301-310 MCQ in Facial Plastic and Reconstructive Surgery

301-310

301) The arrow indicates a third molar tooth in an adult mandible. According to the UNIVERSAL NUMBER SYSTEM (ADA) this tooth is number: Click the picture to enlarge image.
A. 1
B. 9
C. 16
D. 17
E. 32

302) A 6 year-old patient is complaining of ear pain 10 hours after the otoplasty surgery. What is the MOST likely diagnosis?

A. Skin necrosis
B. Herpes infection
C. Hematoma
D. Would dehiscence
E. Granuloma formation

303) A mandibular symphysis fracture is usually associated with:

A. Coronoid fracture
B. Condyle fracture
C. Ramus fracture
D. Angle
E. Body

304) Which of the following statements IS FALSE regarding Tension Band Principles applied to a mandibular fracture (dentulous area)?

A. A tension band must overcome the distracting forces at the alveolar border.
B. An arch bar can be used as a tension band.
C. Ivy loops are a good alternative to a tension band.
D. Bicortical fixation plates are ideal as a tension band.
E. A miniplate can be used as a tension band in any mandibular fracture.

305) Which of the following statements regarding mandibular fractures is TRUE?

A. Lag screws are contraindicated in a symphysis fracture.
B. A dynamic compression plate (DCP) is adequate for the treatment of a symphysis fracture.
C. Almost all fractures of the angle are unfavorable.
D. Rigid Fixation of the mandible involves the use of arch bars with inderdental wiring fixation.
E. The use of eccentric dynamic compression plates (EDCP) will not obviate the need for a tension band.

306) Which of the following statements is TRUE in cutaneous malignancies?

A. Squamous cell carcinoma is the most common type of skin cancer.
B. Actinic keratosis is the most common precursor of squamous cell carcinoma.
C. Nodular basal cell carcinoma has ill-defined borders which can not be detected clinically.
D. Cystic basal cell carcinoma has a tendency to spread at embryonic fusion planes.
E. 5-fluorouracil cream is the ideal management for basal cell carcinomas with well defined borders and less than 1 cm in diameter.

307) Which of the following treatments for actinic keratosis is INCORRECT?

A. Superficial shave excision
B. Cryotherapy
C. Trichloracetic acid peeling
D. 5-fluorouracil
E. Radiation therapy

308) Which of the following statements regarding nasal reconstruction is TRUE?

A. Placement of incisions for local flaps across aesthetic units maximizes the cosmetic result.
B. There are eight aesthetic units in the nose.
C. The lobule has thick sebaceous skin.
D. The skin of the dorsum is more thick and sebaceous than that of the lobule.
E. The structural support of the ala is provided by the lower lateral cartilages.

309) A patient has a partial thickness defect of approximately 12 mm in the right nasal ala after Mohs' microsurgery for a basal cell carcinoma. The patient has thin nasal skin with poor laxity. Which of the following reconstructive techniques is the BEST in this particular case?

A. Secondary intention
B. Full thickness skin graft
C. Full thickness skin graft after granulation tissue is formed in the surgical bed
D. Nasolabial flap
E. Bilobed Flap

310) Which of the following statements is TRUE about external nasal subunits?

A. Any subunit defect greater than 30% should be enlarged to occupy the entire subunit.
B. The ala refers to the skin and soft tissue overlying the lateral crura of the lower lateral cartilages.
C. The tip-defining point indicates the base of the soft triangle of the nose.
D. The lobule is covered by thin sebaceous skin.
E. The sill comprises the most posterior aspect of the nostril rim.




ANSWERS & REFERENCES


301) D     17


Best J.A., Lewis J.S.: Management Dentoalveolar Injuries in the Facial Trauma Patient, in Facial Trauma: Primary and Secondary Repair, Otolaryngologic Clinics of North America, Saunders, Vol. 6, Number 4, p. 432, 1998

302) C     Hematoma

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

http://emedicine.medscape.com/article/1290275-treatment

303) B     Condyle fracture

Garza J. R.: Mandibular Fractures, Chapter 61 in Facial Plastic and Reconstructive Surgery, Thieme, Second Edition, pp. 776-777, 2002

Garza J. R.: Mandibular Fractures, Chapter 72 in Facial Plastic and Reconstructive Surgery, Thieme, Third Edition, pp. 1001-1015, 2009

304) D     Bicortical fixation plates are ideal as a tension band.

Garza J. R.: Mandibular Fractures, Chapter 61 in Facial Plastic and Reconstructive Surgery, Thieme, Second Edition, pp. 776-777, 2002

Garza J. R.: Mandibular Fractures, Chapter 72 in Facial Plastic and Reconstructive Surgery, Thieme, Third Edition, pp. 1001-1015, 2009

305) C     Almost all fractures of the angle are unfavorable.

Garza J. R.: Mandibular Fractures, Chapter 61 in Facial Plastic and Reconstructive Surgery, Thieme, Second Edition, pp. 776-777, 2002

Garza J. R.: Mandibular Fractures, Chapter 72 in Facial Plastic and Reconstructive Surgery, Thieme, Edition, pp. 1001-1015, 2009

306) B     Actinic keratosis is the most common precursor of squamous cell carcinoma.

Hendrix J. D., Slingluff C. L.: Cutaneous Malignancies: Diagnosis and Treatment in Chapter 42 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, pp.485-493, 2002

Hendrix J. D., Slingluff C. L.: Cutaneous Malignancies: Diagnosis and Treatment in Chapter 52 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, pp. 675-702, 2009

307) E     Radiation therapy

Stucker J. F., Nathan C.O., Lian T. S.: Cutaneous Malignancy, Chapter 103, Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, 2001, pp. 1226-1227

Stucker J. F., Nathan C.O., Lian T. S.: Cutaneous Malignancy, Chapter 105, Head and Neck Surgery-Otolaryngology (Bailey), 4th Edition, Lippincott Williams & Wilkins, 2006, pp. 1455-1468

308) C     The lobule has thick sebaceous skin.

Baker Shan: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 601-602, 2002

Baker Shan: Major Nasal Reconstruction, Chapter 59 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 807-820, 2009

309) D     Nasolabial flap

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, pp.45-47

Baker Shan: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 601-602, 2002

Baker Shan: Major Nasal Reconstruction, Chapter 59 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 807-820, 2009

310) E     The sill comprises the most posterior aspect of the nostril rim.

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, pp.19-22

Kim D. W., Mau T.: Surgical Anatomy of the Nose, Chapter 170, Head and Neck Surgery-Otolaryngology (Bailey), 4th Edition, Lippincott Williams & Wilkins, 2006, pp. 2511-2531

--------------------------------------
Updated:  June 1, 2017

311-320 MCQ in Facial Plastic and Reconstructive Surgery

311-320

311) Which of the following basal cell carcinoma lesions represented in the drawing below has the LEAST possibility of recurrence? Click the picture to enlarge image.

