Head and Neck Surgery Practice Questions

Q: Which of the following is true of a carotid body tumor?

All of the above.. A **Carotid Body Tumor (CBT)**, also known as a **Chemodectoma**, is a rare neoplasm arising from the chemoreceptor cells located at the bifurcation of the common carotid artery. ### **Detailed Explanation** * **Option A (Non-chromaffin paraganglioma):** Carotid bodies are derived from the neural crest. Unlike the adrenal medulla, these cells do not stain with chromium salts (non-chromaffin) and do not typically secrete catecholamines. They function as chemoreceptors sensitive to changes in arterial pH, $pCO_2$, and $pO_2$. * **Option B (Good Prognosis):** Most CBTs are slow-growing, painless, and benign. With modern surgical techniques and preoperative embolization, the prognosis is excellent, although there is a risk of cranial nerve injury (CN IX, X, XI, XII) during excision. * **Option C (Rarely metastasizes):** Only about 5–10% of carotid body tumors are malignant. Malignancy is defined by **clinically documented metastasis** to regional lymph nodes or distant organs (lungs/bones), rather than histological appearance. Since all three statements are accurate descriptions of the pathology, **Option D** is the correct answer. ### **High-Yield Clinical Pearls for NEET-PG** * **Fontaine’s Sign:** The tumor is vertically fixed but **horizontally mobile** (due to its location within the carotid sheath). * **Lyre’s Sign:** On angiography, there is a characteristic splaying/widening of the carotid bifurcation. * **Shamblin Classification:** Used to grade the tumor based on its involvement/encasement of the carotid vessels. * **Genetics:** Approximately 10–35% are familial (often autosomal dominant); these are more likely to be bilateral and are associated with **SDHD gene** mutations. * **Treatment of Choice:** Surgical excision, often preceded by preoperative embolization to reduce vascularity.

Q: What is true regarding a ranula?

It is a cystic swelling in the floor of the mouth.. A **ranula** is a clinical term for a translucent, bluish, cystic swelling found in the **floor of the mouth**. It typically arises from the **sublingual salivary gland** due to trauma or obstruction of the ducts (Ducts of Rivinus). ### Why Option B is Correct: The term "ranula" is derived from the Latin word *rana* (frog), as the swelling resembles the translucent underbelly of a frog. It is classically located lateral to the midline in the floor of the mouth, superior to the mylohyoid muscle. ### Why Other Options are Incorrect: * **Option A:** An **epulis** is a non-specific clinical term for any tumor-like swelling or lump on the **gingiva** (gums), not the floor of the mouth. * **Option C:** A **thyroglossal cyst** is a midline neck swelling that moves with protrusion of the tongue and deglutition; it is an embryological remnant of the thyroglossal duct. * **Option D:** While some ranulas are retention cysts, the majority (especially large ones) are **extravasation pseudocysts**. They lack an epithelial lining and are formed by mucus leaking into the surrounding submucosal tissues. Therefore, calling it a "mucus retention cyst" is technically inaccurate in most clinical cases. ### High-Yield Clinical Pearls for NEET-PG: * **Plunging Ranula:** Occurs when mucus extravasates through or around the **mylohyoid muscle**, presenting as a swelling in the submandibular region (neck). * **Management:** The treatment of choice is **Marsupialization** for simple ranulas, though the definitive treatment to prevent recurrence is the **excision of the sublingual gland**. * **Appearance:** It is typically painless, fluctuant, and transilluminant.

Q: Which of the following statements regarding thyroglossal cysts is not true?

Rarely can contain foci of follicular carcinoma. ### Explanation **1. Why Option C is the Correct (False) Statement:** While malignancy in a thyroglossal cyst is rare (occurring in 80%), not follicular carcinoma. Follicular carcinoma is exceptionally rare in this location because the embryonic thyroid primordium lacks the environment typically required for follicular neoplastic transformation. **2. Analysis of Other Options:** * **Option A (True):** The hyoid bone is the most common site. Approximately 80% of cysts are found in juxtaposition to the hyoid (subhyoid being the most frequent, followed by suprahyoid and prehyoid). * **Option B (True):** Heterotopic thyroid tissue (normal thyroid follicles) is found in the wall of the cyst in about 20% of cases. This is a remnant of the descent of the thyroid gland from the foramen caecum. * **Option D (True):** The **Sistrunk Operation** is the gold standard treatment. It involves the excision of the cyst, the entire tract, and the **central portion of the hyoid bone** up to the foramen caecum to minimize the risk of recurrence (recurrence rate drops from ~50% to <5%). **Clinical Pearls for NEET-PG:** * **Embryology:** Arises from a persistent thyroglossal duct (remnant of the descent of the thyroid diverticulum). * **Clinical Sign:** It is a midline swelling that **moves upwards on protrusion of the tongue** (due to its attachment to the hyoid bone and foramen caecum). * **Differential Diagnosis:** Sublingual dermoid (does not move with tongue protrusion) and ectopic thyroid (ensure a normal thyroid gland is present before excision). * **Investigation of Choice:** Ultrasound is the initial investigation to confirm the cyst and verify the presence of a normal thyroid gland in the neck.

