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Continuing medical education examination—surgical management of the boxy tip
PRACTICE FORUM
Continuing Medical Education Examination— Surgical Management of the Boxy Tip Instructions for Category 1 CME Credit ASAPS CME Program No. ASJ-CME-FAS-26. The American Society for Aesthetic Plastic Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society for Aesthetic Plastic Surgery designates this educational activity for a maximum of 1 AMA PRA Category 1 credit™ for correctly answering 14 questions to earn a minimum score of 70%. Each physician should claim credit commensurate with the extent of his/her participation in the activity. ASAPS members, candidates, and residents at approved plastic surgery programs may take the examination online in the Clinical Education area of the ASAPS Members-Only Website (www.surgery.org/members). If taking the print version, please return the examination (photocopy or tear out) with your full name and address, your ASAPS or ASPS identification number, and a selfaddressed, stamped envelope to the following address: ASJ CME c/o ASAPS Central Office 11081 Winners Circle Los Alamitos, CA 90720-2813 Completed forms can be faxed to ASJ/CME at 562-799-1098. Please include your name, address, and ID number. If you are not a member of either ASAPS or ASPS, please note this on your examination. The deadline for receipt of examinations for Category 1 CME credit based on this activity is June 15, 2010.
Multiple Choice 1.
In patients with a boxy nasal tip who are undergoing rhinoplasty, the boxy tip is a feature that patients: A. Hardly ever want to change B. Seldom ever want to change C. Usually want to change D. Almost always want to change
2.
Once patient and surgeon agree on appropriate and realistic rhinoplasty goals: A. A significant other should be consulted B. Photos should be taken C. A “real time” diagrammatic plan should be drawn D. Both B and C
3.
In performing an endonasal approach to the boxy nasal tip: A. Intracartilaginous incisions are best B. Eversion of the lower lateral cartilages (LLC) is best C. Delivery of the LLC is best D. None of the above
4.
To achieve the best results in performing endonasal rhinoplasty in the boxy nasal tip: A. Maximal excision of the LLC is essential B. Minimal excision of the LLC and suture reformation is best C. No removal of the LLC is necessary D. None of the above
5.
The final vertical height of the LLC after excision should never be less than: A. 4 mm B. 6 mm C. 8 mm D. 10 mm
6.
Excessive excision of the LLC during rhinoplasty has been responsible for: A. Alar collapse B. Loss of tip support C. Alar margin elevation D. All of the above
Aesthetic
Surgery
Journal
~
May/June
2007
319
PRACTICE FORUM
7.
8.
9.
When using permanent sutures in nasal tip surgery it is important to: A. Use the thinnest possible suture B. Use only clear sutures C. Avoid contact with teeth and oral structures D. Leave a 1- to 2-mm tail at the knot Separation of the mucosa from the undersurface of the domes is performed to: A. Allow for better dome contour B. Prevent the suture material from presenting intranasally C. Allow for easier passage of the suture needle D. Better visualize the exact dome position The first throw of the dome-binding mattress suture is a surgical twist because: A. It allows for the use of fewer knots B. It allows for the LLC to be placed into their anatomic positions so you can view the tip appearance C. It prevents later loosening of the knot D. None of the above
10. If, at the conclusion of the procedure, the nasal tip is slightly dependent, the most efficient way to elevate the tip without grafts is to: A. Excise more cephalic margin of the LLC B. Tape the tip upward in the splint C. Excise a “base up” anterior triangle from the caudal margin D. Remove an additional segment of the septal angle
True or False 11. If a deep alar crease is noted before surgery, alar batten grafts are usually considered at the conclusion of the procedure. True___ False___ 12. Columellar struts can be placed accurately only via an external rhinoplasty procedure. True___ False___
13. Skin thickness is rarely a factor in the long term result of rhinoplasty. True___ False___ 14. In most patients the boxy tip is such a dominant feature of an unattractive nose that other facial features are minor considerations in determining the correct amount of nasal reduction to perform. True___ False___ 15. When resecting the cephalic margin of the LLC the mucous lining must be removed to achieve the desired effect in nasal tip contouring. True___ False___ 16. In the boxy tip, heavy, dense LLC may require more resection than fragile, thin LLC. True___ False___ 17. In the boxy tip, using a suture between the domes may be as effective as using a mattress suture through the domes. True___ False___ 18. The dome mattress suture (dome-binding suture), when used alone in reforming the boxy nasal tip, is never sufficient to support the tip without additional grafts. True___ False___ 19. If, at the end of the procedure, it is determined that a columellar strut is necessary, a pocket is made in the space between the feet of the LLCs so that the strut will abut against the maxillary spine, providing satisfactory support. True___ False___ 20. In the boxy nasal tip, the initial excision should include the dome area as well as the lateral portion of the LLC. True___ False___
Evaluation 1.
