601-610 MCQ in Facial Plastic and Reconstructive Surgery

601-610

601) Which of the following statements about the reconstruction flap used shown is TRUE?

A. Two rotation flaps are used.
B. Two advancement flaps are used.
C. Two transposition flaps are used.
D. One rotation and one transposition flap is used.
E. One transposition and one advancement flap is used.

602) Which of following statements about the anatomy of the temporal region is FALSE?

A. The superficial temporalis fascia and the temporoparietal fascia are synonymous terms for the same fascia.
B. The temporoparietal fascia is located immediately beneath the skin and subcutaneous fat.
C. The temporal artery and vein travel inferiorly to the temporoparietal fascia.
D. The temporoparietal fascia is continuous with the SMAS in the lower face.
E. The deep temporal fascia is considered the true temporalis fascia.

603) Which of following with respect to the Asian Nose is INCORRECT?

A. Low dorsum
B. Flaring nostrils
C. Retracted columella
D. Retracted ala
E. Bulbous thick nasal tip skin

604) Which of the following statements about WOUND HEALING is TRUE?

A. Polymorphonuclear leukocytes appear after 72 hours.
B. Macrophages are predominant in the first 36 hours.
C. Granulation tissue appears on day # 4.
D. Fibroblasts appear in the wound in the first 24 hours.
E. Wound contraction initiates 3 weeks after injury.

605) Which of the following is NOT USEFUL in the postoperative prevention of vessel thrombosis in free-tissue transfer of microvascular flaps?

A. Aspirin
B. Dextran
C. Statins
D. Prednisone
E. Heparin

606) Which of the following measurements represents the MAXIMUM BONE SEGMENT AVAILABLE in a FIBULAR OSTEOCUTANEOUS FREE FLAP?

A. 15 cm
B. 20 cm
C. 25 cm
D. 30 cm
E. 35 cm

607) Which of the following statements about MICRODERMABRASION is TRUE?

A. Hypopigmentation is a common complication.
B. It can be used safely on the neck.
C. Adjunctive use of isotretinoin is not a contraindication.
D. It is comparable to a medium-depth peel.
E. It is ideal in treating deep wrinkles and thick scars

608) Which of the following statements with respect to the African American Nose is TRUE?

A. Nasolabial angle approximately 90 degrees
B. Thin skin and subcutaneous fibro fatty tissue
C. Absent anterior nasal spine
D. Non-flaring nostrils
E. Convex nasal bones

609) Which of the following complications is MOST COMMONLY seen in bipolar radiofrequency resurfacing?

A. Hyperpigmentation
B. Hypopigmentation
C. Herpetic infections
D. Bacterial infections
E. Persistent erythema

610) In which of the following areas will DEEP PLANE RHYTIDECTOMY address PRIMARILY THE LAXITY problem?

A. Submental area
B. Platysma area
C. Submandibular area
D. Ptotic buccal fat pad area
E. Buccolabial area


ANSWERS & REFERENCES


601) C     Two transposition flaps are used.

Baker S. R.:: Reconstruction of Facial Defects, Chapter 27 in Otolaryngology Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Volume One, Third Edition, Mosby, pp. 527-533, 1998

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

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

602) C     The temporal artery and vein travel inferiorly to the temporoparietal fascia.

Quatela V. C., Graham III D., Sabini P.: Rejuvenation of the Brow and Midface, chapter 16 in Facial Plastic and Reconstructive Surgery, (Papel, I. D., editor), Thieme, second edition, 2002, pp. 171-172

Graham III H. D., Quatela V. C., Sabini P.: Endoscopic Approach to the Brow and Midface, in Chapter 20, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 227-241

Larrabee W. F. Jr., Makielski K. H., Cupp C.: Facelift Anatomy in FaceLift, Facial Plastic Surgery Clinics of North America, (Beeson, W.H., editor), Vol. 1, No. 2, pp. 13-141, 1993

603) D     Retracted ala

Matsunaga R. S.: Augmentation Rhinoplasty of Asian Noses, Surgery in the Asian Patient in Facial Plastic Surgery Clinics of North America, (McCurdy, Jr, J.A., editor), Vol. 4, No. 1, pp. 75-80, 1996

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

Park S. S., Jin H.: Noncaucasian Rhinoplasty, 38 in Cummings Otolaryngology-Head and Neck Surgery, Fifth edition, Volume one, Mosby Elsevier, 2010, pp. 568-579

604) C     Granulation tissue appears on day # 4.

Fisher E., Frodel Jr, J. L.: Wound Healing, Chapter 2 in Facial Plastic and Reconstructive Surgery, Thieme, Second Edition, (Papel, I, editor), 2002, pp. 15-20

Fisher E., Frodel Jr, J. L.: Wound Healing, Chapter 2, in Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 15-25

605) C     Statins

Burkey B. B., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 47, Facial Plastic and Reconstructive Surgery, Second Edition, Thieme (Papel, I., editor), pp. 567-571, 2002

Burkey B. B., Schmalbach C. E., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 57, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 578-581

606) C     25 cm

Burkey B. B., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 47, Facial Plastic and Reconstructive Surgery, Second Edition, Thieme (Papel, I., editor), pp. 567-571, 2002

Burkey B. B., Schmalbach C. E., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 57, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 578-581

607) B     It can be used safely on the neck.

Koch R. J., Hanasono M. M.: Microdermabrasion, Minimally Invasive Surgery, Facial Plastic Surgery Clinics of North America, , (Koch R. J., editor), Vol. 9, No. 3, pp. 377-382, 2001

Freeman M. S.: Microdermabrasion, Facial Rejuvenation Nonsurgical Modalities, Facial Plastic Surgery Clinics of North America, ( Dee Anna Glaser., editor), Vol. 9, No. 2 , pp. 257-266, 2001

608) C     Absent anterior nasal spine

Stucker F. J., Lian T., Sanders K.: African American Rhinoplasty in Facial Plastic Surgery Clinics of North America (Porter, J. P., editor) , pp. 369-376, 2002

609) A     Hyperpigmentation

Carniol P. J., Maas C. S.: Bipolar Radiofrequency Resurfacing, Minimally Invasive Surgery, Facial Plastic Surgery Clinics of North America, , (Koch R. J., editor), Vol. 9, No. 3, pp. 337-349, 2001

610) E     Buccolabial area

Beeson W. H. : Extended Posterior Rhytidectomy in FaceLift, Facial Plastic Surgery Clinics of North America, (Beeson, W.H., editor), Vol. 1, No. 2, pp. 215-216, 1993

http://emedicine.medscape.com/article/841704-overview

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Updated: June 1, 2017

611-620 MCQ in Facial Plastic and Reconstructive Surgery

611-620

611) Which TECHNIQUE to close a surgical defect of the lower lip is demonstrated in the drawing below?


A. Gillies
B. Unilateral Karapandzic flap
C. Parallel Abbé flap
D. Webster flap
E. Johanson flap

612) Which of the following statements about the FIBULAR OSTEOCUTANEOUS FLAP is FALSE?

A. The peroneal artery and vein provide the primary blood supply to this flap.
B. The sensory input to the flap is provided by the direct innervation of the common peroneal nerve.
C. Flap elevation is usually done with a thigh tourniquet inflated to 350 mm Hg.
D. A segment of 8 cm of fibula is preserved proximally and distally.
E. A posterior splint is left in place for 10 days.

613) When will FAST ABSORBING SURGICAL GUT LOOSE virtually ALL TENSILE STRENGTH?

A. 48 hours
B. 72 hours
C. 5 days
D. 7 days
E. 10 days

614) Which of the following flaps is the ONE in which the base of the flap is not adjacent to the recipient defect and a second stage is required?

A. Rotation
B. Advancement
C. Interposition
D. Interpolation
E. Island

615) In which of the following facial areas are SILK SUTURES INDICATED?

A. Nose
B. Cheek
C. Forehead
D. Ear
E. Eyelid margin

616) A patient had botulinum A exotoxin (BTX-A) injected into the forehead. After 3 days there was still no response. Which of the following is TRUE?

A. Reinjection in 3 months
B. Reinjection with a half dose at day 4
C. Reinjection at 2 weeks
D. No for further injections
E. Reinjection increasing the initial dose at 2 weeks

617) Which of the following represents the EARLIEST SYMPTOM of LOCAL ANESTHETIC TOXICITY?

A. Visual disturbance
B. Convulsions
C. Muscular twitching
D. Respiratory system depression
E. Numbness of tongue

618) Which of the following statements about split-thickness skin grafts (STSG) is INCORRECT?

