lat cantotomy or inf C’lysis
- Deep: Tenzel SC +lysis
Tenzel–> McGregor–> Mustarde
- Unilat Tripier MC+ Composite
- Shallow: Hughes Tarsoconj adv + FTSG or MC

>50%
Shallow: Hughs TC Adv+ FTSG or MC
(bio Trip, Must, Frick, FH)
Deep: Septal CondMuc graft + mustarde
-McGregor temp z-plasty flap

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15
Q

Lower Lid
Full thickness

A

25-50%
- DC + lat cantotomy or inf C’lysis
- Deep: Tenzel SC +lysis
Tenzel–> McGregor–> Mustarde
- Unilat Tripier MC+ Composite
- Shallow: Hughes Tarsoconj adv + FTSG or MC

>50%
- Shallow: Hughs TC Adv+ FTSG or MC
(bio Trip, Must, Frick, FH)
- Deep: Septal CondMuc graft + mustarde
-McGregor temp z-plasty flap
-Composite + MC

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16
Q

What are the degrees of levator function?

A

Excursion of lid margin from full down to full up.
Excellent >10mm
Good 8-10mm (Min - FS/ MM Conj resec’n)
Fair 5-7mm. (Mod - Lev adv)
Poor 1-4mm (brow/front suspension)

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17
Q

Asian lid

A

Epicanthal folds
Lack pretarsal show
Lower lid crease (4-6 vs 8-10)
Lower insertion of orbital septum relative to tarsus (lower periorbital fat)

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18
Q

Chemosis Tx

A

Ointment/Lube/patching
Topical steroid drops, tarsorraphy
Conjunctiectomy

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19
Q

Retrobulbar Hematoma
Symptoms
Tx

A

Compression of Central Retinal Artery, Optic nerve.
Sudden onset:
Pain
Proptosis
Decreased visual acuity

Tx:
Admit, Ortho consult
Release sutures, canthotomy,
IV corticosteroids, acetazolimide
OR exploration

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20
Q

lymph drainage lips

A

Upper and lateral lower = summand
central lower = submental

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21
Q

RF for reoccurrence

A

Size, location
Depth, Grade, Perineural Inv., Marjolin
LN
Clinical RF

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22
Q

Vermillion Recon Options?

A
  • Verm Adv or switch
  • Mucosal Adv. VY, Biped
  • Goldstein MC flap?
  • Tongue, FAMM (Incas Bucc for vermillion recon only), Buccal
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23
Q

Commissure

A

Rhomboid mucosal
Double Skin flap and mucosal rhomb/ tongue
Zisser

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24
Q

Lower Lip Recon Options?

A

<1/3: Wedge, 1o
1/4-1/2: Johansson Adv (w=1/2defect) h=8-10mm, Reverse Abbe only lateral (1/2w) start at mid point, Eslander

1/2-2/3: Karapanzic preserves facian nerve for functional recon (Central),
Uni Gilles fan,
DAO

2/3 to total: Bilat Gilles fan,
Web-Bernard Burow, Fujimoro gate, recional/free

General Kara or BB if no lip.

