Saturday, May 22, 2010

21-30 MCQ in Facial Plastic and Reconstructive Surgery

21-30

21) Which of the following surgical techniques used for cleft palate repair is REPRESENTED in the drawing below? Click the picture to enlarge image.



A. Von Langenbeck’s Palatoplasty
B. Three-Flap Palatoplasty
C. Two-Flap Palatoplasty
D. Furlow’s Palatoplasty
E. Four-Flap Palatoplasty

22) Which of the following scars is MOST likely to be well camouflaged?

A. 4 cm linear scar running perpendicular to the RSTL (relaxed skin tension lines)
B. 4 cm linear scar elevated and parallel to the RSTL
C. 4 cm linear scar depressed and parallel to the RSTL
D. 4 cm linear scar parallel to the RSTL without depression or elevation
E. 4 cm linear scar perpendicular to the lower eyelid edge

23) A 10-year-old boy has a linear vertical forehead scar extending from the hairline to the left eyebrow after facial trauma which occurred 1 year ago. Which is the MOST useful scar revision technique in this case?

A. Running W-plasty
B. Single W-plasty
C. Multiple Z-plasty
D. Single excision
E. Serial excision

24) Which is the following surgical techniques is BEST for reconstruction of a full-thickness defect involving 40% of the upper lip reaching the oral commisure?

A. Abbé flap
B. Estlander flap
C. Primary closure
D. Rhomboid flap
E. Nasolabial flap

25) Which of the following statements is TRUE about Millard technique for unilateral cleft lip repair?

A. Minimal tissue is discarded.
B. The suture line is not well camouflaged.
C. The alar base and nasal floor are difficult to reconstruct due to poor access to the nose.
D. The procedure will not allow alterations or adjustments during the operation.
E. Contraction of the vertical scar and/or notching of the vermilion is seldom encountered.

26) A patient is complaining of ear pain on the third postoperative day after an otoplastic procedure. Which of the following conditions is MOST likely the cause of the ear pain?

A. Hematoma
B. Infection
C. Wound dehiscence
D. Granuloma formation
E. Keloid formation

27) The satyr's ear (devil's ear) deformity is BEST treated with:

A. V-Y plasty
B. Z-Plasty
C. Interval intralesional injection with steroids
D. Excision and primary closure
E. Transposition flap

28) A-50-year-old female underwent rhytidectomy and blepharoplasty procedures with local anesthesia and I.V. sedation. The next day postop, less than 24 hours after the surgical procedure, the patient have noted to have a right-sided paralysis of the temporal branch of the facial nerve. The BEST immediate treatment is:

A. Immediate exploration and direct anastomosis without microscope assistance
B. Immediate reexploration and direct anastomosis with microscopic assistance
C. Corticosteroids
D. Corticosteroids and antiviral medications
E. Reassurance

29) The Z-Plasty INVOLVES:

A. An advancement flap
B. A rotation flap
C. A transposition flap
D. An interpolation flap
E. An interpolation and rotation flap

30) The MOST common complication of TRANSCONJUNTIVAL lower blepharoplasty is:

A. Inadequate fat excision
B. Excessive fat excision
C. Inferior oblique muscle injury
D. Eyelid malposition
E. Bleeding


ANSWERS & REFERENCES


21) D     Furlow’s Palatoplasty

Skykes J. M.: Diagnosis and Treatment of Cleft Lip and Palate Deformities, Chapter 65 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 824-828, 2002

Capone R. B., Sykes J. M.: Evaluation and Management of Cleft Lip and Palate Disorders in chapter 76, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 1059-1078, 2009

Davit III A. J., Otteson, Losee J. E.: Comprehensive Cleft Care, Chapter 103 in
Bailey's Head & Neck Surgery Otolaryngology, (Johnson J.T., Rosen C. A., editors), Volume one, Fifth edition, Wolters Kluwer / Lippincott Williams & Wilkins, 2014,  pp. 1556-1573
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22) D     4 cm linear scar parallel to the RSTL without depression or elevation