A. STSG contain a portion of the epidermis.
B. STSG are easy to harvest.
C. STSG have a different texture and lighter color than the neighboring tissue.
D. STSG are cosmetically inferior to full-thickness skin grafts.
E. STSG are less durable to than full-thickness skin grafts.

619) Which is of the following tissues IS LESS TOLERANT of EXPANSION?

A. Epidermis
B. Adipose tissue
C. Blood vessels
D. Muscular tissue
E. Neural tissue

620) Which of the following statements about the RADIAL FOREARM FLAP is TRUE?

A. It is a fascial or a fasciocutaneous flap.
B. The flap is very reliable, but is thick , non-pliable and without sensation.
C. Pathologic fracture is possible, but is not frequently occurring.
D. Primary closure of the donor site is always possible.
E. Magnetic resonance angiography is mandatory preoperatively to assess adequate blood flow


ANSWERS & REFERENCES


611) E     Johanson flap

Ellis D. A.F., Gullane P. J.: Cosmetic and Reconstructive Lip Surgery, chapter 23 in Instructional Courses, American Academy of Otolaryngology Head and Neck Surgery, (Johnson, Blitzer, Ossoff, Thomas, editors) , Volume 1, pp.269-271, 1988

612) B     The sensory input to the flap is provided by the direct innervation of the common peroneal nerve.

Burkey B. B., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 47, Facial Plastic and Reconstructive Surgery, Second Edition, Thieme (Papel, I., editor), 2002, pp. 578-581

Burkey B. B., Schmalbach C. E., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 57, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 578-581

613) C     5 days

Maas C. S.: Wound Management and Suturing Manual, Facial Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, pp. 28-29, 2001

Cheney M. L.: Soft Tissue Techniques, Chapter 3 in Facial Surgery, Plastic and Reconstructive, Williams & Wilkins, pp. 53-55, 1997

614) D     Interpolation

Shumrick D.A., Savoury L. W.: Local Flaps in chapter 3, Otolaryngology, (Paparella, Schumrick, Gluckman, Meyerhoff, editors), Saunders, Vol. IV, Plastic and Reconstructive Surgery and Interrelated Disciplines, Third Edition, pp. 2647-2652, 1991

Triana Jr. R. J., Murakami C. S., Larrabee Jr. W. F.: Skin Grafts and Local Flaps, in Chapter 4, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 41-57

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

615) E     Eyelid margin

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

616) C     Reinjection at 2 weeks

Blitzer A., Binder W. J., Brin M. F.: Botulinum Exotoxin A (Botox) for Facial Wrinkles, Chapter 23 in Facial Plastic and Reconstructive Surgery, Second Edition, Thieme, (Papel, editor), 2002, p. 262-268

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

617) E     Numbness of tongue

Feinstein R., Nielsen H. C.: Local anesthetics chapter 4 in Facial Scars, Incision, Revision and Camouflage (Thomas, Holt, editors), Mosby, pp. 37-38, 1989

618) A     STSG contain a portion of the epidermis.

Levine H. L.: Skin, Dermal and Mucosal grafting, Chapter 2, Otolaryngology, (Paparella, Schumrick, Gluckman, Meyerhoff, editors), Saunders, Vol. IV, Plastic and Reconstructive Surgery and Interrelated Disciplines, Third Edition, pp. 2639-2645, 1991

Triana Jr. R. J., Larrabee Jr. W. F.: Skin Grafts and Local Flaps, Chapter 4 in Facial Plastic and Reconstructive Surgery, Third Edition, Thieme, (Papel, editor), 2009, pp. 41-58

619) B     Adipose tissue

Hoffmann J. F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 45 in Facial Plastic and Reconstructive Surgery, (Papel, I, editor), Thieme,2002, pp. 549-551

Hoffmann J. F.: Tissue Expansion in Reconstruction of the Head and Neck, Chapter 55 in Facial Plastic and Reconstructive Surgery, (Papel, I, editor), Thieme, 2009, pp. 549-551

620) A     It is a fascial or a fasciocutaneous flap.

Burkey B. B., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 47, Facial Plastic and Reconstructive Surgery, Second Edition, Thieme (Papel, I., editor), pp. 567-571, 2002

Burkey B. B., Schmalbach C. E., Coleman Jr., J. R.: Microvascular Flaps, in Chapter 57, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 578-581


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Updated: June 1, 2017

621-630 MCQ in Facial Plastic and Reconstructive Surgery

621-630

621) Which of the following indicates the SENSORY INNERVATION of the areas represented by the TWO ARROWS?


A. Auriculotemporal nerve
B. Auricular nerve
C. Greater Auricular nerve
D. Lesser Occipital nerve Greater
E. Occipital nerve

622) Which of the following statements about the frontal hairline is FALSE?

A. Never place the hairline below the superior border of the upper third of the face.
B. Higher hairline position is better than lower position.
C. The adult male hair line should have a gentle convex curve.
D. The distance of the hair line from the midglabelar point should be less than 7 cm.
E. Micrografts are mandatory for the frontal hairline.

623) Which of the following statements about cervicofacial rhytidectomy is FALSE?

A. Flap elevation is done in the superficial subcutaneous plane.
B. Plication and Imbrication will decrease closing tension on the skin flap.
C. Skin redraping has a superior-posterior component.
D. Surgical staples are used in the temporal and mastoid regions.
E. Suctioning has proven better than penrose drains with compression dressings.

624) Which of the following percentages represents the melanomas originating from previous existing moles?

A. 5%
B. 20%
C. 40%
D. 70%
E. 90%

625) To which level of the Clark's system does a facial melanoma anatomically filling the papillary dermis, but no extension in to the reticular (lower) dermis belong?

A. Level I
B. Level II
C. Level III
D. Level IV
E. Level V

626) Which of the following statements about Hair Replacement Surgery is INCORRECT?

A. Standard round grafts are 4-mm punch graft.
B. Micrografts contain 1-2 hairs.
C. Minigrafts contain 10-12 hairs.
D. Micrografs are used in the anterior portion of the hairline.
E. Minigrafts are used in the crown.

627) Which of the following local flaps IS NOT an option for FOREHEAD RECONSTRUCTION?

A. V-to -Y advancement
B. Rhombic transposition
C. Purse-string closure reduction techniques
D. Serial excision
E. Glabellar

628) What is the maximal percentage of a full thickness upper eyelid defect that can be reconstructed by using THE TENZEL FLAP?

A. 10 %
B. 20 %
C. 30 %
D. 50 %
E. 70 %

629) Which of the following TREATMENTS IS INCORRECT in the initial management of FACIAL BURNS?

A. The head of the adult represents 9% of the total body surface area to be considered for treatment
B. Tracheotomy rather than intubation.
C. Cleansing and debridement
D. Silver Sulfadiazine topical
E. Skin-grafting

630) Which of the following IS THE MOST COMMON etiology for loss of eyebrow hair?

A. Trauma
B. Body piercing
C. Trichotillomania
D. Endocrinopathies
E. Congenital aplasia


ANSWERS & REFERENCES


621) A     Auriculotemporal nerve

Nachlas N. E.: Otoplasty, in Chapter 27, Facial Plastic and Reconstructive Surgery, Second Edition, Thieme (Papel, I., editor), 2002, pp. 309-311

Nachlas N. E.: Otoplasty, in Chapter 34, Facial Plastic and Reconstructive Surgery, Third Edition, Thieme (Papel, I., editor), 2009, pp. 421-433

622) D     The distance of the hair line from the midglabelar point should be less than 7 cm.

Otolaryngology, (Paparella, Schumrick, Gluckman, Meyerhoff, editors), Saunders, Vol. IV, Plastic and Reconstructive Surgery and Interrelated Disciplines, Third Edition, pp. 2639-2645, 1991

623) E     Suctioning has proven better than penrose drains with compression dressings.

Adamson P. A., Moran M. L.: Complications of Cervicofacial Rhytidectomy in FaceLift, (Beeson, W.H., editor), Facial Plastic Surgery Clinics of North America, Vol. 1, No. 2, pp. 257-261, 1993

624) D    70%

Medina J. E.: Malignant Melanoma of the Head and Neck, Facial Skin Malignancy I, Otolaryngologic Clinics of North America, Saunders, Vol. 26, No. 1, pp. 73-74, 1993

625) C     Level III

Wolf G. T., Sullivan M. J.: Management of Head and Neck Malanoma, Chapter 25 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Schuller, Mosby, Second Edition, Volume 1, pp.424-425, 1993

http://emedicine.medscape.com/article/1295718-overview#aw2aab6b6

626) C     Minigrafts contain 10-12 hairs.

