resident:craniofacial
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| resident:craniofacial [2019/10/15 19:51] – melissa | resident:craniofacial [2020/09/09 21:10] (current) – [Oral and Maxillary Facial Surgery] jonathan | ||
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| - | ====Surgical Approaches Review==== | + | ===== Oral and Maxillary Facial Surgery ===== |
| - | ● Submandibular\\ | + | |
| - | ● Retromandibular / transparotid\\ | + | |
| - | ● Preauricular \\ | + | |
| - | ● Transconjunctival / lateral canthotomy / transcaruncular \\ | + | |
| - | ● Subciliary / Subtarsal \\ | + | |
| - | ● Coronal \\ | + | |
| - | ● Upper bleph \\ | + | |
| - | ● Rhino/ | + | |
| - | ● Gilles \\ | + | |
| - | ● Lefort \\ | + | |
| - | ● BSSO \\ | + | |
| - | ● Modified condylotomy \\ | + | |
| - | ● Anterior hip \\ | + | |
| - | ● Posterior hip \\ | + | |
| - | ● Tibia \\ | + | |
| - | ● Rib \\ | + | |
| - | ● Fibula \\ | + | |
| - | ● Tracheotomy \\ | + | |
| - | **Submandibular:** \\ | + | Faculty:\\ |
| + | Dr. Glasgow - 301 237 1377 | ||
| + | |||
| + | Recommended Reading: | ||
| + | [[https:// | ||
| + | [[https:// | ||
| + | |||
| + | |||
| + | ===== Surgical Approaches Review ===== | ||
| + | |||
| + | ====Submandibular==== | ||
| Incision: 2cm below inferior border of the mandible\\ | Incision: 2cm below inferior border of the mandible\\ | ||
| Layers: Skin, subcutaneous tissue, platysma, superficial layer of deep cervical fascia, pterygomasseteric sling, periosteum, mandible \\ | Layers: Skin, subcutaneous tissue, platysma, superficial layer of deep cervical fascia, pterygomasseteric sling, periosteum, mandible \\ | ||
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| Complications: | Complications: | ||
| - | **Retromandibular / Transparotid:** \\ | + | ====Retromandibular / Transparotid==== |
| - Hinds approach \\ | - Hinds approach \\ | ||
| Incision: 0.5 cm below earlobe, continues inferiorly 3 - 3.5cm just behind posterior border of mandible.\\ | Incision: 0.5 cm below earlobe, continues inferiorly 3 - 3.5cm just behind posterior border of mandible.\\ | ||
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| Complications: | Complications: | ||
| - | ** | + | ====Coronal Incision==== |
| - | Coronal Incision:** \\ | + | |
| Layers: skin, subcutaneous tissue, galea, subgaleal (loose areolar tissue), pericranium Laterally the musculoaponeurotic layer becomes temporoparietal fascia \\ | Layers: skin, subcutaneous tissue, galea, subgaleal (loose areolar tissue), pericranium Laterally the musculoaponeurotic layer becomes temporoparietal fascia \\ | ||
| Important structures: Superficial temporal artery (just superficial to temporoparietal fascia), supraorbital neurovascular bundle, temporal branch of facial nerve (just deep to or within temporoparietal fascia). \\ | Important structures: Superficial temporal artery (just superficial to temporoparietal fascia), supraorbital neurovascular bundle, temporal branch of facial nerve (just deep to or within temporoparietal fascia). \\ | ||
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| Complications: | Complications: | ||
| - | **Preauricular:**\\ | + | ====Upper eyelid / bleph==== |
| + | Incision: 10mm superior to upper lid margin and 6mm superior to lateral canthus (can extend as far laterally as needed for surgical access)\\ | ||
| + | Layers: skin, orbicularis oculi, periosteum (incised 2-3mm posterior to orbital rim) \\ | ||
| + | Important structures: Levator palpebrae superioris, Muller' | ||
| + | Complications: | ||
| + | |||
| + | |||
| + | ====Preauricular==== | ||
| Incision: skin fold along entire aspect of the ear within 8mm of EAC. incise to the depth of the superficial layer of the temporalis fascia. \\ | Incision: skin fold along entire aspect of the ear within 8mm of EAC. incise to the depth of the superficial layer of the temporalis fascia. \\ | ||
| Layers: Temporal region (skin, subcutaneous, | Layers: Temporal region (skin, subcutaneous, | ||
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| The TMJ is a ginglymoarthrodial joint (rotation and translation) \\ | The TMJ is a ginglymoarthrodial joint (rotation and translation) \\ | ||
| - | **Transconjunctival: | + | ====Transconjunctival: |
| - Preseptal and retroseptal (retroseptal more direct and easier to perform) - Lateral canthotomy can be added for improved lateral exposure - Transcaruncular to access the medial wall \\ | - Preseptal and retroseptal (retroseptal more direct and easier to perform) - Lateral canthotomy can be added for improved lateral exposure - Transcaruncular to access the medial wall \\ | ||
| Incision: | Incision: | ||
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| Complications: | Complications: | ||
| - | **Rhinoplasty / septoplasty:** \\ | + | ==== Subciliary / Subtarsal==== |
| + | |||
