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--- resident:craniofacial [2019/10/15 20:08] – melissa
+++ resident:craniofacial [2020/09/09 21:10] (current) – [Oral and Maxillary Facial Surgery] jonathan
@@ Line 1: / Line 1: @@
-====Surgical Approaches Review====
+===== Oral and Maxillary Facial Surgery =====
-● Submandibular\\
-● Retromandibular / transparotid\\
+Faculty:\\
-● Preauricular \\
+Dr. Glasgow - 301 237 1377
-● Transconjunctival / lateral canthotomy / transcaruncular \\
-● Subciliary / Subtarsal \\
+Recommended Reading:\\
-● Coronal \\
+[[https://www.amazon.com/Oral-Maxillofacial-Surgery-3-Set/dp/0323414990/ref=sr_1_4?dchild=1&keywords=Fonseca&qid=1599700059&sr=8-4|Oral Maxillofacial Surgery (Fonseca)]] - can get it on library genesis. The OMFS residents say this is where many pimp questions come from.\\
-● Upper bleph \\
+[[https://surgeryreference.aofoundation.org/cmf/trauma|AO Foundation]] - Awesome for thinking about and going through approaches to trauma.\\
-● Rhino/septoplasty \\
-● Gilles \\
-● Lefort \\
+===== Surgical Approaches Review =====
-● BSSO \\
-● Modified condylotomy \\
-● Anterior hip \\
-● Posterior hip \\
-● Tibia \\
-● Rib \\
-● Fibula \\
-● Tracheotomy \\
 ====Submandibular====
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 Important structures: Levator palpebrae superioris, Muller's muscle (superior tarsal muscle), lacrimal gland, orbital septum \\
 Complications: ptosis, epiphora, ocular injury \\
+====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's muscle (superior tarsal muscle), lacrimal gland, orbital septum \\
+Complications: ptosis, epiphora, ocular injury \\
 ====Preauricular====
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 Important structures: lacrimal sac, anterior ethmoid arteries, posterior ethmoid arteries \\
 Complications: Entropion, ectropion \\
+==== Subciliary / Subtarsal====
 ====Rhinoplasty / septoplasty====
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 Complications: \\
 - Ok for weight bearing immediately after procedure. - Avoid contact sports or vigorous physical activity for 6 weeks. - Fracture of tibia plateau \\
+====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====
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 - First 48 hours most important - \\
-====Tracheotomy:====
+====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, platysma, avascular raphe between the strap muscles (sternohyoid and sternothyroid) May encounter anterior jugular veins laterally if your off midline, Pretracheal fascia, then trachea. Inverted U incision is known as Bjork. In between rings 2 and 3. Can place stay suture if desired. \\