Head and Neck Surgery Practice Questions

Q: What is the most appropriate treatment for facial nerve injury in a lateral facial wound?

Primary repair. In facial trauma, the management of facial nerve injury depends on the timing and nature of the wound. **Why Primary Repair is Correct:** The facial nerve is a purely motor nerve (distal to the stylomastoid foramen), and its regeneration potential is excellent. **Primary repair (neurorrhaphy)**, performed within **72 hours** of injury, is the gold standard for clean-cut lateral facial wounds. At this stage, the distal ends of the nerve can still be identified using a nerve stimulator (Wallerian degeneration is not yet complete), and there is minimal scarring or retraction, allowing for a tension-free, end-to-end anastomosis. **Explanation of Incorrect Options:** * **Secondary Repair (A & C):** This is reserved for cases with significant tissue loss, heavy contamination, or when the patient is hemodynamically unstable. Delaying repair leads to proximal stump neuroma and distal stump fibrosis, making identification difficult and outcomes poorer. * **Secondary Repair with Grafting (C):** This is only indicated if a primary tension-free repair is impossible due to a large nerve gap (usually >1-2 cm). * **Healing with Secondary Intention (D):** This is never appropriate for a transected nerve, as it leads to permanent facial paralysis and muscle atrophy. **NEET-PG High-Yield Pearls:** * **The 72-Hour Rule:** Nerve stimulation of the distal stump is possible for up to 3 days post-injury. * **The Vertical Line Rule:** Injuries **medial** to a vertical line dropped from the lateral canthus of the eye often do not require surgical repair, as there is significant plexiform branching and spontaneous recovery is common. * **Suture Material:** Micro-neurosurgical repair is typically done using 9-0 or 10-0 monofilament (Nylon) sutures. * **Best Prognosis:** Primary end-to-end repair always yields better functional results than nerve grafting.

Q: A man presented with a slow-growing, asymptomatic, firm, non-tender, pulsatile mass in the region of the carotid bifurcation. Diagnosis was made as carotid body tumor by angiogram. Where does a carotid body tumor arise from?

Parasympathetic paraganglioma. **Explanation:** **Carotid Body Tumor (CBT)**, also known as a **chemodectoma**, is the most common head and neck paraganglioma. It arises from the **parasympathetic paraganglia** located at the bifurcation of the common carotid artery. These cells are derived from the **neural crest** and function as chemoreceptors sensitive to changes in arterial oxygen, carbon dioxide, and pH. * **Why Option C is correct:** Paragangliomas are classified based on their anatomical location and autonomic association. Head and neck paragangliomas (like carotid body, glomus jugulare, and glomus tympanicum) are almost exclusively **parasympathetic** in origin. Unlike sympathetic paraganglia, they are usually non-secretory (do not produce catecholamines). * **Why Option D is incorrect:** Sympathetic paragangliomas typically arise in the abdomen or thorax (e.g., Organ of Zuckerkandl) and are frequently associated with catecholamine secretion (hypertension, palpitations). * **Why Options A & B are incorrect:** While the tumor is located at the carotid bifurcation near the **carotid sinus** (a baroreceptor), it does not arise from the sinus tissue itself or the vessel wall of the **carotid artery**. It is a neuroendocrine tumor arising from the specialized cells *between* the vessels. **High-Yield Clinical Pearls for NEET-PG:** * **Fontaine’s Sign:** The mass is mobile horizontally but fixed vertically (due to its attachment to the carotid bifurcation). * **Lyre Sign:** On angiography, the tumor causes characteristic widening/splaying of the internal and external carotid arteries. * **Shamblin Classification:** Used to grade the tumor based on its degree of encirclement of the carotid vessels. * **Rule of 10s:** Approximately 10% are bilateral, 10% are malignant, and 10% are familial (associated with SDH gene mutations).

Q: According to Sawhney's classification of TMJ ankylosis, which type is characterized by complete destruction of joint architecture by osseous union with no identifiable sigmoid notch?