Wang T.: Scar Revision in Plastic Surgery Clinics of North America, Vol. 6 Number 2, pp. 137-138, May. 1998

Kokoska M. S., Thomas J.R.: Scar Revision in chapter 5, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 59-65, 2009

Regan Thomas J., Mobley S. R.: Scar Revision and Camouflage, chapter 21 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 295-301

23) A     Running W-plasty

Park S.: Scar Revision through W-Plasty in Plastic Surgery Clinics of North America, Vol. 6 Number 2, p. 160, May. 1998

Kokoska M. S., Thomas J.R.: Scar Revision in chapter 5, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 59-65, 2009

Regan Thomas J., Mobley S. R.: Scar Revision and Camouflage, chapter 21 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 295-301

24) B     Estlander flap

Cupp C. L., Larrabee, Jr.: Reconstruction of the lips, Operative Techniques in Otolaryngology-Head and Neck Surgery, Vol. 4. No. 1, March, pp. 46-53, 1993

Hooffmann J.F., Cook T.A.: Reconstruction of Facial Defects, Chapter 26 in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Schuller, editors), Second Edition, Mosby, Vol. 1, p. 445, 1993

Baker S. R.: Reconstruction of Facial Defects, chapter 24 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 342-363

25) A     Minimal tissue is discarded

Sykes J. M.: Diagnosis and Treatment of Cleft Lip and Palate Deformities in chapter 65, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 813-829, 2002

Bardach J., Salyer K.E.: Surgical Techniques in Cleft Lip and Palate, Mosby Second Edition, p. 9, 1991

Capone R. B., Sykes J. M.: Evaluation and Management of Cleft Lip and Palate Disorders in chapter 76, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 1059-1078, 2009

26) B     Infection

Nachlas N. E.:Otoplasty in chapter 27, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 309-321, 2002

Nachlas N.E: Otoplasty in chapter 34, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 421-433, 2009

Cheney M.L., Rounds M: Otoplasty in Facial Plastic Surgery Clinics of North America, Vol. 5 Number 4, p. 323 Nov. 1997

27) A     V-Y plasty

Perkins S., Dayan S.: Rhytidectomy in chapter 15 Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers p. 169, 2002

Perkins S., Naderi S.: Rhytidectomy in chapter 19, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 207-225, 2009

Baker S. R.: Rhytidectomy, chapter 28 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 404-427

28) E     Reassurance

Perkins S., Dayan S.: Rhytidectomy in chapter 15 Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, pp. 168-169, 2002

Perkins S., Naderi S.: Rhytidectomy in chapter 19, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 207-225, 2009

Baker S. R.: Rhytidectomy, chapter 28 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 404-427

29) C     A transposition flap

Kokoska M.S., Thomas J. Regan: Scar Revision in chapter 5 Facial Plastic and Reconstructive Surgery, second edition (Ira Papel, editor), Thieme Medical Publishers, p. 57, 2002

 Kokoska M. S., Thomas J.R.: Scar Revision in chapter 5, Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) p. 59-65, 2009

Regan Thomas J., Mobley S. R.: Scar Revision and Camouflage, chapter 21 in Cummings Otolaryngology Head and Neck Surgery, Fifth Edition, Volume one, Mosby Elsevier, 2010, pp. 295-301

30) A     Inadequate fat excision

Weinberg D.A., Baylis H. I.: Transconjuntival lower blepharoplasty in chapter 31 in Facial Plastic Surgery (Millet M.J., editor), Appleton & Lange, p. 306, 1997

Palmer FR 3rd, Rice DH, Churukian MM.: Transconjunctival blepharoplasty. Complications and their avoidance: a retrospective analysis and review of the literature, Arch Otolaryngol Head Neck Surg. 1993 Sep;119(9):993-9.

Korchia D, Braccini  F., Paris J, Thomassin JM: Transconjunctival approach in lower eyelid blepharoplasty,  Can J Plast Surg. 2003 Autumn; 11(3): 166–170.


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Updated: April 26, 2017

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