A. A
B. B
C. C
D. D
E. E

312) Which of the following is considered a MAJOR TIP support mechanism in rhinoplasty?

A. Membranous septum
B. Anterior and posterior nasal spine
C. Attachment of the sesamoid cartilage complex to the pyriform aperture
D. Attachment of LLC (lower lateral cartilage) to S-STE (skin-soft tissue envelope)
E. Attachment of the ULC (upper lateral cartilage) to the LLC (lower lateral cartilage)

313) Which of the following radiographic views is THE IDEAL for visualization of dentoalveolar structures?

A. CT
B. Panorex
C. Lateral skull films
D. Anteroposterior skull films
E. Towne

314) What is the time limit that will allow the surgeon to utilize the nerve stimulator intraoperatively to assist in the identification of distal branches of a severed facial nerve?

A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours
E. 72 hours

315) Which of the following mandibular fracture managements is the one MOST USEFUL in the reparation of comminuted mandibular body fracture with traumatic bone loss?

A. Maxillomandibular fixation (MMF)
B. Multiple miniplates
C. Dynamic compression plates (DCP)
D. Eccentric Dynamic compressing plates (EDCP)
E. Mandibular Reconstruction Plates (MRP)

316) Which of the following statements regarding the Zitelli modified bilobe flap is TRUE?

A. Uses narrow angles (60 degrees) between lobes
B. Best used to repair skin defects of the upper third of the nose
C. Is elevated in the subdermal plane
D. Reduces the pin cushion effect in the nasal skin
E. Base usually positioned medially

317) Which of the following nasal subunits has a thick, immobile and sebaceous skin?

A. The lobule
B. The dorsum
C. The sidewall
D. The ala
E. The columella

318) Which of the following donor areas for “full-thickness skin graft” is the BEST to cover a superficial defect in the cephalic aspect of the nose?

A. Preauricular
B. Postauricular
C. Supraclavicular
D. Submental
E. Eyelid

319) Which of the following reconstructive techniques is the BEST for a surface nasal defect involving the columella and lobule?

A. Secondary intention
B. Bilobed flap of the dorsum
C. Rhomboid flap of the dorsum
D. Full thickness skin graft
E. Paramedian forehead flap

320) The number of aesthetic units of the nose is:

A. 5
B. 6
C. 7
D. 8
E. 9


ANSWERS & REFERENCES



311) E     E


Stucker F.J., Nathan C.O., Lian T. S.: Cutaneous Malignancy, Chapter 105 in Head and Neck-Otolaryngology (Bailey B., editor), Lippincott Williams & Wilkins, 4th Edition, 2006, pp. 1455-1468

312) E     Attachment of the ULC (upper lateral cartilage) to the LLC (lower lateral cartilage)

Larrabee, Jr., W. F.: Open Rhinoplasty and the Upper Third of the Nose, Open Rhinoplasty, in Facial Plastic Surgery Clinics of North America, Volume 1, Number 1 August 1993, pp. 23-30

313) B     Panorex

Best J.A., Lewis J.S.: Management Dentoalveolar Injuries in the Facial Trauma Patient, in Facial Trauma: Primary and Secondary Repair, Otolaryngologic Clinics of North America, Saunders, Vol. 6, Number 4, pp. 436-437, 1998

314) E     72 hours

Holt G. R.: Acute Soft Tissue Injuries of the Face, Chapter 54 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p. 692, 2002

Stallworth C. L., Holt G. R.: Acute Soft Tissue Injuries of the Face, Chapter 65 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, pp. 907-918, 2009

315) E     Mandibular Reconstruction Plates (MRP)

Kellman R. M.: Clinical Applications of Bone Plating Systems to Facial Fractures, Chapter 57 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 727-729, 2002

Costantino P. D., Tadros M., Wolpoe M.: Principles of Facial Plating Systems, Chapter 67 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 929-944, 2009

316) D     Reduces the pin cushion effect in the nasal skin

Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 606-607, 2002

Baker S.: Major Nasal Reconstruction, Chapter 59 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 807-820, 2009

317) A      The lobule

Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 610-611, 2002

Baker S.: Major Nasal Reconstruction, Chapter 59 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 807-820, 2009

318) A     Preauricular

Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 610-611, 2002

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, pp.34-35

319) E     Paramedian forehead flap

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, pp.40-52

320) E     9


Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p.p. 610-611, 2002

Baker S.: Major Nasal Reconstruction, Chapter 59 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 807-820, 2009

-------------------------------------
Updated: June 1, 2017

321-330 MCQ in Facial Plastic and Reconstructive Surgery

321-330

321) Which of the following statements is TRUE regarding the Bilobed Flap seen in the drawing below? Click the picture to enlarge image.

A. It has a total rotation angle of approximately 180 degrees.
B. It is suitable for tip and columella defects.
C. Its major advantage is less pin-cushioning compared its counterpart.
D. The tissue undermining is only in the subdermal plane.
E. It will leave circular scars that will blend easily with nasal subunits.

322) When is an elective otoplasty MOST commonly performed?

A. At 4 years of age
B. At 6 years of age
C. At 9 years of age
D. At 12 years of age
E. At 18 years of age

323) Which of following statements regarding facial flaps survival is FALSE?

A. Delaying the flap involves incising the borders and leaving it “in situ” for 2 weeks.
B. Hyperbaric oxygen has a proven beneficial effect on facial flaps with arterial ischemia.
C. Most common vascular problems in facial flaps are due to congestion.
D. Medicinal leeches are beneficial when arterial ischemia is present.
E. Hyperbaric oxygen has a proven beneficial effect on congested facial flaps.

324) Which of following aesthetic nasal subunits is BEST resurfaced using a melolabial interpolation flap?

A. Lobule
B. Ala
C. Dorsum
D. Sidewall
E. Columella

325) Which of the following statements is the MOST appropriate from a mature and responsible patient with realistic expectations?

A. My nose is too big, I would like it to be smaller.
B. I trust you. Anything that you feel necessary is fine with me.
C. My wife wants me to have surgery to improve the appearance of my nose.
D. I trust you. You are the greatest plastic surgeon in town.
E. I want the surgery to be performed prior to my wedding.

326) Which of the following operative techniques is NOT useful in order to correct nasal valve collapse (widen the valve angle)?

A. Spreader Grafts
B. Flaring Sutures
C. Butterfly Grafts
D. Internal Dermal Grafts
E. Allar Battens Grafts

327) The MOST common cause of a “twisted” nose is?

