Plastic and Reconstructive Surgery Board Review Pearls of Wisdom 3th

CHAPTER 92 Special opics in General Surgery
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What diagnostic tests should be per ormed on a patient with posterior knee dislocation?
Posterior knee dislocations are highly associated with popliteal injuries. Per orm extremity vascular examination
and ankle-brachial index. I normal, admit or serial vascular examinations. I any abnormalities ound, proceed to
OR or angiogram.

What is the treatment or venous air embolus?
Supportive care (mechanical ventilation, pressors, and volume), immediately place in le t lateral decubitus position
with head down. In contrast, patients with arterial embolism should be placed f at. In severely unstable patients,
one may attempt to aspirate air (limited bene t).

What are commonly used ventilator settings?
Assist control— ull preset breath given in coordination with patient’s inspiratory e ort. Independent spontaneous
breathing is not allowed.
Synchronous intermittent mandatory ventilation—preset breaths given in coordination with patient’s inspiratory
e ort. Spontaneous breathing is allowed.
Pressure support—decreases work o breathing or spontaneously breathing patient. Patient e ort determines
volume and rate.

When should enterocutaneous stula resection be considered?
Enterocutaneous stulas are associated with inf ammation and dense adhesions, making early surgery risky. I the
stula has ailed to resolve a ter ~6 weeks o nonoperative management it will likely need surgery.

Name some commonly used eponyms or the examination o the acute abdomen?
Eponym

Location

Pain Suggests
• McBurny’s point
• 1/3 the distance from ASIS to umbilicus. • Appendicitis.
• Rovsing’s sign

• Palpation of left lower quadrant causes
pain in right lower quadrant.
• Appendicitis.
• Murphy’s sign

• Palpation of subcostal right upper
quadrant when patient breathes in.
• Cholecystitis.
• Carnett’s sign

• Abdominal pain increases when patient
tenses abdominal wall muscles.
• Abdominal wall etiology vs.
abdominal cavity (i.e., rectus
sheath hematoma vs. diverticulitis).
• Markle’s sign

• Exceptional abdominal tenderness
elicited by shaking bed or foot.
• Peritonitis.
• Blumberg’s sign
• Abdominal wall is compressed slowly
and then rapidly released (rebound).
• Peritonitis.

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What is the most common cause o abdominal pain in patients < 50 years old? How about > 50 years old?
< 50 years old—acute appendicitis, > 50 years old—cholecystitis.
VASCULAR

What are the absolute indications or an IVC lter?
Presence o DV or PE with: (1) contraindication to anticoagulation (i.e., head trauma and retroperitoneal
hematoma), (2) recurrent PE despite anticoagulation, and (3) anticoagulation related complication.

What happens i you ligate the carotid artery?
20% o patients will have stroke.

What are three risk actors or venous thrombosis?
Virchow’s triad: (1) stasis, (2) endothelial injury, and (3) hypercoagulability.

Name di erences between un ractionated heparin (UFH) and low–molecular-weight heparin (LMWH)?
LMWH (i.e., lovenox) has a much smaller risk o heparin induced thrombocytopenia (HI ) and does not
require P monitoring. Unlike LMWH, UFH can be reversed with protamine.

What is the most common peripheral aneurysm?
Popliteal artery. Must screen or other aneurysms (50% incidence).

What is the most common visceral aneurysm?
Splenic artery. Repair or patients who are symptomatic and women who are pregnant or o childbearing age.

What is the treatment or lower extremity claudication?
Conservative therapy rst: ASA, smoking cessation, and exercise until pain ul to improve collateral f ow.

What are the best tests to diagnose osteomyelitis?
Needle bone biopsy is the best diagnostic test. agged WBC scan has the highest sensitivity but is not speci c
(may be alsely positive with surrounding inf ammation).

What are the indications or angiogram in extremity trauma?
Angiogram should be per ormed or so t signs o vascular injury (i.e., ABI < 0.9, unequal pulses, large stable
hematoma, and injury near a major artery). For major signs o vascular injury (i.e., active hemorrhage, pulse
de cit, expanding hematoma, and distal ischemia) go to OR.

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REFERENCES
Albertos R, Caralt B, Rello J. Ventilator-associated pneumonia management in critical illness. Curr Opin Gastroenterol. 2011;27(2):
160–166.
Barrack RL. Current guidelines or total joint V E prophylaxis: dawn o a new day. J Bone Joint Surg Br. 2012;94(11 Suppl A):3–7.
Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH. T romboprophylaxis or trauma patients. Cochrane Database
Syst Rev. 2013;3:CD008303.
Bisbe Vives E, Basora Macaya M. Algorithm or treating preoperative anemia. Rev Esp Anestesiol Reanim. 2015;62 Suppl 1:27–34.
Burgess CA, Dale O , Almeyda R, Corbridge RJ. An evidence based review o the assessment and management o penetrating neck
trauma. Clin Otolaryngol. 2012;37(1):44–52.
Chandrashekar S, Kantharaj A. Legal and ethical issues in sa e blood trans usion. Indian J Anaesth. 2014;58(5):558–564.
Curley GF, Shehata N, Mazer CD, Hare GM, Friedrich JO. rans usion triggers or guiding RBC trans usion or cardiovascular surgery:
a systematic review and meta-analysis*. Crit Care Med. 2014;42(12):2611–2624.
da Silva Fink J, Daniel de Mello P, Daniel de Mello E. Subjective global assessment o nutritional status - a systematic review o the
literature. Clin Nutr. 2015;34(5):785–792.
Goodnough L , Levy JH, Murphy MF. Concepts o blood trans usion in adults. Lancet. 2013;381(9880):1845–1854.
Kuhn JE, Lebus VG, Bible JE. T oracic outlet syndrome. J Am Acad Orthop Surg. 2015;23(4):222–232.
Lawson Ralph C. Perioperative Jehovah’s Witnesses: a review. Br J Anaesth. 2015;115(5):676–687.
Mahmoodie M, Sanei B, Moazeni-Bistgani M, Namgar M. Penetrating neck trauma: review o 192 cases. Arch Trauma Res. 2012;1(1):
14–18.
Ricci Z, Iacoella C, Cogo P. Fluid management in critically ill pediatric patients with congenital heart disease. Minerva Pediatr.
2011;63(5):399–410.
Schulz RJ, Bischo SC, Koletzko B; Working group or developing the guidelines or parenteral nutrition o T e German Association
or Nutritional Medicine. Gastroenterology - Guidelines on Parenteral Nutrition, Chapter 15. Ger Med Sci. 2009;7:Doc13.
Shah A, Stanworth SJ, McKechnie S. Evidence and triggers or the trans usion o blood and blood products. Anaesthesia. 2015;70 Suppl
1:10–9, e3–e5.

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871
Peter F. Koltz, MD and
Samuel J. Lin, MD, MBA, FACS
BREAST AND COSMETIC
Breast

What is the next step ollowing reduction mammaplasty when the resection specimen contains invasive
ductal carcinoma?
Determine tumor margins; decide on completion mastectomy.

What is a critical actor in deciding breast contouring ollowing implant removal?
Preoperative ptosis (remains unchanged ollowing removal).

What best determines per orming contouring and implant removal in the same setting?
T ickness o residual breast (minimum thickness o 4 cm required).

Compared to traditional transaxillary submuscular breast augmentation, endoscopic techniques are
associated with a decreased rate o what?
Malpositioning o the implant.

Breast ptosis results rom elongation and laxity o what structure?
Cooper ligaments.

What is the most appropriate CP code used or at gra ting?
Fat gra ting is reported with code 20926 (tissue gra ts, other [e.g., paratenon, at, dermis]) and includes the
ollowing: Harvest o the at gra t material by any method, closure o the donor site, processing o at gra t
material, injection o at gra t into recipient site, and 90 days o routine postoperative care.
High-Yield Topics
CHAPTER 93

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Mastectomy resulting in decreased bulk in the in erior and lateral portions o the right pectoral muscle is
caused by denervation o what nerve?
Medial pectoral; C8– 1 supplies lower and lateral sternal portion o pectoralis major and pectoralis minor muscle.

What does the lateral pectoral nerve supply?
Arises rom C5–6, supplies the medial portion o the pectoralis muscle.

How does one assess the status o the pectoralis muscle in postmastectomy reconstruction?
Have the patient place hands on hips and contract chest muscles.

During breast augmentation, under lling o the implants below the manu acturer’s recommended minimum
will most likely have what e ect?
Decreases longevity o the implant and leads to early rupture.

What advantage does an extended latissimus dorsi ap have over a standard latissimus dorsi ap in the
setting o breast reconstruction?
A decreased need or adjuvant breast implantation.

What mammographic nding is seen 6 to 18 months ollowing an in erior pedicle reduction mammoplasty?
Parenchymal redistribution, nipple elevation, calci cations, oil cysts rom localized at necrosis.

Breast reduction by liposuction is most use ul in breasts with what percentage o at?
50%.

In a young patient undergoing MRM with postoperative radiation, what procedure will provide the best
aesthetic reconstruction?
Delayed reconstruction with autologous tissue.

In a study comparing early and late complications in patients who underwent RAM reconstruction
ollowed by radiation versus radiation treatment ollowed by RAM reconstruction, what were the
di erences?
T e early complications did not di er, but the late complications were more requent in the group undergoing
immediate reconstruction.

A woman who has the BRCA2 mutation has a li etime incidence o what percentage o developing breast
cancer?
60%.

Sharp dissection lateral to the lateral edge o the pectoralis muscle during augmentation mammaplasty may
result in what complication?
Numbness o the nipple–areola complex; the ourth and th anterolateral intercostal nerves provide sensation to
the nipple–areola complex.

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What is consistently the best marking or the new nipple position during reduction mammaplasty?
T e in ramammary old.

What represents the lateral border o the breast ootprint?
Anterior axillary old.

Sensation to the nipple–areolar complex is derived rom what?
Anterolateral branches o the third through th intercostal nerves (primarily the ourth nerve).

De ne pseudoptosis o the breast.
T e nipple remains above the IMF, but the breast mass descends below the NAC.

What is rst-degree ptosis?
T e NAC descends to the level o the IMF.

