Nose Flashcards by Michelle Bonapace-Potvin

High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
1. Nommer 3 éléments du questionnaire spécifiques à ce type de blessure.

Pressure, volume, type

How well did you know this?

Not at all

Perfectly

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.
1.Nommer 4 options pour la reconstruction du lining.

Septal mucoperichondrial flap
Folded paramedian
Nasolabial
FAMM

How well did you know this?

Not at all

Perfectly

High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
2. Nommer 2 signes clinic a rechercher a l’examen physique ?

Neurovasc compromise, compartment pressure, entry wound

How well did you know this?

Not at all

Perfectly

High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
3. Nommer 1 investigation qui vous aidera dans la prise en charge de ce patient

X ray, compartment pressures

How well did you know this?

Not at all

Perfectly

High pressure injury : patient avec atteinte fusil peinture dans paume distale il y a 2h.
4. Nommer 3 elements de la prise en charge

Immediate OR for debridement +/- fasciotomies, tetanos, broad spectrum antibiotics

How well did you know this?

Not at all

Perfectly

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

Nommer 2 sites donneurs pour la reconstruction du support.

SEPTUM
SPLIT CALVARIAL BONE GRAFT
CHONCHA
RIB

How well did you know this?

Not at all

Perfectly

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

Nommer 3 vaisseaux qui vascularisent le lambeau paramédian ipsilatéral.

Suptratrochlear
Supraorbital
Dorsal Nasal

How well did you know this?

Not at all

Perfectly

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

Nommer les repères de surface anatomique où se situe le point de pivot du lambeau frontal.

Rotation point is 1.7-2 cm lateral from the midline at the level of the superior orbital border. Flap width is 12 mm wide minimum, line is tangental to the medial border of the brow

How well did you know this?

Not at all

Perfectly

Reconstruction du nez : Pt avec déficit pleine épaisseur narine et paroi latérale du nez.

How well did you know this?

Not at all

Perfectly

What condition if associated with rhinophyma

Acne rosacea

How well did you know this?

Not at all

Perfectly

Name two medical treatments for rhinophyma

Accutane PO
Metronidazole topic
Tetracycline PO

How well did you know this?

Not at all

Perfectly

Name 3 surgical treatments for rhinophyma

Cold knife excision
Dermaplanning
Dermabrasion
CO laser

How well did you know this?

Not at all

Perfectly

3 malignant transformations of rhinophyma

BCC (15-30 %)
SCC
Sebaceous carcinoma
Angiosarcoma

How well did you know this?

Not at all

Perfectly

2 ways to close a rhinophyma deficit

Let granulate with dressings
Paramedian flap
Skin grafts

How well did you know this?

Not at all

Perfectly

Name three characteristics of the aging nose

Shorter and more brittle nasal bones
Drooping tip (more acute nasolabial angle)
Thinner 2/3 superior and thicker, more sebaceous tip
Increased nasal length

How well did you know this?

Not at all

Perfectly

Name 3 treatments for internal nasal valve collapse, and where we anatomically will put the grafts

Spreader grafts
Autospreader flaps from ULC
-place between the septum and the ULC, submucoperichondreal
Inferior turbinate outfracture or resection
Septoplasty

How well did you know this?

Not at all

Perfectly

Name 2 donor sites for spreader grafts

Costal cartilage
Septal cartilage

What vascularizes the nasal tip after open rhinoplasty?

Lateral nasal artery from the angular artery

What muscle causes the droopy nose

Depressor septi nasi

Name three valves of the nose

internal
external
velopharyngeal sphincter??

2 approaches to the septum and briefly describe them

transfixion - continuation of the intercartilaginous incision, separating the caudal septum from the membranous septum and the medial crura (through and through)

partial transfixion - attachments of the medial crural footplates and caudal septum are preserved

hemitransfixion- unilaterally at the juntion of hte caudal septum and the membranous septum

killian - high septal transfixion incision, does not violate the junction of the caudal septum and the medial crura or membranous septum

What deformation can result from an aggressive caudal septum resection ?

Short nose deformity and increased nasolabial angle

What medication can we topically apply to reduce risk of recurrence post surgery of rhinophyma

(no source)
Metronidazole

What percentage of family history is positive in rhinophyma?

21% (PRS 2002 article)
43% 2010 article from maisonneuve-rosemont

Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez. 1. Nommer deux option de lambeau local + leur vascularization

1. Paramedian - supratrochlear 2. Washio (retro-auricular temporal flap) - superficial temporal vessels 3. Scalping flap (converse) - superficial temporal vessels

Paramedian flap : Nommer 3 façons de prélever une longueur suffisante pour une reconstruction étendue ad columelle.

1. Diagonal design 2. Design into hairline 3. Lower base of flap below medial eyebrow 4. Pre-expansion

Déficit extensif du nez incluant pointe + murs latéraux ad racine du nez. 2 ways to reconstruct lining

Turn in free flap Pre-laminated paramedial forehead flap Septal pivot flap with mucoperichondral fold overs

What is the structural defect in a saddle nose? Name 2 causes

Loss of dorsal support through loss of septum, ULC and/or nasal roof 1. Over-resection of the septum 2. Trauma 3. Weigner's granulomatosis 4. Cocaine 5. Infx : syphilis, TB)

2 ways to reconstruct a saddle nose

Dorsal reconstruction with onlay graft + columellar strut grafting (moderate) Cantilever dorsal graft and tip support (severe)

Name 2 causes of nasal obstruction

1. Septal deviation 2. Turbinate hypertrophy 3. Rhinitis 4. External or internal valve collapse

Why would a cartilage graft of an asian patient from the nose be insufficient ?

Asian nose has less septal cartilage

Name one autogenic + alloplastic option for nasal augmentation and 4 complications of alloplastic

Autogenic : septal cartilage, choncal cartilage, rib cartilage, SCBG Allplastic : silicone, medpor (porous polyethylene), gortex (polytetrafluoroethylene) 1. migration 2. infection 3. extrusion 4. resporption 5. visability

Grafts used for nasal tip to increase projection?

1. columellar strut 2. septal extension 3. Tip onlay (supra tip) 4. Shield (infra-tip) 5. Combination (supra + infratip)

Name the 4 sides of the internal nasal valve

1. septum 2. ULC 3. inferior turbinate 4. nasal floor

What impact does the internal valve have on the airway resistance ?

50-60%

2 clinical signs of internal nasal valve collapse

positive cottle test on speculum exam, <15 degrees inverted V

3 causes for internal valve collapse

septal deviation age trauma post-rhinoplasty (overaggressive septal or ULC resection, no dorsal reconstitution)

Name the dissection planes for paramedian flap

Subcutaneous for 1-2 distal flap Subfrontalis Subperiostal starting 1cm above superior orbital rim

Name 3 reasons why we would delay a paramedian flap

Smoker Radiation Old scar lies in the flap territory Complex extension of flap design

Pt avec déficit 16mm x 15mm nasal tip post-Moh’s. Le dermato suggère greffe de peau d’épaisseur partielle. 1. Nommer 3 désavantages de reconstruire avec une greffe cutanée d’épaisseur partielle.

1. Retraction 2. Color match 3. Step off 4. Texture

1.5x1.5 nasal tip deficit, what flap do you want to use, draw it

Marchac or Reiger (axial frontonasal)

2 principles of reconstruction for nasal alae and soft triangle

Reconstruct all three layers Maintain airway patency Optimize aesthetics Decrease donor site morbidity