Diseases of the Oral Cavity and Salivary Glands — MCQs

Diseases of the Oral Cavity and Salivary Glands Indian Medical PG Practice Questions and MCQs

Question 121: Which of the following statements regarding hard palate tumors is true?

A. Smoking is not a risk factor
B. The most common tumor is adenocarcinoma
C. Bilateral lymphatic spread occurs (Correct Answer)
D. Tumors typically present as painful ulcers

Explanation: **Explanation:** **1. Why Option C is Correct:** The hard palate is a midline structure with a rich, decussating lymphatic network. Lymphatic drainage from the hard palate primarily goes to the submandibular and upper deep cervical nodes. Because the palate lacks a midline anatomical barrier to lymph flow, tumors in this region frequently exhibit **bilateral or contralateral lymphatic spread**, even if the primary lesion appears unilateral. This necessitates careful evaluation of both sides of the neck during staging and treatment planning. **2. Why the Other Options are Incorrect:** * **Option A:** Smoking (along with alcohol and betel nut chewing) is a significant risk factor for squamous cell carcinoma of the hard palate. Additionally, "reverse smoking" (common in parts of India) is specifically associated with a high incidence of hard palate malignancies. * **Option B:** The most common **malignant** tumor of the hard palate is **Adenoid Cystic Carcinoma** (minor salivary gland origin), followed by Mucoepidermoid carcinoma. While Squamous Cell Carcinoma is common in the oral cavity, the hard palate is unique because of its high density of minor salivary glands. * **Option D:** Most hard palate tumors present as **painless, slow-growing swellings**. Pain is usually a late feature, often indicating perineural invasion (characteristic of Adenoid Cystic Carcinoma) or secondary infection. **Clinical Pearls for NEET-PG:** * **Reverse Smoking:** Strongly linked to hard palate cancer; presents with palatal keratosis. * **Adenoid Cystic Carcinoma:** Known for **perineural spread** and "skip lesions." It has a characteristic "Swiss cheese" appearance on histology. * **Pleomorphic Adenoma:** The most common **benign** tumor of the hard palate. * **Surgical Note:** Malignant tumors often require a maxillectomy; the resulting defect is managed with a prosthetic **obturator**.

Question 122: Which of the following statements regarding tumors of the hard palate is false?

A. Slow growing
B. Bilateral lymphatic spread
C. Adenocarcinoma
D. Presents with pain (Correct Answer)

Explanation: **Explanation:** Tumors of the hard palate, particularly squamous cell carcinomas, are notorious for being **painless** in their early and intermediate stages. Pain is a late feature, occurring only when there is deep infiltration into the palatine nerves or significant bone destruction. Therefore, "Presents with pain" is the false statement as it is not a characteristic early clinical feature. **Analysis of Options:** * **A. Slow growing:** Most hard palate malignancies (especially minor salivary gland tumors like Adenoid Cystic Carcinoma) are characterized by an indolent, slow-growing nature. * **B. Bilateral lymphatic spread:** The hard palate has a rich lymphatic network that crosses the midline. Because the primary site is central, tumors here frequently metastasize to the lymph nodes on both sides of the neck (Level I and II). * **C. Adenocarcinoma:** While Squamous Cell Carcinoma (SCC) is the most common primary malignancy of the oral cavity, the hard palate is unique because it contains a high density of minor salivary glands. Consequently, minor salivary gland tumors (like Adenoid Cystic Carcinoma and Mucoepidermoid Carcinoma) are very common here. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for minor salivary gland tumors:** Hard palate. * **Most common benign tumor of the hard palate:** Pleomorphic adenoma. * **Most common malignant tumor of the hard palate:** Adenoid Cystic Carcinoma (though some texts cite SCC, minor salivary gland malignancies are disproportionately high here compared to other oral sites). * **Perineural invasion:** A hallmark of Adenoid Cystic Carcinoma, often leading to "skip lesions" along nerves.

Question 123: Which type of cyst has the highest recurrence rate?

