Mandibular Reconstruction & Osteoradionecrosis

Chapter 26 of Volume 2, Head, Neck & Craniofacial. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

41 viva questions in this chapter

1. Describe what you see.
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2. What do you want from the history?
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3. Examine him.
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4. How would you investigate him?
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5. Stage it for me.
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6. How is this managed, and by whom?
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7. How will you manage the neck?
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8. Rim resection or segmental resection?
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9. What margin are you aiming for?
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10. What are the aims and principles of mandibular reconstruction?
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11. How do you classify the defect?
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12. Which bone flap, and why?
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13. When would you not reconstruct with bone?
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14. Take me through raising an osteocutaneous free fibula.
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15. Why a CT angiogram, rather than just feeling the pulses?
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16. Where do you put the osteotomies?
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17. What about CAD/CAM and virtual surgical planning?
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18. What will you do about the condyle?
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19. How will you resurface both the mucosa and the skin?
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20. How will you manage his airway?
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21. Why not just trache everyone, or ventilate everyone overnight?
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22. Who does need an elective tracheostomy?
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23. Describe how you perform the tracheostomy.
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24. How will you instruct the ward to care for it, and how do you decannulate safely?
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25. What is your postoperative care and monitoring?
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26. How will you manage him?
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27. What is osteoradionecrosis?
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28. How common is it, and what drives the risk?
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29. What is the pathophysiology?
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30. How would you stage it?
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31. When would you operate?
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32. Where does medical therapy fit?
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33. What about hyperbaric oxygen?
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34. What is the relevance of dental extraction?
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35. Investigations exclude recurrence and confirm osteoradionecrosis. Now what?
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36. Six hours post-operatively the nurse says the flap looks dusky. What do you do?
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37. On day ten there is saliva coming through the neck wound. Talk me through it.
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38. At three months the reconstruction plate is exposed through the skin.
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39. A year on he has a nonunion at one osteotomy.
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40. What about the donor leg?
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41. He comes to clinic angry that he still has no teeth. What do you say?
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