Head and Neck Surgery Practice Questions

Q: Pleomorphic adenomas arising from the minor salivary glands can be treated with

Local excision with 5mm margin. ***Local excision with 5mm margin*** - **Pleomorphic adenomas** are **benign tumors**, but they have a tendency for recurrence if not adequately excised due to their irregular, often lobulated shape and microscopic extensions. - A **5mm margin** is generally recommended for complete removal and to minimize the risk of recurrence, especially for tumors arising from minor salivary glands. *Chemotherapy* - **Chemotherapy** is generally reserved for **malignant tumors** and systemic diseases, not for benign lesions like pleomorphic adenomas. - It carries significant side effects and is unnecessary for a localized, benign tumor that can be surgically removed. *Local excision with 2mm margin* - While local excision is the correct approach, a **2mm margin** may be insufficient for pleomorphic adenomas. - Such a small margin increases the risk of leaving behind microscopic tumor extensions, leading to a higher chance of **local recurrence**. *Radiotherapy* - **Radiotherapy** is primarily used for **malignant tumors** or in cases where surgery is not an option, or as an adjuvant therapy. - It is not the standard primary treatment for **benign pleomorphic adenomas** due to potential side effects and the efficacy of surgical excision.

Q: What does a Commando operation describe?

Mandibulectomy, Neck dissection, Oropharyngeal resection. ***Mandibulectomy, Neck dissection, Oropharyngeal resection*** - A **Commando operation** explicitly refers to the en bloc resection of a segment of the mandible, a portion of the oropharynx, and a neck dissection. - This extensive surgical procedure is typically performed for advanced **head and neck cancers** involving the retromolar trigone or anterior tonsillar pillar, with potential mandibular and cervical nodal involvement. *Mandibulectomy, Neck Dissection, Omohyoid muscle removal* - While a **mandibulectomy** and **neck dissection** are components, the explicit inclusion of **omohyoid muscle removal** as a defining feature of a Commando operation is not standard. - The Commando operation focuses on primary tumor resection (oropharynx) with associated bony (mandible) and lymphatic (neck) involvement. *Maxillectomy, Neck Dissection, Omohyoid muscle removal* - A **maxillectomy** (excision of the maxilla) is not a part of the standard Commando operation, which specifically involves the **mandible** and **oropharynx**. - As mentioned, the explicit inclusion of **omohyoid muscle removal** is not a defining characteristic of this specific operation. *Combined maxillectomy and mandibulectomy* - This describes a **pan-facial resection**, which is a far more extensive procedure than a Commando operation. - While both maxillectomy and mandibulectomy involve bone removal, a **Commando operation** specifically includes **neck dissection** and **oropharyngeal resection** rather than just combined bone resections.

Q: In periodontal surgical treatment, which of the following surgical procedures are typically carried out first:

Flap surgery. ***Flap surgery*** - **Flap surgery**, also known as **open flap debridement**, is a foundational procedure in periodontal treatment to gain access to the **root surfaces** and **bone defects**. - It involves lifting the **gingival tissue** to thoroughly clean and debride the affected areas, and is often the initial surgical approach once **non-surgical therapies** have been exhausted. *Gingivectomy* - **Gingivectomy** is primarily used for the removal of **excess gingival tissue** (gingival enlargement) or for **cosmetic recontouring**. - It is typically performed when there is no **osseous defect** or when access to the bone is not required, making it less suitable as the initial general surgical step for deeper periodontal disease. *Osseous recontouring* - **Osseous recontouring** (osteoplasty/ostectomy) involves reshaping or removing **bone defects** and is usually performed *after* **flap elevation** to correct underlying bony architecture. - It is a more advanced step once the **gingiva has been reflected** and the bone can be directly visualized and accessed. *Mucogingival surgery* - **Mucogingival surgery** addresses issues like **gingival recession**, inadequate **attached gingiva**, or abnormal **frena**. - These procedures (e.g., **gum grafting**) are often performed *after* initial periodontal disease control or when specific mucogingival defects require correction, rather than as a primary approach for pocket reduction.

