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PRS RC 2020 > Head & neck recon > Flashcards

Head & neck recon Flashcards

(47 cards)

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1
Q

Best flaps for Tongue recon?

A
  1. RFFF, ALT
  2. RAM, DIEP, gracilis
  3. Salvage: pec major MC flap
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2
Q

Best flaps for FOM recon?

A
  1. RFFF, ALT

2. Salvage: deltopectoral, PMMC, FAMM, nasolabial

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3
Q

Best flaps for buccal mucosa?

A
  1. RFFF, ALT

2. Platysma

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4
Q

Recon options for pharynx?

A
  1. Tubed ALT, RFFF
  2. Free jejunum or colon, gastric pull-up
  3. Salvage: deltopectoral, IMAP
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5
Q

Recon options for esophagus?

A 
Type 0 (small defect): primary closure
Type 1 (partial, <50% circum): ALT, RFFF
Type 2 (circum, >50%): tubed ALT, jejunum
Type 3 (extensive non circum defects, multiple anatomic levels): Rectus, ALT
Type 4 (thoracic esophagus): gastric pull-up, pedicled (supercharged) jejunum flap
Salvage: deltopectoral
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6
Q

Goals for upper aerodigestive tract?

A

Passage of food
Facilitate airflow
Speech

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7
Q

Goals of tongue recon?

A

Airway protection
Speech/articulation
Swallowing
Protective sensation

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8
Q

Recon options for tongue?

A

15-25% - primary closure, STSG, FAMM
25-60% (hemiglossectomy) - ALT/RFFF (+lateral arm, dorsalis pedis)
>70% (total glossectomy) - ALT (+TRAM, LD, gracilis)

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9
Q

Goals for esophageal recon?

A

prevent stenosis
dysphagia
obstruction

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10
Q

Goals of nasopharynx recon?

A

provide lining

obliterate dead space

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11
Q

Goals of oropharynx reco?

A 
Soft palate: functional velum
Closure of oronasal communication
Airway protection
Aspiration protection
unrestricted swallowing
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12
Q

4 phases of swallowing?

A

Oral preparatory
Oral propulsive
Pharyngeal (airway protection)
Esophageal

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13
Q

Principles of esophageal reconstruction?

A

Anchor flap to pre-vertebral fascia to prevent sagging
Flap monitoring: bowel out to surface, skin paddle to surface, implantation doppler
Salivary bypass tubes

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14
Q

Goals of cranial base defects?

A 
Watertight dural seal
Obliterate dead space
Re-establish orbital + oropharyngeal cavities
Well-vascularized soft tissue cover
Reconstruction bony + ST defects
Cover exposed vessels
Optimal cosmesis
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15
Q

What are the 3 regions of cranial base defects? (Gullane, Irish et al 1994)

A

Region I – anterior cranial fossa, down the clivus to foramen magnum
Region II – middle cranial fossa (mainly infratemporal & pterygopalatine fossa)
Region III – posterior cranial fossa (incl. petrous temporal bone)

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16
Q

Principles of reconstruction of cranial base defects?

A

Multidisciplinary approach
Dural repair
Bone reconstruction (controversial)

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17
Q

Options for dural recon?

A

Primary closure preferred
Pericranial flap
Temporalis muscle flap
Patch (cadaver dura, bovine pericardium, fascial graft)

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18
Q

Local or regional flaps for skull base reconstruction?

A

Temporalis
Peicranial
Glabellar
Galeo-occipitalis

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19
Q

Pedicled flaps for skull base recon?

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A

Pec major
Trapezius
Lat dorsi
SCM

20
Q

Free flap options for skull base recon? (most often first choice)

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A 
RFF
Gracilis
VRAM
TRAM
LD
21
Q

What is the classification for forehead defects?

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A

Zone 1: supraorbital brow
Zone 2: pre-hairline forehead
Zone 3: post-hairline forehead

22
Q

What are the recon options for Zone 1 forehead defect?

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A

split calvarial
rib graft
vascularized bone graft

23
Q

Recon options for Zone 2 forehead?

