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224 Cards in this Set
- Front
- Back
What are the surgical options for repair of a proximal femur fx
|
FHO
Diverging K-wires Lag Screw |
|
Explain the approach to the femoral diaphysis
|
Craniolateral incision
Incise through fascia lata at cranial border of biceps femoris Retract biceps femoris caudally Retract vastus lateralis cranially |
|
What forces is an IM pin good for/bad for
|
Good for: bending forces
Bad for: axial (compression) |
|
What forces is an interlocking nail good for
|
All forces
Will not collapse |
|
Which diaphyseal fx repair methods can be dynamized
|
Interlocking nails
ESF |
|
What are the details for screw placement for an interlocking nail
|
Place screws 2cm away from fx
Try to use 4 screws total |
|
T/F: An IM pin is acceptable if there are multiple injuries
|
False
|
|
What surface is a 1a ESF placed on for radius/tibia
|
Craniomedial
|
|
What is the most common ESF used? the strongest?
|
common- II
strongest- III |
|
How often does the bandage have to be changed for ESF
|
Every day at first
Can eventually do weekly |
|
Who are supracondylar fx most common in
|
4-11mths
Usually d/t trauma |
|
How do you repair supracondylar fx
|
Cross-pinning
Make sure cross is at least 1cm above the fx site |
|
Where is the isthmus of the femur
|
The proximal 1/3
|
|
If there is a piece of metaphysis included in the supracondylar fx, what is its SH type
|
II
if only physis = type I |
|
What are axial pattern flaps based on
|
Direct cutaneous arteries (and often the nerves)
|
|
What does direct arterial supply allow axial patterns to do vs. local flaps
|
increased length of flap
cover larger defects flap across greater distances |
|
What areas is the Cd Superficial Epigastric Flap good for
|
Flank
Inner thigh Stifle Perineum/Preputial |
|
What is the survival rate for the Cd SupEpi Flap
|
Consistent survival if only the caudal 3 mammary glands included
Drops to <50% survival if include mammary gland 2 |
|
Where do you ligate the vessels for the reverse conduit flap
|
b/t the femoral artery/vein and the medial saphenous artery/vein
|
|
What vessels definitely have to be patent for the reverse conduit flap to work
|
Cr and Cd branches of perforating metatarsal artery
Use Doppler |
|
T/F: Place intradermal sutures in cases of reverse conduit flap
|
False; will only increase tension
|
|
What areas is the thoracodorsal flap good for
|
Shoulder
Forelimb Elbow Axilla Thorax |
|
What areas can you graft over? not graft over?
|
Yes: Muscle, Fascia, Granulation tissue
No: Tendon or Bone (blood supply not good enough) |
|
How long does it take new lymphatics to develop in the graft and establish drainage
|
4-5 days post-op
|
|
What is the first stage of graft healing and time frame
|
Plasmatic Imbibition
First 48hrs Fluid comes out of granulation bed and goes directly into the graft (via capillary action) |
|
What is the second stage of graft healing and time frame
|
Inosculation
Capillary anastomosis w/ granulation bed and cut vessels of graft 48-72hrs |
|
What is the third stage of graft healing and time frame
|
Neovascularization
72hrs+ Capillaries grow up into new areas of the graft, or into pre-existing vessels w/in the graft |
|
What are the reasons for graft failure
|
Movement- shear forces worst
Edema Hematomas Infection |
|
How often should the bandage be changed for grafts
|
Every 72hrs at first so movement does not disrupt
Then q 48hrs for 2 wks |
|
What are the advantages to meshing
|
Graft gets bigger
Can contour better esp where there is undulation in wound Alloes fluid escape so there is intimate contact b/t graft and tissue |
|
Why does the graft look bruised/hyperemic after 72hrs
|
Hgb product absorption
We want this to happen |
|
T/F: Head wounds can be grafted
|
False
|
|
What layers is the subdermal plexus deep to
|
SQ
Panniculus Cutaneous trunci |
|
T/F: When undermining, you should also get under the subdermal plexus
|
True
|
|
What are the pros/cons of relaxation incisions
|
Pros: can stretch and decrease tourniquet effects
