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--- resident:craniofacial [2019/10/15 20:09] – [Tracheotomy:] 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====