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A

alloplastic

split calvarium

24
Q

Recon options for Zone 3 forehead?

Study These Flashcards
A 
Split calvarium
vascularized BG
Alloplastic
Free flap (lat dorsi) + split rib
Composite serratus + rib free flap
25
What does the superficial and deep leaflets of the DTF before inferiorly
Superficial: parotidomasseteric fascia Deep: posterior masseteric fascia
26
Goals of recon of zygoma?
Facial width Orbital volume projection
27
Definition of Le Fort I?
Nasal septum Anterior + lateral maxilla walls Pyramidal process of palatine bone Pterygoid plates
28
Definition of Lefort II
``` Nasofrontal suture Medial orbital wall Orbital floor Inferior orbital rim ZM suture Pterygoid plates ```
29
Definition of Lefort III
``` Craniofacial dysjunction Nasofrontal suture Medial orbital walls Orbital floor ZF suture Zygomatic arch Pterygoid plates ```
30
What are 5 pediatric considerations in CMF trauma?
Faster healing (early/immediate treatment) Erupting teeth (MMF difficult - use circummandibular or pyriform drop down wires) Avoid subperiosteal undermining (growth disturbances) Plates: either removal or bioabsorbable Short period of MMF
31
In Champy system, when do 1 line become 2
Posterior to 1st premolar
32
Principles of mandible surgery?
Anatomic reduction of fragements Functionally stable fixation of fragments Atraumatic operating technique Early active pain free mobility
33
What is load-sharing stability?
Functional stability achieved by fixation system with anatomic abutment of fragments
34
What is load-bearing stability?
Functional stability achieved by fixation system only
35
Indications of ORIF of condyle?
In middle cranial fossa Bilateral condylar fractures + midface fracture Interferes with translation Unable to achieve occlusion
36
What are advantages of locking plate?
No pressure on bone Perfect adaptation of plate not needed Less screw loosening "Internal external fixator"
37
What are adv/disav (3) of internal and external approaches to the mandible?
Internal - Adv: Hidden scar, immediate occlusion assessment - Disad: mental nerve, angle and ramus fracture, witch chin deformity External - Adv: wide exposure, can inspect lower border for reduction - Disad: visible scar, MM branch
38
What is ORN?
Non-vital bone in area of previous radiation therapy without recurrence of cancer
39
What are 2 theories of pathophysiology of ORN?
1. Hypoxic theory: progressive endarteritis, not enough blood supply for bone healing 2. Bone turnover theory: osteoblast suppression that impedes healing
40
Risk factors for ORN?
Patient: poor oral hygiene, poor nutrition, state of dentition, ill-fitting dentures Cancer: brachytherapy, high dose radiation, posterior defects, advanced stage tumors Treatment: radiation >60Gy, acute trauma of surgical procedures of the jaw
41
What are the indications for HBO?
Infectious: OM, Nec fasc Ischemia; ORN, flap necrosis, skin necrosis after filler injection, decompression sickness, inhalational injury Wounds: chronic wounds
42
What is the pathophysiology of HBO?
- hyperoxygenation - oxidative killing - toxin inhibition - fibroblast proliferation - angiogenesis
43
Absolute and relative contraindications to HBO?
Absolute: tension pneumothorax, chemotherapy (cisplatin, bleomycin, doxorubicin) Relative: claustrophobia, seizure, COPD, URTI, pregnacy, pacemaker
44
Complications of HBO?
Common: claustrophobia, barotrauma, vision changes Rare: seizure, cataract, pulmonary toxicity, finger numbness
45
Define fibrous dysplasia?
Replacement of bone with fibro-osseous connective tissue and poorly formed trabecular bone
46
What is cherubism?
Familial fibrous dysplasia | Characterized by fibrous dysplasia of the lower face, giving the face a rounded appearance
47
Hypopharyngeal cancers is associated with which syndrome?
``` Plummer-Vinson Splenomegaly Esophageal stenosis Glossitis Anemia (iron deficiency) ```

PRS RC 2020 (6 decks)

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