Head and Neck Surgery Practice Questions

Q: What conditions are treated by Sistrunk's operation?

Thyroglossal duct cyst. ***Thyroglossal duct cyst*** - The **Sistrunk procedure** is the surgical excision of a **thyroglossal duct cyst**, including the central portion of the hyoid bone and a core of tissue extending to the foramen cecum. - This extensive removal is necessary to prevent recurrence by eradicating any remnants of the **thyroglossal tract**, which is the developmental pathway of the thyroid gland. *Parotid tumor* - **Parotid tumors** are usually treated by different surgical procedures, such as **parotidectomy** (superficial or total), depending on the tumor's size and nature. - The surgical approach for parotid tumors involves careful dissection to preserve the **facial nerve**, which is anatomically distinct from the thyroid region. *Thyroglossal fistula* - While a **thyroglossal fistula** can result from an infected or ruptured **thyroglossal duct cyst**, the primary condition treated by Sistrunk's operation is the cyst itself, aiming to prevent both recurrence and fistula formation. - The Sistrunk procedure addresses the entire anatomical remnant, which is crucial for preventing not just fistula but also future cyst formation. *None of the options* - This option is incorrect because **Sistrunk's operation** is specifically designed for the definitive treatment of a **thyroglossal duct cyst**. - The procedure's detailed technique directly corresponds to the embryonic origins and potential recurrence pathways of this specific midline neck mass.

Q: Commonest site of carcinoma tongue -

Lateral borders. ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.

Q: Which levels of cervical lymph nodes are included in a modified radical neck dissection?

I-V. ***I-V*** - A modified radical neck dissection typically removes lymph nodes from levels **I through V**, along with preservation of one or more non-lymphatic structures (sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve). - This extensive dissection addresses potential metastasis to these node groups from head and neck cancers, crucial for adequate oncologic clearance while aiming for functional preservation. *I-III* - This limited dissection would likely be insufficient for many head and neck cancers, as spread often extends beyond level III. - It would miss potential metastases in the lower jugular and posterior triangle nodes, increasing the risk of recurrence. *I-IV* - This dissection omits **level V**, which includes the posterior triangle nodes, a common site for metastatic spread, especially for cancers of the oropharynx, hypopharynx, and thyroid. - Excluding level V would be considered an incomplete radical or modified radical neck dissection in many clinical scenarios. *II-VI* - This option incorrectly excludes lymph nodes at **level I** (submental and submandibular nodes), which are critical draining sites for many oral cavity cancers. - Including level VI (anterior compartment nodes) is typically part of a central compartment neck dissection, often performed for thyroid cancer, but is usually not part of a standard modified radical neck dissection for other head and neck primaries unless specifically indicated.

Q: Which part of the mandible is most commonly fractured?

Angle of mandible. ***Angle of mandible*** - The **angle of the mandible** is a common site for fractures due to its anatomical position and the forces it experiences during trauma. - This area is relatively weaker than other parts and is often impacted during direct blows to the jaw. *Body of mandible* - While fractures of the **mandibular body** can occur (often in the canine region), they are less frequent than those at the angle. - The body of the mandible is generally a robust structure, making fractures here typically result from higher-impact trauma. *Condylar process of mandible* - Fractures of the **condylar process** are very common, especially in children, and are often associated with indirect trauma. - However, the angle region still holds the highest frequency of fractures due to direct impact and leverage forces. *Coronoid process of mandible* - Fractures of the **coronoid process** are relatively rare and usually occur as part of a more extensive mandibular fracture or due to direct trauma to the temporal region. - Its protected position beneath the zygomatic arch makes it less susceptible to isolated injury.

Q: Which of the following statements about thyroglossal cyst is NOT true?

Does not move with deglutition. ***Does not move with deglutition*** - A **thyroglossal cyst** is connected to the **foramen cecum** at the base of the tongue via a remnant of the thyroglossal duct, which **moves superiorly with both tongue protrusion and deglutition** due to its attachment to the hyoid bone. - The statement that it does not move with deglutition is therefore **incorrect**. *Moves with protrusion of tongue* - This statement is **true** because the **thyroglossal duct** is embryologically continuous with the tongue's base at the foramen cecum. - When the tongue is protruded, this connection pulls the cyst **upwards**. *Sistrunk's operation is the treatment of choice* - This statement is **true** because **Sistrunk's operation** involves removing the cyst along with the central portion of the **hyoid bone** and a core of tissue from the path to the foramen cecum. - This extensive removal is crucial to prevent recurrence, as simple excision often leaves remnants of the duct. *Most common site is subhyoid region* - This statement is **true** as approximately 60-65% of **thyroglossal cysts** are located in the **subhyoid region**, just below the hyoid bone. - Other common locations include suprahyoid and at the level of the thyrohyoid membrane.

