Surgical Flashcards
(27 cards)
Canine Space
Between levator anguli oris and levator labii superioris
Buccal space
Anterior- lips
Posterior- Masticatory Space (parotidomasseteri fascia, buccopharengeal fascia
Superior- Maxilla
Inferior- Platysma
Lateral- skin
Medial- buccinator
Contents
-buccal fat
- Stensons
- Facial artery and Vein
- CV VII and Ix
Masseteric Space
Part of masticatory spaces
Anterior- mandible
Posterior- Parotid gland
Medial- lateral pharyngeal space
Superior- temporal space
Lateral- Masseter
Contents
- IMAX and IAN
Pterygomandibular space
Part of masticatory spaces
Lateral- mandible
Medial- medial pterygoid
Inferior- medial pterygoid
Posterior- parotid
Anterior- pterygomandibular raphe (buccinator and superior constrictor muscles)
Contents- IAN, Lingual nerve,
Temporal Space
Part of masticatory spaces
Superior- temporal line
Anterior- lateral orbit
Inferior- buccal space
Sublingual space
Inferior- mylohyoid, geniohyoid, genioglossus
Superior- FOM
Contents- lingual nerve, lingual artery, hypoglossal nerve, glossopharyngeal nerve, whartons duct, sublingual gland, Batholins
Submental space
Anterior- symphsis
Lateral- anterior digastric
Superior- mylohyoid
Inferior- Fascia
Submandibular space
Anterior- mandible
Lateral - mandible
Inferior - fascia
Superior- mylohyoid
Posterior- buccopharyngeal gap
(Connection between submandibular space and lateral pharyngeal space) along styloglossus muscle
Lateral Pharyngeal Space
Superior- skull base
Inferior- hyoid
Posterior- prevertebral fascia
Anterior- raphe of buccinator and constrictors
Lateral by mandible
Anterior- prestyloid
Posterior- retrostyloid (carotid artery, IJ, CN IX, X, XI, XII
Lemierre syndrome- IJ septic thrombosis
Horner Syndrome- CN IX to XII
Airway issues from bulging pharyngeal wall
Retropharyngeal Spaces
Anterior- constrictor muscles
Posterior- alar layer of deep cervical fascia
W/ connections to danger space
Fever, stiff neck, dysphagia, drooling, bulging of posterior wall, airway obstruction.
Intubate with head down
Danger space
Superior- skull base
Anterior- alar fascia
Posterior- prevertebaral fascia
Inferior- diaphragm
Tract to mediastinum/pericardium - from retropharyngeal through buccopharyngela fascia and alar fascia down danger space
Prevertebral space
Superior- skull base
Anterior- prevertebral fascia
Posterior- Transverse process
At C3 normal is 4mm
Abnormal 7mm
Branches of Maxillary Artery
From external maxilla
- deep auricular
- anterior tympanic
- middle meningeal/accessory meningeal
- inferior alveolar
- deep temporal
- pterygoid
- masseteric
- buccinator
- posterior superior alveolar
- infraorbital
- descending palatine
- sphenopalatine
Branches of external maxillary artery
Superior thyroid
A sending pharyngeal
Lingual
Occipital
Facial
Posterior auricular
Maxillary
Superficial temporal - transverse facial
Branches of facial artery
Submental
Inferior labial
Superior labial
Lateral nasal
Angular artery
Kisselbauchs plexus
Anterior ethmoidal
Posterior ethmoidal
Sphenopalatine
Superior labial artery
Woodruffs plexus
Middle turbinate confluence
Sphenopalatine artery
Ascending pharyngeal
Artery distances
Anterior ethmoidal- 24mm
Posterior ethmoidal- 36mm
IMAX- 20mm below head of condyle
Causes of relapse after orthognatic surgery
- Failure of hardware
- Improper seating of the condyle
- Unstable movements including maxilla down, maxilla widen and mandible back
- Muscle pull
- Condylar resorption
Pre auricular Approach
Pre auricular crease
Root of helix to the lobule-facial junction
0.8cm from external auditory canal
Temporoparital fascia
Glistening layer of superficial layer of temporalis fascia
Incision then parallels the facial nerve
Flap Monitoring
I. Color
2. Turgor
3. Temperature
4. Capillary refill
5. Arterial external Doppler
6. Venous flow internal doppler
Risk factors for avascular necrosis of the maxilla
- Radiation
- Segmental sx
- Ligation of DPA
- Palatial stripping or trauma
- Thrombosis
- Infection
- Chemotherapy
- Long surgical time
- Cleft ortho
- Systemic conditions (sickle cell, atherosclerosis)
Hypotensive anesthesia
30% below normal MAP
Never below Map of 50mmHg
MAP = 1/3 (SBP-DBP) + DBP
Treatment of avascular necrosis
Initial treatment of vascular necrosis should involve good oral hygiene, frequent saline irrigation, hyperbaric oxygen therapy, tocopherol, pentoxyfilline and antibiotics to prevent secondary infection. Although hyperbaric oxygen may not prevent necrosis it may limit the extent of the necrosis. It may also hasten delineation of the necrotic tissue and assist debridement.
Reconstruction may require closure of the defects with soft tissue flaps and bone grafts, while lost teeth may be replaced with a prosthesis or dental implants
