Question 6#

The following is true about otoplasty:

A. Glue can be used effectively instead of head bandages

Glue can be used effectively instead of head bandages. Glue for postoperative splinting in the context of suture techniques of prominent ear correction was first described in 2008 and can be used instead of head bandages. This removes the need for an office appointment for removal of head bandages, patients can shower after the first postoperative day, and girls in particular can wear their hair long hiding any stigmata of surgery immediately postoperatively. A finer subcuticular skin closure can also be used, and bandages falling off are no longer an issue. An ‘internal corset’ using an anteriorly-based fascial flap can provide further support to the ear in this context ^{1, 2}. Conchal reduction is best undertaken from a posterior approach to hide the scar, although anterior approaches have been described for this purpose and also for harvest of cartilage grafts without undue cosmetic morbidity. Closed scoring techniques such as popularised by Stenstrom are not particularly associated with any increased risk of complications. Many consider suture techniques to have lower complication rates than cartilage scoring techniques in otoplasty. There is no incontrovertible evidence for this and a number of groups have published excellent results with low complications ³. When severe complications occur, they anecdotally seem to be more prevalent in open cartilage scoring techniques, although this is a controversial and unproven statement. Splinting of the ear within weeks of birth can be effective for correction of prominent ears due to some residual plasticity of the ear cartilage. Skin glue can also be used for this task ⁴ as well as a number of proprietary or custom-made appliances. 

References:

1. Shokrollahi K, Cooper MA, Hiew LY. A new strategy for otoplasty. J Plast Reconstr Surg 2009; 62: 774-81. 
2. Shokrollahi K, Tanner B. ‘Glue ear’: beginning of the end for head bandages after prominent ear correction? J Plast Reconstr Aesthet Surg 2008; 61(9): 1077.
3. Caouette-Laberge L, Guay N, Bortoluzzi P, Belleville CB. Otoplasty: anterior scoring technique and results in 500 cases. Plast Reconstr Surg 2000; 105(2): 504-15.
4. Scrimshaw G. The 30-second otoplasty. Ann Plast Surg 1983; 10(1): 86-7.

Question 7#

A frontonasal encephalocele commonly causes: 

A. Hypertelorism

Telecanthus.

Question 8#

Which is false regarding Treacher-Collins syndrome?

A. It is the same as Franceschetti syndrome and mandibulofacial dysostosis

It is equivalent to combined Tessier clefts 7, 8 and 9. C is false. It is actually equivalent to a 6, 7 and 8 cleft. This is an autosomal dominant condition with an abnormality of chromosme 5 first described by Treacher Collins in 1900. Colobomas of the lower eyelid are common, as is cleft palate. Ear abnormalities (microtia) are seen and there is an overbite malocclusion.

Question 9#

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. Multiple Choice Questions in Plastic Surgery 250 section 8 answers_section 8 answers.qxd 26-04-2013 16:50 Page 250
2. Leber D. Ear reconstruction. In: Textbook of plastic, maxillofacial and reconstruction surgery, 2nd ed. Georgiade GS, Georgiade N, Riefkohl R, Levin LS, Eds. Baltimore, USA: Williams & Wilkins, 1992: 497.
3. Mustardé J. The correction of prominent ears using mattress sutures. Br J Plast Surg 1963; 16: 170.
4. Sugino H. Surgical correction of Stahl’s ear using the cartilage turnover and rotating method. Plast Reconstr Surg 1989; 83(1): 160-4.
5. Tanzer R. The constricted (cup and lop) ear. Plast Reconstr Surg 1975; 55(4): 406- 15.

Question 10#

A neonate has C5-6 brachial plexus palsy at birth. Complete recovery of function is most likely in this patient if some activity is demonstrated in the deltoid and biceps muscles by how many months of age? 

A. 3 months

3 months.

References:

1. Clarke HM, Cuttis CG. An approach to obstetrical brachial plexus oinjuries. Hand Clin 1995; 11: 563-81.
2. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995; 11: 583-55.
3. Michelow BJ, Clarke HM, Curtis CG, Zuker RM, Seifu Y, Andrews D, Laurent J. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg 1994; 93(4): 675-81.