Cons: decreases blood supply |
|
What is the difference b/t feline and canine granulation tissue
|
Feline is less vascular and takes longer to heal
|
|
What is the differencve b/t grafting in cats and dogs
|
Grafts (and flaps) take better in cats than in dogs
|
|
What are full thickness local flaps based on
|
Subdermal plexus
|
|
What are other names for full thickness local skin flaps
|
Subdermal Plexus flaps
Random pattern flaps |
|
Where are rotational flaps good for
|
Head/Neck, Perineum
|
|
What should you remember about measuring for a rotational flap
|
Make flap (arc) 4x length of defect to decrease tension
|
|
What is the rectangular 90degree flap called
|
Transposition flap
Measure w/ suture before cut |
|
What should you do about dog ears that develop when doing advancement flaps
|
Leave them alone
They will regress over time |
|
Who is the flank fold flap used mostly in
|
Cats
|
|
What is the most common cause of diaphragmatic hernia
|
Indirect trauma (i.e. HBC)
|
|
What criteria must be met for a diaphragmatic hernia to occur as the result of indirect trauma
|
Increase in abdominal pressure w/ open glottis
|
|
How many ribs have to be broken to have flail chest
|
More than 4 consecutive ribs
|
|
What percentage of DH cases are diagnosed >4wks after occurrence
|
20%
|
|
What are the signs of DH
|
Can range from no overt signs to severe resp compromise
|
|
What are the most common signs of DH
|
Dyspnea
Arrhythmias (12%) |
|
What are the most common rad changes seen w/ DH
|
97% incomplete diaphragmatic silhouette
61% air-filled SI loops Incomplete cardiac silhouette |
|
Which alternative techniques may have false negatives assoc'd (for dx of DH)
|
+ Contrast Celiography
Pneumoceliography |
|
What is the pre-op Mt rate for DH
|
15%
|
|
What is the Mt for DH cases taken to sx in first 24hrs
|
33%
(this is higher than the pre-op Mt rate for DH) |
|
When is DH a surgical emergency
|
If cannot stabilize resp fxn despite aggressive management (O2 cage and thoracocentesis)
|
|
Where should the incision for repair of DH extend to
|
From xiphoid to umbilicus
|
|
What are the most common organs herniated in DH (in order)
|
Liver
Stomach SI (jejunum) Spleen |
|
How should you work to repair a radial DH tear
|
From dorsal to ventral
|
|
What does free fluid in abd and liver congestion (on U/S) suggest in cases of DH
|
That you closed it too snugly around the vena cava
|
|
What is the first step in fixing a chronic hernia
|
Enlarge the defect
|
|
What is the #1 problem in cases of chronic hernias
|
Pulmonary reperfusion injury
|
|
What is the problem w/ adhesions in DH
|
Increases sx and anesthesia time
Luckily, does not occur often in dogs |
|
What is the most common complication after repair of DH
|
Pneumothorax (esp. if chronic and if adhesions)
|
|
What can you use if you are faced w/ a large DH defect (like those often seen w/ congenital hernias)
|
Regional Muscle Flaps
(from peritoneum, transverse abd muscle) Omentum Synthetic material (i.e. polypropylene mesh) |
|
What is the px for DH repair
|
52-88%
Best if survives first 12-24hrs post-op |
|
What are some reasons you could expect a worse px after DH repair
|
Arrhythmias (VPCs)
Re-expansion pulmonary edema Multi-organ failure Shock Hypoventilation |
|
Which is worse px: chronic or acute DH
|
chronic (assuming that by acute we mean stable acute)
|
|
What is PPDH a common result of
|
Intrauterine trauma
|
|
When should you perform hernia repair in a congenital case
|
8-16wks
Fewer adhesions present yet More pliable skin/muscle/sternum/rib cage |
|
T/F: All congenital hernias require repair
|
False
|
|
When should prophylactic Abx be used in cases of DH
|
If hepatic herniation
|
|
What is the px for congenital hernia after repair
|
Guarded
B/c: re-expansion pulmonary edema anesthesia other congenital defects (i.e. cardiac) |
|
What is one cause of primary peritonitis
|
FIP
Primary is usually d/t IC |
|
What is the px for primary peritonitis
|
Poor
|
|
What is secondary peritonitis usually d/t
|
Bacteria (coliform or enteric, esp.)