Buchwach K. A.: Standard Grafts, Minigrafts, and Micrografts, Their Use in Hair Transplantation, Facial Plastic Surgery Clinics of North America , Hair Replacement Surgery, (Konior R.J. and Rousso D. E. ., editors), May 1994, Vol. 2, No. 2, pp. 149-161

627) E     Glabellar

Ling E. H., Wang T.D.: Local Flaps in Forehead and Temporal Reconstruction in Facial Plastic Surgery Clinics of North America, Local Skin Flaps, Vol. 4, No. 4, pp.469-478, 1996

628) D     50 %

Howard G., Hochman M.: Local Flaps in Periorbital Reconstruction, Facial Plastic Surgery Clinics of North America, Local Skin Flaps, Vol. 4, No. 4, pp. 481-489

Millay D. J. , Larrabee Jr., Wl F.: Eyelid Reconstruction, Chapter 43 in Facial Plastic and Reconstructive Surgery (Papel, & Nachlas, editors), Mosby, pp. 399-406, 1992

629) B     Tracheotomy rather than intubation.

Young V. L., Bartell T.H.: Burns of the face, chapter 19 in Facial Scars, Incision, Revision and Camouflage (Thomas J. R. & Holt G. R., editors), Mosby, 229-270

Gibson F. B.: Management of Soft-Tissue Trauma, chapter 64, Head and Neck Surgery – Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, Third Edition, pp. 761-763, 2001

630) A     Trauma

Gandelman M. , Epstein J.S.: Hair transplantation to the eyebrow, eyelashes and other parts of the body, Facial Plastic Surgery Clinics of North America , Hair Restoration and Removal, (Epstein J. S., editor), May 2004, Vol. 12, N0 2, pp.253-261

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Updated: June 15, 2017

631-640 MCQ in Facial Plastic and Reconstructive Surgery

631-640

631) The drawing below depicts the final result after closing a scalp defect. WHICH OF THE FOLLOWING FLAPS IS REPRESENTED?


A. Bilobed flap
B. O-T flap
C. A-T flap
D. Bilateral Z-plasty
E. Bilateral rotation

632) Which of the following sensory nerve is the ONE that will produce tip numbness after rhinoplasty?

A. Supratrochlear branch of the ophthalmic nerve
B. Infratrochlear branch of the ophthalmic nerve
C. Supratrochlear and infratrochlear branches of the ophthalmic nerve
D. External nasal branch of the anterior ethmoidal nerve
E. Infraorbital branches of the maxillary nerve

633) Which of the following statements about nasal osteotomies is FALSE?

A. They are used to straighten an asymmetrical nasal pyramid.
B. Medial osteotomies are usually done first.
C. Intermediate osteotomies are done after lateral osteotomies.
D. Lateral osteotomies are done through a stab incision at the level of the attachment of the inferior turbinate.
E. Lateral osteotomies can be accomplished transcutaneously using a 2-mm straight osteotome.

634) Which of the following statements regarding the management of pediatric facial fractures is INCORRECT?

A. Most mandibular fractures can be managed with intermaxillary fixation.
B. Intermaxillary Fixation is usually maintained for 8 weeks.
C. Open reduction and internal fixation are reserved for severely comminuted or displaced fractures.
D. Ivy loops are adequate for intermaxillary fixation between the upper and lower jow.
E. Reduction and fixation should be done early, usually within the first 72 hours.

635) Which of the following defects can be closed with a TRIPLE RHOMBOID Flap?

A. A triangular defect
B. A fusiform defect
C. A rectangular defect
D. A circular defect
E. A rhomboid defect

636) Which of the following PHARYNGEAL ARCHES forms the MAXILLARY PROCESS?

A. Arch 1
B. Arch 2
C. Arch 3
D. Arch 4
E. Arch 5

637) Which of the following locations is IDEAL for the use of TISSUE EXPANDERS?

A. Scalp
B. Cheek
C. Nose
D. Neck
E. Temple

638) Which of the following COMPLICATIONS can most likely be prevented by identifying the lacrimal gland and avoiding fat removal from the lateral area of the upper eyelids during the performance of blepharoplasty?

A. Hooding of the lateral canthus
B. Tear deficiency
C. Persistent fat bulging
D. Blepharoptosis
E. Eyebrow ptosis

639) What AMOUNT OF BLOOD can a medical leech remove during its active feeding period?

A. 1.5 ml
B. 2.5 ml
C. 3.5 ml
D. 4.5 ml
E. 5.5 ml

640) Which of the following statements about RHINOPHYMA is TRUE?

A. It is more common in female patients.
B. It is more common in Asians.
C. It represents the fourth stage of evolving rosacea.
D. The only accepted surgical treatment is the CO2 Laser.
E. Its major histological findings involve decreased dermal thicknening and vascularity.


ANSWERS & REFERENCES


631) E     Bilateral rotation

Hicks D. L., Watson D.: Soft Tissue Reconstruction of the Forehead and Temple, Local Cutaneous Flaps, (Park S.S., editor), Facial Plastic Surgery Clinics of North America, Vol. 13, No. 2, May 2005, pp.243-251

632) D     External nasal branch of the anterior ethmoidal nerve

Oneal R. M., Beil R. J. Beil, Jr., Schhesinger J.: Surgical Anatomy of the Nose, in Rhinoplasty and Septoplasty, ( Park and Holt, editors), in Otolaryngology Clinics of North America, Saunders, Vol. 32, No. 1, pp.145-181, 1999

633) C     Intermediate osteotomies are done after lateral osteotomies.

Most S. P., Murakami C. S.: A modern approach to nasal osteotomies, Facial Plastic Surgery Clinics of North America, Seminal Review Issue (Regan Thomas, J, editor), February 2005, Vol. 13, No. 1, pp.85—92

Most S. P., Murakami C. S., Larrabee Jr. W. F.: Surgery of the Bony Nasal Vault, Chapter 42 in Facial Plastic and Reconstructive Surgery, Thieme, Third Edition, (Papel, I, editor), 2009, pp. 547-553

634) B     Intermaxillary Fixation is usually maintained for 8 weeks.

Koltai P. J.: Pediatric Facial Fractures, Chapter 92 in Head and Neck Surgery - Otolaryngology, (Bailey), Volume I, Lippincott Williams & Wilkins, Third Edition, pp. 1105-1115, 2001

Doerr T. D., Mathog R. H.: Le Fort Fractures (Maxillary Fractures), Chapter 71 in Facial Plastic and Reconstructive Surgery, Thieme, Third Edition, (Papel, I, editor), 2009, pp. 991-1000

635) D     A circular defect

Larrabee, Jr. W.F.: Design of Local Skin Flaps, chapter 20 in Instructional Courses, American Academy of Otolaryngology-Head and Neck Surgery (Johnson, Blitzer, Ossoff, Thomas, editors),Vol. 3, pp. 252-273, 1990

636) A    Arch 1

Goding G. S., Eisele D. W.: Embryology of the Face, Head and Neck, Chapter 62 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D., editor), 2002 , pp.785-794

Goding G. S., Eisele D. W.: Embryology of the Head, Face and Neck, Chapter 73 in Facial Plastic and Reconstructive Surgery, Thieme, Third Edition, (Papel, I, editor), 2009, pp. 1019-1028

637) A     Scalp

Hoffmann J. F.: Tissue Expansion in Reconstruction of the Head and Neck , Chapter 45 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D., editor), 2002 , pp.549-559

Hoffmann J. F.: Tissue Expansion in Reconstruction of the Head and Neck , Chapter 55 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 745-756

638) B     Tear deficiency

Wolfley D. E.: Blepharoplasty: The Ophthalmologist’s view, The aging face, (Tarddy Jr. M. E., editor), Otolaryngologic Clinics of North America, Vol. 13, N0, 2, May 1980, pp. 237-263

639) B     2.5 ml

Conforti M.L., Connor N.P., Heisey D.M., Harting G. K.: Evaluation of Performance Characteristics of the Medical Leech (Hirudo medicinalis) for the treatment of Venous congestion, Plastic and Reconstructive Surgery, January 2002, Vol. 109, No. 1, pp.228-235

640) C     It represents the fourth stage of evolving rosacea.