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25
Upper Lip Recon Options?
By unit Philtrum: 1o, SG, Abbe, Peri alar White lip: NL Phil and lateral \<1/4: b/l perialar cres+abbe, Rev Kara Phil and lateral \>2/3: b/l NL + Abbe Rev Kara + Abbe WBB Reg, free Lateral: 1o, A-T, Peri Alar Cres Adv, NL, Abbe, Rev Est Abbe or slander if comm, large do BB + Cres excision
26
Karapanzic
U incise skin in mental crease parallel to free margin and continue into melolabial crease, - ID NVB release Ris to advance, - back cut mucosa, or burow at commissure Preserves sensation/orb function. Dis: micro, asym, under proj.
27
Uni Gillies
Full thickness No preservation of OO innervation, lacks sensory
28
WBB
Incise in labiodental and NL crease Burows skin and sc only to preserve OO. Narrow as possible to prevent puckering (NEEDS Verm flap) Adv: SS, local, complete LL Dis: no function, insensate, Microstom. income.
29
Lip recon regional: Indications for free:
Pec Mj, DP, Tubed neck, FC scalp Large, Rads, composite, failed
30
Chin
Boardering on verm: A-T Adv flap with burow triangle in parental crease Modified limberg with scar in vertical midline (not crossing inf boarder of mind)
31
Lip Development
Upper: two medial nasal prom fuse with maxillary prom Lower Mandibular pro
32
Lip Subunits
Lateral: Phil col Nasal sił Alar base NL fold Med: Phil
33
Lip: Sensory Innervation
Fifth CN: Upper: Infraorbital - Max Nerve, (Sidewall/ala, col, med cheek) Lower: Mental (Mandibular)
34
Mental foramen landmark
Second mand bicusp
35
Most common lip cancer Excision Recommendation
90% SCC 95% LL, lip is 1/4 of oral ca. Diff: Sebacious ca Adenoid cystic Acinic cell Merkel Cell "Full thickness 3-5mm hard for 90% with 2-3% RR at 5 year"
36
Eslander Gillies Kara WB
Triangular based on superior lab artery Gillies: rat advancement flap, upper cheek to close large centra LL \>50% Flap l= Defect w, w=h -Kara: composite flap with innervated OO. Midline Upper and lower defects. uni = 50%, bi for total/ WB- \>80% Medial advancement of cheek (need ver recon - mucosal adv).
37
75% UL Defect
B/l Kara (innervated lip )+Abbe
38
Lateral lower lip defect + comm
Estlander
39
Mentalis function
Elevates central lower lip.
40
Tongue Recon Options
\<25 = 1o, STSG, FAMM 20-60% = ALT, RFFF, Lateral Arm, Dorsalis Pedis (ALT MC for larger defect) \>70% ALT, TRAM, LD, Grac
41
Floor of mouth
Stage 1 \<2cm local flap or STSG Stage 2: 2-4cm local or free flap Anterior: Local: NL, Temp, FAMM, Tongue Distant: PM, DP, Lat Free: Rad/Ulnar FA, ALT, Fib if bone Posterior: Local: NL, FAMM Distant: PM, DP Free: RFFF, ALT, LA, DP, Fib
42
Buccal
Local: plat, FAMM, TPF +SG, Tongue Distant: Pm (Bulky), DP Free: RFFF, Ulnar, ALT thin
43
Cordeiro Classification
1- limited (1 or 2 walls) - FC 2- Subtotoal Orbit preserved a) \<50% transverse palate - FC/ obturator b) \>50% - OC required 3- Total - all 6 incl floor a) orb contents preserved Double (Fib+ RA + NVBG/ allo for Orbital floor), Temporalis for poor candidate. b) resected - RA 3 paddle + fib for dental 4- Orbitomaxillectomy - RA
44
Test
45
Blood & Nerve Supply of Nose
_Ext Carotid_ Facial A --\> Angular--\> lateral nasal --\> Superior Lab --\> columellar Internal Max --\> Infraorb _Internal Carotid_ Opthalmic --\> Anterior ethmoidal A --\> External Nasal Br Opthalmic --\> Dorsal nasal (anast to lateral nasal) Nerve: External: Infratroch (radix), IO (sidewalls), Ant Ethmoid -External Br. (tip, alae) Internal: Ant Ethmoid - Internal Br, Nasopalatine, Lesser Palatine
46
Nasal Recon Max Local flap? Bilobe Design. NL design and blood supply
1.5cm Bilobe: lower third laterally based for tip, and vv. NL: Medial edge in NL crease. Options: superior or inferior, one stage island or 2 stage pedicled. Blood supply = perforators Inferior = facial artery ( Nasal ala, dorsum and sidewall) 1.5-2.5cm Superior based = angular (random pattern) for lipa and oral.
47
Blood supply of Fronto nasal advancement, Rieger, dorsal nasal or miter Defect? Glabellar?
Angular artery. Middline lower or middle third. Glabellar--\> medial canthi
48
Anatomy of Paramed FH flap Ways to lengthen?
Supratroch travels on PO becoming SC at hairline.
49
Nasal Lining:
SG Infold flap Vestibular lining. Septal Muco Pericondrial Facial artery musculo mucosal Free
50
Describe Submental Artery Flap Indications/ CI
MC Platysma Flap (laterally based). Submental br of facial artery parallel to ant belly of diagastic. Indications: Extra oral (lower and midface), Oral (up to palate posterior tongue) Combined, hair bearing. CI: Ips neck dissection.
51
Juri cervicofacial flap
Continue lateral from defect alon Zygomatic arch, preauriclar fold, retro auricular hairline. Ped: Facial and submental artery.
52
Safe zone of frontal branch of facial Nerve.
\>3.5 cm anterior to external auditory canal.
53
Cervicopectoral flap
MC based on Anterior thoracic perforators off the internal mammery artery. Defect: lower lateral cheek (line from trag to commissure) Steps: Extend defect posteriorly inferior to ear , retroauricular hairline, parallel to anterior border of trapezius crosses clav at DP groove then extended inferior PRN. SubCut in face , sub platy in neck deep to anteriro pectoral fascia on chest.
54
Deltopectoral Flap
Blood supply: IMA, and TA (axial flap)
55
Temporalis Flap:
Blood Supply: Internal Max Artery --\> Deep temportal branches (anterior and posterior) STA - Middle temporal Artery Indications: Turnover - posteriro oral, nasopharyns, orit, ear, Lenthening: disinsert from corinoid, remove arch.
56
Trapezius
Blood Supply: Upper: Occipital Middle: Transverse Cerv--\> Superficial Cerv Lower: Deep br or TCA (dorsal scap) + IC
57
Frontal Br of facial nerve Galea continuation Scalp PO continuation
RUNS IN Superficial temporal fascia STF laterally, smas in face, frontalis, occipitalis Deep temporal fascia (at fusion line seprate and envelope ST fat pad)
58
Extending Scalp flap
Score PERPENDICULAR to axis
59
Facial Nerve Landmarks?
1. Tragal pointer 0.5-1cm deep and inferior 2. Deep to dephalad boarder of Posterior belly of diagastic 3. Tampanomastoid suture 6-8mm deep to inferior end of suture line. 4. Retrograde dissection
60
Salivary Tumors: When Rads?
Close or microscopically positive margins. Proximity to facial nerve Perineural/Lymphovascular invasion Cervical Mets
61
Gustatory Sweating? Tx
Cross innervation post surgery disruction AT nerve. Cholenergic parasympathetic fibers ( GP CN9 via otic ganglion) innervate sympathetic skin sweat gland. Observaation if mild, botox, alloderm or fascia graft.
62
Most common salivary tumors? Benign (1, 2nd) Malig? Mets?
Benign: Plemorpic adenoma 80% of benign tumors, Warthins (papillary cystadenoma) Children: hemangioma Mucoepidermoid (in parodid), Adenoid cystic in other glands Mets: Melanoma, SCC (heme spread of Breast, lung prost, kid, GI)
63
History of Salivary Gland tumor
64
First Branch Arch
Nerve: Trigem Art: Maxillary Cart: Mandible, Malleus & incus Muscles: Temporalis, mass, Pter, TTym/VP, MH ABD.
65
Second Branch Arch
Facial nerve Stapedial artery Reicherts Cart: Mall (man), incus (proces), stapes, styloid process, styloid hyoid lig. Muscles of facial expression, plat, stylohyoid, hyoid
66
Third Arch
GP nerve Internal carotid Hyoid (body, cornu) Stylopharyngeus
67
4th Arch | (5th Arch = Nothing)
Sup Laryngeal nerve Left: Aortic arch, Right: SC artery Thyroid, cuneform Pharyngeal construction, cricopharyngeal. Cricothyroid
68
6th Arch
Recurrent laryngeal Pulmonary artery Cricoid, arytenoids, corniculate Intrinsic larynx muscles
69
Midface Embryo
Maxillary, Med (tip, phil, UL) & lat Nasal (ala), Frontonasal (dorsem) Prominances fuse to form nose and upper lip. (1st branchial arch)
70
71
Congen ML Mass Diff?
Dermoid Gliomas - firm, nonpulse from lateral nasal wall Encepaloceles - blue, pulsatile, compressibl emass or intrasasal mass at crib plate. Furstenberg test (compression of Int jug)
72
Primary Palate? Secondary Palate?
MNP Shelves of max prominences.
73
Tongue Embryo
1st pharngeal arch (lingual nerve = branch of trigeminal , nerve to 1st.) Posterior (GP nerve to 3rd)
74
Thyroglossal Duct Cyst
Asym Midline mass at hyoid - elevate with swallow. Mgmt: Sustronk- excision and central hyoid
75
Frontal Sinus
Appears at 5-6 adult size by 12-20.
76
PHACE
Post Fossa Hemangioma Arterial lesions Cardiac mal/ Corarctation Eye

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