Plastic Flashcards
(109 cards)
0
Q
Nasofrontal angle
A
Line tangent to glabella through nasion and intersecting with a line tangent to dorsum
115-135 deg
1
Q
Boundaries of forehead
A
Hairline to glabella
2
Q
Trichion
A
Anterior hairline in the midline
3
Q
Glabella
A
Most prominent point of the forehead on profile
4
Q
Nasion
A
Deepest depression at the root of the nose. Corresponds to nasofrontal suture
5
Q
Radix
A
Region root of nose
Superior orbital ridge to lateral nasal wall
6
Q
Rhinion
A
Soft tissue correlate of osseocartilagenous junction
7
Q
Sellion
A
Osseocartlagenous junction at nasal dorsum
8
Q
Supratip
A
Point cephalic to tip
9
Q
Tip
A
Most anterior projection of nose in profile
10
Q
Subnasale
A
Junction of columella and upper lip
11
Q
Labrale superius
A
Vermilion border of upper lip
12
Q
Stomion
A
Central portion of interlabial gap
13
Q
Labrale inferius
A
Vermillion border of lower lip
14
Q
Mentolabial sulcus
A
Most posterior point between lower lip and chin
15
Q
Pogonion
A
Most anterior soft tissue point of the chin
16
Q
Menton
A
Most inferior soft tissue point on chin
17
Q
Cervical point
A
Innermost point between the submental area and neck
18
Q
width of eye
A
1/5 of facial width
19
Q
normal intercanthal distance
A
- 5-37.5mm for women
26. 5-38.7mm for men
20
Q
average palpebral opening
A
10-12mm in height 28-30mm in width
21
Q
upper lid crease
A
11mm from the lash line
22
Q
nasolabial angle
A
angle is formed between the intersection of a line tangent to labrale superius and subnasal and a line tangent to the most anterior point of the columella
95 to 110 deg women
90 to 95 deg men
23
Q
nasofacial angle
A
incline of the nasal dorsun in relation to facial plane
30-40 deg ideally 36 deg
24
nasomental angle
angle between tangent line from nasion to tip intersecting with a line from tip to pogonion
120-132 deg
25
simons tip projection
1:1 with upper lip
26
goodes method tip projection
55 to 60 deg
27
alar to tip lobular complex
1:1
28
gonzales ulloa zero meridian
ideal chin position
| Tangential line from nasion to pogonion and perpendicular frankfurt horizontal plane
29
Cervical point
Innermost point between the submentum and neck
30
Long axis of ear is parallel to long axis of nasal dorsum
15 degrees from the vertical plane
31
Ear protrudes from theskull
At an angle of 20-30 deg/ 15-25mm
32
Hyperdynamic facial lines
Long term facial animation
| Forehead creases, crows feet and glabellar lines
33
fitzpatrick classification
I white always burns never tans
II white usually burns tans with difficulty
III white sometimes burns sometimes tans
IV white rarely burns tans with ease
V brown very rarely burns tans very easily
VI black never burns always tans
34
Seborrheic keratoses
Verrocous surface slightly raised soft friable brownish black
Benign inherited with no malignant potential
35
Lesser trelat sign
Colonic adenoca
36
Dermatosis papulosa nigra
Small smooth pigmented hyperkeratotic papules
| Variant of sebboreheic keratoses
37
Verruca vulgaris
```
HPV
Common warts (filiform) - HPV 2 and 3
```
38
Molluscum contagiosum virus family (EM2)
Small discrete skin colored dome shaped papillomas with umbilicated centers
39
Actinic keratoses
precancerous lesion
sun exposed area fourth decade of life
5Fu imiquimod retinoid cream
photodynamic therapy dermabrasion and chemical peels
40
```
most common malignancy in humans
more common in men
40-60 yrs old
UVB
nasal tip and ala most common
```
basal cell CA
41
ideal scar
flat level of the skin
good color match
narrow parallel to RSTL at the edge of subunits
42
indicationa for scar revision
```
widened
perpendicular to RSTL
webbed
pin cushioned
long and linear and misaligned with RSTL
hypertrophied
interrupting aesthetic units of the face
adjacent to but not lying within a favorable site
causing distortion of facial features
scar revision after 60-90 days
```
43
excision
fusiform shape with 30 degree angled ends positioned within RSTL
44
serial excision
wide scars
birthmarks
skin grafts
45
tissue exapnder
base of an expander should br approximately 2.5 to 3 times as large as the area to be constructed
46
tissue expanders
epidermis is thickened melanin production increases mitotic activity increases dermis thins collagen synthesis is enhanced hair follicle
number remains unchanged hair
density decreases muscle thins blood vessels proliferate
47
Irregularization is needed
GBLC and W plasty
48
Irregularization and lengthening
Z plasty
49
Z plasty
60 deg- 75%
45 deg- 50%
30 deg- 25%
50
Dermabrasion
6-8 week intervals
Preservation if reticular dermis
Re epithialization accomplished after 5 to 7 days post treatment erythema 2to 3 mos
51
Intralesional steroids
Lessen pin cushion edema
| Can cause hypopigmentation and telangiectasia
52
Silicone sheeting
8 to 12 hours per day use it for 6 to 12 months
53
Pivotal flaps
Rotation
Transposition
Interpolated
54
Rotation flap
Width of the pedicle twice as large ad width of defect
55
Transposition flaps
```
Linear axis
Random blood supply
Compound or axial
Mose useful local flap
Length of random flap must not exceed three times the width
```
56
Interpolated flap
Pivotal flap with linear configuration
| Must pass over and under intervening tissue
57
Advancement flap
Linear flap
| Depends on elasticity