Rohirch R.J., Griffin J. R., Adams Jr. W. P. : Rhinophyma: Review and Update, Plastic and Reconstructive Surgery, January 2002, Vol. 110, No. 3, pp. 860-869


http://emedicine.medscape.com/article/843957-overview

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Updated: June 15, 2017

641-650 MCQ in Facial Plastic and Reconstructive Surgery

641-650

641) The drawing below represents the medial orbital wall, in particular the frontoethmoidal suture. What is the measurement of the area indicated by the arrow marked with an X?

A. 25 mm
B. 30 mm
C. 35 mm
D. 40 mm
E. 55 mm

642) Which of the following represents the FIRST STAGE of Nagata’s Method for microtia reconstruction is TRUE?

A. Framework placement
B. Framework placement and lobule transposition
C. Framework placement, incorporation of tragal component and lobule transposition
D. Excision of remnant cartilages and lobule transposition
E. Lobule transposition

643) Which of the following is the MOST COMMON complication related to the use of silastic material for auricular reconstruction?

A. Hematoma
B. Infection
C. Exposure
D. Displacement
E. Poor cosmetic result

644) Which of the following INCISIONS is the one recommended for the retrograde approach in Rhinoplasty?

A. Transcartilaginous
B. Intercartilaginous
C. Marginal
D. Rim
E. Transcolumellar and marginal

645) Which of the following dissections IS RECOMMENDED for protection of the facial nerve in the temporal approach for Endoscopic Brow Elevation?

A. Dissection in the subperiosteal plane
B. Dissection in the areolar tissue plane (innominate fascia)
C. Dissection in the supraperiosteal plane
D. Dissection medial and inferior to a branch of the zygomaticotemporal vein
E. Dissection lateral and superior to a branch of the zygomaticotemporal vein

646) Which of the following represents the SECOND STAGE of BRENT’S technique for microtia reconstruction?

A. Framework placement
B. Lobule transposition
C. Lobule transposition and tragus reconstruction
D. Excision of remnant cartilages and lobule transposition
E. Framework placement, incorporation of tragal component and lobule transposition

647) Which of the following statements about head and neck embryology is TRUE?

A. The development of the pharyngeal arches begins at approximately day 20.
B. Each pharyngeal arch contains an artery, a nerve, a cartilaginous bar, and a muscle component.
C. The stapedius muscle and posterior belly of digastric muscle form part of the first pharyngeal arch.
D. The stylopharyngeus muscle forms part of the second pharyngeal arch.
E. The thyroid and cricoid cartilages form part of the third pharyngeal arch.

648) Which of the following anatomical structures is a derivative of the second pharyngeal arch?

A. Maxilla
B. Zygoma
C. Incus
D. Cricoid
E. Stapes

649) Which of the following MEASUREMENTS refers to the distal radius bone segment that can safely be harvested in a composite reconstruction using a Radial Forearm Free Flap?

A. 5 cm
B. 10 cm
C. 15 cm
D. 20 cm
E. 25 cm

650) Which of the following PERCENTAGES APPROXIMATES the survival rate of Micrografts in Hair Replacement Surgery?

A. 60%
B. 70%
C. 80%
D. 90%
E. 100%


ANSWERS & REFERENCES


641) C     35 mm

Burkat C. N., Lemke B. N.: Anatomy of the Orbit and Its Related Structures, Advances in Oculo-facial Surgery, ( Bosniak S. L., editor), Otolaryngologic Clinics of North America, October 2005, Vol.38, No. 5, pp.825-856

642) C     Framework placement, incorporation of tragal component and lobule transposition

Walton R. L., Beahm E. K.: Auricular Reconstruction for Microtia: Part II. Surgical Techniques, Plastic and Reconstructive Surgery, January 2002, Vol. 110, No. 1, pp. 234-249

643) C     Exposure

Walton R. L., Beahm E. K.: Auricular Reconstruction for Microtia: Part I, Anatomy, Embryology and Clinical Evaluation, Plastic and Reconstructive Surgery, June 2002, Vol. 109, No. 7, pp. 2473-2482

644) B     Intercartilaginous

Tardy M. E., Toriumi D. M., Hecht D.A.: Philosophy and Principales of Rhinoplasty, Chapter 32 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, second edition (Ira Papel, editor), 2002, pp. 369-389

Tardy M. E., Toriumi D. M., Hecht D.A.: Philosophy and Principales of Rhinoplasty, Chapter 32 Facial Plastic and Reconstructive Surgery, Thieme Medical Publishers, Third edition (Ira Papel, editor), 2009, pp. 507-528

645) D     Dissection medial and inferior to a branch of the zygomaticotemporal vein

http://emedicine.medscape.com/article/839535-overview

http://emedicine.medscape.com/article/1276726-overview

646) B     Lobule transposition

Walton R. L., Beahm E. K.: Auricular Reconstruction for Microtia: Part II. Surgical Techniques, Plastic and Reconstructive Surgery, January 2002, Vol. 110, No. 1, pp. 234-249

647) B     Each pharyngeal arch contains an artery, a nerve, a cartilaginous bar, and a muscle component.

Goding G. S., Eisele D. W.: Embryology of the Face, Head and Neck, Chapter 62 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D., editor), 2002 , pp.785-794

Goding G. S., Eisele D. W.: Embryology of the Face, Head and Neck, Chapter 73 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 1019-1028

648) E     Stapes

Goding G. S., Eisele D. W.: Embryology of the Face, Head and Neck, Chapter 62 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D., editor), 2002 , pp.785-794

Goding G. S., Eisele D. W.: Embryology of the Face, Head and Neck, Chapter 73 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 1019-1028

649) B     10 cm

Burkey B. B., Schmalbach C. E., Coleman Jr. J. R.: Microvascular Flaps, Chapter 57 in Facial Plastic and Reconstructive Surgery, Third Edition, (Papel I. D., editor), 2009 , pp. 765-793

Chepeha D. B., Teknos T. N.: Microvascular Free Flaps in Head and Neck Reconstruction, Chapter 162, in Head & Neck Surgery Otolaryngology, (Bailey, B. J., editor), 4th Edition, Lippincott Williams & Wilkins, 2006, pp. 2369-2391

650) E     100%

Buchwach K. A.: Standard Grafts, Minigrafts, and Micrografts, Their Use in Hair Transplantation, Facial Plastic Surgery Clinics of North America , Hair Replacement Surgery, (Konior R.J. and Rousso D. E. ., editors), May 1994, Vol. 2, No. 2, pp. 149-161

-------------------------------------
Updated: June 15, 2017

651-660 MCQ in Facial Plastic and Reconstructive Surgery

651-660  

651) Which of the following surgical techniques provides the BEST CONTOUR to repair the alar-columellar deformity shown below?

A. Skin graft (ear lobule)
B. Local flap (skin and soft tissue)
C. Cartilage graft (septal)
D. Composite graft (cymba concha of the left ear)
C. Composite graft (cymba concha of the right ear)

652) Which of the following craniofacial synostosis syndromes is characterized by the following anatomical features : craniosynostosis, brachycephaly, shallow orbits with eyes proptosis, maxillary hypoplasia and absence of syndactyly?

A. Apert’s Syndrome
B. Crouzons Syndrome
C. Pfeiffer’s Syndrome
D. Saethre-Chotzen Syndrome
E. Carpenter’s Syndrome

653) Which of the following types of male-pattern baldness is the one depicted by a large vertex region of alopecia separated from a large frontotemporal region of alopecia by a narrow and sparse band of hair?

A. Type III
B. Type IV
C. Type V
D. Type VI
E. Type VII

654) After a facelift which of the following anatomical areas is the most common place for minor skin sloughing unrelated to hematoma?

A. Temporal area
B. Preauricular area
C. Lobule area
D. Mastoid area
E. Infero-posterior aspect of neck

655) Which of the following statements regarding cartilage grafts for head and neck augmentation and reconstruction is FALSE?

A. Homologous cartilage grafts resorb more frequently than cartilage autografts.
B. Lyophilized cartilage does not need re-hydration prior to implantation.
C. Nasal autogenous cartilage grafts are harvested preserving a dorsal and caudal struts of 10 mm widths.
D. Composite helical rim grafting shold not be wider than 1.5 cm.
E. Costal cartilage can be harvested from ribs 6,7,8, and 9.

656) Which of the following PERCENTAGES represents the 20 year survival rate of nasal tip grafts from autogenous septal cartilage?

A. 65%
B. 75%
C. 85%
D. 95%
E. 100%

657) Which of the following statements about the superior trapezius flap is TRUE?