|
|
What is the most common etiology of peritonitis
|
GI
Followed by U/G (often bladder rupture) |
|
What is the most common cause of uroabd in cat and dog
|
Cat- urethra
Dog- bladder |
|
When is blood/bile in abdomen an emergency
|
Only if also w/ bacteria causing increased inflamm response and Mb
|
|
What is local peritonitis often d/t
|
FB like sponge left in, trying to be walled off
|
|
How does the px for generalized peritonitis differ from local
|
Generalized has worse px (systemic signs)
|
|
What is the most common cause of chemical peritonitis
|
Uroabdomen
|
|
How often is GI neoplasia the cause of peritonitis
|
Rarely
|
|
When do you do sx for peritonitis d/t GI neoplasia
|
Only if obstructed
Histamine and Heparin present will impair wound healing and likely cause dehiscence |
|
True/False: Abdominal trauma, if the cause of peritonitis, has to have occurred recently
|
False
|
|
What are some of the more common signs of peritonitis
|
Fever >103
Generalized pain (can be local, but general more often) Shock |
|
What do rads show in cases of peritonitis
|
Loss of abd detail
Maybe free air, obstructed pattern, linear FB/plication |
|
When should sx-induced abd free air be gone
|
By 6wks post-op
|
|
What is the #1 tool in referral setting for dx of peritonitis
|
U/S
|
|
What are the common lab findings in peritonitis
|
Marked leukocytosis (>40,000)
Anemia/Hypoproteinemia E-lyte imbalance |
|
What is the most useful diagnostic in most settings for peritonitis
|
Abdominocentesis
|
|
When should DPL be done
|
Only after failure of response to aggressive medical management, or when there is non-diagnostic or negative abdominocentesis findings despite your great suspicion of peritonitis
|
|
How Se is DPL for peritonitis
|
95% Se
|
|
What should always be done w/ the fluid obtained from abdominocentesis/DPL
|
Cytology
Look for degenerate neutros and I/C bacteria |
|
Besides cytology, what is also a helpful test to run on abd fluid in cases of suspected peritonitis
|
Creatinine (to see if might be uroabdomen)
|
|
What should you do for medical management of peritonitis
|
Fluids 90 mL/kg/hr
Correct electrolytes Broad-spectrum Abx (single drug most common now; cephazolin, for example) |
|
What are some controversial txs for peritonitis
|
Low Dose Hep- for DIC
Steroids- for septicemia Banamine- for septicemia (but worry about renal fxn and GI ulcers) |
|
What type of nutritional support is best in cases of peritonitis
|
Combo of enteral and parenteral
|
|
What are the most impt facets of surgical management of peritonitis
|
Find/Stop Contamination
Vigorous lavage w/ saline (ONLY) |
|
When is open peritoneal drainage recommended
|
Cannot stop source of contam
Anaerobic infection Colonic rupture |
|
What are the advantages of open peritoneal drainage
|
Improved drainage
Access for inspection of abd Increased O2 tension (improves macrophage and neutro fxn) Decreased bacterial counts Decreased adhesions/abscesses |
|
What are the disadvantages of open peritoneal drainage
|
Hypoproteinemia
Evisceration Cost (lots of bandage changes) Nursing Care |
|
What is the px for peritonitis
|
Guarded (Mt 20-67%)
Worse for open peritoneal drainage, but these cases are worse anyway |
|
What are the three fxns of the patella
|
Modifies direction of pull of extensor muscles (quadriceps mechanism- vastuses and rectus femoris)
Acts as lever arm Provides cranial and rotational stability to the stifle |
|
What holds the patella in the femoral trochlea
|
Lateral Fascia Lata
Medial Femoral Fascia Med/Lat Retinaculum |
|
What percentage of patellar luxations are medial
|
75-80%
|
|
What percentage of patellar luxations are bilateral? also have CCL rupture?