A. Trauma
B. Iatrogenic
C. Congenital
D. Cocaine use
E. Infection

328) Which area of the nose is IDEAL for Alloplastic Implant placement?

A. Tip
B. Dorsum
C. Ala
D. Sill
E. Columella

329) A 21 year old male patient has a significant "S" shaped naso-septal deformity due to a motor vehicle accident. There is displacement of nasal bones, upper lateral cartilages and septum. Which of the following is the LEAST useful in order to correct the problem?

A. Septoplasty technique using the external approach
B. Use of bilateral spreader cartilage grafts
C. Use of bilateral septo-mucoperichondral elevation
D. Evaluation of the internal nasal valve preoperatively
E. Killian, hemitransfixion and closed approach

330) Which of the following metallic implants is the BEST tolerated and has the greatest MRI compatibility?

A. Stainless steel
B. Vitalium
C. Titanium
D. Cobalt
E. Nickel

ANSWERS & REFERENCES


321) C     Its major advantage is less pin-cushioning compared its counterpart.

Park S.S.: Local and Regional Cutaneous Flaps, Chapter 44, in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 539-540, 2002

Park S.S.: Local and Regional Cutaneous Flaps, Chapter 54, in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 721-743, 2009

322) B     At 6 years of age

Cheney M.L., Rounds M: Otoplasty in Facial Plastic Surgery Clinics of North America, Vol. 5 Number 4, p. 319, Nov. 1997

http://emedicine.medscape.com/article/1290275-overview

http://emedicine.medscape.com/article/839886-overview

323) D     Medicinal leeches are beneficial when arterial ischemia is present.

Park S.S.: Local and Regional Cutaneous Flaps, Chapter 44, in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 539-540, 2002

Park S.S.: Local and Regional Cutaneous Flaps, Chapter 54, in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 721-743, 2009

324) B     Ala

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, pp.40

Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, 2002, p.p. 611-612

325) A     My nose is too big, I would like it to be smaller.

Holt G. R.: Septorhinoplasty, Form Versus Function, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 8-14

326) D     Internal Dermal Grafts

Schlosser R. J., Park S. S.: Functional Nasal Surgery, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 42-49

Papel I. D.: Surgery of the Middle Vault, Chapter 43 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, 2009, p.p. 555-561

327) A     Trauma

Terkonda R. P., Sykes J. M.: Repairing the Twisted Nose, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 53-54

328) B     Dorsum

Lovice D. B., Mingrone M.D., Toriumi D. M: Grafts and Implants in Rhinoplasty and Nasal Reconstruction, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 123-126

329) E     Killian, hemitransfixion and closed approach

Keefe M. A., Cupp C.L.: The Septum in Rhinoplasty, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 15-36

330) C     Titanium

Holt G. R.: Grafts and Implants in Facial, Head and Neck Surgery, Chapter 160, Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, 2001, pp. 2023-2024

Holt G. R.: Grafts and Implants in Facial, Head and Neck Surgery, Chapter 160, Head and Neck Surgery-Otolaryngology (Bailey), 4th Edition, Lippincott Williams & Wilkins, 2006, pp. 2345-2356

-------------------------------------
Updated: June 1, 2017

331-340 MCQ in Facial Plastic and Reconstructive Surgery

331-340

331) Which of the following surgical options is the ONE represented in the drawing below? Click the picture to enlarge image

A. Gilles Flap
B. Estlander flap
C. Karapandzic flap
D. Abbé flap
E. Bernard-Burrow flap

332) Which of the following postoperative Blepharoplasty instructions is INCORRECT?

A. Sleep on your back with the head elevated.
B. Take acetaminophen if needed.
C. Avoid lifting or straining for 3 weeks.
D. Apply occlusive dressing over the eyes for the first 24 hours.
E. Discomfort is common, pain is unusual.

333) Which of the following managements is the BEST for isolated fractures of the coronoid process of the mandible?

A. Analgesics and follow-up
B. Maxillomandibular fixation (MMF)
C. Miniplates
D. Microplates
E. Dynamic compression plate (two-holes)

334) Which of the following suture materials will produce LESS tissue reaction when used on the face?

A. Chromic catgut
B. Vicryl
C. Silk
D. Nylon
E. Prolene

335) Which of the following complications is the LEAST common in Blepharoplasty?

A. Hematoma
B. Lagophthalmos
C. Ectropion
D. Diplopia
E. Eyelid skin necrosis

336) Which of the following nasal skin defects is BEST reconstructed with skin of the ear lobule?

A. Sidewall
B. Columella
C. Soft triangle
D. Lobule
E. Dorsum

337) Which of the following statements about nasal anatomy is FALSE?

A. The lateral crus is the largest component of the nasal lobule.
B. The lobule is subdivided into tip, supratip and infratip.
C. The domes are 3 mm caudal and 8 mm anterior to the anterior septal angle.
D. The supratip defines the inferior limit of the nasal dorsum.
E. The marginal incision follows the caudal edge of the lower lateral cartilage.

338) The FIRST STEP in the management of intraorbital hemorrhage is?

A. Reassure the patient
B. Open the incision
C. Lateral canthotomy
D. Manitol IV
E. Stat ophthalmology consult

339) A patient comes to your office for a cosmetic facial surgery consultation. The BEST way to initiate the interview process is?

A. Ask for the referral source.
B. Ask about the requested cosmetic surgery.
C. Ask open questions.
D. Ask direct questions.
E. Discuss the different surgical cosmetic procedures and their alternatives.

340) Which of the following statements regarding implantable material is FALSE?

A. Cartilage has poor resorption rate predictability.
B. Calvarial bone has more resorption than iliac crest.
C. Silicone implants have an increased number of extrusions and displacements.
D. Acelular dermis is a material useful to cover dorsal nasal irregularities in the thin-skinned patient.
E. Mersilene will allow significant tissue in growth and/or bacteria colonization.


ANSWERS & REFERENCES


331) A     Gilles Flap

DeFatta R. J.,Williams III E. F: Lip Reconstruction, Chapter 61 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p. 841-854, 2009

http://emedicine.medscape.com/article/876634-treatment

332) D     Apply occlusive dressing over the eyes for the first 24 hours.