What is second-degree ptosis?
T e nipple is located beneath the IMF, but is not the lowest point o the breast.

In polymastia, where are accessory mammary structure most commonly ound?
T e axilla.

What supplies sensation to the upper breast?
Cervical branches rom the third and ourth.

T e medial and in erior breast?
Branches rom the anterior cutaneous branches.

What is the most common cause o asymmetric enlargement o a breast over a year with a palpable mass in a
teenage girl?
Fibroadenoma; treat with excision.

What is the rst treatment or nipple cyanosis ollowing breast reduction?
Releasing the sutures surrounding the NAC and return to the OR.

What are the criteria or ree nipple gra ting?
Reduction amount greater than 1,500 g, nipple transposition length greater than 25 cm, and a history o smoking
or diabetes.

What a ects the quality o mammography with breast implants?
Implant position, capsular contracture, native breast volume.

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What common medications may cause gynecomastia?
agamet, Digoxin, Minocycline, spironolactone.

What are key elements o the Lejour reduction mammaplasty?
Central vertical gland excision and excision o skin in one direction, upper pedicle, more di cult to determine
resection end point.

What is considered the best reconstructive option or the breast as a secondary procedure ollowing
mastectomy and irradiation?
RAM reconstruction; implant reconstruction associated with increased capsular contraction rate with prior
irradiation.

What condition has an increased risk o hypercoaguability and must be considered in ree ap
reconstruction?
Systemic lupus erythematosus (SLE).

What is the next appropriate step or a woman preceding breast augmentation with milky discharge and
regular menstrual cycles?
Obtaining a serum prolactin level to rule out a pituitary lesion; thyroid unction studies, medication history (e.g.,
tricyclic antidepressants).

What is the most requent complication ollowing periareolar mastopexy?
Areolar widening.

What de nes a tuberous breast?
Constricted appearance o breast; unilateral narrowing o the breast; narrow breast diameter, superior displacement
o the IMF; areola enlarged; breast hypoplasia.

How is a tuberous breast treated?
Augmentation mammaplasty with IMF adjustment, radial scoring o the breast glandular tissue, areola reduction.

What is the rate o additional procedures ollowing breast implant augmentation?
25% o patients requiring additional procedure within 13 years.

What is the rate o de ation a ter implant augmentation?
1% annually.

What is the approximate rate o capsular contraction?
20% to 25%.

What portion o breast parenchyma is a ected a ter implant augmentation?
Estimated 5%, not entirely seen on mammography.

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What nerve supplies the nipple–areola complex?
T e lateral branch o the ourth intercostal nerves.

What actors are increased in smokers who undergo ree RAM breast reconstruction?
Necrosis o the mastectomy skin, abdominal skin, and hernia rates.

What actors are not increased with smokers undergoing ree RAM breast reconstruction?
Vessel thrombosis, at necrosis, ap loss, or wound in ection.

What are the grades o gynecomastia?
I: mild enlargement without redundant skin.
IIA: moderate enlargement without redundant skin.
IIB: moderate enlargement with skin redundancy.
III: marked enlargement with signi cant redundant skin.

What are the methods o treating gynecomastia?
Suction lipectomy, excising a concentric circle o skin, amputation with ree nipple gra ting, glandular resection
with liposuction.

What are the general indications or delayed mastopexy ollowing implant explantation?
Marked ptosis requiring nipple elevation o greater than 4 cm, breast mound less than 4 cm, smoking history.

What is the procedure that should be done or grade II breast ptosis?
For repositioning o the nipple–areola complex o 2 to 4 cm, a Wise pattern mastopexy may be per ormed.

What procedure is recommended or pseudoptosis?
Wedge excision rom the in ramammary old.

What is the most appropriate next step or a smoker having undergone implant explantation with marked
ptosis and less than 4 cm o breast thickness?
Delayed mastopexy or 3 months at minimum.

What patients are appropriate candidates or nipple sparing mastectomy?
umor size o 3 cm or less, at least 2 cm rom the nipple, not multicentric, and those with clinically negative
nodes.

A ter bilateral RAM elevation, what supplies the umbilicus primarily?
Ligamentum teres.

o minimize hernia recurrence ollowing abdominal-based autologous reconstruction, where is the optimal
position to place mesh to minimize recurrence?
Between rectus muscle and posterior rectus sheath.

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Plastic & Reconstructive Surgery Board Review

What are the venous thromboembolism guidelines based on Caprini score (risk assessment model)?
Patients undergoing major plastic and reconstructive operative procedures per ormed during general anesthesia
that last longer than 60 minutes should receive V E prevention. For patients with Caprini score o 3 to 6, the use
o postoperative low–molecular-weight heparin (LMWH) or un ractionated heparin (UH) should be considered.
For patients with Caprini score o 3 or more, use o mechanical prophylaxis throughout the duration o chemical
prophylaxis or nonambulatory patients should be considered. For patients with Caprini score o 7 or more, the
use o extended LMWH postoperative prophylaxis should be strongly considered.

What is the greatest source o dissatis action ollowing breast reduction?
Noticeable scarring.

Following reduction mammaplasty, what is the percentage o being able to breast- eed?
30%.

What is the best radiologic study to assess or silicone breast implant rupture? What is the linguine sign?
MRI. T e linguine sign is a nding on MRI o multiple curvilinear low–signal-intensity lines within the high–
signal-intensity silicone gel signi ying implant rupture.

Patient presents 6 weeks a ter breast reduction with a rm, painless mass in the breast. Diagnosis?
Fat necrosis.

De ne the ollowing chest wall abnormalities:
Anterior thoracic
hypoplasia
Anterior chest wall depression, posteriorly displaced ribs, ipsilateral breast hypoplasia,
superiorly displaced nipple complex.
Pectus excavatum Most common de ormity. Results in concave anterior chest wall, typically the lower
third o the sternum. Normal breasts.
Pectus carinatum
Sternum and ribs are displaced anteriorly. Normal breasts.
Poland syndrome
Unilateral anomaly o varying severity consisting o absent sternal head o pectoralis,
hypoplasia o breast/nipple, ipsilateral upper extremity anomalies, + /− chest wall
abnormalities.
Sternal cle t

Rare congenital anomaly in which the sternum ails to use in the midline. Normal
breasts.

What ndings are seen in Poland syndrome?
Pectoralis muscle sternal head hypoplasia, hypoplasia/aplasia o the breast, ipsilateral hand anomalies; males and
emales equally a ected; chest wall anomalies.

What is the initial management o gynecomastia in puberty in the absence o other abnormalities?
Observation and ollow-up in 12 months.

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How old do you have to be to get cosmetic silicone breast augmentation?
T e FDA has approved silicone gel breast implants or women aged 22 and older. Younger patients get saline
implants.

What is the proper shape and location o the male nipple–areola complex?
Oval in shape and located at the ourth to th intercostal spaces.

rue/False: Size o the implant in breast augmentation in uences postoperative nipple sensation.
rue.

What is the downside to using a textured silicone implant over a smooth silicone implant?
Increased rate o rippling.

rue/False: extured implants have a higher rate o capsular contracture than smooth implants?
False, they have slightly less.

What nerves may be injured during transaxillary breast augmentation?
Intercostobrachial and medial brachial cutaneous nerves providing sensation to the medial aspect o the upper arm.

What is the li etime risk o breast cancer in a male with the BRCA2 gene mutation? Female with BRCA1
mutation? Female with BRCA2 mutation?
7% in males, in emales, 85% BRCA1, 60% BRCA2.

What is a phyllodes tumor? How is it treated?
umors rom the periductal stromal cells o the breast. T ey are typically ast growing but 90% are benign.
Management is local excision and close annual surveillance.
Nose

How is a “hanging” columella treated?
rimming o the caudal margin o the septum and medial crura o the lower lateral cartilage.

What is the best ap to use or a de ect o the lateral nasal ala?
Nasolabial ap, superiorly based.

What should be used or a de ect o the lateral nasal wall above the ala?
Cheek advancement ap.

A de ect o the caudal third o the nose centrally?
Frontonasal ap.

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Plastic & Reconstructive Surgery Board Review

What skin characteristics negatively a ect results a ter rhinoplasty?
T ick skin with large sebaceous glands; skin envelope does not con orm easily.

What are the three zones o injury occurring in a nasal racture?
Upper vault (nasal bones, ethmoid, vomer, cephalic septal border); middle vault (upper lateral cartilages, septum,
maxilla); lower vault (alar cartilages, in erior septum).

What is the limit at which airway resistance increases in the internal nasal valve?
Less than 10 to 12 degrees.

What de nes the internal nasal valve area?
T e caudal margin o the upper lateral cartilage, septum, nasal oor, and anterior edge o in erior turbinate.

Secondary healing o what part o the nose is least likely to provide an acceptable cosmetic result?
T e nasal tip.

What techniques have important roles in providing tip projection in addition to tip gra ting?
Suturing o the medial crura, placing a strut gra t between the medial crura.

What e ect occurs with resection o the lateral and medial crura and the nasal spine?
Decrease o tip projection.

What e ect does a complete trans xion incision have?
Decreases projection secondary to weakening o nasal support.

rue/False: T e evaluation o the nasal airway should include the nasal dorsum.
False.

In a patient with a negative Cottle maneuver, what procedure is likely to improve the nasal airway?
Lateral strut gra t o the crus.

What comprises the external nasal valve?
Columella, ala, nasal sill.

What comprises the internal nasal valve?
Area o the angle between the upper lateral cartilage and septum.

How is vestibular stenosis treated?
An alar base ap.

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What actors lead to a saddle nose de ormity?
Excessive dorsal or septal resection, nasal bone comminution during in racture, or a racture o the perpendicular
ethmoid plate.

What supplies sensation to the nasal radix?
T e supratrochlear and in ratrochlear nerves.

What supplies sensation to the nasal tip?
External nasal branch o the anterior ethmoidal nerve; emerges rom nasal bone and lateral nasal cartilage.

What part o the nose is innervated by the in raorbital nerve?
Lower lateral hal and skin o the columella.

What is supplied by the in ratrochlear nerve?
Superior portion o the nasal side wall and skin over the radix.

Where is a 1-cm de ect on the nose most amenable to healing by secondary intention?
Area o the medial canthus, glabella, nasolabial old, and philtrum.

