Head And Neck Grabb

Front 1

% of facial trauma patients with cervical spine injuries

Back 1

10%

Front 2

indicaiton for tracheostomy

Back 2

inability to secure airway via intubation

Front 3

advantage of endoscopic intubation

Back 3

less c-spine manipulation

Front 4

which is preferable

tracheostomy

cricothyrotomy

Back 4

traceostomy

Front 5

airway compromise from swelling

Back 5

occurs in first 24 - 48 hours

Front 6

source of hemorrhage in craniofacial trauma

method of control

Back 6

ext carotid system

intubate, packing, angiographic embolism

Front 7

% of patients with facial fractures with traumatic brain injury

Back 7

80%

Front 8

concomitant head injury is a containdication to facial fracture repair

T/F ?

Back 8

False

once stabilized

Front 9

AMPLE acronym = ?

Back 9

allergies, medications, past history, last meal, events surrounding injury

Front 10

ct scanning in facial fractures

? mm cuts

where ct not as accurate

Back 10

3mm

mandible esp angle (rec panorex)

Front 11

most important detemination to final result of facial laceration

Back 11

degree of crush, contusion and vascular compromise.

Front 12

5-0 or 6-0 fast absorbing gut

? suture marks

Back 12

no (according to the book)

Front 13

ear wounds are closed in how many layers

Back 13

one (skin)

Front 14

nose wounds are closed in how many layers

Back 14

three

Front 15

most important structure repair in laceration lip

Back 15

vermillion border

Front 16

facial nerve injuries

how long the distal end can be stimulated?

Back 16

48 - 72 hours

Front 17

where is it poss. to leave transected branches of facial nerve unrepaired

Back 17

buccal branch medial to lateral canthus of eyelid

Front 18

parotid laceration is important because

Back 18

poss. facial nerve injury

Front 19

stenson duct laceration repair

Back 19

over stent

Front 20

stenson duct found intra-orally

Back 20

adjacent ot maxillary 2nd molar

Front 21

first or most sensative sign of opitc nerve injury

Back 21

loss of color red

Front 22

direct and consensual light reflex tests which nerves

Back 22

Crania N. II & III

Front 23

Anissocoria
def:

Back 23

a condition in which the pupils are not of equal size

may indicate injury to CN II or III or and injury to the iris.

Front 24

ophthamology consult should be considered in all cases of orbital trauma

T/F ?

Back 24

True

Front 25

indications for orbital floor surgery

Back 25

entrapment causing diplopia
defect > 1 square cm becaus of enophtahlomus

Front 26

does enophtahlmos worsen with resolution of swelling

Back 26

this book says yes, I say no

"you can't argue with a piece of paper" (ycawapop)

Front 27

delaying surgery will complicate the eventual repair for enophthalmos

T/F ?

Back 27

True (ycawapop)

Front 28

delay of surgery till the swelling is abated is of benefit

T/F ?

Back 28

T (this is in the next paragraph to the question above ycawapop)

Front 29

When correcting enophthalmos the operated eye is overcorrected

T/F ?

Back 29

True (ycawapop)

Front 30

According to G&S, what is the timeing of "late surgery"

Back 30

7 - 10 days

Front 31

incision for orbital floor exploration with greatest lid retraction problems

Back 31

subciliary

Front 32

lid retraction with orbit surgery can be ectropion or entropion

T/F ?

Back 32

True

Front 33

lateral canthotomy with transconjunctival incision provides ?

Back 33

better exposure of the floor

Front 34

orbital floor implants must be supported where ?

Back 34

rim and the posterior margin of the orbit fracture (found by placing elevator into the max sinus through the lid incision)

Front 35

best implant for reconstruction of orbital floor

Back 35

bone

Front 36

best implant for orbital floor and medial orbital wall

Back 36

titanium mesh

Front 37

most common complication of orbital fractures

Back 37

ectropion and enophthalmos

Front 38

timing for repair of post op lid retraction

Back 38

4 - 6 months

Front 39

typical cause of lid retraction post orbit surgery

Back 39

scarring middle lamella

Front 40

most common cause of post op enophtaslmos

Back 40

inaccurate correction

not easily repaired (i agree)

Front 41

decision to operate on orbitozygomatic frx is based on

Back 41

ct - swelling often makes clinical eval inaccurate (ycawapop)

Front 42

coronal incision for malar fracture is necess when

Back 42

the zygomatic arch must be directly repaired

Front 43

size of plate used on the infraorbital rim

Back 43

1.5 mm

Front 44

size of plate used on maxilolary butress

Back 44

1.5 - 2.0 mm

Front 45

most malar fractures may be controlled by how many plates?