Overall, did the activity provide an adequate overview of the subject matter? ____ Yes
2.
Was the subject matter of the activity: ____ Too basic
320
____No
Aesthetic
____Too advanced
Surgery
Journal
~
____ Just right
May/June
2007
Volume 27, Number 3
PRACTICE FORUM
3.
Do you feel that the length of the activity was: ____ Too short
4.
____Too long
____ Just right
This activity increased my awareness and understanding of the surgical procedures described in the article. ____ Strongly agree
____ Agree
____ Neutral
____ Disagree
____ Strongly disagree
5.
Did any commercial bias negatively impact this educational activity? ____________ If yes, which product? __________________
6.
I would again participate in an Aesthetic Surgery Journal CME activity. ____ Yes
7.
Would you recommend an Aesthetic Surgery Journal CME activity to a colleague? ____Yes
8.
____ No ____ No
What other topics (including instructor names, if possible) would you like covered in future issues of Aesthetic Surgery Journal? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Name: __________________________________________________________
Address: ________________________________________________________
City/State/Zip: ___________________________________________________
ASAPS/ASPS ID No.: ____________ Check if not a member of ASAPS or ASPS ____ Copyright © 2007 by The American Society for Aesthetic Plastic Surgery, Inc. 1090-820X/$32.00 doi:10.1016/j.asj.2007.04.009
Surgical Management of the Boxy Tip
Aesthetic
Surgery
Journal
~
May/June
2007
321
Continuing Medical Education Examination— Surgical Management of the Boxy Tip Instructions for Category 1 CME Credit ASAPS CME Program No. ASJ-CME-FAS-26. The American Society for Aesthetic Plastic Surgery is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society for Aesthetic Plastic Surgery designates this educational activity for a maximum of 1 AMA PRA Category 1 credit™ for correctly answering 14 questions to earn a minimum score of 70%. Each physician should claim credit commensurate with the extent of his/her participation in the activity. ASAPS members, candidates, and residents at approved plastic surgery programs may take the examination online in the Clinical Education area of the ASAPS Members-Only Website (www.surgery.org/members). If taking the print version, please return the examination (photocopy or tear out) with your full name and address, your ASAPS or ASPS identification number, and a selfaddressed, stamped envelope to the following address: ASJ CME c/o ASAPS Central Office 11081 Winners Circle Los Alamitos, CA 90720-2813 Completed forms can be faxed to ASJ/CME at 562-799-1098. Please include your name, address, and ID number. If you are not a member of either ASAPS or ASPS, please note this on your examination. The deadline for receipt of examinations for Category 1 CME credit based on this activity is June 15, 2010.
Multiple Choice 1.
In patients with a boxy nasal tip who are undergoing rhinoplasty, the boxy tip is a feature that patients: A. Hardly ever want to change B. Seldom ever want to change C. Usually want to change D. Almost always want to change
2.
Once patient and surgeon agree on appropriate and realistic rhinoplasty goals: A. A significant other should be consulted B. Photos should be taken C. A “real time” diagrammatic plan should be drawn D. Both B and C
3.
In performing an endonasal approach to the boxy nasal tip: A. Intracartilaginous incisions are best B. Eversion of the lower lateral cartilages (LLC) is best C. Delivery of the LLC is best D. None of the above
4.
To achieve the best results in performing endonasal rhinoplasty in the boxy nasal tip: A. Maximal excision of the LLC is essential B. Minimal excision of the LLC and suture reformation is best C. No removal of the LLC is necessary D. None of the above
5.