What is the blood supply to the nasal tip during an open rhinoplasty?
Lateral nasal artery that arises rom the angular artery.

What artery is divided during open rhinoplasty?
T e columellar branch o the superior labial artery.

What vessels rom the internal carotid artery supply the nasal skin?
Dorsal nasal artery, external branch o the ethmoidal artery.

What de ect is a dorsal nasal ap typically used or?
A de ect o the nasal tip up to 2 cm.

What is the polybeak de ormity ollowing rhinoplasty due to?
Excessive reduction o the tip particularly in the setting o poor nasal tip projection.

What is the treatment or alar collapse with inspiration and a pinched nasal tip?
Gra ting o the nasal tip with cartilage.

What are the causes o a saddle nose de ormity a ter rhinoplasty?
Overresection o the septum, separation o the cartilaginous septum rom the vomer, collapse o the vertical
component o the L-strut.

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What causes the inverted V de ormity a ter rhinoplasty?
Collapse o the upper lateral cartilage.

What causes the open-roo de ormity a ter rhinoplasty?
Failure o the nasal bones to come together in the midline a ter osteotomies.

What causes a stair-step de ormity a ter rhinoplasty?
An osteotomy that is too high on the nasal process and not ush with the maxilla resulting in a visible and
palpable de ormity.

How do you correct the inverted V de ormity a ter rhinoplasty?
Spreader gra ts correct the collapse o the internal nasal valve.

What is the advantage o partial submucous resection o the in erior turbinate over turbinate ablation?
Decreased incidence o atrophic rhinitis.

How do you treat a collapsed external nasal valve?
Alar batten gra ts.
Ear

What is the Antia–Buch ap used or?
Lesions located on the lateral rim; tissue used rom postauricular skin to reconstruct the helical margin.

Where on the avulsed pinna is anastomosis o the arteries most appropriate?
T e posterior sur ace; larger arteries enter the pinna on the posterior sur ace.

reatment o an auricular hematoma by needle aspiration is likely to result in what?
Seroma.

A 6-year-old boy with an obtuse concha-mastoid angle with a normal antihelical old is best treated by what
technique?
Setback o the concha using concha-mastoid sutures.

What are common causes o prominent ears?
Enlarged conchal bowl, obtuse concha-mastoid angle, loss o the antihelical old.

How is ear prominence corrected rom loss o the antihelical old?
Abrading or scoring the antihelix and placing Mustarde sutures between the conchal and scaphoid eminence.

rue/False: Microtia and inner ear abnormalities may be closely related.
False.

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What is orbital auricular vertebral syndrome otherwise known as?
Goldenhar syndrome (associated with microtia, cervical spine abnormalities, mandibular hypoplasia, preauricular
pits/sinuses, hemi acial microsomia).

What develops rom the rst three hillocks o the ear during development?
First three hillocks are rom the rst arch; tragus, helical root, superior helix.

What develops rom the second three hillocks o the ear?
Antitragus, antihelix, in erior helix and lobule; rom the second branchial arch.

What is the treatment principle o cryptotia?
Detaching the superior auricle rom the temporal area and placing a skin gra t in the retroauricular area.

How is Stahl ear treated?
Advancing the third crus o the antihelix.

Placing sutures rom the concha to the mastoid bowl and rasping the anterior sur ace o the antihelix has
been described or what condition?
Correction o prominent ears.

How is the constricted ear treated?
Partially detaching the helix rom the scapha and suturing the helix.

What is the treatment or an auricular implant (porous polyethylene) covered with a temporoparietal ascial
ap with subsequent exposure o the implant?
Dressing changes and secondary wound healing or at least 6 months.

What principle guides the Mustarde otoplasty approach?
Using mattress sutures to bend the antihelix.

What is the Stenstrom technique?
Using an otoabrader to bend the anterior antihelical sur ace.

What is the Graham and Gault otoplasty technique?
Endoscopic scoring and suture o the cartilage posteriorly.

What is the Luckett procedure?
Excision o a crescent-shaped piece o skin/cartilage.

What is the Furnas technique?
Sutures spanning the concha to the mastoid.

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What are the common descriptive ndings in the prominent ear?
Conchal valgus, cranioauricular angle greater than 40 degrees, antihelical under olding; widened conchoscaphal
angle (greater than 90 degrees).

What are general options or correcting the prominent ear?
Concha to scapha sutures, concha to mastoid sutures, scoring the cartilage anteriorly, conchal resection,
postauricular skin resection.

What is the optimal timing or microtia surgery in a child?
At 6 to 7 years o age, the ear is practically ully developed by age 7.

What is the ear canal typically created in microtia with respect to auricular reconstruction?
ypically ollowing the creation o the auricle.

What is the initial management o the neonate with prominent ears?
Molding with tape and splinting.

How long do maternal estrogens remain in the neonate?
6 months, which allows or shaping o auricular cartilage.

What is the Stahl ear de ormity?
A third crus, antihelical attening, scaphoid ossa de ormity.

What is the constricted ear?
Helical and scaphal hooding.

What is seen in cryptotia?
Upper pole o the ear is buried beneath skin; absence o superior auriculocephalic sulcus missing.

What nerve supplies sensation to the superior cranial sur ace o the ear?
Lesser occipital nerve.

What nerve supplies sensation to the skin o the anterosuperior EAC?
Lesser occipital nerve.

What areas are supplied by the great auricular nerve?
In erior hal o the lateral ear and in erior portion o the cranial sur ace o the ear.

What area is supplied by the auriculotemporal nerve?
Sensation to the anterosuperior sur ace o the external ear.

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What does Arnold nerve supply?
Sensation to the concha and posterior EAC.

At what trimester does maldevelopment occur and microtia result?
First trimester between 4.5 and 10 weeks.

What is the treatment or a complete upper auricular de ect rom a burn several years ago?
Rib cartilage ramework or the upper ear with temporoparietal ascia ap and skin gra t.

What is the likely cause o recurrent prominence o ears ollowing otoplasty at 7 months?
Suture ailure at the antihelical old.
Eye

What is the treatment or chronic ectropion and excessive scleral show a ter a chemical burn?
Full-thickness skin gra ting.

What is the mechanism o involutional ectropion?
Laxity o the lower lid rom the lower lid retractors becoming disinserted rom the tarsal plate.

What is the treatment or involutional ectropion?
Lateral canthoplasty, lateral wedge excision, or excising o a ull-thickness wedge rom the lateral canthal region.

What structure does the common canaliculus enter the lacrimal sac posterior to?
T e medial canthal tendon.

What muscle is most commonly injured in blepharoplasty?
Superior oblique; clinically may see tilting o head, and depression o chin.

What is the procedure required or a patient who exhibits a Jones I test without dye and a Jones II test with
dye in the tear sac?
Dacryocystorhinostomy.

How is a Jones I test per ormed?
Instill 2% uorescein dye into the conjunctival ornices; recovery o dye indicates a normal lacrimal system (or
positive result); a negative result necessitates a Jones II test.

How is a Jones II test per ormed?
Dilation o the punta is per ormed rst; uid passing into the nose indicates that obstruction o the nasolacrimal
duct is cleared.

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A negative Jones I and a positive Jones II test indicate what?
Blockage o the nasolacrimal duct system.

What procedure will address lower eyelid skin laxity with 2 mm o scleral show bilaterally?
Lower lid blepharoplasty with lateral canthopexy.

Following lower lid blepharoplasty, a woman exhibiting scleral show, round, sad-looking eyes, photophobia,
epiphora, what has anatomically occurred?
Scarring between the orbital septum and the capsulopalpebral ascia, resulting in lower lid retraction (without lid
eversion); other causes include lateral canthal tendon laxity, mid ace descent.

What is the eyelid unction in patients with Bell palsy?
Ectropion rom dys unction o the orbicularis muscle; inability to close the eye.

What characterizes aponeurotic ptosis?
Good levator unction; elevation o eyelid crease, ability to visualize shadow o iris with eyelid closure (positive
Nesi sign), or translucent upper eyelid.

What may be done to improve excess scleral show and slowed retraction o a “snap-back” test ollowing
blepharoplasty?
Lateral canthopexy.

How is a patient treated with 3.5 mm o ptosis and 10-mm levator unction?
Resuturing o the levator aponeurosis.

What are the classi cations o ptosis?
Neurogenic, myogenic, mechanical, aponeurotic.

When is eyebrow suspension used or ptosis treatment?
Poor levator unction (less than 4 mm) and greater than 3 mm o ptosis.

When is the Fasanella–Servat procedure used?
Good levator unction and minimal ptosis (less than 2 mm).

What procedure is used or levator unction between 4- and 10-mm and 3-mm ptosis?
Levator resection.

What is the treatment o 4-mm ptosis and 2-mm levator unction in a 5-year-old child?
Frontalis suspension.

What is associated with inadvertent blepharoptosis—Botox injection o the corrugator or lateral orbicularis?
T e corrugator.

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ranscutaneous lower lid blepharoplasty is associated with what undesired nding most commonly?
Malpositioned lower eyelids.

What may be done or asymmetrical lower eyelids ollowing blepharoplasty?
Conservative (taping, Frost stitches) treatment rst; surgery or ailed conservative treatment (tarsal strip, wedge
tarsectomy).

What percentage o patients undergoing orbital oor racture repair through a preseptal transconjunctival
approach develop ectropion?
Close to 0%.

What clinical ndings are seen in levator aponeurosis dehiscence?
Ptosis, elevated supratarsal crease, thinning o upper eyelid skin.

What is typically done or levator aponeurosis dehiscence?
Levator advancement.

What is a likely cause o chronic lower lid de ormity ollowing ORIF o the orbital oor?
Posterior lamella shortening; posterior lamella (capsulopalpebral ascia) comprising tarsus, lower lid retractors,
conjunctiva.

What is done or nasolacrimal duct obstruction?
Dacryocystorhinostomy.

What predisposing actors cause patients to have dry eye syndrome a ter blepharoplasty?
Exophthalmos, scleral show, lower lid hypotonia, maxillary hypoplasia.