Norman Pastorek: Baggy Eyelids, in Current Therapy in Otolaryngology-Head and Neck Surgery-4, (Gates, editor), 1990, pp. 144-149

http://emedicine.medscape.com/article/838696-treatment

333) A     Analgesics and follow-up

Gates G.A.: Current Therapy in Otolaryngology-Head and Neck Surgery, Mosby, Sixth Edition, pp. 150-152, 1998

334) D     Nylon

Holt G. R.: Esthetic Primary Wound Treatment to Improve Scars, Chapter 6 in Facial Scars, Incision, Revision and Camouflage (Thomas, Holt, editors), Mosby, 1989, pp. 66-68

335) E     Eyelid skin necrosis

Pastorek N. J.: Upper Lid Blepharoplasty, Chapter 17 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 185-195, 2002

Rankin B. S., Arden R. L., Crumley R. L.: Lower Eyelid Blepharoplasty, Chapter 18 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 196-207, 2002

Crumley R. L., Torkian B. A., Karam A. M.: Lower Eyelid Blepharoplasty, Chapter 23 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 271-285, 2009

336) B     Columella

Larrabee, Jr. W. F., Sherris D. A.: Principles of Facial Reconstruction, Lippincott-Raven Publishers, 1995, p. 84

337) C     The domes are 3 mm caudal and 8 mm anterior to the anterior septal angle.

Oneal R. M., Beil Jr. R. J., Schlesinger J.: Surgical Anatomy of the Nose, Otolaryngology Clinics of North America, Vol. 32 No. 1, Feb. 1999, pp. 145-179

338) B     Open the incision

Crumley R. L., Torkian B. A., Karam A. M.: Lower Eyelid Blepharoplasty, Chapter 23 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 271-285, 2009

http://emedicine.medscape.com/article/838696-treatment

339) C     Ask open questions.

Holt G. R., Septorhinoplasty, Form Versus Function, Rhinoplasty and Septoplasty, Part I, Otolaryngologic Clinics of North America, Vol. 32 No. 1, Feb. 1999, pp. 7-10

http://emedicine.medscape.com/article/838696-overview

340) B     Calvarial bone has more resorption than iliac crest.

Lovice D. B., Mingrone M.D., Toriumi D. M.: Grafts and Implants in Rhinoplasty and Nasal Reconstruction, Rhinoplasty and Septoplasty, Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 113-137

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Updated: June 1, 2017

341-350 MCQ in Facial Plastic and Reconstructive Surgery

341-350

341) Which of the following measures represents the distance indicated by the arrow seen in the drawing below? Click the picture to enlarge image



A. 4 cm
B. 6 cm
C. 8 cm
D. 10 cm
E. 3/4 of the ear’s height

342) The main DISADVANTAGE in applying cyanoacrylate tissue adhesive to the skin is its

A. Erythema effect
B. Foreign body effect
C. Blister effect
D. Necrosis effect
E. Local histotoxicity effect

343) A nasal subunit deficit will require the removal of the entire subunit, if the percentage of the defect is GREATER than:

A. 20%
B. 25%
C. 30%
D. 40%
E. 50%

344) Which of the following full-thickness eyelid defects is IDEAL for use of the lateral canthotomy with cantholysis technique?

A. 30%
B. 55%
C. 60%
D. 75%
E. 80%

345) Which of the following statements regarding Trap-Door Deformity is FALSE?

A. It is a bulging elevation of the skin following the use of a transposition flap.
B. Early trap-door deformities can be treated with intralesional 1 ml triamcinolone acetonide (40 mg/ml).
C. Long standing trap-door deformities can be treated with multiple Z-plasties.
D. Cartilage support replacement during reconstruction will minimize the risk of trap-door formation.
E. Prevention can be achieved by wide undermining of the surrounding skin.

346) Which of the following incisions employed in Rhinoplasty is INCORRECT in order to gain access to the tip and dorsum?

A. Transcartilaginous incision
B. Intercartilaginous incision
C. Transcolumellar incision
D. Marginal incision
E. Rim incision

347) Which of the following statements about nasal anatomy is FALSE?

A. The skin thickness is greatest in the nasofrontal groove.
B. The arterial supply to the external structures of the nose is derived from the ophthalmic, facial and internal maxillary arteries.
C. The sensibility of the external nose is through branches of the ophthalmic and maxillary divisions of the fifth cranial nerve.
D. The supratip defines the cephalic limit of the nasal tip.
E. The narrowest part of the bony vault is at the level of the rhinion.

348) Which of the following alloplastic implants is the BEST for use in nasal dorsal augmentation?

A. Silicone
B. Polyamide
C. Polyethylene mesh
D. Polytetrafluoroethylene
E. Proplast

349) Which of the following reconstructive techniques will give the BEST cosmetic result in the repair of a defect of the entire lobule of the nose?

A. Secondary intention
B. Bilobed flap of the dorsum
C. Nasolabial flap
D. Full thickness skin graft
E. Paramedian forehead flap

350) Which of the following mandibular fractures has the HIGHEST complication rate?

A. Symphysis
B. Condyle
C. Ramus
D. Angle
E. Body


ANSWERS & REFERENCES


341) B     6 cm.

Ruder R. O.: Congenital Auricular Deformities, Chapter 75 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 1043-1057, 2009

342) E     Local histotoxicity effect

Toriumi D.M., Bagal A.A.: Cyanocrylate tissue adhesives for skin closure in the outpatient setting in Otolaryngologic Clinics of North America (J. P. Porter, editor), Saunders, Volume 35, Number 1, pp.104-107

343) E     50%

Danahey D. G., Hilger P. A.: Reconstruction of Large Nasal Defects, Management of Facial Cutaneous Defects, Part II, Otolaryngologic Clinics of North America, Vol. 34, August 2001, pp. 695-696

Leach J.: Reconstruction of Nasal Tissue Deficits, A Self-Instructional Package, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1998, p. 19

344) A     30%

Jewett B. S., Shockley W. W.: Reconstructive Options for Periocular Defects, Management of Facial Cutaneous Defects, Part I, Otolaryngologic Clinics of North America, Vol. 34, No. 3, June 2001, pp. 609-625

Millay D. J., Larrabee Jr., W. F.: Eyelid Reconstruction, Chapter 43, in Facial Plastic and Reconstructive Surgery, (Papel, Nachlas, editors), Mosby, First Edition, 1992, pp.405-406

345) D     Cartilage support replacement during reconstruction will minimize the risk of trap-door formation.

Vural E., Key J. M.: Complications, Salvage, and Enhancement of Local Flaps in Facial Reconstruction, in Management of Facial Cutaneous Defects, Part II, Otolaryngologic Clinics of North America, Vol. 34, No. 4, August 2001, pp. 739-751

346) E     Rim incision

Tardy M. E., Toriumi D. M., Hecht D. A.: Philosophy and Principles of Rhinoplasty, Chapter 32 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, pp. 377-379, 2002

347) E    The narrowest part of the bony vault is at the level of the rhinion.

