Head and Neck Surgery Practice Questions

Q: When forceps are utilized for tooth removal, what is the initial direction of force application?

Apically. ### Explanation **Core Concept: The Mechanics of Tooth Extraction** In oral surgery, the primary objective of using forceps is to expand the bony socket and sever the periodontal ligament (PDL) fibers. The **initial force** applied must always be **apical** (towards the root tip). **Why "Apical" is the Correct Answer:** 1. **Center of Rotation:** By pushing the forceps apically, the center of rotation of the tooth is moved further down the root. This reduces the risk of root fracture by minimizing the arc of movement at the apex. 2. **Wedge Effect:** The beaks of the forceps act as a wedge, expanding the alveolar bone crest and facilitating the subsequent luxation of the tooth. 3. **Grip:** Apical pressure ensures the forceps seat firmly on the root surface rather than the crown, preventing the instrument from slipping. **Analysis of Incorrect Options:** * **A. Occlusally:** This is the final step of extraction (traction). Applying occlusal force prematurely without expanding the socket or severing the PDL will lead to root fracture or failure to remove the tooth. * **B. Buccally & C. Lingually:** These are **luxation forces** used *after* the initial apical pressure. While buccal/lingual movements are essential for expanding the cortical plates, they must follow apical seating to ensure the tooth rotates at the correct axis. **High-Yield Clinical Pearls for NEET-PG:** * **The Wedge Principle:** Forceps beaks should be placed subgingivally to act as wedges against the alveolar bone. * **Primary Force Direction:** For most teeth, the secondary major force is **buccal** (as the buccal plate is thinner), except for **mandibular second and third molars**, where the lingual plate is thinner, requiring stronger lingual pressure. * **Rotational Force:** This is specifically indicated for teeth with single, conical roots (e.g., **Maxillary Central Incisors** and **Mandibular Premolars**).

Q: Warthin's tumor is characterized by which of the following?

A hot pertechnetate scan. **Explanation:** **Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)** is the second most common benign salivary gland tumor, typically occurring in the parotid gland of elderly males with a strong association with smoking. **Why Option C is Correct:** Warthin’s tumor is unique because it is characterized by a **"Hot Spot"** on a **Technetium-99m (Tc-99m) pertechnetate scan**. This occurs because the tumor contains a high density of ductal epithelial cells and oncocytes that lack the ability to secrete the trapped pertechnetate into the ductal system. Consequently, the radionuclide accumulates within the tumor, making it appear "hot" compared to the surrounding normal salivary tissue. (Note: Most other salivary tumors, like Pleomorphic Adenoma, appear as "cold" spots). **Why Other Options are Incorrect:** * **Option A:** Warthin’s tumor is a **benign** neoplasm. It has an extremely low potential for malignant transformation (<1%). * **Option B:** It is typically a **slow-growing**, painless, and cystic mass. Rapid growth is more characteristic of malignant tumors or secondary infections. * **Option D:** As explained above, Warthin’s tumor is the classic exception that presents as a hot scan; a cold scan is typical of almost all other salivary gland pathologies. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Almost exclusively found in the **Parotid gland** (specifically the tail/lower pole). * **Bilateralism:** It is the most common salivary tumor to present **bilaterally** (10-15% of cases) or multicentrically. * **Risk Factor:** Strongest association is with **Smoking**. * **Histology:** Characterized by a double layer of oncocytic epithelium forming papillary projections into cystic spaces, with a dense **lymphoid stroma** (germinal centers). * **Treatment:** Surgical excision (Enucleation or Superficial Parotidectomy).

Q: What is true regarding the sagittal split mandibular operation?