What is blepharochalasis?
Recurrent episodes o painless edema o the eyelids; unclear etiology; caused by elastic tissue de ciency; leading to
“baggy” appearance o lids.

What is dermatochalasis?
Excess eyelid skin.

What is the blepharophimosis syndrome?
Genetic condition; telecanthus, ptosis, upper eyelid phimosis.

What is the most common orm o acquired ptosis?
Involutional; results rom thinning o the levator aponeurosis; good levator unction, elevated eyelid creases.

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Plastic & Reconstructive Surgery Board Review

What characterizes blepharophimosis syndrome?
ype I: large epicanthal olds, epicanthus inversus, horizontal shortening o the eyelids, marked ptosis.
ype II: telecanthus, epicanthal old absence, bilateral ptosis, no levator unction, shortened eyelids.
ype III: missing epicanthal olds, telecanthus, antimongoloid slant; telecanthus.

What treatment is done or blepharophimosis?
Epicanthal old repair, levator resection, medial canthoplasty, eyelid suspension.

What de nes normal levator unction?
Greater than 10 mm o excursion.

What degree o ptosis is the Fasanella–Servat procedure per ormed or?
Mild ptosis.

What is given or ptosis seen in Horner syndrome?
Phenylephrine eye drops.

What is the treatment o choice 14 days a ter blepharoplasty in a patient with lagophthalmos?
Corneal lubrication.

What structure are the upper eyelid at pads immediately posterior to?
T e orbital septum; the at pads sit just anterior to the levator aponeurosis.

In the lower lids the at pads are located just anterior to what structure?
T e in erior retractors.

What separates the medial and middle at pads in the lower lid?
T e in erior oblique.

What is an epiblepharon?
A congenital anomaly in which a old o skin lies across the upper or lower lid margin. In the lower eyelid it causes
a turning inward o the eyelashes.

What is senile ptosis?
Most common cause o ptosis in elderly patients, the result o dehiscence o the levator aponeurosis. T e
supratarsal crease is elevated on examination.

How do you measure the prominence o the globe in relation to the orbit?
Distance rom anterior border o globe to most anterior aspect o the lateral orbital rim. Enophthalmos is
< 14 mm, exophthalmos is > 18 mm.

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What happens to the lacrimal drainage system on eyelid closure?
Lacrimal puncta are closed, the lacrimal diaphragm is compressed, the lacrimal sac opens.

What is the appropriate amount o pretarsal eyelid show?
2 to 5 mm.

What is symblepharon?
Pathologic adhesion o the palpebral conjunctiva to the bulbar conjunctiva, usually related to thermal injury.

What is chemosis?
Edema o the bulbar conjunctiva.

What is a chalazion?
A cyst on the eyelid caused by in ammation rom a blocked meibomian gland.

What is a hordeolum?
Also known as a sty, it is an in ection o the sebaceous glands at the base o the eyelashes. Unlike a chalazion, these
are acute, pain ul and usually do not resolve without intervention.

What is the unction o the in erior oblique muscle? Superior oblique muscle?
In erior oblique: abducts, elevates, laterally rotates; superior oblique: abducts, depresses, medially rotates.

What is the most commonly injured muscle during blepharoplasty?
In erior oblique muscle. Presents as diplopia with upward gaze.

What muscle acts as the primary depressor o the lateral eyebrow?
Orbicularis oculi muscle.
Face

What type o genioplasty should be per ormed in a patient with sagittal de ciency and vertical excess with
class I occlusion?
Jumping genioplasty.

Where should the brow peak in a emale patient undergoing browli ting?
At the lateral limbus to lateral canthal area.

What branch o the acial nerve is injured most requently during ace li t?
Buccal.

What e ect do corticosteroids have on edema and ecchymosis ollowing rhytidectomy?
No change in both instances.

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Plastic & Reconstructive Surgery Board Review

Compared with primary rhytidectomy, distortion o the hairline is more or less requent in secondary
rhytidectomy?
More likely to occur; i the same incisions are used, recession o the temporal hairline, obliteration o sideburn
hair, and alopecia may occur.

Are the risks o hematoma, hypertrophic scarring, and skin slough higher in the setting o secondary
rhytidectomy?
ypically not.

What adverse e ect is lessened by endoscopic browli ting as opposed to conventional coronal browli ting?
Scalp sensibility changes.

In a patient with microgenia who has both bony de ciencies in the anteroposterior and vertical dimensions,
what is the most appropriate treatment?
Osseous genioplasty.

How well does chin implantation correct vertical de ciency o the chin?
It only corrects anteroposterior dimension.

ransverse rhytids along the root o the nose are rom which muscle group?
Procerus (originates rom upper lateral cartilage inserting into skin/glabella).

What is the origin/insertion o the corrugator?
Originate along periosteum/medial orbital rim inserting into dermis o upper eyelid.

Following a ace li t, an inability to raise the upper lip on one side is due to what complication?
Injury to the buccal branch o the acial nerve (innervates levator labii oris).

What does injury to the cervical branch o the acial nerve mani est as?
Platysmal weakening, or an asymmetric smile.

What must be evaluated rst during a consult or chin implantation?
T e patient’s occlusion.

Fullness o the lateral orbit noted during browli t may be due to what structure?
A ptotic lacrimal gland.

What is the treatment o a ptotic lacrimal gland?
Suspension o the gland, not resection.

What approach is used or browli t in a 60-year-old woman with a high hairline with brow descent under
the level o the supraorbital rim?
Open browli t through a hairline incision.

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What may cause resorption o the malar at pad ollowing rhytidectomy?
Disruption o the branches o the angular artery; signi cant in malar at pad advancement greater than 2 cm.

What is the treatment or bone resorption ollowing chin implantation with chin asymmetry?
Implant removal, bone gra t, and sliding genioplasty.

What is the treatment o an obtuse cervicomental angle, marked at pads in anterior neck, subcutaneous
banding, and loose redundant skin in the neck?
Removal o cervical at and platysmaplasty.

What is the relation o the temporal branch o the acial nerve to the super cial temporal ascia above the
zygomatic arch?
Deep to the super cial temporal ascia.

What is the most requent rhytidectomy complication?
Hematoma (0.3–8.1%).

What are risk actors or hematoma ollowing rhytidectomy?
Male patients and hypertension.

What vascular supply are the temporal scalp ap and Washio ap based on?
Posterior temporal branch o the super cial temporal artery.

What does the deep branch o the supraorbital nerve innervate?
Central rontoparietal scalp.

What does the super cial branch o the supraorbital nerve innervate?
Central orehead and hairline.

What supplies sensation to the temporal orehead?
V2 and V3.

What supplies sensation to the temporal scalp?
T e occipital nerve.

What is the most worrisome component o a secondary rhytidectomy regarding postoperative
complications?
Hairline distortion.

How does the vascular supply o the skin ap compare in a secondary rhytidectomy?
Usually good or better due to the delay actor ollowing the primary procedure; skin slough is less requent.

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Plastic & Reconstructive Surgery Board Review

What is the mechanism o outward pseudoherniation o the buccal at pad?
Buccopharyngeal membrane attenuation.

What is the natural progression o Bell palsy?
85% have recovery spontaneously within 3 weeks.

What is the description o the mandible in Pierre Robin sequence?
Retrognathia; normal mandibular dimensions.

What de nes microgenia?
Maldevelopment o the mental symphysis.

What is the likely cause o increased show o the lower incisors ollowing genioplasty?
Inadequate repair o the mentalis muscle on closure; lower lip dri ts downward with healing.

What muscle supplies blood to the anterior bony segment ollowing a horizontal genioplasty?
T e anterior digastric.

What are the zones o the malar region?
Zone I: First third o the zygomatic arch and malar bone.
Zone II: Middle third o the zygomatic arch.
Zone III: Paranasal.
Zone IV: Posterior third o the zygomatic arch.
Zone V: Submalar region.

What is the largest zone?
Zone I.

Which malar zones are rarely augmented in aesthetic surgery?
Zone III and zone IV.

What is the appearance with zone V malar augmentation?
Mid ace ullness, rounded appearance o the cheeks.

What is the management o an anterior platysmal band?
Plication in the midline.

What is the most important actor in acial reanimation ollowing trauma?
Length o time between injury and reconstruction; acial muscles are viable or 2 years ollowing paralysis; a ter
2 years, ree muscle trans er is required.

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What is the appropriate amount o tooth show in repose?
2-mm upper incisor show (may be 4 mm in women). Lower incisors should not show in repose.

What is the most commonly injured nerve during rhytidectomy?
Great auricular nerve.

What is the MACS li t?
Minimal access cranial suspension. A short scar rhytidectomy technique in which the SMAS is purse-string
sutured to the deep temporal ascia above the zygomatic arch using a vertical vector.
Body Contouring

When do serum lidocaine concentrations peak postoperatively?
Approximately 12 hours.

How do you increase gra t survival in autologous at gra ting?
Maximize sur ace area contact between at gra t and vascularized bed. Minimize the amount o at injected
per pass.

What is the sa e dose o lidocaine when used in tumescent solution or liposuction?
35 mg/kg.

What diagnosis should be considered with disorientation a ter massive weight loss surgery?
Wernicke–Korsako encephalopathy rom thiamine de ciency, which can be present rom malnutrition o massive
weight loss. reat with intravenous thiamine.

What cosmetic procedure is associated with the highest incidence o venous thromboembolic events (V E)?
Abdominoplasty.

What is the most common complication o brachioplasty?
Hypertrophic scarring in as many as 40% o patients.

Numbness o the anterolateral thigh a ter abdominoplasty is due to what complication?
Injury to the lateral emoral cutaneous nerve (becomes super cial 10 cm below the anterior superior iliac spine).

What is the course o the lateral emoral cutaneous nerve?
Arises rom L2–3, passes 1 cm medial to the ASIS, super cial to the sartorius, and branches anteriorly and
posteriorly.

What does the genito emoral nerve innervate?
Sensation to skin o scrotum, mons pubis, labia, and over the superior portion o the emoral triangle.

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Plastic & Reconstructive Surgery Board Review

What does the iliohypogastric supply?
Sensation to the skin o the lateral buttocks and abdomen above the pubis.

What does the ilioinguinal nerve supply?
Sensation to the superomedial thigh and scrotum or mons pubis.