Terkonda R. P., Sykes J. M.: Repairing the Twisted Nose, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 53-54

348) D     Polytetrafluoroethylene

Oneal R. M., Beil R. J., Jr., Schesinger J.: Surgical Anatomy of the Nose, Rhinoplasty and Septoplasty (Park S. S., Holt G.R, editors), Part I, Otolaryngologic Clinics of North America, Vol. 32, No. 1, Feb. 1999, pp. 145-181

349) E     Paramedian forehead flap

Baker S.: Major Nasal Reconstruction, Chapter 49 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p. 611, 2002

350) D    Angle

Winzenburg S.M., Imola M. J.: Mandibular Fractures, in Facial Trauma: Primary and Secondary Repair, Otolaryngologic Clinics of North America, Saunders, Vol. 6, Number 4, p. 457, 1998

-------------------------------------
Updated: June 1, 2017

351-360 MCQ in Facial Plastic and Reconstructive Surgery

351-360

351) Which of the following represents a marginal incision? Click the picture to enlarge image


A. A
B. B
C. C
D. D
E. E

352) What is the percentage of Swiss-Webster mice killed with 1 standard unit of Botulinum toxin A (Botox)?

A. 10%
B. 25%
C. 50%
D. 75%
E. 100%

353) Which of the following about repair of cleft lip and palate is FALSE?

A. 3 months, cleft-lip repair
B. 3 months, myringotomy and tube placement
C. 6 months, palatoplasty
D. 5 years, columellar lengthening (bilateral cleft-lip deformity)
E. 11 years, alveolar cancellous bone grafting

354) The MOST common complication of upper blepharoplasty in persons of Asian ethnicity is:

A. Bleeding
B. Unsatisfactory scar formation
C. Infection
D. Asymmetry
E. Hematoma

355) Which of the following about the African American Nose is FALSE?

A. The nasal tip is flat and bulbous.
B. There is flaring of the lateral ala.
C. The columella is short with poor tip projection.
D. The skin is thin secondary to decreased subcutaneous fibro-fatty tissue.
E. The nasolabial angle is acute with a poorly developed anterior nasal spine.

356) The MOST common cause of acquired aponeurotic ptosis is:

A. Involution
B. Surgery
C. Trauma
D. Blepharochalasis
E. Allergy

357) How MUCH TIME should the average blepharoplasty patient stay off work post surgery?

A. 3 days
B. 7 days
C. 14 days
D. 3 weeks
E. 4 weeks

358) The MOST common complication of the aponeurotic repair of blepharoptosis is?

A. Overcorrection
B. Undercorrection
C. Notching of the eyelid margin
D. Recurrence of ptosis
E. Loss of eyelashes

359) In the emergency treatment of retrobulbar hematoma, which of the following is INCORRECT?

A. Opening the suture lines
B. Mannitol IV
C. Diamox IV
D. Lidocaine IV
E. Decadron IV

360) Which of the following chemical peeling agents IS RECOMMENDED for use in conjunction with transcutaneous skin flap Lower Eyelid Blepharoplasty?

A. Tricloroacetic acid 25%
B. Tricloroacetic acid 35%
C. Jessner’s solution
D. Phenol 88%
E. None



ANSWERS & REFERENCES


351) D     D

Tardy M.E., Toriumi D.M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 32 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 377-381, 2002

Tardy Jr. M.E., Toriumi D.M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 40 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 507-528, 2009

Renner G. J.: Introduction to Rhinoplasty, Chapter 171 in Head and Neck Surgery-Otolaryngology, (Bailey, B. J, editor), Lippincott Williams & Wilkins, 4th Edition, 2006, pp. 2533-2550

352) C     50%

http://emedicine.medscape.com/article/841964-overview

Meyer T. K., Blitzer A.: Botulinum Toxin for Facial Wrinkles, Chapter 30 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 369-377, 2009

353) C     6 months, palatoplasty

Capone R. B., Sykes J. M.: Evaluation and Management of Cleft Lip and Palate Disorders, Chapter 76 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 1059-1078, 2009

Larrabee Jr. W.F. , Alsarraf R.: Special Considerations in Rhinoplasty, Chapter 177 , Head and Neck Surgery-Otolaryngology (Bailey), Third Edition, Lippincott Williams & Wilkins, 2001, pp. 2073-2280

354) D     Asymmetry

McCurdy Jr. J. A.: Cosmetic Surgery of the Asian Face, Chapter 28 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p. 329, 2002

McCurdy Jr. J. A.: Cosmetic Surgery of the Asian Face, Chapter 35 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 435-458, 2009

McCurdy Jr., J.A.: Upper Blepharoplasty in the Asian Patient:” the double eyelid” operation, Facial Plastic Surgery Clinics of North America, 10, 2002, pp. 351-368

355) D     The skin is thin secondary to decreased subcutaneous fibro-fatty tissue.

Stucker F. J., Lian T., Sanders K.: African American Rhinoplasty, Facial Plastic Surgery Clinics of North America, 10, 2002, pp. 351-368

356) A     Involution

Millary D.J.: Repair of Blepharoptosis, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 2, May 1995, pp. 195-201

http://emedicine.medscape.com/article/1212082-overview

357) B     7 days

Pastorek N.: Upper Lid Blepharoplasty, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 2, May 1995, p. 152

http://emedicine.medscape.com/article/838696-treatment

358) B     Undercorrection

http://emedicine.medscape.com/article/839075-treatment


359) D     Lidocaine IV

Adamson P.A., Constantinides M. S.: Complications of Blepharoplasty, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 2, May 1995, pp. 211-221

http://emedicine.medscape.com/article/838696-treatment

360) E     None

Smullen S. M., Mangat D. S.: Cosmetic Lower Eyelid Surgery, Transcutaneous Approach, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 2, May 1995, pp. 167-174

http://emedicine.medscape.com/article/838696-treatment

-------------------------------------
Updated: June 1, 2017

361-370 MCQ in Facial Plastic and Reconstructive Surgery

361-370

361) Which of the aesthetic Facial Proportions in the drawing below is NOT IDEAL? Click the picture to enlarge image


A. A
B. B
C. C
D. D
E. E

362) Which of the following statements is FALSE regarding the medicinal Leech therapy?

A. Hirudo medicinalis is the most commonly used leech in compromised flaps
B. Aeromonas hydrophila has been found in wound infection when using leeches.
C. The use of a third-generation cephalosporin is mandatory for wound infection prophylaxis when using leeches.
D. Hematocrit and ortho stasis should be monitored during long term leech therapy.
E. Monitoring of serum myoglobin is mandatory during leech therapy.

363) Which of the following nasal anatomical terms is INCORRECT?

A. Nasion –- depression at root of nose overlying the naso-frontal suture
B. Rhinion –- junction of nasal bones and upper lateral cartilages
C. Tip defining point –- most anterior projection of nasal tip
D. Anterior septal angle –- most inferior and caudal point of cartilaginous septum
E. Pogonion –- most prominent anterior projection of the chin

364) Which of the following statements about surgical anatomy of the eyelid is TRUE?