It rarely leads to a non-union of the osteotomy site.. **Explanation:** The **Sagittal Split Ramus Osteotomy (SSRO)** is the most versatile and commonly performed procedure for correcting mandibular deformities (prognathism, retrognathism, and asymmetry). **Why Option D is Correct:** The sagittal split creates a **large surface area of cancellous bone-to-bone contact** between the proximal and distal segments. This extensive contact, combined with modern rigid internal fixation (screws or plates), ensures excellent stability and rapid primary bone healing. Consequently, **non-union is extremely rare** in this procedure. **Why Other Options are Incorrect:** * **Option A:** SSRO is primarily used for horizontal movements (advancement or setback). While it can be used in conjunction with other procedures, it is **not the ideal operation for closing an anterior open bite**; this often requires a Le Fort I osteotomy of the maxilla or a segmental mandibular procedure. * **Option B:** The most common complication of SSRO is **inferior alveolar (dental) nerve injury**. Because the osteotomy cut is made directly through the mandibular canal, even in the most skilled hands, the incidence of temporary or permanent paresthesia is high (up to 85-100% immediately post-op). * **Option C:** For mandibular setback (pushing back), the **Intraoral Vertical Subsigmoid Osteotomy (IVSO)** generally has lower morbidity regarding nerve injury compared to SSRO, as the cut is posterior to the mandibular foramen. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Gold standard for mandibular advancement (retrognathism). * **Nerve at risk:** Inferior Alveolar Nerve (branch of V3). * **Advantage:** No external scars (entirely intraoral) and no need for prolonged intermaxillary fixation (IMF) if rigid fixation is used. * **Complication:** Neurosensory deficit is the most frequent; "Bad Split" (unfavorable fracture) is a known intraoperative risk.

Question 1

Which of the following is FALSE about a thyroglossal fistula?

Accepted Answer

It is a congenital remnant of the thyroglossal tract, typically presenting in the midline of the neck.

Answer

It often presents as a discharging sinus that is prone to recurrent infections.

Answer

Treatment involves the excision of the fistula and the entire thyroglossal tract up to the base of the tongue.

Answer

Surgical excision typically requires the removal of the middle third of the hyoid bone.

Question 2

What is the treatment of choice for bilateral bony tissue undercut?

Accepted Answer

Removal of the bony undercut on both sides

Answer

Removal of the bony undercut on one side only

Answer

No need for removal of the bony undercut

Answer

Any of the above

Question 3

A 65-year-old tobacco chewer presents with sublingual cancer involving the mandible. Commando surgery has been planned. Which of the following structures is NOT removed during a commando operation?

Accepted Answer

Accessory nerve

Answer

Involved mandible

Answer

Oral cancer

Answer

Neck lymph nodes

Question 4

When forceps are utilized for tooth removal, what is the initial direction of force application?

Accepted Answer

Apically

Answer

Occlusally

Answer

Buccally

Answer

Lingually

Question 5

An elderly male presents with a 4x5 cm lump in the right neck. FNAC revealed it to be squamous cell carcinoma. No primary was found, and a diagnosis of unknown primary was made. According to the AJCC system of classification, what would be the TNM staging of the tumor?

Accepted Answer

T0 Nx M0

Answer

T1 N2 M0

Answer

T0 N2a M1

Answer

T1 N2c M0

Question 6

Warthin's tumor is characterized by which of the following?

Accepted Answer

A hot pertechnetate scan

Answer

A malignant neoplasm

Answer

Rapidly growing

Answer

A cold pertechnetate scan

Question 7

Which of the following statements about a thyroglossal cyst is FALSE?

Accepted Answer

The cyst moves upwards on tongue protrusion.

Answer

They often occur in children but may also present in adults.

Answer

They may rarely contain only functioning thyroid tissue.

Answer

Surgical treatment is typically performed using the Sistrunk operation.

Question 8

Carcinoma of the cheek:

Accepted Answer

Has a recognized association with chewing betel nut.

Answer

Characteristically is columnar-celled.

Answer

Has a recognized association with chewing gum.

Answer

Has a recognized association with geographic tongue.

Question 9

Myoplasty and sulcus extension procedures are helpful in:

Accepted Answer

Increasing retention and stability

Answer

Increasing retention

Answer

Increasing stability

Answer

Increasing support

Question 10

What is true regarding the sagittal split mandibular operation?

Accepted Answer

It rarely leads to a non-union of the osteotomy site.

Answer

It is a good operation for closing an anterior open bite.

Answer

It has a very low incidence of inferior dental nerve anesthesia or paresthesia with a skilled operator.

Answer

It has a lower morbidity when used for pushing back a mandible than an intraoral vertical subsigmoid osteotomy.

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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