T e obturator nerve?
Skin o the medial and lower thigh.

With tumescence during suction lipectomy, what percentage o total blood loss is to be expected o the total
aspirate?
1%.

T e wet technique?
T is technique utilizes 300 mL o uid per region—25% blood in the aspirate.

Complications rom smoking arise in what percentage o patients undergoing abdominoplasty?
50%.

In addition to contour irregularities, UAL is likely to cause what complication more requently than SAL?
T ermal injury.

A 1:1 in ltrate to aspirate ratio during liposuction indicates which technique?
Superwet.

What de nes tumescent technique during liposuction?
2 to 3 cc wetting solution/1 cc o aspirate.

What is the wet technique?
Injecting 100 to 300 cc o wetting solution per area regardless o the amount o aspirate removed.

What speci c technique has been shown to decrease the recurrence rate in thigh li ts?
Super cial ascial system suspension; anchoring skin ap to Colles ascia.

What is the most likely cause o death ollowing liposuction?
T romboembolism; ollowed by abdominal wall per oration, anesthetic complication, in ection.

In a patient returning several days a ter liposuction with clear gray uid rom incisions, erythema, and early
sepsis, what is the most appropriate management?
Surgical debridement o involved tissues. Necrotizing asciitis is a rapidly progressive so t-tissue in ection that
occurs in 0.4 per 100,000 patients ollowing liposuction.

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What is the most requent chronic complication ollowing brachioplasty?
Scar widening.

What surrounding nerves are at risk during abdominoplasty?
Ilioinguinal, iliohypogastric, and intercostals.

What procedure is appropriate or a 33-year-old patient who has lost 140 lb a ter a gastric bypass?
Lower body li t.

What procedure is appropriate or a 40-year-old patient with good skin tone and muscle tone with a
localized area o excess at?
Suction lipectomy.

Is the umbilicus altered in mini abdominoplasty?
No.

What area o the incision is most at risk or necrosis a ter abdominoplasty?
Area o the suprapubic region; lower midline ap is most at risk or ischemia.

Skin laxity o the arms ollowing massive weight loss is due to laxity o what structure?
T e clavipectoral ascia.

What is the most requent complication o abdominoplasty combined with liposuction?
Seroma ormation.

What normally supplies the umbilical skin?
Vessels rom the deep in erior epigastric arteries, ligamentum teres, and the medial umbilical ligament.

What is the likely cause o a supraumbilical bulge a ter abdominoplasty?
Not placating the rectus muscle.
Skin/ Lasers

What type o basal cell carcinoma (BCC) requires additional excision by Mohs technique?
Morphea orm; also known as sclerosing BCC.

rue/False: Suction lipectomy may be an e ective procedure or the management o axillary hyperhidrosis,
HIV-associated lipodystrophy, lymphedema, and Madelung disease.
rue.

What is Madelung disease?
Benign symmetric lipomatosis; di use growth o nonencapsulated lipomas, in neck, shoulders, posterior trunk.

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Plastic & Reconstructive Surgery Board Review

What nerve is typically involved in Frey syndrome?
Auriculotemporal nerve, a branch o V.

What is the nerve o Jacobson?
T e tympanic branch o IX, which provides sensation to the tympanic cavity.

What is the mechanism o greater dermal injury with the CO2 laser as compared with the Er:YAG laser?
T e Er:YAG laser has an a nity or water that is 10× greater; also, the pulse rate is shorter than that o the CO2
laser.

A pain ul vesicular rash in the days ollowing CO2 laser treatment o acial rhytids is best treated by what
method?
Acyclovir (prophylactic treatment is important).

Is isotretinoin used or premedicating laser patients?
No; Accutane is contraindicated.

What is the most common complication ollowing 30% CA peeling?
Hyperpigmentation.

What complication is associated with phenol peeling?
Cardiac arrhythmias.

With laser treatments?
HSV reactivation.

What agent is typically used in rejuvenating ne acial rhytids?
CA (15–35%).

What patients should Botox not be injected into?
Egg/albumin sensitivity.

What agents are administered be ore dermabrasion to prevent hyperpigmentation?
Hydroquinones.

Is tretinoin or isotretinoin used or skin preparation be ore dermabrasion?
retinoin; isotretinoin (Accutane) is contraindicated or 1 year be ore laser or dermabrasion due to risk o scarring
and delayed healing.

What is the mechanism o Botox?
Prevents acetylcholine uptake.

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What is the latency period and duration o e ect o Botox?
Onset beginning 3 to 7 days and lasting or 4 to 6 months.

What is pachydermoperiostosis?
Genetic syndrome resulting in enlarged hands, eet, eyelids, and toes.

What is the mechanism o retinoids in regard to the skin?
Decreased activity o metalloproteases rom AP1 transcription inhibition.

What is the mechanism o tretinoin?
T inning the stratum corneum, epidermal thickening, atypia reversal, increased collagen synthesis.

What is the mechanism o topical vitamin C?
Decreased ree radical e ects o UVB and increased collagen production.

What is the mechanism o alpha hydroxy acids?
Increased desquamation rom decreased corneocyte adhesion.

What is the mechanism o hydroquinones?
Block conversion o dopamine to melanin; blocking tyrosinase.

What level o dermis is dermabrasion per ormed at?
Down to the upper third o the dermis.

What treatment is recommended or ice-pick acne scars?
Excision.

What skin layer are hair ollicles ound at?
T e subcutaneous level.

What treatment relieves burning and itching associated with keloids?
Intralesional injection o steroid.

What lasers are used or blue-green tattoos?
Q-switched Nd:YAG and alexandrite lasers.

What colors is the Nd:YAG laser used or?
Red, brown, and orange.

What is the Q-switched ruby laser used or?
attoos with purple and violet pigments.

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Plastic & Reconstructive Surgery Board Review

What are eatures o Gorlin syndrome?
Nevoid BCC syndrome; AD; multiple BCCs; mandibular cysts; intracranial calci cations.

T e strati cation o Fitzpatrick skin types is important or what?
Risk o pigmentary changes ollowing chemical peeling.

What Fitzpatrick skin types are at risk or pigmentary changes a ter chemical peel?
4, 5, and 6.

What physiologic changes with collagen are seen with application o tretinoin or periorbital rhytids?
Increased type III collagen over 6 to 12 months; up to 80% increase in collagen.

What changes are seen in the skin with tretinoin therapy?
T ickened dermis; skin elasticity improves.

What is the best treatment or multiple actinic keratoses o the ace?
opical 5- uorouracil (5-FU) treatment.

What is the most common in ection ollowing acial laser resur acing?
Reactivation o latent herpes simplex virus. reat with antivirals (e.g., acyclovir).

What is the di erence between botulinum toxin type A (BO OX Cosmetic) and botulinum toxin type B
(Myobloc)?
Lower pH results in greater pain with injection, shorter duration o action, quicker onset o action, greater
di usion area.

What test should be per ormed prior to the use o bovine collagen llers?
Skin test to assess or allergic reaction.
CRANIOFACIAL

What is the only acial muscle to compress the cheek?
Buccinator.

rue/False: T e metopic suture usually uses be ore 1 year o age?
rue.

What common medication can contribute to osteonecrosis o the mandible?
Bisphosphonate therapy, o ten used to treat osteoporosis and as chemotherapy to treat bone metastases.

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A patient with a prior cle t lip and palate undergoes Le Fort I advancement or maxillary hypoplasia, what
postoperative complication is he or she at higher risk or?
Velopharyngeal incompetence.

Patient with partial tongue numbness a ter third molar removal. Diagnosis?
Injury to the lingual nerve, which provides sensation to the anterior two-thirds o the tongue.

What is the sensory nerve supply to the tongue?
Lingual nerve: general sensation to anterior two-thirds. Chorda tympani (CN VII): taste to anterior two-thirds.
Glossopharyngeal nerve: taste and sensation to posterior one-third.

How do you treat a small salivary leak presenting 10 days a ter pharyngeal reconstruction?
Conservatively with local wound care.

What is the “coup de sabre” de ormity?
Frontal linear scleroderma, an acquired condition presenting as a linear band o atrophy and a urrow in the skin
on the rontal or rontoparietal scalp.

What imaging study should be obtained on patients with progressive hemi acial atrophy (Parry–Romberg
syndrome)?
Brain MRI.

Progressive hemi acial atrophy ollows the distribution o branches o what nerve?
rigeminal nerve (CN V).

A mother and rst child have a cle t lip and palate, what is the risk that the next child will have the
de ormity?
14%.

What is the ideal ree ap or a hemiglossectomy de ect?
Radial orearm ree ap.

Where should the medial canthus be reattached in relation to the lacrimal ossa?
Posterior and superior to the posterior crest o the lacrimal ossa.

What is the treatment or proptosis, increased intraocular pressure, and decreased visual acuity a ter trauma?
Lateral canthotomy and cantholysis (within 90 minutes!).

In Bell palsy, paralysis o what structure results in hypersensitivity to sound? Changes in taste?
Stapedius muscle dampens sound. Chorda tympani provides taste to anterior two-thirds o tongue.

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Plastic & Reconstructive Surgery Board Review

What nerve innervates the tensor tympani and tensor veli palatine muscles?
rigeminal nerve.

What nerve innervates the levator palatine muscle?
Vagus nerve.

What is the initial treatment o cutaneous angiosarcoma?
Surgical excision with wide margins.

What type o bone gra t can result in overgrowth when used in the pediatric temporomandibular joint
reconstruction?
Rib gra t due to the presence o a cartilaginous cap.

What joint type best describes the temporomandibular joint?
Hinge-sliding (ginglymoarthrodial).

What is Cobb syndrome?
A rare congenital disorder characterized by visible skin lesions with underlying spinal angiomas or AVMs.

What is nevus ammeus neonatorum?
A lesion that is present at birth, usually in the upper ace and posterior neck, but disappears or ades by 1 year o
age.

What is the most appropriate ap or nasal lining in a large ull-thickness nasal sidewall de ect? What is the
blood supply?
Mucoperichondrial ap; anterior ethmoidal artery.

Which tooth root is longest?
Canine, approximately 30 mm.