A. The upper lid is tangential to the superior corneal limbus.
B. The lower lid covers 3 mm of the inferior corneal limbus.
C. The upper lid has three fat compartments.
D. The lower lid has two fat compartments.
E. Muller’s muscle is a smooth muscle innervated by the cervical sympathetic chain.

365) The MOST common complication of epicanthoplasty performed on the Asian eyelid is:

A. Hematoma
B. Bleeding
C. Hypertrophic scarring
D. Infection
E. Necrosis of the epicanthal area

366) Which of the following statements regarding Upper Blepharoplasty in the Asian patient is TRUE?

A. 75% of East Asians demonstrate a “single eyelid”.
B. Asian patients desire full “Westernization” of the eye.
C. In the single eyelid the levator filaments penetrate the orbital septum and orbicularis muscle.
D. The periorbital fat compartment descends inferiorly creating “puffiness” of the eyelid.
E. 50% of East Asians have the epicanthal fold.

367) Which of the following conditions is BEST IMPROVED by Blepharoplasty?

A. Lateral crow’s feet
B. Exophthalmos
C. Orbicularis muscle hypertrophy
D. Cheek bags
E. Dark shadow on the lower lids

368) Which of the following preoperative photographs is NOT a standard view for blepharoplasty documentation?

A. Full-face frontal
B. Full-face lateral
C. Close-up frontal
D. Close-up lateral
E. Close-up oblique

369) Injury to the superior oblique muscle is MOST commonly seen during surgery related to the:

A. Medial upper eyelid fat pocket
B. Central upper eyelid fat pocket
C. Lateral upper eyelid fat pocket
D. Medial lower lid fat pocket
E. Lateral lower lid fat pocket

370) Which of the following statements is TRUE regarding postoperative care after Transcutaneous Blepharoplasty of the lower eyelid?

A. Patient must stay overnight for visual checks.
B. Prophylaxis with oral antibiotics is mandatory.
C. Patient usually can return to work at 2 weeks.
D. Patient can use make-up after 10 days.
E. Swimming, running and other strenuous exercises are not allowed earlier than 2 months postop.



ANSWERS & REFERENCES


361) D     D

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter 9 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor) pp. 96-109, 2002

Ridley M.B., VanHook S. M.: Aesthetic Facial Proportions, Chapter11 in Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor) pp. 119-133, 2009

Tardy Jr. M.E.: Rhinoplasty, Chapter 47 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrikson, Harker, Krause, Schuller, editors), Second Edition, Mosby, 1993, p. 815

362) E     Monitoring of serum myoglobin is mandatory during leech therapy.

Utley D.S., Koch R.J., Goode R.L.: The Failing Flap in Facial Plastic and Reconstructive Surgery: Role of the Medicinal Leech, Laryngoscope 108, August 1998, pp 1129-1135

363) D     Anterior septal angle –- most inferior and caudal point of cartilaginous septum

Papel I.D., Mabrie D.C.: Deprojecting the Nasal Profile,Rhinoplasty and Septoplasty, Part I, (Park S.S., Holt G. R., editor), Otolaryngology Clinics of North America, Vol. 32 No. 1, Feb. 1999, p. 66

364) E     Muller’s muscle is a smooth muscle innervated by the cervical sympathetic chain.

Henderson P. S. , Regan Thomas J.: Surgical Anatomy and Pathology of the Eyelids and Periorbita, Blepharoplasty, Facial Plastic Surgery Clinics of North America, Vol. 3, No.2, May 1995, pp. 135-140

365) C     Hypertrophic scarring

McCurdy Jr. J. A.: Cosmetic Surgery of the Asian Face, Chapter 28 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, p. 329, 2002

McCurdy Jr. J. A.: Cosmetic Surgery of the Asian Face, Chapter 35 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 435-458, 2009

366) D     The periorbital fat compartment descends inferiorly creating “puffiness” of the eyelid.

McCurdy Jr. J. A.: Upper Blepharoplasty in the Asian Patient: the “double eyelid” operation, Facial Plastic Surgery Clinics of North America, 10, 2002, pp. 351-368

McCurdy Jr. J. A.: Cosmetic Surgery of the Asian Face, Chapter 35 in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Third Edition, p.p. 435-458, 2009

367) C     Orbicularis muscle hypertrophy

Pastorek N.: Blepharoplasty, A Self-Instructional Package Committee on Continuing Education in Otolaryngology, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1983, pp. 26-38

http://emedicine.medscape.com/article/838696-overview

368) B     Full-face lateral

Pastorek N. J.: Upper Lid Blepharoplasty, Chapter 17, in Facial Plastic and Reconstructive Surgery, (Papel, editor) Thieme, Second Edition, pp. 185-195, 2002

http://emedicine.medscape.com/article/838696-overview


369) A     Medial upper eyelid fat pocket

Pastorek N.: Blepharoplasty, A Self-Instructional Package Committee on Continuing Education in Otolaryngology, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1983, pp. 82-83

http://emedicine.medscape.com/article/842137-treatment#a17

370) D     Patient can use make-up after 10 days.

Smullen S. M., Mangat D. S.: Cosmetic Lower Eyelid Surgery, Transcutaneous Approach, Blepharoplasty, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 2, 1995 pp.172-173

-------------------------------------
Updated: June 1, 2017

371-380 MCQ in Facial Plastic and Reconstructive Surgery

371-380

371) Which of the following statements is FALSE regarding the surgical technique represented in the drawing below? Click the picture to enlarge image

A. The lower lateral cartilage is exposed through intercartilaginous and marginal incisions.
B. A bipedicle condrocutaneous flap is surgically created.
C. Conservative reduction of the caudal margin of the lower lateral cartilage is recommended.
D. Preservation of 6 mm of the complete strip of residual lower lateral cartilage is preferred.
E. The approach is usually associated with transdomal sutures in order to narrow a broad and wide arched domes.

372) Which of the following statements about the surgical technique used in upper eyelid blepharoplasty is FALSE?

A. Local anesthesia with light premedication is used in the ambulatory setting.
B. Topical corneal anesthesia is used in addition to the local anesthesia.
C. The medial fat compartment is whiter and denser than the central fat compartment.
D. Polypropylene suture is used to close the skin incision.
E. Application of cool moist compresses over the eyelids is recommended postoperatively.

373) Which of following is CORRECT regarding the preferred Palatoplasty techniques?

A. Complete bilateral palate: Three-Flap palatoplasty
B. Complete secondary palate: Two-Flap palatoplasty
C. Complete unilateral: Von Langenbeck Palatoplasty
D. Soft palate cleft: Two-Flap palatoplaty
E. Submucous cleft: Double Reversing Z-plasty

374) Which of following statements is FALSE regarding the lateral canthus in Cosmetic Blepharoplasty?