Type 4. ### Explanation **Sawhney’s Classification** is the most widely used system to categorize the severity of Temporomandibular Joint (TMJ) ankylosis based on radiological and clinical findings. **Correct Option: D (Type 4)** In **Type 4 ankylosis**, there is complete destruction of the joint architecture. The condyle, notch, and coronoid process are replaced by a massive, solid block of bone (synostosis) extending from the ramus to the zygomatic arch. The **sigmoid notch is completely obliterated**, making this the most severe form. **Analysis of Incorrect Options:** * **Type 1 (Option A):** Characterized by minimal bone formation. There is a flattening or deformity of the condyle with fibrous adhesions, but the joint space is still visible. * **Type 2 (Option B):** Features more extensive bony fusion, typically involving the outer surface of the joint. However, the **medial part of the joint remains relatively unaffected**, and the anatomy of the condyle is still somewhat recognizable. * **Type 3 (Option C):** There is a bony bridge (ankylotic mass) connecting the ramus to the zygomatic arch. Crucially, the **sigmoid notch is still identifiable**, and a small portion of the original condylar head may be seen medially. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Trauma (specifically undiagnosed/untreated condylar fractures) is the leading cause of TMJ ankylosis, followed by infections (Otitis media). * **Clinical Presentation:** Progressive limitation of mouth opening (trismus), facial asymmetry (if unilateral), and "bird-face" deformity (micrognathia) if bilateral and occurring during growth. * **Treatment Gold Standard:** Gap arthroplasty or Interpositional arthroplasty (using temporalis fascia or cartilage) to prevent re-ankylosis. * **Radiology:** The "Panorex" (OPG) and CT scans are the imaging modalities of choice to differentiate between Sawhney types.

Question 1

A thyroglossal cyst is most often located:

Accepted Answer

Near the hyoid bone

Answer

At the base of the tongue

Answer

Submandibular region

Answer

Opposite the cricoid cartilage

Question 2

A 56-year-old smoker presented with swelling over the parotid region. Histology shows papillary structures composed of granular eosinophilic cells, cystic changes, and mature lymphocytic infiltration, which is pathognomonic of Warthin tumor. What is the treatment of choice for Warthin tumor?

Accepted Answer

Complete excision of the affected portion of the gland with uninvolved margins

Answer

Enucleation

Answer

Radiotherapy

Answer

Injection of a sclerosant agent

Question 3

What is the most appropriate treatment for facial nerve injury in a lateral facial wound?

Accepted Answer

Primary repair

Answer

Secondary repair

Answer

Secondary repair with grafting

Answer

Healing with secondary intention

Question 4

A 40-year-old female presented with a progressively increasing lump in the parotid region. On oral examination, the tonsil was pushed medially. Biopsy showed it to be pleomorphic adenoma. What is the appropriate treatment?

Accepted Answer

Conservative total parotidectomy

Answer

Superficial parotidectomy

Answer

Lumpectomy

Answer

Enucleation

Question 5

A man presented with a slow-growing, asymptomatic, firm, non-tender, pulsatile mass in the region of the carotid bifurcation. Diagnosis was made as carotid body tumor by angiogram. Where does a carotid body tumor arise from?

Accepted Answer

Parasympathetic paraganglioma

Answer

Carotid sinus

Answer

Carotid artery

Answer

Sympathetic paraganglioma

Question 6

A 32-year-old female, with a history of chronic tobacco chewing since 14 years of age, presents with difficulty in opening her mouth. On oral examination, no ulcers are seen. What is the most probable diagnosis?

Accepted Answer

Submucous oral fibrosis

Answer

Carcinoma of the tongue

Answer

Trigeminal nerve paralysis

Answer

Carcinoma of the buccal mucosa

Question 7

According to Sawhney's classification of TMJ ankylosis, which type is characterized by complete destruction of joint architecture by osseous union with no identifiable sigmoid notch?

Accepted Answer

Type 4

Answer

Type 1

Answer

Type 2

Answer

Type 3

Question 8

You are performing a 5-year follow-up on a 43-year-old implant patient. When comparing radiographs, you estimate that there has been almost 0.1 mm loss of bone height around the implant since it was placed. What is indicated?

Accepted Answer

The implant is doing well; this amount of bone loss is considered acceptable.

Answer

Removal of the implant and replacement with a larger size implant.

Answer

Removal of the implant to allow healing before another one can be placed 4 months later.

Answer

Remaking the prosthetic crown because of tangential forces on the implant.

Question 9

A 43-year-old teacher underwent left parotidectomy. Upon awakening from surgery, paralysis of the left lower lip was observed. This complication was most likely due to injury to which of the following?

Accepted Answer

Facial nerve cervical branch

Answer

Parotid duct

Answer

Facial nerve temporal branch

Answer

Facial nerve main trunk

Question 10

What is described as the en bloc resection of a segment of bone?

Accepted Answer

The entire tumor is removed intact with a rim of uninvolved bone while maintaining continuity of the jaw

Answer

Complete resection of the jaw bone

Answer

Resection of half of the affected jaw

Answer

Resection of the tumor only

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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