In treatment o oral cancer, how do you decide whether to do a marginal mandibulectomy or a segmental
mandibulectomy?
I the tumor abuts the mandible, marginal mandibulectomy (removal o the alveolar process) is an option. I the
tumor invades bone, segmental mandibulectomy is indicated.

At what point during ear reconstruction should a bone-anchored hearing aid be placed?
A ter completion o ear reconstruction because it is placed in the mastoid region that may be used during ear
reconstruction.

What is Möbius syndrome?
Congenital disorder characterized by acial weakness combined with abnormal ocular abduction (weakness o CN
VI and CN VII). Limb abnormalities are also common.

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899

A teenager presents with a acial mass that has been gradually enlarging since birth, MRI shows a high
vascular ow. Diagnosis?
Arteriovenous mal ormation.

What is the diagnosis in a patient with a clicking sensation on jaw opening?
Subluxation o the articular disk o the MJ joint.

What is a thyroglossal duct cyst?
A remnant o the thyroglossal duct that orms anywhere along the course o the embryologic migration o the
thyroid gland rom the base o the tongue to the anterior midline neck.

What is the most common congenital nasal mass?
Dermoid cyst.

A pediatric patient presents with a midline nasal mass, what is the next step?
Imaging study to rule out intracranial communication, which is o ten suggested by broadening o the nasal root or
increased intercanthal distance.

What is a pilomatrixoma?
A rare, benign super cial skin neoplasm originating rom the hair matrix cells.

What is the most appropriate surgical approach to a patient with a de ect compromising 75% o the central
upper lip?
Bilateral Karapandzic aps with a central Abbe ap.

A ree gracilis trans er is planned or acial reanimation, the vector o pull should mimic which muscle o
acial expression?
Zygomaticus major.

What is the li etime risk o a malignant peripheral nerve sheath tumor in patients with neuro bromatosis
type 1?
Approximately 10%, usually arising rom a pre-existing neuro broma.

A ter a acial nerve laceration, how long can the distal end o the nerve be success ully stimulated?
Approximately 72 hours, a ter which the neurotransmitter stores are depleted.

What is a branchial cle t stula?
Embryologic remnant o the cle t between the second and third branchial arches, usually located at the anterior
border o the lower sternocleidomastoid muscle.

What nerve is at risk when excising a branchial cle t stula?
Hypoglossal nerve (CN XII). T e stula ollows the carotid sheath superiorly and crosses the hypoglossal nerve.

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Plastic & Reconstructive Surgery Board Review

What is the treatment or osteoradionecrosis o the mandible associated with a pathologic racture?
Segmental resection and ree tissue trans er.

What is the landmark or mental nerve block?
T e mandibular second premolar.

What is the landmark to locate the opening o Stensen duct?
T e maxillary second molar.

What is the landmark or the location o the in erior alveolar nerve?
T e sigmoid notch.

What ndings are consistent with vertical maxillary excess (long ace syndrome)?
Gummy smile, long obtuse nasolabial angle, class II angle classi cation, obtuse nasolabial angle, lip incompetence,
show o upper incisors with lips in repose; mentalis muscle strain.

What is appearance o the chin in vertical excess syndrome?
Chin is retruded; mandible appears retrognathic.

What de nes a “gummy” smile?
Greater than 4 mm o incisor show at rest and greater than 2 mm with active movement.

What is the lip-to-tooth relationship in long ace syndrome?
Lip-to-tooth relationship greater than 3 mm.

What di erentiates mandibular de ciency rom vertical maxillary excess?
SNB angle decreased with mandibular de ciency.

What are the characteristics o mandibular excess?
Wide lower third o ace, prominent lower lip, anterior crossbite, class III angle classi cation, increased SNB angle.

What are the characteristics o vertical maxillary de ciency (short ace syndrome)?
Decreased acial height, absence o maxillary show with edentulous look, protruding chin, wide alar bases, class III
angle, normal or greater SNB.

In patients younger than 2 years, when should mandibular distraction osteogenesis be per ormed?
When there is tongue-based airway compromise secondary to mandibular hypoplasia that pulls the mandible
orward relieving airway obstruction.

Why should children younger than 2 years with only selected congenital hypoplasia or aplasia o only
selected portions o the mandible not undergo distraction osteogenesis?
Risk or permanent dental injury in patients who do not have airway compromise.

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901

How reliably does distraction osteogenesis improve patients with laryngomalacia or tracheomalacia?
It will not reliably improve airway obstruction.

At what time is distraction osteogenesis initiated in patients with hemi acial microsomia?
Older than 1 year.

What is the treatment o patients with an acute open lock de ormity o the mandible?
Attempted closed reduction under sedation in the ED.

What is the de ormity in open lock de ormity?
Condyle slips into position anterior to the articular eminence.

What is the treatment o a teenaged girl with RA and mandibular retrusion and anterior open bite?
Maxillary impaction (to close the open-bite de ormity), advancement genioplasty.

A 35-year-old man sustains nasal trauma resulting in a localized purplish mass on the le t side o the
septum—what is the next step in management?
Immediate incision and drainage o the septal mass.

What is a long-term sequelae o septal hematoma?
Septal per oration leading to saddle nose de ormity.

Application o an arch bar to the maxillary alveolus requires anesthesia o which nerves?
Nasopalatine and anterior superior alveolar.

What nerve trunk does the nasopalatine nerve originate rom?
V2.

Which nerve provides sensation to the posterior palate?
Greater palatine nerve.

Following resection o a pleomorphic adenoma, a recurrent multinodular tumor requires what type o
therapy next?
XR .

In patients sustaining bilateral parasymphysial ractures, which muscle exerts a distractive orce on the
anterior racture segment?
T e geniohyoid.

What is the unction o the geniohyoid muscle?
o depress and retract the mandible.

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Plastic & Reconstructive Surgery Board Review

What is the unction o the posterior belly o the digastric muscle?
Elevates the hyoid, has only a secondary e ect on the anterior mandible.

Which essier cle t has displacement o the medial canthus o the eyelid?
No. 3 cle t is characteristic o having a medially displaced medial canthus; also re erred to as a naso-ocular cle t
(in eromedial wall is absent); nose is shortened, colobomas, NLD obstruction.

What are the characteristics o a No. 1 cle t?
Just lateral to midline, begins at Cupid bow and passes through dome o nostril; notching o alar dome; nasal bone
may be absent; septum una ected; hypertelorism and encephalocele may be associated.

A No. 4 cle t?
Passes between the piri orm aperture and in raorbital oramen, begins lateral to Cupid bow and philtrum, passes
lateral to the nasal ala onto cheek, terminates in lower eyelid, medial canthal tendon una ected.

A No. 5 cle t?
Begins behind canine and extends through maxillary sinus to orbital oor; colobomas o lateral lower lids and
cle ting o upper lip medial to oral commissure associated.

Which cle t is the incomplete orm o reacher Collins syndrome?
No. 6; passes in erior and lateral to the oral commissure, toward angle o mandible; colobomas o lateral lower
eyelids; downward slant o palpebral ssures.

Which is the most common atypical cle t?
No. 7; 1 per 3,000 births; absent zygomatic arch.

Where does a No. 8 cle t extend?
From lateral commissure o palpebral ssure to temporal region; colobomas o lower eyelids also seen.

Which cle t is the supraorbital extension o the No. 5 cle t?
No. 9.

A patient sustaining a rontal sinus racture in an MVA with CSF rhinorrhea and displacement o anterior/
posterior sinus walls and injured naso rontal ducts requires what operation?
Cranialization o the rontal sinus in conjunction with neurosurgery.

What are the steps in cranialization?
Bi rontal craniotomy to repair dura, removal o posterior wall o rontal sinus and associated mucosa; occlusion
o naso rontal duct with a pericranial ap or at; burring down sharp edges; allowing the brain to expand into this
new potential space.

Frontal sinus exenteration involves what?
Removal o the anterior table o the rontal sinus only.

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What is involved in rontal sinus obliteration?
Removing all the mucosa within the rontal sinus; allowing the naso rontal duct to occlude.

Which muscles produce side-to-side grinding motions o the mandible?
Medial and lateral pterygoid; rotation occurs around the vertical axis o the contralateral condyle.

What is the origin/insertion o the medial pterygoid? How does it unction?
Originates rom the medial sur ace o the lateral pterygoid plate and tuberosity o maxilla and inserts into the
medial sur ace o the mandibular angle/ramus; elevates and pulls mandible medially.

What is the origin/insertion o the lateral pterygoid? Its unction?
Originates rom the lateral sur ace o the lateral pterygoid plate (in erior head) and in ratemporal sur ace o the
greater wing o the sphenoid (superior head) and inserts into the mandibular condylar neck (in erior head) and
articular disk o MJ (superior head); protrudes the mandible orward and opens mouth.

Simultaneous action o all our pterygoid muscles results in what motion o the mandible?
Protrusion o the mandible.

Where does the masseter originate/insert?
Originates rom zygomatic arch; inserts onto ramus.

Where does the temporalis muscle insert?
Originates rom the temporal ossa and attaches to the coronoid process o the mandible; primarily elevates
mandible, but also can retract mandible.

Following a bilateral cle t lip repair, tightness o the upper lip with a wide hypoplastic philtrum with the
absence o muscle competence and redundant lower lip may be treated with what kind o ap?
Abbe ap (to create a unctional philtrum in patients with tightness o the upper lip ollowing cle t lip repair).

What are the dimensions o a reconstructed philtrum in the adult?
No wider than 10 mm and no longer than 15 mm.

What is the incidence o concomitant cervical spine injury with a mandibular racture?
10%.

In a patient with VPI with central velopharyngeal closure and poor lateral wall motion, what procedure is
indicated?
Sphincter pharyngoplasty.

What muscle is transposed in sphincter pharyngoplasty?
Palatopharyngeus (incorporated into the posterior pharyngeal wall to create a sphincter).

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Plastic & Reconstructive Surgery Board Review

When is a pharyngeal ap indicated?
Correction o de cits o the central palate with good lateral wall motion; the levator veli palatini is used as well in
the palate or attachment o the posterior wall ap.

Where is the tensor veli palatini muscle located relative to the levator veli palatini?
T e VP is anterior to the LVP.