Q: Paresthesia is seen with which of the following types of fractures:

Zygomatico maxillary. ***Zygomatico maxillary*** - Fractures involving the **zygomatico maxillary complex** (ZMC) can damage the **infraorbital nerve**, which passes through the infraorbital canal within the maxilla part of the ZMC. - Damage to the infraorbital nerve results in **paresthesia** (numbness or tingling) in the distribution of this nerve, affecting the cheek, upper lip, and anterior maxillary teeth on the affected side. *Coronoid process* - Fractures of the **coronoid process** are generally stable and typically do not involve nerves that would cause paresthesia. - The primary symptoms are usually pain, swelling, and an inability to open the mouth fully. *Subcondylar* - **Subcondylar fractures** primarily affect the **mandibular condyle**, leading to issues with occlusion, pain, and limited mouth opening. - While branches of the **trigeminal nerve** are nearby, significant nerve damage leading to paresthesia is uncommon with this type of fracture, unless there's an associated extensive injury. *Symphyseal* - **Symphyseal fractures** involve the midline of the mandible. - Although the **inferior alveolar nerve** passes through the mandible, paresthesia due to a symphyseal fracture is less common as the nerve is typically not transected at this site.

Q: A patient has carcinoma on the right side of anterior 2/3rd of the tongue with lymph node of size 4cm in level 3 on the left side of the neck. Stage of the disease is

N2. ***N2 (Correct Answer)*** - The patient has a **contralateral lymph node** (left side neck node with right-sided primary tumor) measuring **4 cm**. - According to TNM 8th edition, this classifies as **N2c**: bilateral or contralateral lymph nodes ≤6 cm without extranodal extension (ENE-). - N2c is a subcategory of N2, making this the correct answer. - The 4 cm size is within the N2 range (>3 cm but ≤6 cm) and the contralateral location specifically indicates N2c. *N0 (Incorrect)* - **N0** indicates no regional lymph node metastasis. - This is clearly incorrect as the patient has a clinically evident 4 cm lymph node in level 3. *N3 (Incorrect)* - **N3a** requires a lymph node **>6 cm** in size, OR - **N3b** requires evidence of **extranodal extension (ENE+)**. - Since this node is 4 cm (not >6 cm) and there is no mention of extranodal extension, N3 is incorrect. *N1 (Incorrect)* - **N1** is defined as a single **ipsilateral** lymph node ≤3 cm without ENE. - This patient fails N1 criteria on two counts: the node is **contralateral** (not ipsilateral) and measures **4 cm** (exceeds 3 cm limit).

Q: Lymph node metastasis in neck is almost never seen with:

Carcinoma vocal cords. ***Carcinoma vocal cords*** - The **vocal cords** are relatively poor in lymphatic drainage, which significantly reduces the likelihood of regional lymph node metastasis. - Due to this sparse lymphatic network, spread to cervical lymph nodes is rare, especially in early-stage disease. *Supraglottic carcinoma* - **Supraglottic** regions have a rich lymphatic network, leading to a high incidence of cervical lymph node metastasis, even in early stages. - Bilateral lymphatic drainage further increases the risk of nodal involvement. *Carcinoma of tonsil* - The **tonsils** are richly supplied with lymphatic vessels, making them prone to early and frequent metastasis to cervical lymph nodes. - Metastasis is often seen in levels II, III, and IV of the neck. *Papillary carcinoma thyroid* - **Papillary thyroid carcinoma** commonly metastasizes to regional lymph nodes, with documented rates as high as 30-80%. - Nodal metastasis can occur in the central compartment (level VI) and lateral neck (levels II-V).

Q: Most mucostatic impression material among the following is:

ZOE paste. ***ZOE paste*** - **Zinc Oxide-Eugenol (ZOE) paste** is a **mucostatic impression material**, meaning it records the soft tissues in their resting, undisplaced state. - Its low viscosity and slow setting time allow the material to flow gently over the tissues without compressing them, making it ideal for **edentulous ridges** to capture detailed anatomy without distortion. *Alginate* - **Alginate** is a **mucocompressive** impression material, meaning it displaces soft tissues due to its higher viscosity during insertion and setting. - It is commonly used for diagnostic casts and study models where some tissue displacement is acceptable, but not for definitive impressions requiring a mucostatic record. *Impression compound* - **Impression compound** is a **thermoplastic** material that is highly **mucocompressive** as it is manipulated in a plastic state and can deform soft tissues during impression taking. - It is often used for border molding or preliminary impressions where some tissue displacement can help define the periphery of a denture. *Elastomer* - **Elastomers** (e.g., silicone, polyether) can be both **mucostatic** or **mucocompressive** depending on their viscosity and the technique used for impression taking. - While some low-viscosity elastomers can be used mucostatically, many common elastomeric techniques involve moderate pressure, leading to some tissue displacement.

