A 30-year-old woman is undergoing examination 6 months after sustaining peri-orbital lacerations in a motor vehicle collision. She has 3.5mm of ptosis, and her levator function is greater than 10mm. Which of the following is the most appropriate management?
Repositioning/repair of the levator aponeurosis. Levator procedures require reasonable contractility of the levator muscle with fair to good levator function (>5mm) to elevate the lid. Dehiscence of the levator aponeurosis causes the most common type of ptosis. It is almost always an acquired condition, and its repair the commonest levator procedure undertaken. The indication is for circumstances where the aponeurosis has stretched (age-related) or has dehisced from the tarsal plate (trauma).
References:
The projection of a normal ear (rim-mastoid distance) is:
Based on current knowledge which of the following is a better estimate of the risk of acute rejection of the facial flap in facial transplantation?
10-70%. Based on extrapolations from clinical hand transplantations and also solid organ transplantation, the risk of acute rejection in facial transplantation is estimated to be between 10-70%. Almost all of these rejection episodes have been reversible, due to early diagnosis with visual inspection and adjustment in the maintenance immunosuppressive regimen and topical therapy.
Regarding MRI in the investigation of head and neck cancer:
Is capable of identifying all enlarged nodes greater than 4-5mm in diameter.
Regarding reconstruction/excision of tumours of the oral cavity:
Soutar described the use of the radial forearm flap in oral cavity reconstruction. An approximate 10cm section of radius can also be taken, but it is advised that this is taken in a scaphoid shape and the radius plated to avoid fracture. Mandibular osteotomy should be undertaken more mesially to avoid alveolar nerve damage.
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