Q: Weber Ferguson incision is used for the surgical management of which cancer?

Hard palate cancer. **Explanation:** The **Weber-Ferguson incision** is the standard surgical approach used for **Maxillectomy**. It provides excellent exposure to the midface, including the maxilla, paranasal sinuses, and the **hard palate**. **Why the Correct Answer is Right:** Cancer of the hard palate often requires a partial or total maxillectomy to achieve clear oncological margins. The Weber-Ferguson incision involves an infraorbital component and a midline lip-split (cheilotomy), allowing the surgeon to reflect a large cheek flap. This provides the necessary visualization to resect the bony structures of the upper jaw and palate. **Why the Incorrect Options are Wrong:** * **Breast cancer:** Surgical management typically involves a periareolar, elliptical (Stewart), or transverse (Orr) incision for mastectomy. * **Thyroid cancer:** The standard approach is the **Kocher’s transverse collar incision**, made approximately 2 cm above the sternal notch. * **Cancer of the penis:** Surgical management (Partial or Total Penectomy) involves circular or elliptical incisions around the base of the shaft or the lesion; it does not involve facial incisions. **High-Yield Clinical Pearls for NEET-PG:** * **Dieffenbach Extension:** An extension of the Weber-Ferguson incision towards the temple to provide better access to the zygomatic bone. * **Lynch Extension:** An extension towards the medial canthus/bridge of the nose for access to the ethmoid sinuses. * **Complication:** A common post-operative concern with this incision is ectropion (eversion of the lower eyelid) or persistent facial edema. * **Alternative:** For smaller palatal lesions, an intra-oral approach may be used, but for malignant tumors, Weber-Ferguson remains the gold standard for exposure.

Question 1

A 25-year-old male patient presents with a bony expansile swelling of the right body of the mandible and mild paresthesia of the right inferior alveolar nerve. An OPG shows a multilocular radiolucency without root resorption. What is the management of an odontogenic keratocyst?

Accepted Answer

Enucleation with peripheral ostectomy

Answer

Marsupialization

Answer

Enucleation

Answer

Resection and radiation

Question 2

During the surgical removal of a torus palatinus, a portion of the palatal bone was fractured. What would you expect to occur?

Accepted Answer

An opening into the nasal cavity

Answer

An opening into the maxillary antrum

Answer

A vertical fracture of the maxilla

Answer

A horizontal fracture of the maxilla

Question 3

Which of the following is true of a carotid body tumor?

Accepted Answer

All of the above.

Answer

It is a non-chromaffin paraganglioma.

Answer

It has a good prognosis.

Answer

It rarely metastasizes.

Question 4

A 80-year-old edentulous patient presents with a midline tumor of the lower jaw, involving the alveolar margin. What is the treatment of choice?

Accepted Answer

Segmental mandibulectomy

Answer

Hemi-mandibulectomy

Answer

Commando operation

Answer

Marginal mandibulectomy

Question 5

Rubber band extraction is indicated in a haemophiliac patient as it facilitates the extraction by:

Accepted Answer

Necrosis of the periodontal ligament (PDL)

Answer

Traction force on the periodontal ligament (PDL)

Answer

Necrosis of the alveolar bone

Answer

Pulling of the periodontal ligament (PDL)

Question 6

What is the most commonly used flap in head and neck surgery?

Accepted Answer

Pectoralis major flap

Answer

Deltopectoral flap

Answer

Latissimus dorsi flap

Answer

Temporalis flap

Question 7

What is true regarding a ranula?

Accepted Answer

It is a cystic swelling in the floor of the mouth.

Answer

It is also called an epulis.

Answer

It is a type of thyroglossal cyst.

Answer

It is a type of mucus retention cyst.

Question 8

In a fracture of the zygomaticomaxillary arch, what is the most definite check point for zygomatic arch reduction?

Accepted Answer

Click on reduction

Answer

Inferior orbital rim symmetry between the two sides

Answer

Zygomatic buttress symmetry between the two sides

Answer

Zygomatic arch symmetry between the two sides

Question 9

Which of the following statements regarding thyroglossal cysts is not true?

Accepted Answer

Rarely can contain foci of follicular carcinoma

Answer

80% are found in juxtaposition to the hyoid bone

Answer

Heterotopic thyroid tissue is present in 20% of cases

Answer

The treatment of choice is Sistrunk operation

Question 10

Weber Ferguson incision is used for the surgical management of which cancer?

Accepted Answer

Hard palate cancer

Answer

Breast cancer

Answer

Thyroid cancer

Answer

Cancer of the penis

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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