P1: PJL 0521618134c01 CB1006/Lane 0 521 61813 4 November 26, 2005 21:56 Physical Examination 7 Anterior and medial legs L2–4 Foot L4, L5, S1 Medial great toe L5 Posterior and lateral legs L5, S1, S2 Lateral foot and small toe S1 Perineum S2–4 Anterior and superior helix Auriculotemporal nerve Tragus Auriculotemporal nerve Occipital scalp Greater occipital nerve Posterior superior helix Lesser occipital nerve Posterior inferior helix Greater auricular nerve Posterior earlobe Greater auricular nerve Neurology Function C5 abduct arm C6–8 adduct arm C5,6 flex elbow C7,8 extend elbow; flex/extend fingers C6 pronate/supinate C6,7 flex/extend wrist T1 abduct/adduct fingers L1–3 flex, adduct, medially rotate hip L3,4 extend knee L4,5 dorsiflex, invert ankle L5, S1 evert ankle S1 plantar flex P1: PJL 0521618134c01 CB1006/Lane 0 521 61813 4 November 26, 2005 21:56 8 Pocket Guide for Cutaneous Medicine and Surgery Oculomotor exam SR SR LR MR LR IR IR SO R eye L eye SO IO IO CN III Superior division SR superior rectus LA levator palpebrae superioris Inferior division MR medial rectus IO inferior oblique IR inferior rectus CN IV SO superior oblique CN VI LR lateral rectus P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 Anatomy 9 P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 10 P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 Anatomy – Trigeminal Nerve (CN V) – Facial Sensory Ophthalmic nerve (CN V1) Lacrimal lateral upper eyelid, conjunctiva Frontalis Supraorbital anterior scalp, forehead, upper eyelids (pierces frontalis to reach skin) Supratrochlear medial upper eyelid, medial forehead, anterior scalp, nasal root, nasal bridge, upper nasal sidewalls (pierces corrugator to reach skin) Nasociliary Infratrochlear medial upper eyelid, nasal root, medial canthus, nasal bridge, upper nasal sidewalls Anterior ethmoidal External nasal branch of anterior ethmoidal supplies nasal dorsum, supratip, tip, columella Posterior ethmoidal Maxillary nerve (CN V2) Infraorbital lower eyelid, nasal sidewall, nasal alae, upper lip, medial cheek, columella, anterior nasal mucous membrane (below infraorbital rim) Zygomaticofacial malar eminence Zygomaticotemporal preauricular cheek, anterior temple/scalp 11 P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 12 Pocket Guide for Cutaneous Medicine and Surgery Mandibular nerve (CN V3) Auriculotemporal anterior/superior ear (helix, tragus, temple, anterior half of external canal, tympanic membrane), temporoparietal scalp Buccal buccal mucosa/gingivum, cheek P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 Anatomy 13 Inferior alveolar Mental chin, lower lip, lower lip mucosa, nearby gingiva (exits mental foramen ∼2.5 cm lateral to midline and inferior to 2nd premolar) P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 14 Pocket Guide for Cutaneous Medicine and Surgery Anatomy – Facial Nerve (CN VII) – Facial Motor Temporal Innervates: frontalis, orbicularis oculi (with zygomatic branch), corrugator supercilii, temperoparietalis Severed: ipsilateral brow ptosis and forehead paresis Danger: as crosses mid-zygoma lateral to eyebrow Zygomatic Innervates: orbicularis oculi, procerus, nasalis, few mouth elevators Severed: inability to close eyelids Danger: buccal fat pad covered by SMAS and risorius Buccal Innervates: depressor septi; nasalis levator superioris alaeque nasi, levator labii superioris; buccinator, risorius, mouth elevators, zygomaticus major and minor; orbicularis oris, levator angulis oris Severed: food remains in cheek Danger: buccal fat pad Mandibular Innervates: risorius; orbicularis oris; depressor anguli oris; depressor labiii oris, levator anguli oris Severed: drooping of ipsilateral lip and drooling Danger: mandibular angle P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 Anatomy 15 Cervical Innervates: platysma and superior neck muscles Severed: decreased retraction of lower lip inferolaterally CN VII: r innervates all muscles of facial expression r enters skull via stylomastoid foramen r enters/traverses parotid gland P1: JPJ 0521618134c02 CB1006/Lane 0 521 61813 4 November 26, 2005 22:21 16 Pocket Guide for Cutaneous Medicine and Surgery Anatomy – Arteries of the Face External carotid artery (supplies majority of face and scalp) Facial artery (chief artery of the face) Angular (supplies eyelids; joins ophthalmic artery) Lateral nasal Superior labial Inferior labial Superficial temporal artery Frontal branch Parietal branch Zygomaticotemporal Middle temporal Transverse facial (anastomosis with branches of facial artery) Occipital artery Posterior auricular artery Internal maxillary artery Infraorbital Buccal Mental Internal carotid artery Ophthalmic artery Supraorbital artery Supratrochlear artery Infratrochlear artery Dorsal nasal artery [...]