|
Bilateral- 25%
CCL concurrently- 15-20% |
|
How are the distal femur, proximal tibia, and distal tibia affected by luxating patella
|
Distal femur- lateral bowing
Proximal tibia- medial bowing Distal tibia- lateral torsion |
|
T/F: Some grades of patellar luxation are non-wt bearing
|
False
Even grade 4 usually bears wt |
|
What Grade of luxation can be luxated, but manipulation of limb puts it back
|
2
|
|
What kind of lameness do you see w/ Grade 3 luxation
|
Occasional skipping to weight bearing lameness
|
|
What view is best for visualization of the femoral trochlea
|
sky-line
|
|
What are the DDx for patellar luxation
|
Hip things- LCP, coxofemoral luxation, HD
CCL rupture Ligamentous/Muscle strain |
|
Who is conservative management of luxation appropriate for
|
Grade 1-2
Likely, older, asymptomatic patients |
|
Where does the patellar ligament insert
|
Tibial crest
|
|
How can you affix the tibial crest after you have transposed it in a TTT
|
K wires
Tension Band |
|
What is done more often: sulcoplasty or recessions
|
Recessions
|
|
Why is sulcoplasty less than ideal for luxation remedy
|
You are counting on scar tissue/fibrocartilage to fill in your created articular cartilage/subchondral bone defect (which is not as resilient as articular cartilage)
|
|
Who is chondroplasty appropriate for
|
Those <5mths old
Elevate cartilage, remove subchondral bone, and then lay cartilage back down |
|
What is the advantage of block recession, as compared to wedge
|
Greater resistance to luxation when stifle in extension (takes out more surface area of trochlear notch)
|
|
Which side is retinacular release done on
|
The side of the luxation (i.e. medial for medial luxation)
Incise into fascia +/- jt capsule |
|
Which side is retinacular imbrication done on
|
The side opposite of the luxation (i.e. lateral side for medial luxation)
|
|
What is the post-op care for patellar luxation sx
|
MRJ bandage for 1-2 days
NSAIDs Hot/Cold compresses 5-7d Restricted exercise 1mth PT/Rehab for 1st 6wks Rads at 6-8wks |
|
How do you deal w/ over/under correction for patellar luxation
|
May need to redo sx, if still clinical
|
|
How often does wound dehiscence occur in cases of patellar luxation
|
Not often
|
|
What is the px after sx for patellar luxation
|
Good for grades 0-3
Guarded for grade 4 |
|
Can animals affected w/ luxated patellas be bred
|
Should not be
|
|
What is the basic abnormality in patellar luxation
|
Biomechanical
|
|
When can you deepen the trochlear groove w/o realigning the quads
|
Never
It WILL fail ST techniques alone will NOT prevent reluxation |
|
Why can CCL rupture be a sequela to patellar luxation
|
Loss of cranial stability of stifle makes it more likely
|
|
What is the most common cause of abdominal trauma
|
HBC
Animal bite is second most common |
|
Is free abdominal air an emergency
|
Yes (unless had recent sx, and then it is harder to tell)
|
|
Do you need sedation for DPL
|
Yes
|
|
What might you see on abd fluid cytology if there is a ruptured hollow viscous organ
|
I/C bacteria
Vegetative material |
|
Is uroabdomen a surgical emergency
|
No
Use aggressive fluids to diurese and lower K+ |
|
When might a patient develop signs of biliary rupture
|
May not be until 4-6 weeks after rupture
|
|
When is biliary rupture an emergency
|
If there is bacteria
|
|
What is the only reason you should take a hemoabdomen to surgery
|
Unable to stabilize despite aggressive management
|
|
When is a ruptured hollow viscous an emergency
|
Always
Could cause sepsis |
|
Where do most abd wall hernias occur
|
Caudal abdomen
|
|
What is the most frequent penetrating wound
|
Gunshot
Mandatory exploration, unless in chest |
|
Who is conservative therapy for (abd trauma)
|
Hemoabdomen
|
|
Who should you stabilize, and then go to sx with (abd)
|
Uroabdomen
Hernias |
|
Who is emergency sx indicated for (abd)
|
Ruptured hollow viscous
Non-responsive to medical mgmt |
|
What are the 3 fxns of the CCL
|
Limits cranial translation of tibia w/ respect to femur
Prevents hyperextension of stifle jt Limits internal rotation of tibia (does not eliminate, but limits) |
|
Why is it impt to test the CCL in extension and flexion
|
If caudolateral still intact, you might not get drawer in extension
|
|
What are the 3 reasons for doing sx for CCL rupture
|
Remove damaged/abnormal tissues since ends can incite inflammation
Stabilize for periarticular fibrosis or provide fxnl stability Retard/Prevent SEVERE DJD |
|
What movement of the stifle occurs in the X direction? Y direction?
