Rhinoplasty

Chapter 33 of Volume 4, Breast, Trunk, Lower Limb & Aesthetics. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

49 viva questions in this chapter

1. Describe this photograph.
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2. Take a history from her.
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3. How do you screen for body dysmorphic disorder?
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4. Examine her.
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5. Cottle versus modified Cottle?
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6. Photographs and documentation.
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7. A 16-year-old girl asks for a rhinoplasty. Her mother is with her and says “we just want her to stop being teased.”
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8. How would you counsel and consent her?
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9. Open or closed?
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10. What incisions do you use?
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11. What is preservation rhinoplasty, and how does it differ from structural?
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12. Take me through the operation.
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13. Septoplasty — incision, and how much L-strut?
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14. Where do you get your cartilage, and how do you harvest it?
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15. Take me through a hump reduction.
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16. Component versus en-bloc — what is the difference and why does it matter?
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17. What is an open roof, and how do you deal with it?
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18. Spreader graft — what does it do? And an autospreader?
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19. How do you augment a dorsum?
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20. Would you use silicone?
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21. What types do you use, in what order, and how do you avoid a rocker?
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22. What is a rocker deformity?
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23. What are the tip support mechanisms?
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24. How do you increase tip projection?
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25. How do you rotate the tip?
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26. Columellar strut versus septal extension graft?
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27. What is a lateral crural steal? A tongue-in-groove?
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28. What is a cephalic trim for, and how much do you leave?
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29. How would you treat a boxy tip?
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30. The tripod concept — what does it predict?
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31. Depressor septi nasi — why do you care?
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32. Shield graft — when, and when not?
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33. How do you deal with the airway?
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34. Boundaries of the internal nasal valve, and the normal angle?
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35. External valve collapse — which grafts, and what does each do?
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36. Turbinates — how do you reduce them, and why not resect?
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37. What is empty nose syndrome?
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38. When and how do you reduce the alar base?
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39. How do you approach the deviated nose?
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40. What is your postoperative care?
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41. Bleeding on day two.
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42. Septal haematoma — why does it matter, and how do you manage it?
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43. Septal perforation — causes, symptoms, management?
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44. Inverted-V — what and why?
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45. Pollybeak — the causes, and how do you tell them apart?
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46. Saddle nose — causes, and how would you reconstruct?
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47. Alar retraction, bossae and step deformity?
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48. A patient returns three months after your rhinoplasty and is unhappy.
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49. When would you revise? Would you charge? What is your revision rate?
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