Back 45

1 on the zygomaticomaxillary butress

Front 46

most zygomatic arch fractures are stable?
T/F ?

Back 46

false - require permanent suture to hold position

boy is this wrong (ycawapop)

Front 47

most common complicatio of orbitozygomatic fractures id

Back 47

enophthalmos

reoperate and reposition zygoma

Front 48

dx of nasal fractures is

Back 48

clinical

Front 49

septal hematoma Rx

Back 49

drain and quilt suture sepal mucosa or splint the septum

Front 50

treatment may be delayed how many days

Back 50

2 - 3 weeks.

i think three weeks is too long, these tend to deform as the scar is too mature and can be moved but pulls the nose bace into deformity (up to 17 days)

Front 51

Le Fort fracture must involve what structure

Back 51

pterygoid plate

Front 52

key to Le Fort fracture reduction =

Back 52

occlusion

Front 53

diagnosis of NOE (nasoorbitalethomoid) fracture

Back 53

often requires operative exploration and palpation of medial canthus with intranasal manipulation

Front 54

repait of NOE

Back 54

Type I large bone Type II small bone fragment = direct repair

Type III transnasal wire

Front 55

directio of trans nasal wire for NOE fracture

Back 55

posterior and superior

(sounds good but in these there is nothing to keep the wire in that position so the tendon is pulled medially but migrates anteriorly)

Front 56

incision for NOE fracture

Back 56

coronal and lower lid

Front 57

Nasal contour reconstructions for NOE fractures

Back 57

dorsal bone graft

Front 58

Dx of nasofrontal duct injury

Back 58

usually obvious from ct

attn to medial inferior sinus where the duct originates

Front 59

obliteration of the frontal sinus requires ?

Back 59

removal of the entire frontal sinus wall and using a burr to remove all mucosa

Front 60

Rohrich -

in is unnecessary to fill the sinus with bone after obliteration

T/F ?

Back 60

True

Front 61

most common complicatio of failed frontal sinus ablation

Back 61

infection commonly occurs late

Front 62

rigid fixation of mandible requires what size plates

Back 62

2.4 - 2.7 mm

Front 63

most common complicatio of mandible fracture is

Back 63

malocclusion

Front 64

hypoglobus def:

Back 64

inferior displaced globe

commonlyu associated with enophthalmos

Front 65

temporal hollowing - etiol

prevetion

Back 65

loss of volume in temmporal fat pad

dissect on duperficial layer of the deep temporal fascia (ycawapop) sounds dumb to me

Front 66

seconday reconstruction telecanthus

Back 66

same as accute med canthal tendo posterior and superior

Front 67

etiol of most muscosal derived h&n cancer

Back 67

dna alteration from combined effect of alcohol and smoking

Front 68

syncronous ca in h&n

metachroonus ca ih h&n

Back 68

5%

5-15% (second primary)

Front 69

most likely anatomic area on the lips for metastatic spread

Back 69

commisure - periparotid nodes therefore eval nedded for parotidectomy

Front 70

anterior tongue (floor of mouth)

risk of occult metastasis

Rx recomendation

Back 70

60%

radiate neck or suprahyoid dissection

Front 71

scc floor mouth contiguous with or invading mandible

Rx recommendations

Back 71

contiguouis = marginal mandibulectomy

invacing = segmental resection

Front 72

hard palate malignancies

risk of metastasis

Back 72

low risk

Front 73

symptoms assoc. with oropharyngeal primary tumors

Back 73

Cranial nerve involvement

IX - X = referred otalgia or paresis of palate

XII = hemiparisis of tongue

Front 74

symptoms of presentation hypopharyngeal scc

risk of met

Back 74

dysphagia, referred otalgia
high risk of met

Front 75

reconstruction of hypopharynx

Back 75

ftt fasciocutaneous for hemicircumferential

and intestinal interposition for complete defects

Front 76

risk of neck l.n. involvement with
laryngeal scc

supraglotic

Back 76

low with larynx

20% with supraglottic therefore neck dissection (bilateral for midline and large lesions)