|
X- flexion/extension
Y- axial rotation |
|
Why must you test for drawer as you tighten Lateral Retinacular Stabilization suture
|
If too tight, you will have leg stuck in flexion
|
|
How does a TPLO work
|
Neutralizes tibiofemoral shear forces
Corrects slope so thrust does not occur |
|
T/F: With TPLO, TWO, and TTA you may still have drawer after sx
|
True
|
|
What side do you do the arthrotomy on for TPLO
|
Medial (will plate on the medial side of the tibia)
|
|
What are 2 advantages of TWO over TPLO
|
Less equipment needed
Avoids working near joint |
|
What is the goal of a TTA
|
Change angle of patellar ligament to be perpendicular to tibial plateau
|
|
What angle should rads be taken at for TTA
|
135 degrees
|
|
Which procedure for CCL do you need to use bone graft
|
TTA
|
|
What are some problems assoc'd w/ Lateral Suture for CCL
|
Draining tract b/c non-absorbable suture
Wire-breakage (don't use any wire or anything braided) Instability |
|
T/F: The Cd CL is fixed in the same ways
|
False
Usually just fix whatever else is wrong w/ the joint |
|
What parts can be used for intracapsular reconstruction of CCL
|
Part of patellar ligament OR fascia lata
|
|
T/F: Suture used for CCL Lateral Suture eventually disappears
|
True
|
|
Which meniscus is more commonly damaged? Why?
|
Caudal pole of medial meniscus
Lateral meniscus is attached to the femur, so it moves w/ it |
|
Where are most injuries w/in the medial meniscus
|
Within the inner 75% (where there is no blood supply)
|
|
What percent of CCL dogs will rupture the other side w/in 2yrs
|
30-40%
|
|
Are rads needed for intracapsular methods
|
No
Only for the osteotomies, and are done at 6-8wks post-op |
|
What percentage of CCL dogs improve after sx
|
85-90%
|
|
When would you elect to perform a complete or partial meniscectomy
|
When the meniscus is damaged
|
|
What is the minumum O2 tension needed for wound healing
|
30mmHg
|
|
What is the best adjunct we can do to help w/ wound healing
|
Debridement, in the form of hydrotherapy (10-15psi)
|
|
How can you achieve 10-15psi
|
16G needle on 20mL syringe
|
|
T/F: Hydrotherapy must be done under general anesthesia or at least heavy sedation
|
True
|
|
What is the simplest mechanical adjunct we can use to get a wound to heal
|
Undermining to take advantage of viscoelastic properties of the skin
|
|
What is stress-relaxation
|
Reduced force that is eventually needed to hold skin closed over time and maintain stretched collagen
|
|
What is mechanical creep
|
Ability of skin to expand past its normal inherent elasticity
|
|
What is the most impt skin layer to preserve in sx
|
Subdermal plexus (has tenuous blood supply)
|
|
How does externally stretching the skin help
|
Displaces fluid around collagen to get collagen to rearrange longitudinally to tension
If done right, wound can close in 3 days! |
|
What are 2 advantages to external skin stretching
|
Can keep observing the wound to make sure it is healthy
Decreases tension |
|
When can external skin stretching be employed
|
Pre and Post Op
|
|
When is Ioban Banding done
|
Post-op
Relieves tension and protects wound |
|
What are some complications w/ the button method of stretching skin
|
If one suture pulls out, the whole line fails
Contamination Old/Thick, unhealthy, or infected skin does not hold sutures well |
|
What sort of suture do you use for skin stretching w/ button
|
Non-absorbable
|
|
What is the maximum tension of a sure closure device (SCD)
|
2.5kg
|
|
How quickly can a 15cm wound be closed w/ DermaClose RC
|
24hrs
|
|
What is DermaClose RC
|
Equipment that uses tension controller and tension wire to sense when then skin has relaxed enough for it to tighten further (via clutch) to bring edges closer together
|
|
T/F: Vacuum Assisted Closure can be used on big wounds
|
True
|
|
What is the purpose of the open-cell polyurethane ether foam in VAC
|
Allows maximal tissue ingrowth, and stimulates granulation tissue
|
|
How far should the cover foam adhesive drape extend
|
5cm overlap into healthy tissue
|
|
What are the C/I for VAC
|
Untreated osteomyelitis
Malignancy in the wound Over exposed BVs/organs Non-enteric and unexplored fistula Necrotic tissue w/ eschar F OMEN |
|
How often should the VAC dressing be changed in a clean wound? contaminated?