A. The lateral canthal tendon becomes attenuated (lax) with age.
B. The lateral canthus normally is 2 mm higher than the medial canthus.
C. In cases of lateral canthal tendon laxity the canthus can be pulled to the lateral limbus of the eye.
D. Lateral tarsal strip is effective in the treatment of mild degrees of eyelid laxity.
E. Lateral canthal plication is effective in the treatment of mild, moderate and severe degrees of laxity.

375) Which of the following is the IDEAL incision to be used in a non-delivery approach for conservative tip refinement in the presence of medium skin thickness and adequate tip cartilage symmetry.

A. Transcartilaginous
B. Marginal
C. Rim
D. Transcolumellar
E. Retrograde-eversion incision

376) Which of the following statements is FALSE regarding brow and forehead endoscopic lifting?

A. The indications are the same as those for a coronal open approach.
B. It will improve asymmetric brow ptosis
C. It will improve horizontal forehead rhytids
D. It will improve vertical glabellar rhytids
E. Patients with facial nerve paralysis on one or both sides are excellent candidates

377) Which of the following statements about the nasofrontal region is TRUE?

A. The normal naso-facial angle is 50 degrees.
B. The normal naso-frontal angle is 140 degrees.
C. A shallow nasofrontal angle creates the illusion of a shorter nose.
D. A deep nasofrontal angle creates the illusion of longer nose.
E. A deep nasofrontal angle creates the illusion of a dorsal hump.

378) Which of the following statements regarding the Nasal Tip Graft is FALSE?

A. A shield-shaped tip graft can be sculpted from the auricular cartilage.
B. Tip grafts are sutured to the caudal margin of the medial or intermediate crura.
C. Prolene 6-0 material is ideal for suturing.
D. Medium skin thickness is conducive to better camouflage action.
E. Cyanoacrylate tissue adhesives are ideal for reinforcing tip sutures.

379) Which of the following statements regarding aesthetic nasal proportions is INCORRECT?

A. Male noses tend to be longer and have a smaller dorsal hump.
B. The projection is measured in the lateral view using a 3-4-5 triangle.
C. The lobule comprises one third of the nasal height and the columella the remaining two thirds.
D. The upper lateral cartilages are a pair of triangular cartilages that are situated over the caudal surface of the nasal bone.
E. The cephalic portion of the lower lateral cartilages overlaps the caudal portion of the triangular cartilages (scroll).

380) Which the following surgical managements is the BEST in order to correct a severe right nasal alar retraction?

A. Septal cartilage graft
B. Ipsolateral cavum concha graft
C. Contrateral cavum concha graft
D. Composite cymba concha of the left ear
E. Composite cymba concha of the right ear

ANSWERS & REFERENCES


371) C     Conservative reduction of the caudal margin of the lower lateral cartilage is recommended.

Tardy M. E., Toriumi D. M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 32 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p. 379, 2002

Tardy M. E. Jr., Toriumi D. M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 40 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp.507-528, 2009

372) B     Topical corneal anesthesia is used in addition to the local anesthesia.

Pastorek N.: Upper Lid Blepharoplasty, Blepharoplasty, Facial Plastic Surgery Clinics of North America, Vol.3, No. 1, 1995 pp. 143-157

Pastorek N. J.: Blepharoplasty, A Self-Instructional Package from the Committee on Continuing Education in Otolaryngology, AAO-HNS Foundation, Inc., 70-86, 1983

373) E     Submucous cleft: Double Reversing Z-plasty

Sykes J. M.: Diagnosis and Treatment of Cleft Lip and Palate Deformities, Chapter 65 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 824-829, 2002

Capone R. B., Sykes J. M.: Evaluation and Management of Cleft Lip and Palate Deformities, Chapter 76 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 1059-1078, 2009

374) E     Lateral canthal plication is effective in the treatment of mild, moderate and severe degrees of laxity.

Glassman M. L., Hornblass A.: The Lateral Canthus in Cosmetic Surgery, ComtemporaryTechniques: An update with the Masters, Facial Plastic Surgery Clinics of North America, Vol. 10, No. 1, 2002, 29-35

375) A     Transcartilaginous

Tardy M.E., Toriumi D.M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 32 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp. 377-381, 2002

Tardy M. E. Jr., Toriumi D. M., Hecht D.A.: Philosophy and Principles of Rhinoplasty, Chapter 40 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp.507-528, 2009

376) E     Patients with facial nerve paralysis on one or both sides are excellent candidates

Graham III, H. D.: Endoscopic Rhytidectomy, Chapter 36, in Otolaryngology-Head and Neck Surgery (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Mosby, Vol. 1, pp.700-701, 1998

Adamson P. A., Dahiya R.: The Aging Forehead, Chapter 179 in Head and Neck Surgery-Otolaryngology, (Bailey, B.J., editor), Lippincott Williams & Wilkins, 4th Edition, 2006, pp. 2663-2683

377) E     A deep nasofrontal angle creates the illusion of a dorsal hump.

Toriumi D. M. , Hecht D. A.: Skeletal Modifications in Rhinoplasty, Advances in Rhinoplasty, Facial Plastic Surgery Clinics of North America, Vol. 8, No.4, 2000, pp. 413-414

378) E     Cyanoacrylate tissue adhesives are ideal for reinforcing tip sutures.

Toriumi D. M., Johnson Jr., C. M.: Open Structure Rhinoplasty, Featured Technical Points and Long-Term Follow-up, Open Rhinoplasty, Facial Plastic Surgery Clinics of North America, Vol. 1, No. 1, 1995, pp. 10-21

379) D     The upper lateral cartilages are a pair of triangular cartilages that are situated over the caudal surface of the nasal bone.

Larrabee Jr, W. F., Cupp C.: Advanced Nasal Anatomy, Advanced Rhinoplasty, Facial Plastic Surgery Clinics of North America, Vol. 2, No. 4, 1994 pp. 393-416

380) D     Composite cymba concha of the left ear

Becker D. G.: Complications of Rhinoplasty, Chapter 39 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p. 454, 2002

Becker D. G.: Complications of Rhinoplasty, Chapter 49 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p. 641, 2009

-------------------------------------
Updated: June 1, 2017

381-390 MCQ in Facial Plastic and Reconstructive Surgery

381-390

381) Which of the following statements is FALSE regarding the Palatoplasty Technique represented in the drawing below? Click the picture to enlarge image.



A. A single mucoperiosteal flap is elevated for each palatal shelf.
B. The neurovascular bundle coming from the greater palatine foramen is identified.
C. Medial mobility of the soft palate is enhanced by dissecting the posterior extension of the relaxing incision in the plane of the pterygoid and superior constrictor muscles.
D. In patients with wider clefts it is necessary to infracture the hamulus process.
E. The incidence of fistulization at the hard-soft palate junction is high.