Where are the palatoglossus muscles located—in the anterior or posterior tonsillar pillar?
Anterior.

A neonate with a 1.5-cm reddish mass adjacent to the nasal root with overlying telangiectasias that is rm,
not compressible and nonpulsatile is most likely what type o mass?
Glioma (rarely with bony de ects, intracranial connections).

What embryonic tissue derives nasal dermoids?
Mesoderm and ectoderm (hair ollicles, sebaceous glands, smooth muscle).

What external nasal lesions transilluminate and are compressible?
Encephaloceles (external, or sincipital) are so t, bluish, compressible, and pulsatile lesions that transilluminate;
Furstenberg sign.

What nerve innervates the oral commissures bilaterally?
Buccal nerve, a branch o V3.

What causes a 10-month-old boy to tilt his head to the right who also has an uncorrected le t coronal
synostosis?
Paresis o the ipsilateral superior oblique muscle ( oreshortening o the orbital roo on the a ected side; relative
paresis o superior oblique occurs).

In surgically correcting the patient with NOE racture, what is the most appropriate management o the
lacrimal system?
Observation; generally low incidence o duct injury in patients undergoing ORIF without overlying lacerations.

How does one evaluate persistent epiphora ollowing surgery or an NOE racture?
Dacryocystography; ollowed by a DCR i required or treatment.

What muscle courses around the pterygoid hamulus?
T e tensor veli palatini.

Where does the levator veli palatini run relative to the hamulus?
It passes posterior to the hamulus creating a muscular sling.

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A complete unilateral cle t lip is associated with what type o movement o the ala?
Lateral, in erior, and posterior (the piri orm rim is also de cient, which also supports the ala).

reacher Collins syndrome involves which essier cle t(s)?
No. 6, 7, and 8 cle ts.

What is the class occlusion seen in reacher Collins?
Class II.

What are the characteristics o the maxilla, palate, and mandible in reacher Collins?
Maxilla protrudes, palatal plane is moved upward and posteriorly; micrognathia, decreased length o the ramus
and body; hypoplastic or absent condyle; cle t in the in erolateral orbital oor also occurs; hypoplastic zygoma,
maxilla, and mandible.

What type o synostosis is seen in Crouzon?
Bilateral coronal synostosis (acrocephalosyndactyly) orehead and superior orbital rim retrusion, proptosis, mid ace
hypoplasia.

What type o occlusion is seen in Crouzon?
Angle type III.

What abnormalities are seen in Goldenhar?
Oculoauriculovertebral dysplasia; subset o hemi acial microsomia, epibulbar dermoids and scapula/spine
anomalies seen; may be bilateral; resemble a No. 7 cle t; mandibular hypoplasia.

What is Romberg syndrome?
Progressive hemi acial atrophy, appears initially as cutaneous pigmentation and progresses to destruction o acial
so t tissues and skeleton.

What are the zones o distraction osteogenesis?
Fibrous zone (central region o the distraction gap); transitional zone (adjacent to the brous zone, contains
brous tissue undergoing ossi cation); zone o remodeling bone (surrounded by zone o mature bone).

What nerve supplies sensation to the buccal mucosa?
T e trigeminal nerve (V).

What are the clinical ndings o a unilateral condylar racture?
Upward cant o mandible to the ractured side, early contact o molars on ipsilateral side; contralateral lateral open
bite.

What are the clinical ndings o a bilateral condylar racture?
Anterior open-bite secondary to loss o posterior vertical height.

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Plastic & Reconstructive Surgery Board Review

What is the malocclusion seen in a 6-year-old who has undergone a unilateral cle t lip/palate previously with
an unrepaired alveolar cle t?
Posterior crossbite (an unrepaired alveolar cle t causes maxillary arch collapse, the arch will be de cient in the A-P,
transverse, and vertical directions.

What is the clinical appearance o a posterior crossbite?
Lower dentition is labial to the upper dentition.

What is the de nition o Angle class I?
T e mesiobuccal cusp o the rst maxillary molar sits in the buccal groove o the rst mandibular molar.

De ne overbite and overjet.
Overbite describes the distance between the mandibular and maxillary incisors in the vertical plane; overjet
describes the distance between the incisors in the horizontal plane.

What direction does the central mandibular segment move in a patient sustaining bilateral vertically and
horizontally un avorable ractures adjacent to the canine roots?
Downward and posterior (actions o the digastric and geniohyoid/genioglossus).

What points o xation are required in patients with zygomaticomaxillary complex ractures?
Z-F suture, in erior orbital rim, and zygomaticomaxillary buttress.

What is the most common type o nonsyndromic single-suture craniosynostosis?
Sagittal (50% o patients with single-suture usions); elongated skull with rontal/occipital bossing.

What is turribrachycephaly?
Shortened, wide skull with increased vertical height at top o skull; rom bilateral coronal synostosis.

How common is lambdoid suture usion?
Extremely rare, in 1% to 2% in patients with craniosynostosis.

What is trigonocephaly?
Metopic suture usion; leaves a prominent midline ridge in orehead; occurs in 10% o all single-suture usions;
triangularly shaped orehead.

How o ten does single-suture squamosal synostosis occur?
Isolated usion does not occur.

What areas are a ected in auriculotemporal nerve paresis during super cial parotidectomy?
Numbness o tragus, EAC, tympanum, and temporal skin; bers also go to the parotid gland as secretomotor
bers and articular bers to the MJ.

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What branch is the auriculotemporal nerve rom?
V3, mandibular division o V.

What nerve innervates the concha? T e antihelix?
Auricular branch o X.

What areas are supplied by the great auricular nerve? T e lesser occipital nerve?
Both these nerves are derived rom C2 to C3; the areas supplied are the helix and lobule.

What procedure is most appropriate or a 15 year old with Apert in need o 25 mm o mid ace advancement?
Le Fort III with distraction osteogenesis or advancement; distraction osteogenesis pre erred over bone gra ting or
greater than 10 mm.

In an in ant with hemi acial microsomia, should macrostomia or de ciencies o the mandibular ramus/body
be corrected rst?
Macrostomia; hemi acial microsomia associated with rst and second branchial arch anomalies and essier No. 7
cle t.

What nerve passes through the oramen ovale?
V3.

Where does V1 pass through?
T e superior orbital ssure.

What nerve passes through the oramen rotundum?
V2.

What is the most likely diagnosis o a patient with a painless mass at the angle o the mandible or the past
10 years with a biopsy showing luminal ductal cells mixed with sheets o myoepithelial cells?
A pleomorphic adenoma; most common benign tumor o the parotid; contains two populations o cells (epithelial
and mesenchymal cells).

How does a myoepithelioma o the parotid di er rom a pleomorphic adenoma?
More rare, a ects parotid or palate, histologically similar but also shows spindle cells.

What parotid tumor has a characteristic o being bilateral?
Warthin’s (papillary cystadenoma lymphomatosum); male smokers; 10% multicentric, 10% bilateral.

What structures arise rom the lateral nasal processes?
T e nasal ala.

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Plastic & Reconstructive Surgery Board Review

What structures arise rom the medial nasal processes?
T e columella, nasal tip, philtrum, and premaxilla; this occurs during the sixth week o gestation.

What structures arise rom the rontonasal processes?
T e bridge and root o the nose.

Which muscle o mastication pulls the mandible upward, medially, and orward?
T e medial pterygoid.

What is the origin/insertion o the anterior digastric muscle? T e posterior digastric?
Originates rom the inside lower border o the symphysis and attaches to the lateral corner o the hyoid bone.
Posterior belly extends between the hyoid and mastoid.

How does the digastric unction in distracting the mandible in the setting o a racture?
T e digastric pulls the anterior mandibular ragments posteroin eriorly.

What is the unction o the mylohyoid?
Elevates the tongue.

Abnormalities o the corpus callosum is most requently associated with premature usion o which cranial
suture?
T e metopic suture (trigonocephaly); also associated with higher incidence o developmental delay.

What is the most appropriate initial step in evaluating an in ant in respiratory distress with retrogenia and
glossoptosis?
Prone positioning; Pierre Robin sequence occurs with a 50% incidence o high-arched cle ts o the so t palate;
hard palate cle ting also occurs in some patients.

What are alternative treatments i prone positioning does not help the neonate with Pierre Robin sequence?
Lip–tongue adhesion, tracheostomy, mandibular distraction osteogenesis.

What cranial suture has the greatest incidence o synostosis associated with mutations in the loci or FGF
receptors?
Coronal; in both unilateral and bilateral.

What bony segments are moved together in a Le Fort I osteotomy?
T e entire alveolar process o the maxilla, vault o the palate, pterygoid processes.

What bony segments are included in a Le Fort II?
A central maxillary segment is undisturbed; also included are portions o the medial orbital walls, orbital oor, and
naso rontal junction.

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T e external auditory canal develops rom which embryologic structure?
First branchial groove.

Which hillocks does the rst branchial arch give rise to?
T e rst three hillocks.

What cranial nerve innervates the temporalis muscle?
V3.

An anterior chamber hemorrhage o the eye is known as what?
A hyphema.

What de nes subconjunctival hemorrhage?
Bleeding occurring in the bulbar or palpebral conjunctiva; rom extravasation o conjunctival capillaries.

What is the most common complication o a sagittal split osteotomy?
Loss o lower lip sensibility.

Cranio acial microsomia is the most common major cranio acial anomaly—how is it transmitted?
It does not demonstrate genetic transmission—likely an intrauterine event; or example, hematoma.

How are Apert and Crouzon patients di erentiated clinically?
Apert’s patients have severe syndactyly o the middle three digits o the hands and eet; Crouzon patients have
normal extremities; both have craniosynostosis, exorbitism, and mid ace retrusion.

How is reacher Collins transmitted?
Autosomal dominant.

What are clinical characteristics o reacher Collins?
Facial cle ting, antimongoloid slant, colobomas, absence o eyelashes on medial portion o the lower eyelid,
preauricular displacement o hair, micrognathia, malar/mandibular de ects.

What is the maximum bony de ect (in mm) that will not require bone gra ting?
5 mm.

What structures pass through the superior orbital ssure?
III, IV, V1, VI, sympathetic nerve bers.