... 26 , 20 05 22 :21 Pocket Guide for Cutaneous Medicine and Surgery P1: JPJ 0 521 618134c 02 CB1006/Lane Anatomy 0 521 61813 4 November 26 , 20 05 22 :21 23 P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 24 November 26 , 20 05 22 :21 P1: JZZ 0 521 618134c03 CB1006/Lane 0 521 61813 4 November 28 , 20 05 Dermatologic Surgery 25 14 :2 P1: JZZ 0 521 618134c03 CB1006/Lane 0 521 61813 4 26 November 28 , 20 05 14 :2 P1: JZZ 0 521 618134c03... mm 13 mm 16 mm 19 mm 24 mm 9 mm 13 mm 15 mm 19 mm 24 mm PC-13 PC-10* PC-11* PC- 12 P-10 P-13 P-11 P- 12* P-14 P -2 1 P -2 2 P -2 4 C-13** C-14 P-1 PC-1* PC-3* PC-5 P-1 P-3 PS-3 PS -2 * PS-1 P -2 * ** PS-5 PS-4 FS -2 * * FS-1 3 /8 1 /2 RC2 1 2 1 /2 CC = conventional cutting needle ( ) RC = reverse cutting needle ( ) ∗ Representative facial cosmetic needles Representative biopsy needle ∗∗∗ Useful for vessel ligature...P1: JPJ 0 521 618134c 02 CB1006/Lane Anatomy 0 521 61813 4 November 26 , 20 05 22 :21 17 P1: JPJ 0 521 618134c 02 18 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 Pocket Guide for Cutaneous Medicine and Surgery Anatomic Triangles of the Head and Neck Anterior cervical triangle Boundaries: anterior median line of neck inferior border of mandible anterior border of sternocleidomastoid... Polyhexafluoropropylene-VDF (Pronova: Ethicon) Weitzul S, Taylor RS Suturing technique and other closure materials In: Robinson JK, Hanke CW, Sengelmann RD, Siegel DM., eds Surgery of the Skin Philadelphia, Elsevier 20 05: pp 22 7 23 0 27 P1: JZZ 0 521 618134c03 CB1006/Lane 28 0 521 61813 4 November 28 , 20 05 14 :2 Pocket Guide for Cutaneous Medicine and Surgery Needles Needle CC 1 RC2 Curvature Length Syneture... 32 CB1006/Lane 0 521 61813 4 November 28 , 20 05 14 :2 Pocket Guide for Cutaneous Medicine and Surgery Limitations: limited fluid handling capacity Products: Duoderm, NuDerm, Comfeel Foam Description: r porous, single/multiple layered dressings r high fluid handling capacity (less maceration) r insulating and permeable to moisture vapor and gases r non-adherent; non-particulate; non-toxic r highly conformable... RD, Siegel DM., eds Surgery of the Skin Philadelphia: Elsevier 20 05: p 1 82 P1: JZZ 0 521 618134c03 CB1006/Lane 30 0 521 61813 4 November 28 , 20 05 14 :2 Pocket Guide for Cutaneous Medicine and Surgery Antiseptic Cleansers Chlorhexidine (HibiclensTM ) r r r r r r disrupts cell membranes excellent gram-positive and good gram-negative coverage intermediate onset (∼1 min scrub) ototoxicity and keratitis residual... artery in apex and accessory nerve Supraclavicular (subclavian) triangle: external jugular vein and suprascapular artery located superficially, subclavian artery located deep Moore KL Clinically oriented anatomy, 3rd ed 19 92, Williams and Wilkins, Philadelphia, pp 783–8 52 P1: JPJ 0 521 618134c 02 CB1006/Lane Anatomy 0 521 61813 4 November 26 , 20 05 22 :21 21 P1: JPJ 0 521 618134c 02 22 CB1006/Lane 0 521 61813 4... sternocleidomastoid and median plane of neck r contains infrahyoid muscles, thyroid, parathyroid r contains submental lymph nodes, anterior jugular vein P1: JPJ 0 521 618134c 02 20 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 Pocket Guide for Cutaneous Medicine and Surgery Posterior cervical triangle Boundaries: posterior border of sternocleidomastoid anterior border of trapezius middle 1/ of clavicle 3 Veins:... (periorbital) ∗∗ Weitzul S, Taylor RS Suturing technique and other closure materials In: Robinson JK, Hanke CW, Sengelmann RD, Siegel DM., eds Surgery of the Skin Philadelphia: Elsevier 20 05: pp 23 0 23 2 P1: JZZ 0 521 618134c03 CB1006/Lane 0 521 61813 4 November 28 , 20 05 14 :2 Dermatologic Surgery 29 Electrosurgery Electrocautery Not true electrosurgery Heated filament transfers heat No electric current... bone and laterally by anterior bellies of digastric muscles r contains submental lymph nodes and anterior jugular vein Submandibular: r lies between inferior mandible and anterior/posterior portions of digastric muscle r contains submandibular glands, submandibular lymph nodes, hypoglossal nerve (CN XII), parts of facial artery/vein P1: JPJ 0 521 618134c 02 CB1006/Lane Anatomy 0 521 61813 4 November 26 , 20 05 . November 26 , 20 05 22 :21 22 Pocket Guide for Cutaneous Medicine and Surgery P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 Anatomy 23 P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 . JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 Anatomy 17 P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 18 Pocket Guide for Cutaneous Medicine and Surgery Anatomic. JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 Anatomy 9 P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813 4 November 26 , 20 05 22 :21 10 P1: JPJ 0 521 618134c 02 CB1006/Lane 0 521 61813