58
V to Y advancement flap
A structure or region requires lengthening or release from contracted state
59
y to v advancement flap
Reduce redundancy
60
Hinge flaps
```
Trap door
Turn in
Turn down
Full thickness nasal defect
With a second flap
Close mature sino nasal and salivary fistulas
```
61
Nasa subunits
```
Dorsum
Sidewall
Alae
Facets
Tip
Collumella
```
62
Melolabial interpolated flap
Does not violate aesthetically important faciAl sulcus
63
Paramedian forehead flap
Surface defect of collumella dorsum nasal sidewall
64
Auricular cartilagr
Replace lower lateral cartilage
65
Septal cartilage
Replace upper lateral cartilage
66
Ipsilateral septal mucosal flap
Septal branch of labial artery
67
Contralateral septal mucosal flap
Anterior ethmoid artery
68
Composite turn out flap
Full thickness central nasal defects
69
Paramedian forehead flap
Supratrochlear artery
1.7 to 2 cm lateral and midline corresponds to the vertical tangent of the medial aspect of the brow
Proximal 1/4 remains thick
Pedicle detachment after 3 weeks
70
Aesthetic unit upper lip
Philltrum
| Two lateral segments
71
Lip reconstruction
Those that use remaining lip tissue
Those that borrow tissue from opposite lip
Those that use adjacent cheek tissue
Those that use distant flaps
72
Less than 1/2 defect of lip
Primary closure
73
One half to two thirds defect of lip
Karpazandic flap
74
Lip defects with oral commisure
Estlander
75
Lip defects without oral commisure
Abbe flap
76
Abbe flap
Labial artery
Full thickness flap pedicled at the vermillion border
Pedicle is severed after 2-3 weeks
77
Closure of the lip in 4 layers
Mucosa
Muscle
Deep dermal
Skin
78
Recon of cheek defect
Rhomboid flap
| 120 and 60 degree angle
79
Bilobed flap
For cheek defect
1st lobe 20%smaller than the defect
2nd lobe 20% smaller than the 1st lobe
80
Medial cheek defects
Rotational flap border along the lower lid
81
Large inferiorly based rotation flap for cheek defects
Dissected beneath the SMAS and platysma
82
Small and medium sized skin defects cheek
V to Y advancement
83
Medial and lateral cheek defect
Superiorly based transposition flap
84
Reconstruction of forehead defect
Preservation of frontalis muscle function
Preservation of sensation of the forehead skin
Placement of scars within aesthetic borders
85
Aesthetic units of forehead
Lateral temple
Paramedian
Median
86
Goals for reconstruction of forehead defects
```
Maintenance of eyebrow symmetry
Maintenance of natural appearing temporal and frontal hairlines
Hiding of scars along the hairline
Creation of transverse scars
Avoidance of diagonal scars
```
87
Ideal location in forehead defect to heal by secondary intention
Well away from the brow, lateral third
88
SMAS
submuscular fibromuscular extension of the pladtyma muscle arises superiorly from the zygoma and is continuous with the inferior cheek with the platysma
89
Facial nerve
Deep to SMAS
90
Sub SMAS
Ameliorate melolabial fold
91
Extended supra SMAS
improve midface
92
Subperiosteal advantage
```
Extensive release of periosteum away from the zygoma and maxilla for better elevation of upper lip
No pre auricular scar
Does not impair vascular supply
Lifts orbicularis oculi
Lifting of oral commisure
```
93
Transorbital acces
Ectropion
94
Subperiosteal disadvantages
Increase horizontal width
Risk to temporal and buccAl branch
Greater postoperative edema
95
Supra SMAS advantage
Does not reposition zygomatic musculature
Avoid risk to temporal and buccal branch
Less post operative edema
96
Supra SMAS disadvantage
Long preauricular cutaneous flap
Reduces skin vascularity of the face
Risk to zygomatic branch of nerve VII
Does not lift orbicularis oculi
97
Subcutaneous facelift with plication of the SMAS
most common
Safest from facial nerve paralysis
Shorter long term improvement of the jowl and no correction of midface
98
SMAS rhytidectomy
SMAS flap is dissected from the parotid
99
Strip SMASectomy
Excising a strip of SMAS advancing the mobile SMAS posterosuperiorly to the junction of the SMAS
Advantage of simplicity but no effect on midfacr
100
Subperiosteal rhytidectomy
Superior displacement of muscles
101
Transtemporal subperiosteal advantages
No pre auricular incision
| Concomitant lateral brow lift
102
Transtemporal subperiosteal disadvantages
Risk to temporal and buccal bramch
Requires endoscope
Poor access to periosteal dissection of maxilla
103
Transorbital subperioosteal supraperiosteal advantages
Direct access for dissection and suspension of midface
| More vertical vector for suspension of midface tissues
104
Transorbital subperioosteal supraperiosteal disadvantages
Risk to buccal bramch
Risk to infraorbital nerve
Risk of lower lid retraction
105
Transoral subperiosteal advantages
Direct access for dissection of mid face
| Ease in elevating periosteum of maxilla
106
Transoral subperiosteal disadvantages
Risk to buccal branch
Does not provide suspension for midface
Greater risk of infection risk to infraorbital nerve
107
Goals of rhytidectomy
Preserve motor and sensory function
Modify cervical fat if excessive
Tighten the SMAS and platysma
Redrape cervical and facial skin and trim excess
108
Classic rhytidectomy incision
Above the auricle curving upward and forward to end 1 to 2 cm above the level of the eyebrow
