Facial Plastic and Reconstructive Surgery
Facial Plastic and Reconstructive Surgery
This domain tests nasal reconstruction, facial trauma assessment, skin cancer margins, and facial nerve preservation. The exam emphasizes function and aesthetics, not just closure.
Core rules
- High-risk basal cell carcinoma on the nose is best managed with Mohs micrographic surgery before reconstruction; the reconstruction ladder runs from secondary intention and primary closure to grafts, local flaps, and free tissue transfer.
- Nasal ala defects need cartilage support when the defect is large; a nasolabial flap is useful for alar reconstruction.
- Orbital blowout fracture is suggested by diplopia, restricted upgaze, enophthalmos, and a positive forced duction test; CT is the imaging study.
- Rhinoplasty assessment includes airway, septal deviation, tip support, and skin thickness; photographs and informed consent document goals.
- Facial nerve function is graded with the House-Brackmann scale and must be documented before and after trauma surgery.
Worked example
A 67-year-old has a 1.5 cm basal cell carcinoma on the nasal ala. Mohs clears the margins, leaving a full-thickness alar defect. Reconstruction uses a nasolabial flap with cartilage support if needed. The reasoning is that margin control comes first and alar shape requires structural support.
Traps
Do not reconstruct before confirming clear margins. Do not ignore facial nerve function in trauma. Do not promise a cosmetic result without documenting preoperative asymmetry. Do not use a single technique for every nasal defect.