Front 77

maxillaary sinus scc
prognosis

Back 77

worse above a line connecting medial canthus and angle of mandible

Front 78

traditional neck dissection includes

Back 78

ln groups I - IV,
spinal acces nerve
internal jug vein
sternocleido mastoid muscle

Front 79

elective neck dissection is indicated in the unreliable patient

T/F

Back 79

True (ycawapop)

Front 80

effectiveness in control opf locoregional recurrence of radioRx and neck dissection in N0 neck

Back 80

equal

Front 81

likelihood of a tumor being malignant in salivary glands related to size of the gland

Back 81

the smaller the gland the higher rate of malignancy
33% parotid
50% submaxillary
75% minor salivary gland

Front 82

the most common benign salivary neoplasm

Back 82

pleomorphic adenoma (benign mixed tumor)

Front 83

the most common benign salivary neoplasm post rediation

Back 83

pleomorphic adenoma (benign mixed tumor)

Front 84

the most common malignant tumor
parotid =
submalillary =
minor salivary gland =

Back 84

parotid = mucoepidermoid
submalillary =adenoid cystic
minor salivary gland =adenoid cystic

Front 85

only predisposition to salivary tumors =

Back 85

external radiation usually for acne or adenoid hypertrophy

latency 10 - 30 years

Front 86

adenoid cystic carcinoma

characteristics of spread

Back 86

perineural (therefore radioRx)

hemnotogenous to lung, liver, bone

can have prolonged survival with met disease

Front 87

malignant transformation of benign mixed tumor

Back 87

10%

Front 88

acinic cell carcimona saliv gland

bilateral =

Back 88

3%

most common malignant saliv neoplasm in children

Front 89

recurrent pleomorphic adenoma may occur decades after treatment of the original tumor
T/F

Back 89

True

Front 90

Rx of multinodular recurrent pleomorphic adenoma

Back 90

resection and post radioRX

Front 91

aids related lympho-epithelioma

located
RX

Back 91

intraparotid lymph node

Radiotherapy

Front 92

Rx of deep lobe pleomorphic adenoma

Back 92

superficial and deep parotidectomy

Front 93

role of FNAB (fine needle asperate biopsy) in parotid neoplasm

Back 93

usually a clinical diagnosis

no need for ct scan or FNAB unless latter useful in patient swher surgical delay is considered.

Front 94

Sx assoc with parotid malignancy

Back 94

pain and facial nerve paresis

Front 95

% submaxillary duct stones that are radiopaque

Back 95

50%

dx best on Sx

Front 96

direct dissection of the marginal mandibular (facial n. branch) is advised in submaxillary gland resection

T/F

Back 96

False - dissection of the marginal mand. nerve oftens results in permanent neuropraxia

Front 97

anatomic guidline to avoid the marginal mandibular nerve

Back 97

incision at or below 2 fingerbreadths below the border of the mandible

Front 98

cranial nerves requiring identification in submaxillary gland resection

Back 98

lingual
hypoglossal

Front 99

reconstructive approach for permanent injury to marginal mandibular nerve

Back 99

botox to contralateral nerve

Front 100

Frey syndrome (nerve = ?)

occurrence
RX

Back 100

gustatory sweating (auriculotemporal)
80% (20% noticable)
alloderm interpostion or botox for sweating

Front 101

best prognosis in parotid malignancies

Back 101

acinicic cell; and low grad mucoepidermoid

Front 102

effect of fetal exposure to anticonvulsant phenytoin on incidence of cleft lip

Back 102

10 fold increasein cleft lip

Front 103

effect of fetal exposure to maternal smoking on incidence of cleft lip

Back 103

doubles risk of cleftlip

Front 104

% of isolated cleft palates associated with syndromes

most common syndromes =
etiol of most common

Back 104

40%

velocardiofacial,DiGeorge, conotruncal syndromes

microdeletions of chromnosome 22q

Front 105

most common syndrome associated with cleft lip and palate

Back 105

van der Woude

Front 106

cause of cleft nasal deformity

Back 106

lower lateral cartilage tilt not hypoplasia of the cartilage (ycawapop - this is wrong)