What is the superior orbital ssure syndrome?
Fractures that extend to the superior orbital ssure and orbital roo ; vision is not a ected.

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Plastic & Reconstructive Surgery Board Review

What is orbital apex syndrome?
Injury to the optic nerve rom extension o the racture into the optic canal; loss o vision.

Prominence o the ear is caused by e acement o what part o the ear?
Superior crus o the antihelix; conchoscaphal angle is greater than 90 degrees; helix is greater than 12 to 15 mm
rom the temporal skin.

Prominence o the middle portion o the ear is caused by hypertrophy o what structure?
Concha cavum; here the concha cavum has a depth o more than 1.5 cm.

What so t-tissue change is most likely seen ollowing Le Fort I advancement?
Increased nasolabial angle, widened alar base; shortened upper lip, increased incisor show.

How is upper lip shortening prevented during Le Fort I advancement?
V-Y advancement during closure.

Regarding the chin, lower acial height, labiomental old, and sagittal de ciency, alloplastic chin
augmentation is best recommended in what setting?
Symmetric chin, normal lower acial height, shallow labiomental old, minimal sagittal de ciency.

How is velocardio acial syndrome diagnosed?
FISH analysis; or deletion o 22q11.2.

What are the components o velocardio acial syndrome?
AD; VPI, developmental delay, upward slanting o palpebral ssures, prominent nose with broad nasal root,
aberrant carotid arteries; submucous cle t.

De ne Angle class I.
T e mesiobuccal cusp o the rst maxillary molar ts into the buccal groove o the rst mandibular molar.

De ne Angle class II, division 1.
T e mesiobuccal cusp o the rst maxillary molar is anterior to the buccal groove o the rst mandibular molar;
division 1: lateral incisors angled labially.

De ne Angle class II, division 2.
Same previous Angle class II but the lateral incisors are angled lingually; retrognathic on appearance.

What are operative indications or MJ pathology?
Internal derangement associated with neoplasia, trauma.

What are surgical options or internal derangement?
Intracapsular repositioning o the disk, excision o the disk, temporalis ascia ap placement.

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A decreased SNA and normal SNB indicate what process o the maxilla?
Maxillary retrusion.

What are normal values o SNA and SNB?
SNA 82 degrees; SNB 80 degrees.

Normally how much incisor show appears at rest?
2 to 3 mm.

What muscle causes the medial displacement o the condyle ollowing a racture?
Lateral pterygoid.

What is the sequence o repair in a patient with mid ace ractures and bilateral condylar neck ractures?
ORIF o condylar neck ractures ollowed by mid ace ractures.

What is the most common cause o an open-bite de ormity ollowing Le Fort I and bilateral sagittal split
osteotomy in a patient?
Centric relation not equaling centric occlusion, or having the condyles not seated properly in each respective
glenoid ossa.

What population o patients does progressive condyle resorption occur in?
Young women; a late cause o open-bite de ormity causing shortening o the condyle and clockwise rotation o the
mandible.

What de nes vertical maxillary de ciency?
Decrease in vertical height, absence o maxillary incisor show, short/ at upper lip, protrusive chin, acute
mandibular plane.

During pediatric distraction osteogenesis, what techniques optimize bone ormation?
Lower-energy corticotomy (minimizing central medullary bone trauma); less than 5 mm o intraoperative
immediate distraction; stable xator placement.

What passes through the stylomastoid oramen?
T e acial nerve and stylomastoid artery.

What passes through the jugular oramen?
IX, X, XI, and the internal jugular vein.

What passes through oramen ovale?
V3 and accessory meningeal artery.

How is scaphocephaly treated?
Cranial vault remodeling with barrel staving.

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Plastic & Reconstructive Surgery Board Review

What is scaphocephaly?
Premature closure o the sagittal suture; skull is long, narrow, and characteristically keel shaped.

What procedures are done or unicoronal and bicoronal synostosis?
Bilateral rontal craniotomy and bilateral ronto-orbital advancement.

T e buccal nerve is a branch o which nerve?
V3; arises rom sur ace o the buccinator. Supplies sensation to medial cheek.

What is the dorsal nasal nerve a branch o ?
Nasociliary nerve, V1.

What is the sensory territory o the in ratrochlear nerve?
T e nasal root and medial eyelid.

What is the zygomatico acial nerve a branch o ?
V2; supplies zygomatic skin and upper portion o central cheek.

What symptoms de ne Pierre Robin sequence?
Micrognathia, glossoptosis, respiratory distress, and cle t palate.

What is the initial management o a neonate with Pierre Robin?
Prone positioning; evaluation o the lower airway or synchronous anomalies; later, other interventions include
distraction osteogenesis, tongue–lip adhesion, tracheotomy.

What are symptoms o Binder syndrome?
Nasomaxillary hypoplasia, low/ at nasal tip, absent nasal spine; Angle class III malocclusion.

What is Klippel–Feil syndrome?
Shortened neck, low posterior hairline, hearing loss, cle t palate, acial abnormalities; usion o cervical spine.

What is Shprintzen syndrome?
Otherwise known as velocardio acial syndrome; most common syndrome seen in cle t lip/palate; thymus/
parathyroid glands absent; cardiac anomalies, velopharyngeal dys unction.

What is van der Woude syndrome?
Cle t lip/palate, LOWER lip pits ( rom accessory saliva glands); extremity anomalies.

Does the medial or lateral pterygoid elevate the mandible?
T e medial.

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What action does the digastric muscle have on the mandible ollowing a racture?
Pulls anterior mandibular segment posteriorly and in eriorly.

What is the action o the lateral pterygoid in unilateral subcondylar ractures?
T e ipsilateral condylar head is pulled anteriorly and medially; the contralateral lateral pterygoid continues to
protrude the mandible, thus deviating the jaw to the racture side.

In patients with subcondylar ractures, what is the most appropriate duration o maxillomandibular xation
(MMF)?
4 weeks.

Embryologically, what arises rom the rontonasal process?
T e nasal bridge and root.

What arises rom the medial nasal processes?
Columella, tip, philtrum, premaxilla.

What arises rom the lateral nasal processes?
T e alae.

Which branchial arch gives rise to the stylopharyngeus muscle?
T e third.

What muscles are derived rom the rst branchial arch?
Muscles o chewing, anterior digastric, mylohyoid, tensor tympani.

What is the most appropriate next step or treatment o a naso-orbital-ethmoid racture?
ORIF and bone gra ting.

What muscle travels around the hamulus in the mouth?
T e tensor veli palatini.

What bone does the hamulus arise rom?
T e medial pterygoid plate.

A 5-month-old child with anterior displacement o the right ear and zygoma and right side o the orehead
with attening o the right side o the occiput has what process?
Right-sided posterior de ormational plagiocephaly.

What are the most common causes o synostotic plagiocephaly?
Unilateral coronal and lambdoidal craniosynostosis.

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Plastic & Reconstructive Surgery Board Review

How requent is de ormational plagiocephaly?
1 per 70 in ants.

What ndings are seen in posterior de ormational plagiocephaly?
Unilateral; parallelogram-shaped head; ipsilateral attening o the occiput with anterior displacement o
ipsilateral ear.

What ndings are seen in bilateral de ormational plagiocephaly?
Flattening o the occipital area, mastoid bulging bilaterally, biparietal eminence bossing.

What is seen in lambdoidal craniosynostosis?
Ipsilateral occipital attening with lambdoid suture ridging ( rom usion o the suture); INFERIOR displacement
o the ear.

What shape is the skull in lambdoidal craniosynostosis?
rapezoid-like.

On the basis o radiographic C ndings, what are operative indications or an orbital blowout racture?
Orbital oor de ect greater than 2 cm, low vertical height o the globe, coexisting other acial ractures.

What are clinical indications or operative intervention in orbital blowout ractures?
Symptomatic diplopia, positive orced duction testing, ailed resolution o extraocular muscle entrapment a ter 1 week.

Does the supraorbital artery derive its blood supply rom the internal or external system? T e supratrochlear
artery?
Both are branches o the ophthalmic artery, which branches rom the internal carotid artery.

What is an important consideration when deciding whether to use an external or internal distraction device
ollowing a Le Fort III?
Using an external device allows or in-o ce removal, saving an operative procedure or the patient.

Nerve injury during osseous genioplasty most likely results in what symptom?
Numbness o the lower lip (mental nerve).

In a teenaged boy with Angle class III, 12 mm o negative overjet, and normal SNB angle, what procedure is
most appropriate or maxillary advancement?
Distraction osteogenesis o the maxilla; Le Fort I single-stage advancement o more than 10 mm is considered
unpredictable.

What is the procedure o choice in a patient to advance the maxilla who has had cle t lip/palate repair and
pharyngeal ap with a 14-mm negative overjet?
Maxillary distraction osteogenesis.

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What environmental exposure has been linked to squamous cell carcinoma o the maxillary sinus?
Nickel.

What is the most use ul component to anatomically reduce in a ZMC racture?
T e lateral orbital wall, alternatively, the sphenoid wing can be also used.

Where does the levator palpebrae superioris originate rom?
T e lesser wing o the sphenoid.

Where do the superior oblique and rectus muscles originate rom?
T e annulus tendineus communis.

What structure does the in erior oblique arise rom?
T e maxilla.

Gustatory sweating ollowing parotid surgery is due to mal unction o what nerve?
Auriculotemporal.

What is the mechanism o Frey syndrome?
Aberrant connections between postganglionic parasympathetic bers rom the otic ganglion and postganglionic
sympathetic bers to sweat glands.

What e ect does Botox have on Frey syndrome?
Intracutaneous administration blocks acetylcholine transmission and may improve symptoms or up to a year.

What structure does the stapes derive rom?
T e second branchial arch.

A melanoma with a Clark level o IV and Breslow thickness o 2.8 mm with an in-transit metastasis has
what stage?
Stage III ( 4, N0).

How is vertical maxillary excess and a retruded chin treated?
ypically by Le Fort I with maxillary impaction and genioplasty.

What is the appearance o the nose in vertical maxillary excess typically?
Alar base constriction and an obtuse nasolabial angle.

What are other signs o vertical maxillary excess?
Lip incompetence, incisor show, mentalis strain.