| + | ====Rhinoplasty / septoplasty==== | ||
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Gilles:** \\ | + | ====Gilles==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Lefort:** \\ | + | ====Lefort==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **BSSO:** \\ | + | ====BSSO==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Modified Condylotomy:** \\ | + | ====Modified Condylotomy==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Anterior hip:** | + | ====Anterior hip==== |
| Anatomy: \\ | Anatomy: \\ | ||
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| in dysesthesia and anesthesia to lateral thigh. - Bleeding: most common source of bleeding during harvest is the gluteal artery. - Avitene - microfibrillar collagen \\ | in dysesthesia and anesthesia to lateral thigh. - Bleeding: most common source of bleeding during harvest is the gluteal artery. - Avitene - microfibrillar collagen \\ | ||
| - | **Posterior hip:** \\ | + | ====Posterior hip==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| - Ok for weight bearing immediately after procedure. - Avoid contact sports or vigorous physical activity for 6 weeks. - Fracture of tibia plateau \\ | - Ok for weight bearing immediately after procedure. - Avoid contact sports or vigorous physical activity for 6 weeks. - Fracture of tibia plateau \\ | ||
| - | **Rib:** \\ | + | ====Tibia==== |
| + | - 25cc of cancellous bone - Can be performed in the office \\ | ||
| + | Anatomy: \\ | ||
| + | - Lateral approach to the tibia metaphysis. - Primary bony landmark in the proximal tibia is Gerdy’s tubercle. - Gerdy’s tubercle is a bony protuberance between the patellar ligament (midline) and the | ||
| + | head of the fibula, which is palpable 90 degrees laterally. - No vital anatomic structures located over Gerdy’s tubercle. - Cutaneous branches of the lateral sural nerve in the area - Fibular nerve is well protected beneath the head of the fibula and does not enter surgical field. - No major nerve structures are located over Gerdy’s tubercle \\ | ||
| + | - Branches of the inferior genicular artery and recurrent tibial artery. Easily cauterized. - Iliotibial tract attaches from above \\ | ||
| + | Incision: 3-4 cm incision directly over Gerdy’s tubercle, carried thru skin, subcutaneous tissues (including iliotibial tract) and periosteum. The periosteum is elevated in preparation for making a cortical window through the cortical bony plate at Gerdy’s tubercle. \\ | ||
| + | Bone harvest: \\ | ||
| + | - A cortical window can be made with a surgical drill or osteotome and mallet. - An oval hole offers less stress in the cortical bone as opposed to square or rectangle. - Harvest the cancellous bone with a curette by going across the tibial plateau and down the shaft of the tibia. - Care must be taken going superiorly to avoid the joint space of the knee. - Close in layers with iliotibial tract being reapproximated. \\ | ||
| + | Important structures: \\ | ||
| + | - iliotibial tract is the only anatomic structure one encounter during the dissection. \\ | ||
| + | A dense fascial band that runs from the anterior iliac crest to lateral surface of the tibia. \\ | ||
| + | Complications: | ||
| + | - Ok for weight bearing immediately after procedure. - Avoid contact sports or vigorous physical activity for 6 weeks. - Fracture of tibia plateau \\ | ||
| + | |||
| + | |||
| + | ====Rib==== | ||
| Incision: over the 5th or 7th rib \\ | Incision: over the 5th or 7th rib \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Fibula:** \\ | + | ====Fibula==== |
| Incision: \\ | Incision: \\ | ||
| Layers: \\ | Layers: \\ | ||
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| Complications: | Complications: | ||
| - | **Radial Forearm:** \\ | + | ====Radial Forearm==== |
| - Based on the radial artery - 10-12 cm with good diameter (2.5 cm) \\ | - Based on the radial artery - 10-12 cm with good diameter (2.5 cm) \\ | ||
| - Can harvest nerves with the flap (Sensory innervation is derived from the lateral | - Can harvest nerves with the flap (Sensory innervation is derived from the lateral | ||
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| - First 48 hours most important - \\ | - First 48 hours most important - \\ | ||
| - | **Tracheotomy:** Incision: Trace out Thyroid cartilage, cricoid cartilage and sternal notch. Horizontal line is drawn halfway in between the sternal notch and cricoid cartilage. Horizontal incision, Skin subcutaneous, | + | ====Tracheotomy==== |
| + | Incision: Trace out Thyroid cartilage, cricoid cartilage and sternal notch. Horizontal line is drawn halfway in between the sternal notch and cricoid cartilage. Horizontal incision, Skin subcutaneous, | ||
| Al-Kayat & Bromley: 1979 \\ | Al-Kayat & Bromley: 1979 \\ | ||
resident/craniofacial.1571183498.txt.gz · Last modified: 2019/10/15 19:51 by melissa