Q: Treatment of non-displaced sagittal condylar fracture?

Reduction for two weeks and elastic guided jaw movements. ***Reduction for two weeks and elastic guided jaw movements*** - This approach aims for **closed reduction** with **minimal immobilization**, promoting early mobilization to prevent **ankylosis** and foster optimal healing. - **Elastic guided jaw movements** help restore function and prevent stiffness during the critical healing phase, aligning with current best practices for condylar fractures. *No treatment* - Leaving a condylar fracture untreated can lead to **malocclusion**, **TMJ dysfunction**, chronic pain, and **facial asymmetry**. - **Condylar fractures** require intervention to ensure proper healing and restoration of mandibular function. *ORIF* - **Open reduction and internal fixation (ORIF)** is generally reserved for displaced condylar fractures, particularly those that cause significant **malocclusion**, cannot be managed by closed reduction, or involve dislocation of the condyle from the fossa. - While ORIF provides rigid fixation, it carries risks such as **facial nerve injury** and **scarring**, and is not the first-line treatment for all condylar fractures. *Reduction for four weeks + physiotherapy* - **Prolonged immobilization** for four weeks can lead to **joint stiffness**, **muscle atrophy**, and **ankylosis** of the temporomandibular joint (TMJ). - While physiotherapy is essential, it should be initiated earlier and combined with shorter periods of reduction to promote **early functional recovery**.

Q: Infection of the submandibular space is seen in:

Ludwig angina. ***Ludwig angina*** - This is a rapidly progressive and potentially life-threatening **cellulitis** of the **submandibular, sublingual, and submental spaces**. - It typically originates from an **infected mandibular molar tooth** (most commonly the 2nd or 3rd molar). - Characterized by **bilateral** involvement, **brawny induration** of the neck, and potential for **airway compromise**. *Prinzmetal angina* - This is a type of **angina pectoris** characterized by chest pain due to **coronary artery spasm**, unrelated to infection. - It primarily affects the **heart** and does not involve the submandibular space. *Unstable angina* - This refers to **chest pain** or discomfort that occurs at rest or with minimal exertion, indicating a **pre-infarction state** due to coronary artery disease. - It is a cardiac condition and has no association with head and neck infections. *Vincent angina* - This condition is also known as **acute necrotizing ulcerative gingivitis (ANUG)** or trench mouth, a severe infection of the **gums and oral mucosa**. - While it is an infection of the oral cavity, it primarily affects the **gingiva** and does not involve the deep submandibular space in the same way as Ludwig angina.

Question 1

What conditions are treated by Sistrunk's operation?

Accepted Answer

Thyroglossal duct cyst

Answer

Parotid tumor

Answer

Thyroglossal fistula

Answer

None of the options

Question 2

Which fracture pattern is classified as a Le Fort I fracture?

Accepted Answer

Horizontal fracture of the maxilla separating teeth from upper jaw

Answer

Pyramidal fracture involving maxilla and nasal bones

Answer

Complete craniofacial separation involving the upper face

Answer

Isolated nasal bone fracture

Question 3

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 4

What is the surgical procedure known as the 'Commando operation' primarily used for?

Accepted Answer

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes en bloc

Answer

Disarticulation of the hip due to gas gangrene

Answer

Extended radical mastectomy for breast cancer

Answer

Abdomino-perineal resection for rectal carcinoma

Question 5

What causes Frey's syndrome?

Accepted Answer

Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands.

Answer

Facial nerve damage.

Answer

Greater auricular nerve involvement.

Answer

None of the options

Question 6

Which levels of cervical lymph nodes are included in a modified radical neck dissection?

Accepted Answer

I-V

Answer

I-IV

Answer

I-III

Answer

II-VI

Question 7

Which part of the mandible is most commonly fractured?

Accepted Answer

Angle of mandible

Answer

Body of mandible

Answer

Coronoid process of mandible

Answer

Condylar process of mandible

Question 8

Which of the following statements about thyroglossal cyst is NOT true?

Accepted Answer

Does not move with deglutition

Answer

Sistrunk's operation is the treatment of choice

Answer

Most common site is subhyoid region

Answer

Moves with protrusion of tongue

Question 9

Treatment of non-displaced sagittal condylar fracture?

Accepted Answer

Reduction for two weeks and elastic guided jaw movements

Answer

ORIF

Answer

No treatment

Answer

Reduction for four weeks + physiotherapy

Question 10

Infection of the submandibular space is seen in:

Accepted Answer

Ludwig angina

Answer

Prinzmetal angina

Answer

Unstable angina

Answer

Vincent angina

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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