Question 16#

A 32-year-old woman has near complete paralysis of the lower portion of the left side of the face 3 years after onset of Bell’s palsy. There has been no return of nerve function for the past year. Examination shows adequate function of the orbicularis oculi muscle and a good Bell’s reflex. Which of the following is the most appropriate management?

A. Continued observation

Neurotized free muscle transfer using innervation from cross-face grafts.

References:

1. Bove A, Chiarini S, D’Andrea V, Di Matteo FM, Lanzi G, De Antoni E. Facial nerve palsy: which flap? Microsurgical, anatomical, and functional considerations. Microsurgery 1998; 18(4): 286-9.
2. Snyder MC, Johnson PJ, Moore GF, Ogren FP. Early versus late gold weight implantation for rehabilitation of the paralyzed eyelid. Laryngoscope 2001; 111(12): 2109-13.
3. Wei W, Zuoliang Q, Xioaxi L, Jiasheng D, Chuan Y, Hussain K, Hongtai H, Gontur S, Li Z, Hua M, Tisheng C. Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation. Plast Reconstr Surg 1999; 103(2): 473-80.

Question 17#

Calcification of the ear occurs in all except: 

A. Frostbite injuries

Neurofibromata and keloids.

Question 18#

A 7-year-old has cryptotia. Which of the following operative techniques is most appropriate for correction?

A. Advancement of the third crus of the antihelix

Separation of the superior auricle from the temporal skin with placement of a retro-auricular skin graft.

References:

1. Furnas D. The correction of prominent ears by concha-mastoid sutures. Plast Reconstr Surg 1968; 42(3): 189-94.
2. Leber D. Ear reconstruction. In: Textbook of plastic, maxillofacial and reconstruction surgery, 2nd ed. Georgiade GS, Riefkohl R, Levin LS, Eds. Baltimore, USA: Williams & Wilkins, 1996: 496.
3. Mustardé J. The correction of prominent ears using mattress sutures. Br J Plast Surg 1963; 16: 170.

Question 19#

With regards to tracheostomies:

A. A Bjork flap is an inferiorly-based U-shaped flap of anterior tracheal wall

A Bjork flap is an inferiorly-based U-shaped flap of anterior tracheal wall. Entering the trachea above the first cartilaginous ring would lead to vocal cord damage. The rings are below the cricoid cartilage. The parathyroids are not usually seen during the procedure, and there are blood vessels and the isthmus of the thyroid that cross the midline. 

Question 20#

Concerning acute rejection in composite tissue transplantation, which one of the following statements is incorrect?

A. Is primarily T-cell-mediated

Topical immunosuppressives have no role in its treatment. This statement is incorrect. Acute rejection is mediated by T-lymphocytes. There is also a high correlation between the clinical and histopathological findings of acute rejection. Acute rejection in the early stages is characterised by perivascular infiltration of lymphocytes in the upper and mid dermis. Early diagnosis and immunosuppressive adjustment result in high reversibility of acute rejection episodes. Topical drugs (tacrolimus, steroids or both) in combination with systemic immunosuppressives have been used successfully in the treatment of acute rejection in previous composite tissue transplantations.