The final vertical height of the LLC after excision should never be less than: A. 4 mm B. 6 mm C. 8 mm D. 10 mm
6.
Excessive excision of the LLC during rhinoplasty has been responsible for: A. Alar collapse B. Loss of tip support C. Alar margin elevation D. All of the above
Aesthetic
Surgery
Journal
~
May/June
2007
319
PRACTICE FORUM
7.
8.
9.
When using permanent sutures in nasal tip surgery it is important to: A. Use the thinnest possible suture B. Use only clear sutures C. Avoid contact with teeth and oral structures D. Leave a 1- to 2-mm tail at the knot Separation of the mucosa from the undersurface of the domes is performed to: A. Allow for better dome contour B. Prevent the suture material from presenting intranasally C. Allow for easier passage of the suture needle D. Better visualize the exact dome position The first throw of the dome-binding mattress suture is a surgical twist because: A. It allows for the use of fewer knots B. It allows for the LLC to be placed into their anatomic positions so you can view the tip appearance C. It prevents later loosening of the knot D. None of the above
10. If, at the conclusion of the procedure, the nasal tip is slightly dependent, the most efficient way to elevate the tip without grafts is to: A. Excise more cephalic margin of the LLC B. Tape the tip upward in the splint C. Excise a “base up” anterior triangle from the caudal margin D. Remove an additional segment of the septal angle
True or False 11. If a deep alar crease is noted before surgery, alar batten grafts are usually considered at the conclusion of the procedure. True___ False___ 12. Columellar struts can be placed accurately only via an external rhinoplasty procedure. True___ False___
13. Skin thickness is rarely a factor in the long term result of rhinoplasty. True___ False___ 14. In most patients the boxy tip is such a dominant feature of an unattractive nose that other facial features are minor considerations in determining the correct amount of nasal reduction to perform. True___ False___ 15. When resecting the cephalic margin of the LLC the mucous lining must be removed to achieve the desired effect in nasal tip contouring. True___ False___ 16. In the boxy tip, heavy, dense LLC may require more resection than fragile, thin LLC. True___ False___ 17. In the boxy tip, using a suture between the domes may be as effective as using a mattress suture through the domes. True___ False___ 18. The dome mattress suture (dome-binding suture), when used alone in reforming the boxy nasal tip, is never sufficient to support the tip without additional grafts. True___ False___ 19. If, at the end of the procedure, it is determined that a columellar strut is necessary, a pocket is made in the space between the feet of the LLCs so that the strut will abut against the maxillary spine, providing satisfactory support. True___ False___ 20. In the boxy nasal tip, the initial excision should include the dome area as well as the lateral portion of the LLC. True___ False___
Evaluation 1.
Overall, did the activity provide an adequate overview of the subject matter? ____ Yes
2.
Was the subject matter of the activity: ____ Too basic
320
____No
Aesthetic
____Too advanced
Surgery
Journal
~
____ Just right
May/June
2007
Volume 27, Number 3
PRACTICE FORUM
3.
Do you feel that the length of the activity was: ____ Too short
4.
____Too long
____ Just right
This activity increased my awareness and understanding of the surgical procedures described in the article. ____ Strongly agree
____ Agree
____ Neutral
____ Disagree
____ Strongly disagree
5.
Did any commercial bias negatively impact this educational activity? ____________ If yes, which product? __________________
6.
I would again participate in an Aesthetic Surgery Journal CME activity. ____ Yes
7.
Would you recommend an Aesthetic Surgery Journal CME activity to a colleague? ____Yes
8.
____ No ____ No
What other topics (including instructor names, if possible) would you like covered in future issues of Aesthetic Surgery Journal? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Name: __________________________________________________________
Address: ________________________________________________________
City/State/Zip: ___________________________________________________
ASAPS/ASPS ID No.: ____________ Check if not a member of ASAPS or ASPS ____ Copyright © 2007 by The American Society for Aesthetic Plastic Surgery, Inc. 1090-820X/$32.00 doi:10.1016/j.asj.2007.04.009
Surgical Management of the Boxy Tip
Aesthetic
Surgery
Journal
~
May/June
2007
321