A. It is the least reliable of the three trapezius flaps.
B. Its blood supply is from the transverse and dorsal scapular arteries.
C. Its blood supply is compromised by a previous neck dissection.
D. It is a reliable flap for coverage of exposed major neck vessels after radiation therapy.
E. It is not a reliable flap to be used when neck wounds are infected.

658) Which of the following correctly CLASSIFIES the mid-forehead flap?

A. It is a rotation flap.
B. It is a transposition flap.
C. It is an interpolation flap.
D. It is an advancement flap.
E. It is a hinged flap.

659) Which of the following statements about free composite grafts is FALSE?

A. Once in place, immediate serum imbibition occurs.
B. Inosculation phenomenon occurrs within 72 hours after placement.
C. Neovascularization phenomenon occurrs within 4-5 days after placement.
D. The graft appears blanched for approximately 24 hours after placement.
E. After 24 hours in place the graft becomes cyanotic due to venous congestion.

660) Which of the following is the MOST COMMON COMPLICATION of the cervicofacial rotation-advancement flap?

A. Hematoma
B. Infection
C. Distal ischemic necrosis
D. Poor color and texture matching
E. Facial nerve paresia


ANSWERS & REFERENCES


651) D     Composite graft (cymba concha of the left ear)

Becker D. G.: Complications of Rhinoplasty, chapter 39, in Facial Plastic and Reconstructive Surgery (Papel I, editor), second edition, 2002, pp. 452-460

Becker D. G.: Complications of Rhinoplasty, chapter 49, in Facial Plastic and Reconstructive Surgery (Papel I, editor), Third edition, 2009, pp. 639-648

Papel I. D.: Secondary Rhinoplasty, chapter 46, in Facial Plastic and Reconstructive Surgery (Papel I, editor), Third edition, 2009, pp. 589-603

652) B     Crouzons Syndrome

Katzen J. T., McCarthy J. G.: Syndromes involving craniosynostosis and midface hypoplasia, Syndromic and other congenital anamalies of the Head and Neck, Otolaryngologic Clinics of North America, Vol. 33, No. 6, December 2000, pp.1257-1284

653) C     Type V

Norwood O. T.: Male Pattern Baldness: Classification and Incidence: Southern Medical Journal, Nov. 1975, Vo. 58, No. 11, pp. 1359-1365

654) D     Mastoid area

Quatela V. C., Russell Ries W.: Aesthetic Facial Surgery, Chapter 24 in Complications in Head and Neck Surgery, (Krespi & Ossoff, editors), 1993, pp.385-435

Rees T. D.: The Classical Operation, Chapter 22, in Aesthetic Surgery of the Neck and Face, pp . 600-633

Perkins S. W., Naderi S.: Rhytidectomy, chapter 19, in Facial Plastic and Reconstructive Surgery (Papel I, editor), Third edition, 2009, pp. 207-225

655) B     Lyophilized cartilage does not need re-hydration prior to implantation.

Allcroft R. A., Friedman C. D., Quatela V. C.: Cartilage Grafts for Head and Neck Augmentation and Reconstruction, Autografts and Homografts, Soft-Tissue Augmentation and Reconstruction in the Head and Neck, in Otolaryngologic Clinics of North America , Vol. 27,, No. 1, February 1994, pp.69-79

656) D     95%

Allcroft R. A., Friedman C. D., Quatela V. C.: Cartilage Grafts for Head and Neck Augmentation and Reconstruction, Autografts and Homografts, Soft-Tissue Augmentation and Reconstruction in the Head and Neck, in Otolaryngologic Clinics of North America , Vol. 27,, No. 1, February 1994, pp.69-79

657) D     It is a reliable flap for coverage of exposed major neck vessels after radiation therapy.

Annino Jr. D.J., Shu R. S.: Chapter 46 Musculocutaneous Flaps, Facial Plastic and Reconstructive Surgery, (Papel I.D., editor), 2002, pp. 560-566

Annino Jr. D.J., Shu R. S., Gold D. R.: Chapter 56 Musculocutaneous Flaps, Facial Plastic and Reconstructive Surgery, (Papel I.D., editor), 2009, pp. 757-764

Aviv J. E., Urken M. L., Lawson W.. Biller H. F.: The Superior Trapezius Myocutaneos Flap in Head and Neck Reconstruction, Arch. Otolaryngology Head Neck Surgery, Vol. 118, July 1992, pp. 702-706

658) C     It is an interpolation flap.

Baker S. R.: Local Cutaneous Flaps, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, No 1, February 1994, pp. 139-159

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

659) B     Inosculation phenomenon occurs within 72 hours after placement.

Konior R. J.: Free Composite Grafts, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clincis of North America, Vol. 27, No. 1, February 1994, pp.81-90

Triana Jr. R. J., Murakami C. S., Larrabee Jr. W. F.: Skin Grafts and Local Flaps, chapter 4, in Facial Plastic and Reconstructive Surgery (Papel I, editor), Third edition, 2009, pp. 41-58

660) C     Distal ischemic necrosis

Koll S. S., Reece G. Robb G., Black J.: Deep Plane Cervicofacial Rotation Advancement Flap for Reconstruction of Large Cheek Defects, Plastic and Reconstructive Surgery, July 1994, Vol. 94, no. 1, pp. 88-93

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Updated: June 15, 2017

661-670 MCQ in Facial Plastic and Reconstructive Surgery

661-670

661) Which of the following SUTURES are depicted in the drawing below?

A. Transdomal sutures
B. Interdomal sutures
C. Flaring sutures
D. Dome-binding sutures
E. Submucosal sutures

662) Which of the following ABOUT the Temporalis Muscle for facial reanimation is TRUE?

A. It is successful in restoring a smile in 60% of the patients.
B. It is successful in improving mouth function in 70 % of the patients.
C. Incision in the scalp is made just posterior to the auricle and is extended superiorly to the parietal region.
D. The mid-portion of the Temporalis Muscle is used.
E. The Temporalis Muscle is sutured to the corner of the mouth without overcorrection.

663) Which of the following statement is the PRINCIPAL VASCULAR SUPPLY for the Iliac Crest Composite Flap used in oromandibular reconstruction?

A. The Superficial Circumflex Iliac artery (SCIA)
B. The Deep Circumflex Iliac Artery (DCIA)
C. The Superior Deep Branch of the Gluteal Artery alone
D. The Ascending Branch of the Lateral Circumflex Femoral Artery alone
E. Both the Superior Deep Branch of the Gluteal Artery and the Ascending Branch of the Lateral Circumflex Femoral Artery

664) Which of the following represents the HIGHEST PERCENTAGE OF PATHOLOGICAL FRACTURE reported after harvest of a Radial Bone Foream Free Flap?

A. 10%
B. 20%
C. 30%
D. 40%
E. 50%

665) Which of the following represents THE PERCENTAGE of a muscle atrophy occurring after muscular flap transfer?

A. 5%
B. 10%
C. 20%
D. 30%
E. 40%

666) Which of the following statements about the Sternocleidomastoid Muscle Flap is FALSE?

A. It can be used for repair of cheek defects.
B. Superiorly it is perfused by branches of the Occipital Artery.
C. It is critical to include at least two vessels to have a reliable axial-patterned flap
D. It is innervated by the Spinal Accessory Nerve.
E. It can only be used if it is superiorly based.

667) Which of the following is THE PROPER TIMING for initial surgical intervention in MID-FACIAL abnormalities associated with craniomaxillofacial deformities?

A. 6 months
B. 12 months
C. 2 years
D. 4 years
E. 16 years

668) Which of the following statements about the Buccal Fat Pad and its "pseudoherniation" is FALSE?

A. The normal buccal fat pad has four extensions from its body.
B. The antero-inferior displacement of the pterygoid extension is the cause of the "pseudoherniation" of the Buccal Fat Pad.
C. "Pseudoherniation" of the Buccal Fat Pad presents clinically as a soft, nontender, walnut-sized, lower cheek subcutaneous mass.
D. The "pseudoherniation" of the Buccal Fat Pad is reduced temporarily by pushing it in and upward toward the zygoma.
E. The "pseudoherniation" of the Buccal Fat Pad can be accessed though an incision in the upper gingivobuccal groove just above the first molar.

669) Which of the following anatomical structures is the one that comprises the PHARYNGEAL COMPONENT of the velopharyngeal closure?