|
Clean- q 48hrs w/ sedation
Contam- q24hrs and do 2nd debridement |
|
What are the advantages of VAC
|
Controlled, closed wound now
Removes edema to increase vasc/lymph flow Increased proteolytic enzyme release Increased bacterial clearance Increased granulation tissue (mechanical stress/creep) Early wound prep Fewer dressing changes Bolster for skin grafts in difficult areas Increases survival of random flaps |
|
T/F: Facial n. paraysis may resolve after sx
|
False
|
|
Which compartment of the feline bulla do you enter
|
Ventromedial
|
|
Where is the vestibular apparatus in regards to the bullae
|
Dorsomedial
|
|
Where does the facial nerve exit
|
Stylomastoid foramen
|
|
What artery supplies the pinna
|
Cd Auricular Artery
|
|
What are the sensory and motor nerves to the ear
|
Sensory- Vagus
Motor- Facial |
|
What ear procedure whould always be done w/ TECA? Why?
|
Lateral bulla osteotomy
Removes rest of epithelial lining |
|
Why are lateral ear canal resections done
|
To change the microenvironment of ear
Will still have to clean ears |
|
What part of the ear is used as the drain board for lateral ear canal resection
|
Part of vertical canal
|
|
T/F: Lateral ear canal resection can be used a prophylactic sx in young
|
True
|
|
What are the indications for lateral ear canal resection
|
Chronic otitis externa (uncomplicated)
Polyp, etc. confined to vertical Minimal hyperplasia |
|
What are the C/I for lateral ear canal resection
|
End stage otitis externa
Stenosis of horizontal canal |
|
What do you do if there is incisional dehiscence of a lateral ear canal resection sx
|
Do not redo sx
Culture and give Abx Manage as open wound |
|
What are some complications of lateral ear canal resection
|
Continued otitis
Stenosis Incisional dehiscence-25% |
|
What are the indications for TECA
|
Chronic otitis
Calcified ear canal Neoplasia Trauma/Avulsion at annular cartilage |
|
When should the ear be bx'd in TECA
|
ALWAYS
send the entire ear Do C&S for Abx |
|
What is the most impt technical aspect of the TECA
|
Stay close to the cartilage
|
|
How should the horizontal canal be transected in TECA
|
Caudal to cranial to avoid cutting facial nerve
|
|
What level is the annular cartilage at
|
The level of the stylomastoid foramen
|
|
What structures do you need to protect when doing a bulla osteotomy
|
Use freer elevators to protect:
Facial nerve caudally Retroarticular v. cranially |
|
What direction do you need to avoid while curetting in bulla osteotomy
|
Don't go dorsomedial (semi-circular canals)
|
|
When should you place a drain in TECA
|
Only if abscess
|
|
Why is it so impt to remember to lube the eyes after TECA
|
All patients will have some facial n. palsy w/ palpebral n. fxn diminished
|
|
What is the #1 complication of TECA
|
Facial nerve palsy (lip droop, absent palpebral)
|
|
What are #2 and #3 complications of TECA
|
Incisional dehiscence
Inner ear damage |
|
What do you do if there is a fistulous tract from a previous TECA
|
Do VENTRAL bulla osteotomy
|
|
How often is Horner's permanent in cats after TECA
|
14%
|
|
Who do ear polyps occur in, mostly
|
Young cats (<2)
If mid-old age, more likely tumor |
|
Where are most polyps
|
In tympanic cavity
|
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What are the best views for evaluating bulla
|
Open mouth rostro-caudal
Lateral |
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What is the recurrence rate for polyps if do traction avulsion
|
50%
|
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What is the only definitive cure for polyps
|
Ventral bulla osteotomy (recurrence <2%)
|
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What nerve should you be very careful to avoid when doing ventral bulla osteotomy
|
Hypoglossal
|
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Why is CT/MRI impt in cases of suspected ear neoplasia
|
To see if invaded through horizontal/vertical canal
Correlates w/ survival time |
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When should ear masses be bx'd
|
Always
Unilateral dz suggests neoplasia possible |
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What is Bowen's dz
|
Multicentric SCC
not related to UV Excision is curative Occurs on haired, pigmented areas |