382) Which of the following is the MOST important factor in DECREASING the incidence of nasal alar retraction during rhinoplasty?

A. The incidence of alar retraction will decrease by using a nondelivery approach and transcartilaginous incisions during surgery.
B. The incidence of alar retraction will decrease by avoiding trauma to the caudal septal area during surgery.
C. The incidence of alar retraction will decrease by gentle care of the lower lateral cartilage and soft-tissue envelope during surgery.
D. The incidence of alar retraction will decrease by conservative resection of the alar cartilage during surgery.
E. Alar retraction will decrease by avoiding severe external nasal trauma during surgery.

383) Which of the following statements regarding “pinching” of the nose is TRUE?

A. Pinching is due to over-excision of the lower lateral cartilages.
B. Pinching is due to over-excision of the upper lateral cartilages.
C. Pinching is increased with open rhinoplasty.
D. Pinching is increased with exposure and delivery of the lower lateral cartilages.
E. Pinching is increased with nasal flaring reduction.

384) Which of the following statements regarding the Two-Triangular Flap technique for the surgical repair of a complete unilateral cleft lip is FALSE?

A. The lengthening is calculated by measuring the difference in distance between the base of the columella and the high point of the Cupid’s bow on the noncleft side compared with the cleft side
B. If the dimension of the designed flap has 6 mm or more, two triangular flaps instead of one are recommended.
C. Two-triangular flaps are created on the medial aspect of the cleft side of the lip in its lower and upper portion.
D. With respect to these Two-Triangular flaps, the lower is greater than the upper.
E. The advantage of two-triangular Flap technique is that it minimizes the violation of the philtral column and distributes evenly the tension on the lip.

385) Which of the following statements regarding the use of irradiated homograft costal cartilage in Revision Rhinoplasty is TRUE?

A. Irradiated homograft costal cartilage is a poor material alternative for Revision Rhinoplasty.
B. Before using the implant it must be soaked in gentamicin sulfate solution.
C. The use of this material implies a very high rate of infection.
D. The use of this material implies a very high rate of extrusion.
E. The resorption of the irradiated rib cartilage is insignificant.

386) Which of the following antibiotic ointments is NOT RECOMMENDED for an eyelid incision?

A. Bacitracin
B. Neomycin
C. Erytromycin
D. Polysporin (polymixin B-bacitracin)
E. Bactroban (mupirocin)

387) Which of the following surgical options is MOST effective in the treatment of congenital webbing of the neck?

A. Excision
B. Serial excision
C. W-plasty excision
D. Geometric broken-line plasty excision
E. Multiple Z-plasties

388) In which of the following anatomical areas is silk the RECOMMENDED material for wound closure?

A. Margin of the helix
B. Margin of the eyelid
C. Margin of the brow
D. Margin of the tragus
E. Tip of the nose

389) Which of the following suture materials will induce the MOST inflammatory tissue reaction?

A. Nylon
B. Vicryl
C. Dexon
D. Prolene
E. Chromic catgut

390) Which of the following margins of resection is RECOMMENDED for a melanoma of the cheek with a thickness of 3 mm?

A. 0.5 cm
B. 1 cm
C. 2 cm
D. 3 cm
E. 4 cm

ANSWERS & REFERENCES


381) E     The incidence of fistulization at the hard-soft palate junction is high.

Seibert R. W.: Unilateral Cleft Lip and Palate in Current Therapy in Otolaryngology-Head and Neck Surgery-4 (Gates, editor), B.C. Decker Inc. 1990, pp. 320-322

382) D     The incidence of alar retraction will decrease by conservative resection of the alar cartilage during surgery.

Becker D. G.: Complications of Rhinoplasty, Chapter 39 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p. 454, 2002

Becker D. G.: Complications of Rhinoplasty, Chapter 49 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p. 639, 2009

Becker D. G., Becker S. S.: Reducing Complications in Rhinoplasty, Otolaryngology Clinics of North America, 2006; 39: 473-492

383) A     Pinching is due to over-excision of the lower lateral cartilages.

Kamer F. M., Silberberg M. B.: Revision Rhinoplasty, Advanced Rhinoplasty, Facial Plastic Surgery Clinics of North America, Vol. 2 No. 4, 1994, pp. 533-534

384) D     With respect to these Two-Triangular flaps, the lower is greater than the upper.

Bardach J., Salyer K. E.: Surgical Techniques in Cleft Lip and Palate, Mosby, Second Edition, 1991, pp. 50-52

385) B     Before using the implant it must be soaked in gentamicin sulfate solution.

Kridel R.W.H., Kraus W.M.: Grafts and Implants in Revision Rhinoplasty, Revision Rhinoplasty, Facial Plastic Surgery Clinics of North America, Vol. 3, No. 4, 1995, pp.480-482

386) B     Neomycin

Quatela V. C., Ries W. R.: Aesthetic Facial Surgery, Chapter 24, Complications in Head and Neck Surgery, (Krespi and Ossoff, editors), Saunders, 1993, p. 399

387) E     Multiple Z-plasties

Renner G. J., Walter C.: Revision of scars on the neck, Chapter 22 in Facial Scars, Incision, Revision and Camouflate (Thomas and Holt, editors) Mosby, 1989, p. 306

388) B     Margin of the eyelid

Holt G. R.: Esthetic primary wound treatment to improve scars, Chapter 6 in Facial Scars, Incision, Revision and Camouflate (Thomas and Holt, editors) Mosby, 1989, p. 67

389) E     Chromic catgut

Thomas J. R.: Wound closure materials, Chapter 7 in Facial Scars, Incision, Revision and Camouflage (Thomas and Holt, editors) Mosby, 1989, p. 69

390) C     2 cm.

Hendrix J. D., Slingluff C. L.: Cutaneous Malignancies: Diagnosis and Treatment, Chapter 42 in Facial Plastic and Reconstructive Surgery, (Ira Papel, editor), Thieme Medical Publishers, second edition, 2002, pp.493-500

Myers J.N., Nemechek A. J.: Malignant Melanoma, Chapter 104 in Head and Neck Surgery-Otolaryngology, (Bailey, B.J., editor), Lippincott Williams & Wilkins, Third Edition, 2001, pp. 1241-1244

Hendrix Jr., J.D., Slingluff C.L.: Diagnosis and Treatment of Cutaneous Malignancies, Chapter 52, Facial Plastic and Reconstructive Surgery, (Ira Papel, editor), Thieme Medical Publishers, Third edition, 2009, pp. 675-702

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Updated: June 1, 2017