A. Levator veli palatine
B. Palatoglossus
C. Inferior constrictor
D. Superior constrictor
E. Tensor veli palatine

670) Which of the following statements is FALSE regarding the Fasciocutaneous Radial Forearm Free Flap (FCRFFF) and/or the Osteocutaneous Radial Forearm Free Flap (OCRFFF)?

A. The FCRFFF is the most common free flap used in Head and Neck Reconstruction.
B. Both the FCRFFF and OCRFFF are based on the Perforator Arteries and their two venae comitantes.
C. In the OCRFFF, the thickness of the bone graft is usually 50% of the cross sectional area of the Radius.
D. The length of the bony graft in the OCRFFF can reach up to 14 cm.
E. In the OCRFFF, the reported rate of radial fracture is usually very high.


ANSWERS & REFERENCES


661) C     Flaring sutures

Papel I. D.: Management of the Middle Vault, Chapter 35 in Facial Plastic and Reconstructive Surgery , Second Edition, (Papel I. D, editor), 2002, pp. 407-413

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

662) D     The mid-portion of the Temporalis Muscle is used.

May M., Drucker C.: Temporalis Muscle for Facial Reanimation, a 13-Year Experience with 224 Procedures, Arch. Otolaryngogology Head and Neck Surgery, Vol. 119, April 1993, pp.378-384

663) B     The Deep Circumflex Iliac Artery (DCIA)

Hayden R. E., O’Leary M. J. : Mandibular Reconstruction, Chapter 46 in Facial Plastic and Reconstructive Surgery, (Papel and Nachlas, editors), 1992, pp.424-434

Moscoso J. F., Urken M. L.: The Iliac Crest Composite Flap for Oromandibular Reconstruction, in Reconstruction of the Mandibule and Oropharynx, Otolaryngologic Clinics of North America, Vol. 27, No. 6, Dec. 1994, pp.1097-1115

664) D     40%

Richardson D., Fisher S. E., Vaughan E. D., Brown J. S.: Radial Forearm Flap Donor-Site Complications and Morbidity”A Prospective Study, Plastic and Reconstructive Surgery, January 1997, Vol. 99, no.1, pp.109-115

Burkey B. B., Coleman Jr. J. R.: Microvascular Flaps, Chapter 47 in Facial Plastic and Reconstructive Surgery (Papel I. D., editor), 2002, pp. 567-590

665) E     40%

Shindo M. L., Sullivan M. J.: Muscular and Myocutaneous Pedicled Flaps, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, no. 1, February 1994, pp. 161-172

666) E     It can only be used if it is superiorly based.

Shindo M. L., Sullivan M. J.: Muscular and Myocutaneous Pedicled Flaps, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, no. 1, February 1994, pp. 161-172

667) D     4 years

Vander Kolk C. A., Carson B. S., Guarnieri M.: Craniomaxillofacial Deformities, Chapter 63 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Facial Plastic and Reconstructive Surgery, Second Edition, 2002, pp.795-802

668) B     The antero-inferior displacement of the pterygoid extension is the cause of the "pseudoherniation" of the Buccal Fat Pad.

Matarasso A.: Pseudoherniation of the Buccal Fat Pad: A New Clinical Syndrome, Plastic and Reconstructive Surgery, Nov. 2003,1716-1720


669) D     Superior constrictor

Johns D. F., Rohrich R. J., Awada M: Velopharyngeal Incompetence: A Guide for Clinical Evaluation, Plastic and Reconstructive Surgery, Dec. 2003, Vol.112, No.7, pp.1890-1897

670) D     The length of the bony graft in the OCRFFF can reach up to 14 cm.

Burkey B. B., Coleman Jr, J.R.: Microvascular Flaps, chapter 47 in in Facial Plastic and Reconstructive Surgery, (Papel, I.D. , editor), Second Edition, 2002, pp.569-571

Burkey B. B., Schmalbach C. E., Coleman Jr, J.R.: Microvascular Flaps, chapter 57 in in Facial Plastic and Reconstructive Surgery, (Papel, I.D. , editor), Third Edition, 2009, pp. 765-793

http://emedicine.medscape.com/article/881055-overview

---------------------------------------
Updated: June 15, 2017

671-680 MCQ in Facial Plastic and Reconstructive Surgery

671-680  

671) Which of the following statements about the reconstruction of the lower eyelid defect depicted in the drawing below is FALSE?
A. The flap is a Lateral Canthal, Semicircular Flap.
B. The flap is applicable to the lower eyelid only.
C. The flap will require canthotomy and cantholysis prior to musculocutaneous elevation.
D. The flap is called a Tenzel musculocutaneous flap
E. The flap is commonly complicated with retraction of the reconstructed lateral eyelid

672) Which of the following statements about Pilomatrixoma is TRUE?

A. It is a locally invasive skin neoplasm
B. It occurs more frequently on the trunk and lower extremities, rather than on the head and neck.
C. It is more common in adults than children.
D. It is treated with surgical excision.
E. It commonly has a high local recurrence rate.

673) You are consultated to see a 7-year-old girl for surgical excision of a round, ulcerated hemangioma localized in the left cheek and measuring 2.5 cm in diameter. Which of the following surgical techniques is the best for this particular patient?

A. Fusiform excision and linear closure.
B. Serial excision and linear closure.
C. Circular excision and purse string closure.
D. Fusiform excision and advancement local facial flap.
E. Circular excision and local facial flap.

674) The Radial Foream Flap has the HIGHEST INCIDENCE of which of the following complications?

A. Partial loss of donor-site skin.
B. Partial loss of donor-site skin with exposure of tendons.
C. Donor-site cold intolerance.
D. Lack of superficial Radial Nerve sensation in the donor-site
E. Poor aesthetic result in the donor-site

675) Which of the following statements about TESSIER OPERATIVE ADVANCEMENT performed in patients with craniosynostosis is FALSE?

A. Hydrocephalus should be repaired first.
B. Procedure should be done at 6 months of age.
C. It is a fronto-orbital advancement.
D. It will allow a maximal advancement of 10 mm.
E. It will not require bone grafting in the resulting gaps.

676) Which of the following structures is the one containing the HAIR MATRIX?

A. The Bulb
B. The Infundibulum
C. The Inner and Outer Root Sheath
D. The Isthmus
E. The Suprabulb

677) Which of the following flap monitors IS THE BEST TOOL for reliable detection of early problems in flap perfusion?

A. Thermal Clearance
B. Pulse Oximetry
C. Photoplethysmography
D. Laser-Doppler Velocimetry
E. Dupplex Doppler Ultrasonography

678) Which of the following anatomic structures is NOT innervated by V3?

A. The Lateral Pterygoid Muscle
B. The Mylohyoid Muscle
C. The Posterior Belly of the Digastric Muscle
D. The Tensor Veli Palatini Muscle
E. The Tensor Tympani Muscle

679) Which of the following methods for Unilateral Primary Cleft Lip Repair will concentrate the closure tension at the UPPER PORTION of the lip?

A. The Bardach
B. The Millard
C. The Skoog
D. The Tennison
E. The Randall

680) Which of the following areas is THE MOST COMMON SITE for metastasis in patients with Facial Cutaneous Melanomas treated with adequate margins of wide local excision?

A. Lymph nodes
B. Lung
C. Liver
D. Brain
E. Bone


ANSWERS & REFERENCES


671) B     The flap is applicable to the lower eyelid only.

Kaltreider S. A. : Periocular Reconstruction, chapter 52 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Facial Plastic and Reconstructive Surgery, Second Edition, 2002, pp.646-659

Kaltreider S. A. : Periocular Reconstruction, chapter 62 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Facial Plastic and Reconstructive Surgery, Third Edition, 2009, pp. 855-867

672) D     It is treated with surgical excision.

Pirouzmanesh A., Reinisch J.F., Gonzalez-Gomez I., Smith E. M., Meara J.G.: Pilomatrixoma: A review of 346 Cases, Plastic and Reconstructive Surgery, Dec. 2003, Vol. 112, No. 7, pp1784-1789

673) C     Circular excision and purse string closure.

Mulliken J. B., Rogers G. F., Marler J. J.: Circular Excision of Hemangioma and Purse-String Closure: The Smallest Possible Scar, April 2002, Vol. 109, No. 5, pp. 1544-1555

674) D     Lack of superficial Radial Nerve sensation in the donor-site

Richardson D., Fisher S. E., Vaughan E. D., Brown J. S.: Radial Forearm Flap Donor-Site Complications and Morbidity, ”A Prospective Study, Plastic and Reconstructive Surgery, January 1997, Vol. 99, no.1, pp.109-115

675) D     It will allow a maximal advancement of 10 mm.