Front 107

incomplete cleft lips require the same surgical technique as a complet cleft lip

T/F

Back 107

True

Front 108

in wide unilateral cleft lip and palate agressive preoperative orthopedic manipulation has eliminated the need for preoperative lip adhsions

T/F

Back 108

True

Front 109

cause of retrusion under base of columella and recession of footplates of medial crura in bilateral cleft lip

Back 109

poor development of nasal spine

Front 110

major advantage of nasoaveolar molding (NAM)

Back 110

lengthen the columella

Front 111

when performing rotation or triangular flap in incomplete bilateral cleft lip, the procedure must be staged as opposed to the straight line repairs

T/F

Back 111

True

Front 112

def: primary palate

Back 112

lip, alveolus and anterior palate to the incisive foramen

Front 113

most important consideration in infant with isolated cleft palate

Back 113

Pierre Robin
Airway concerns

Front 114

very few patients with Pierre Robin will require intubation or tongue lip adhesion

T/F

Back 114

True

Front 115

cleft palate repair in Pierre Robin patients is delayed for several months

T/F

Back 115

True - airway concerns

Front 116

submucous cleft

incidence of VPI (velopharyngeal incompetence)

indicaiton for surgery

Back 116

15%

speech indcation of VPI

Front 117

timing of cleft palate repair to optimize speach production

Back 117

befroe 18 months

Front 118

frequency of palatal fistulas post hard palate repair

Back 118

5 - 155

Front 119

there is clear advantage of sphyncter palatoplasty over pharyngeal flap

Back 119

none documentat to date

Front 120

NAM is associate with a decrease in need for secondary alveolar bone grafting

T/F

Back 120

True

Front 121

secondary repair of a short upper lip (cleft lip repair) requires recreation of the complete defect

T/F

Back 121

True

Front 122

Best treatment of bilateral Cleft lip whistle deformity

Back 122

recreate central lip from lateral segments (ycawapop)

Front 123

how wide should one plan the phyltrum in bilateral cl lip repair

Back 123

5mm

Front 124

timing of maxillary reposition in relation to cleft rhynoplasty

Back 124

reposition maxilla first

Front 125

fusion of a solitary cranial suture does not result in neurologic impairment

T/F

Back 125

True

Front 126

deformities associated with synostosis of
metopic
sagital
unilat coronal
bialteral coronal

Back 126

metopic = trigonocephalaphy
sagital = schaphcepalaphy
unil coron = plagiocephalay
bilat coron = brachycephalaphy

Front 127

multiple cranial suture synostosis results in what % increase in intracranial pressure

Back 127

42%

Front 128

first cranial suture to fuse

Back 128

metopic - age 7-8 months

Front 129

cranial vault and brain growth are 85% complete by what age

Back 129

3 years

Front 130

saggital synostosis has what % geneic or familial presisposition

Back 130

2%

Front 131

difference between synostotic and deformational plagiocephaly

Back 131

ear position and malar position is normal in positional plagiocephaly

Front 132

mortality rates in cranial vault surgeries

Back 132

1.5 - 2 %

Front 133

etiology of cranial synostosis

Pfeiffer, Apert, Crouzon, Jackson-Weiss syndromes

Back 133

mutations in known FGFR (fibroblast groth factor receptor) genes

Front 134

Crouzon
genetic
sutures involved
maxillary growth
mandible growth
mental function

Back 134

autosomal dominent
coronal = most com. others involved

max growth inhibited
mandible growth = normal
normal

Front 135

Apert syndrome
genetic
suture involved
mental function

Back 135

sporadic
coronal = most common
mental retardation

Front 136

Pheiffer syndrome

hallmark of syndrome

Back 136

broad thumbs and great toes
craniofacial features similar to aperts

Front 137

Ssethre-Chotzen syndrome
preedominent features

Back 137

brachyceph skull
low-set hairline
ptosis of eyelids

Front 138

Carpenter syncrome

Back 138

assymetric head
partial syndactyly
preaxial polydactyly

Front 139

brain size change in1st year of life

Back 139

brain triples in size

Front 140

increased intracranial pressure in syndromic craniosynostosis

Back 140

higher than non syndromic
crouzon 66%
Apert 43%