Q: A glomus tumor extending to involve the carotid canal is classified as:

Type CI. ***Type CI*** - The **Fisch classification system** for **glomus jugulare tumors** defines Type C1 as tumors involving the **vertical portion of the carotid canal**. - Type C tumors extend into the infralabyrinthine compartment of the temporal bone and involve the petrous apex. - C1 specifically indicates involvement of the carotid canal, representing a higher extent of disease and often requiring more complex surgical approaches due to the involvement of critical neurovascular structures. *Type C2* - In the Fisch classification, Type C2 refers to **glomus tumors** involving both the **vertical and horizontal portions of the carotid canal**. - This represents more extensive involvement than C1 but does not primarily denote carotid canal involvement as the defining characteristic asked in the question. *Type B* - This classification in the Fisch system describes **glomus tympanicum tumors** limited to the **tympanomastoid area** without involvement of the infralabyrinthine compartment. - It does not apply to tumors extending into the carotid canal. *Type C3* - In the Fisch classification, Type C3 refers to **glomus tumors** that invade the **horizontal (intrapetrous) portion of the carotid canal**. - While it also involves the carotid canal, C1 is the most appropriate answer as it specifically denotes initial carotid canal involvement.

Question 1

Pleomorphic adenomas arising from the minor salivary glands can be treated with

Accepted Answer

Local excision with 5mm margin

Answer

Chemotherapy

Answer

Local excision with 2mm margin

Answer

Radiotherapy

Question 2

Le Fort II facial fracture implies:

Accepted Answer

Fracture running through zygomatic process of the maxilla, floor of orbit, and root of nose bilaterally

Answer

Fracture running through alveolar ridge

Answer

Fracture running through midline of the palate and zygomatico-maxillary suture

Answer

Bilateral fracture involving multiple facial bones with midface mobility

Question 3

What does a Commando operation describe?

Accepted Answer

Mandibulectomy, Neck dissection, Oropharyngeal resection

Answer

Mandibulectomy, Neck dissection, Omohyoid muscle removal

Answer

Maxillectomy, Neck dissection, Omohyoid muscle removal

Answer

Combined maxillectomy and mandibulectomy

Question 4

In periodontal surgical treatment, which of the following surgical procedures are typically carried out first:

Accepted Answer

Flap surgery

Answer

Gingivectomy

Answer

Osseous recontouring

Answer

Mucogingival surgery

Question 5

Paresthesia is seen with which of the following types of fractures:

Accepted Answer

Zygomatico maxillary

Answer

Coronoid process

Answer

Subcondylar

Answer

Symphyseal

Question 6

Which of the following statements about branchial cyst is FALSE?

Accepted Answer

It is found at the anterior border of lower third of sternocleidomastoid muscle.

Answer

It is usually lined by squamous epithelium.

Answer

Treatment involves complete excision.

Answer

It develops from the remnants of 2nd branchial cleft.

Question 7

A patient has carcinoma on the right side of anterior 2/3rd of the tongue with lymph node of size 4cm in level 3 on the left side of the neck. Stage of the disease is

Accepted Answer

N2

Answer

N0

Answer

N3

Answer

N1

Question 8

Lymph node metastasis in neck is almost never seen with:

Accepted Answer

Carcinoma vocal cords

Answer

Supraglottic carcinoma

Answer

Carcinoma of tonsil

Answer

Papillary carcinoma thyroid

Question 9

Most mucostatic impression material among the following is:

Accepted Answer

ZOE paste

Answer

Alginate

Answer

Impression compound

Answer

Elastomer

Question 10

A glomus tumor extending to involve the carotid canal is classified as:

Accepted Answer

Type CI

Answer

Type C2

Answer

Type B

Answer

Type C3

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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