Katzen J. T., McCarthy J. G.: Syndromes involving craniosynostosis and midface hypoplasia, Syndromic and other congenital anamalies of the Head and Neck, Otolaryngologic Clinics of North America, Vol. 33, No. 6, December 2000, pp.1257-1284

676) A     The Bulb

Bennett R. G.: Anatomy and Physiology of the Skin, Chapter 1, in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Thieme, Second Edition, 2002, pp. 10-12

Bennett R. G.: Anatomy and Physiology of the Skin, Chapter 1, in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Thieme, Third Edition, 2009, pp. 3-14

http://emedicine.medscape.com/article/835470-overview

677) D     Laser-Doppler Velocimetry

Stepnick D. W., Hayden R. E.: Postoperative Monitoring and Salvage of Microvascular Free Flaps, Reconstruction of the Mandible and Oropharynx, Otolaryngologic Clinics of North America, Vol. 27, N0. 6, Dec. 1994, pp.1201-1217

678) C     The Posterior Belly of the Digastric Muscle

Graney D. O., Baker S. R.: Anatomy, Chapter 18, in Otolaryngology-Head and Neck Surgery (Cummings, Fredrikson, Harker, Krause, Schuller, editors), Vol. 1, Second Edition, 1993, pp. 305-314

679) B     The Millard

Schuller D. E., Krause C. J.: Cleft Lip and Palate, A Self-Instructional Package from the Committee on Continuing Education in Otolaryngology, AAOHNS Foundation, Inc., 1983, pp27-37

680) A     Lymph nodes

Wagner J.D., Gordon M.S., Chuang T, Coleman III J.J. : Current Therapy of Cutaneous Melanoma,Plastic and Reconstructive Surgery, April 2000, Vol. 105, No. 5, pp.1774-1799

Hendrix J. D.: Jr., Slingluff C. L.: Cutaneous Malingnancies: Diagnosis and Treatment, Chapter 42 in Facial Plastic Reconstructive Surgery, (Papel, I, edidor), Second Edition, 2002, pp. 493-500

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Updated: June 15, 2017

681-690 MCQ in Facial Plastic and Reconstructive Surgery

 681-690  

681) The drawing below represents a Transposition Flap designed to close a circular defect with a diameter of "d". A tangent is drawn on one side of the circle , parallel to the RSTL. Which of the following measurements represents an adequate proportion between the length "X" and "d"?

A. X is equal to 1 d
B. X is equal to 1.25 d
C. X is equal to 1.50 d
D. X is equal to 1.75 d
E. X is equal to 2 d

682) Which of the following statements about the Dorsal Nasal Flap is FALSE?

A. It is a Transposition Flap.
B. It is useful for reconstruction of defects of the distal half of the nasal dorsum.
C. The flap is elevated in the submuscular/aponeurotic plane.
D. The defect should have a diameter not greater than 2 cm.
E. The defect should not extend more inferiorly than the Tip-Defining points.

683) Which of the following measurements can reduced the incidence of hematoma formation in male rhytidectomy?

A. Use of bipolar cauterization.
B. Use of vasoconstriction infiltration in the surgical wound.
C. Use of suctioning systems rather than penrose drains.
D. Meticulous perioperative blood pressure control and monitoring.
E. Heavy smoking history.

684) Which of the following statements regarding percutaneous lateral osteotomies is FALSE?

A. The percutaneous incision should be made with the flat edge of a 2-mm straight chisel
B. The chisel should be sharpened on a saline-moistened surgical black stone before each osteotomy
C. The percutaneous entry site is not closed with sutures
D. The chisel should be cleansed of any foreign body matter or material
E. Percutaneus osteotomies produce an imperceptible scar 100% of the time

685) Which of the following eyelid abnormalities is adequately corrected by the “Madame Butterfly” Procedure?

A. Postblepharoplasty Lower Eyelid Malposition
B. Eyelid Ptosis
C. Eyelid Dermatochalasis
D. Lower Eyelid Entropion
E. Lower Eyelid Mid-Third Full Thickeness Defect

686) Which of the following statements regarding Propofol is TRUE?

A. It is a benzodiazepine sedative.
B. It is very soluble in water.
C. Pain at the injection site is negligible.
D. The duration of action is aproximately 60 minutes.
E. It is related to a much faster recovery and reduced incidence of nausea and vomiting.

687) Under normal circumstances when does REVASCULARIZATON USUALLY occur after a Skin Flap Placement?

A. 6 hours
B. 12 hours
C. 24 hours
D. 4 days
E. 10 days

688) Which of the following statements is TRUE about LASER suspension microlaryngoscopy done under general anesthesia?

A. FIO2 should not be above of 5%
B. FIO2 should not be above of 10%
C. FIO2 should not be above of 20%
D. FIO2 should not be above of 30%
E. FIO2 should not be above of 40%

689) Which of the following skin grafts is BEST for covering the anterior floor of the mouth?

A. Split-thickness skin graft (STSG) with 0.005 inches of thickness
B. Split-thickness skin graft (STSG) with 0.010 inches of thickness
C. Split-thickness skin graft (STSG) with 0.017 inches of thickness
D. Split-thickness skin graft (STSG) with 0.025 inches of thickness
E. Full-thickness skin graft (FTSG)

690) Which of the following WILL NOT increase nasal tip projection?

A. Transdomal suture
B. Onlay tip graft
C. Columella strut
D. Approximation of medial crura footplates
E. Reduction of alar base


ANSWERS & REFERENCES


681) C     X is equal to 1.50 d

Toriumi D. M., Larrabee Jr.: Skin Grafts and Flaps, Chapter 4 in Facial Plastic and Reconstructive Surgery (Papel I.D., Nachlas N.E., editors), 1992, pp. 31-44

682) A      It is a Transposition Flap.

Rohrich R. J. , Muzaffar A. R., Adams Jr. W. P., Hollier L. H.: The Aesthetic Unit Dorsal Nasal Flap: Rationale for Avoidind a Glabellar Incision, Plastic and Reconstructive Surgery, October 1999, Vol. 104, No. 5, pp. 1289-1294

http://emedicine.medscape.com/article/880003-overview

683) D     Meticulous perioperative blood pressure control and monitoring.

Baker D. C., Stefani W. A., Chiu E.S.: Reducing the Incidence of Hematoma requiring Surgical Evacuation following Male Rhytidectomy: A 30-Year Review of 985 Cases, Plastic and Reconstructive Surgery, Dec 2003, Vol.116, No.7, pp.1973-1985

Perkins S. W., Naderi Shervin: Rhytidectomy, Chapter 19 in Facial Plastic and Reconstructive Surgery (Papel I.D., editor), 2009, pp. 207-225

684) E     Percutaneus osteotomies produce an imperceptible scar 100% of the time

Gryskiewicz J. M.: Visible Scars from Percutaneous Osteotomies, Plastic and Reconstructive Surgery, Nov. 2005, Vol.116, No.6, pp. 1771-1775

685) A     Postblepharoplasty Lower Eyelid Malposition

Li T. G. , Shorr N., Goldberg R.A: Comparison of Efficacy of Hard Palate Grafts with Acellular Human Dermis Grafts in Lower Eyelid Surgery, Plastic and Reconstructive Surgery, Nov. 2005, Vol.116, No.6, pp. 1771-1775

Codner M.A.: Comparison of the Efficacy of Hard Palate Grafts with Acellular Human Dermis Grafts in Lower Eyelid Surgery, Discussion, Sept 2005, Vol. 116, No. 3, pp.879-880

686) E     It is related to a much faster recovery and reduced incidence of nausea and vomiting.

Murakami C. S. , Ross B. K.: Local Anesthesia in Facial Plastic Surgery, Chapter 27 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Schuller, editors), Second Edition, Volume 1, 1993, pp.468-479

Fletcher M.V.: Anesthesia in Facial Plastic Surgery, Chapter 17 in Facial Plastic and Reconstructive Surgery (Papel I.D., editor), 2009, pp. 189-206

687) D     4 days

Krause G. E., Lepore M. L.: Principles of Grafts and Flaps in chapter 51, Facial Plastic Surgery, in ENT secrets, Jafek B. W., Stark A.K., editors), 1996-pp.245-251

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Grafts for Cutaneous Reconstruction, Chapter 53 in Facial Plastic and Reconstructive Surgery (Papel I.D., editor), 2009, pp. 703-719

688) E     FIO2 should not be above of 40%

Ossoff R. H., Reinish L.: Laser Surgery: Basic Principles and Safety Considerations, Chapter 12 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Schuller, editors), Second Edition, Volume 1, 1993, pp.199-213

689) C     Split-thickness skin graft (STSG) with 0.017 inches of thickness

Hom D. B., Tope W. D.: Minimally Invasive Options and Skin Options and Skin Grafts for Cutaneous Reconstruction, Chapter 43 in Facial Plastic and Reconstructive Surgery, (Papel, I. D, ,editor), Second Edition, 2002, pp. 512-527

Petruzzelli G. J., Johnson J. T.: Skin Grafts, Soft-Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, N0. 1, February 1994, pp. 25-37

690) E     Reduction of alar base

Guyuron B.: Dynamics in Rhinoplasty, Plastic and Reconstructive Surgery, May 2000, Vol. 105, No. 6, pp.2257-2259

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

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Updated: June 15, 2017

691-700 MCQ in Facial Plastic and Reconstructive Surgery

691-700  

691) Which of the following arteries is the one represented in the drawing below?

A. Occipital Artery
B. Paravertebral Perforators Arteries
C. Transverse Cervical Artery
D. Dorsal Scapular Artery
E. Suprascapular Artery

692) After completion of a forehead lift, blepharoplasty and rhytidectomy, with general anesthesia, a 45 year old female patient is agitated, uncooperative and not understanding or responding to verbal commands. Which of the following is the PROBABLE CAUSE?

A. Anxiety disorder
B. Allergic reaction
C. Hypoxia
D. Severe pain
E. Acute bleeding under the face lift flaps

693) Which of the following nerves is a terminal branch of the EXTERNAL NASAL NERVE?

A. The Anterior Ethmoidal Nerve
B. The Posterior Ethmoidal Nerve
C. The Supratrochear Nerve
D. The Supraorbital Nerve
E. The Nasociliary Nerve

694) Which of the following anatomical areas is the "danger zone" of the temporal branch for the facial nerve as it passes over the zygomatic arch?

A. The region between 0.5 cm anterior to the helical root and 0.5 cm posterior to the anterior end of the zygomatic arch.
B. The region between 1.5 cm anterior to the helical root and 1 cm posterior to the anterior end of the zygomatic arch.
C. The region between 1.5 cm anterior to the helical root and 1.5 cm posterior to the anterior end of the zygomatic arch.
D. The region between 1.8 cm anterior to the helical root and 2 cm posterior to the anterior end of the zygomatic arch.
E. The region between 2.5 cm anterior to the helical root and 3 cm posterior to the anterior end of the zygomatic arch.

695) Which of the following is THE BEST IMPLANT for use in an augmentation rhinoplasty which is performed to correct a severe nasal dorsum defect?

A. Autogenous sixth rib bone
B. Autogenous seventh rib bone
C. Autogenous calvarial bone
D. Autogenous Ileac bone
E. Homografts of irradiated rib cartilage

696) Which of the following statements about the hair growth cicle is TRUE?

A. The growth is 90% of hairs in the anagen phase and 10 % in the telogen phase
B. The growth is 80% of hairs in the anagen phase and 20 % in the telogen phase
C. The growth is 70% of hairs in the anagen phase and 30 % in the telogen phase
D. The growth is 60% of hairs in the anagen phase and 40 % in the telogen phase
E. The growth is 50% of hairs in the anagen phase and 50 % in the telogen phase

697) Which of the following statements about the dynamics of rhinoplasty is FALSE?

A. Reduction of the nasion will make the nose longer.
B. Dorsum augmentation will result in a nose that appears narrower.
C. Reduction of the nasal spine will create the illusion of reduction in the columella-labial angle.
D. Resection of the caudal septum based anteriorly will rotate the tip cephalically.
E. Resection of the cephalic portion of the lower lateral cartilage will result in significant increase in tip projection.

698) Which of the following tissues SHOULD NOT BE USED in the lower eyelid Madame Butterfly Procedure?

A. Alloderm
B. Autogenous Split Thickness Skin Graft
C. Autogenous Hard Palate Graft
D. Autogenous Septal mucosa with cartilage graft
E. Autogenous Tensor Fascia Lata Graft

699) Which of the following signs or symnptoms raises EARLY SUSPICION OF MELANOMA in an adquired nevus?

A. Pruritus
B. Asymmetry
C. Bleeding
D. Change of color
E. Elevated area in a previously flat nevus

700) Which of the following statements about the Lower Trapezius Island Musculocutaneous Flap is TRUE?

A. It is a large flap but the arc of rotation is limited.
B. It is supplied by the occipital artery and the posterior intercostal vessels.
C. An arteriogram to evaluate vascular patency is mandatory prior to its execution.
D. It is used for the lateral skull, anterior and lateral neck and oral cavity and face.
E. Usually skin grafting or a local flap is necessary for closing the donor site.


ANSWERS & REFERENCES


691) C     Transverse Cervical Artery

Urken M.L, Naidu R. K., Lawson W., Biller H.F.: The Lower Trapezius Island Musculocutaneous Flap Revisited, Report of 45 Cases and a Unifying Concept of the Vascular Supply, Arch. Otolaryngology Head Neck Surgery, Vol. 117, May 1991, pp.502-511

Annino D. J. Jr. , Shu R. S., Gold D. R.: Musculocutaneous Flaps, Chapter 46 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Facial Plastic and Reconstructive Surgery, Second Edition, 2002, pp. 560-566

Annino D. J. Jr. , Shu R. S.: Musculocutaneous Flaps, Chapter 56 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), Facial Plastic and Reconstructive Surgery, Third Edition, 2009, pp. 757-764

692) C     Hypoxia

Courtiss E. H., Kanter M. A.: The Prevention and Management of Medical Problems During Office Surgery, Plastic and Reconstructive, January 1990, Vol. 85, No.1, pp.127-136

693) A     The Anterior Ethmoidal Nerve

 
Graney D. O., Baker S. R.: Anatomy, Chapter 18, in in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Schuller, editors), Third Edition, Volume 1, 1993, pp. 305-314

694) D     The region between 1.8 cm anterior to the helical root and 2 cm posterior to the anterior end of the zygomatic arch.

Weinberger M. S., Becker D. G., Toriumi D. M.: Rhytidectomy, Chapter 33 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Volume 1, 1998, pp.648-659

695) C     Autogenous calvarial bone

Romo III T., MacLaughlin L. A., Levine J. M., Sclafani A. P.: Nasal Implants:autogenous, semisynthetic and synthetic, Facial Plastic Surgery Clinics of North America, New Horizons in Facial Plastic Surgery, Sclafqni A. P., and Sabini P., editors), May 2002, Vol. 10, No. 2, pp. 155-166

696) A     The growth is 90% of hairs in the anagen phase and 10 % in the telogen phase

Kabaker S.S., Macdonald M. R.: Hair Restoration Surgery, Chapter 30, in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Richardson, Schuller, editors), Third Edition, Volume 1, 1998, pp.599-627

697) E      Resection of the cephalic portion of the lower lateral cartilage will result in significant increase in tip projection.

Guyuron B.: Dynamics in Rhinoplasty, Plastic and Reconstructive Surgery, May 2000, Vol. 105, No. 6, pp.2257-2259

698) B     Autogenous Split Thickness Skin Graft

Li T. G. , Shorr N., Goldberg R.A: Comparison of Efficacy of Hard Palate Grafts with Acellular Human Dermis Grafts in Lower Eyelid Surgery, Plastic and Reconstructive Surgery, Nov. 2005, Vol.116, No.6, pp. 1771-1775

Codner M.A.: Comparison of the Efficacy of Hard Palate Grafts with Acellular Human Dermis Grafts in Lower Eyelid Surgery, Discussion, Sept 2005, Vol. 116, No. 3, pp.879-880

699) A     Pruritus

Wagner J.D., Gordon M.S., Chuang T, Coleman III J.J. : Current Therapy of Cutaneous Melanoma,Plastic and Reconstructive Surgery, April 2000, Vol. 105, No. 5, pp.1774-1799

700) D      It is used for the lateral skull, anterior and lateral neck and oral cavity and face.

Urken M.L, Naidu R. K., Lawson W., Biller H.F.: The Lower Trapezius Island Musculocutaneous Flap Revisited, Report of 45 Cases and a Unifying Concept of the Vascular Supply, Arch. Otolaryngology Head Neck Surgery, Vol. 117, May 1991, pp.502-511

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Updated: June 15, 2017