A. Keratocyst (Correct Answer)
B. Periapical cyst
C. Nasoalveolar cyst
D. Globulomaxillary cyst

Explanation: **Odontogenic Keratocyst (OKC)**, now often referred to as a Keratocystic Odontogenic Tumor, is notorious for its high recurrence rate (ranging from 25% to 60%). This high recurrence is primarily due to its unique biological characteristics: 1. **Thin, Friable Lining:** The epithelial lining is very thin and fragile, making complete surgical removal (enucleation) difficult as it tends to fragment. 2. **Daughter/Satellite Cysts:** Small nests of epithelial cells or "daughter cysts" are often found in the fibrous capsule beyond the main cyst wall. If these are left behind, they lead to recurrence. 3. **High Proliferative Index:** The basal layer shows high mitotic activity, reflecting its aggressive neoplastic nature. **Analysis of Incorrect Options:** * **Periapical (Radicular) Cyst:** The most common odontogenic cyst, usually associated with a non-vital tooth. It has a very low recurrence rate once the source of infection is removed (via root canal or extraction) and the cyst is curetted. * **Nasoalveolar (Nasolabial) Cyst:** A soft-tissue developmental cyst located outside the bone. Because it is easily accessible and does not involve bone remodeling, recurrence is rare following simple excision. * **Globulomaxillary Cyst:** Historically described as a "fissural" cyst between the maxillary lateral incisor and canine. Most are now reclassified as radicular or lateral periodontal cysts. They do not possess the aggressive growth pattern of OKCs. **NEET-PG High-Yield Pearls:** * **Association:** Multiple OKCs are a hallmark of **Gorlin-Goltz Syndrome** (Nevoid Basal Cell Carcinoma Syndrome). * **Radiology:** Typically presents as a well-defined radiolucency with "scalloped" margins, often in the posterior mandible/ramus. * **Management:** Due to the recurrence risk, aggressive treatment like **Carnoy’s solution** application or en bloc resection is often preferred over simple enucleation.

Question 124: Kuttner tumour is a lesion of which gland?

A. Lymph gland
B. Salivary gland (Correct Answer)
C. Sebaceous gland
D. Thymus gland

Explanation: **Explanation:** **Kuttner tumour**, also known as **Chronic Sclerosing Sialadenitis**, is a benign, inflammatory condition primarily affecting the **salivary glands**. It most commonly involves the **submandibular gland** (80% of cases). Clinically, it presents as a firm, painless, and progressive swelling that mimics a malignant neoplasm, which is why it is termed a "tumour" despite being an inflammatory process. * **Why Option B is correct:** Histologically, it is characterized by periductal fibrosis, dense lymphocytic infiltration with lymphoid follicles, and acinar atrophy. It is now recognized as a manifestation of **IgG4-related disease**. * **Why Options A, C, and D are incorrect:** While lymph nodes and the thymus can be involved in IgG4-related diseases, the specific eponym "Kuttner tumour" is strictly reserved for the sclerosing inflammatory process of the salivary glands. Sebaceous glands are not associated with this pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** Submandibular gland (unilateral > bilateral). * **Pathology:** It is the "salivary gland equivalent" of Riedel’s thyroiditis or Autoimmune pancreatitis. * **Diagnosis:** Often requires a biopsy to rule out malignancy (like Adenoid Cystic Carcinoma) due to its hard consistency. * **Key Association:** Elevated serum **IgG4 levels** and infiltration of IgG4-positive plasma cells. * **Management:** Usually surgical excision (Sialadenectomy) if symptomatic or to exclude malignancy.

Question 125: Inflammatory disease of salivary glands is called as?

A. Sialadenitis. (Correct Answer)
B. Sialodochitis.
C. Sialadenosis.
D. Sialosis.

Explanation: **Explanation:** **Sialadenitis** is the correct answer as it refers specifically to the **inflammation of the salivary gland parenchyma**. In medical terminology, the suffix "-itis" denotes inflammation, and "sialaden-" refers to the salivary gland. This condition can be acute or chronic and is caused by various factors including bacterial infections (most commonly *Staphylococcus aureus*), viral infections (e.g., Mumps), or autoimmune processes (e.g., Sjögren’s syndrome). **Analysis of Incorrect Options:** * **Sialodochitis (Option B):** This refers specifically to the inflammation of the **salivary duct system** rather than the gland parenchyma itself. It is often associated with ductal strictures or stagnation of saliva. * **Sialadenosis / Sialosis (Options C & D):** These terms are synonymous. They refer to a **non-inflammatory, non-neoplastic enlargement** of the salivary glands (usually the parotid). It is typically bilateral and associated with systemic metabolic or endocrine disorders like Diabetes Mellitus, chronic alcoholism, or malnutrition. **Clinical Pearls for NEET-PG:** * **Acute Bacterial Sialadenitis:** Most commonly affects the **Parotid gland**. It is often seen in dehydrated or postoperative patients. Treatment involves hydration, sialogogues (to stimulate saliva), and antibiotics. * **Sialolithiasis:** Most common in the **Submandibular gland** (80%) due to the alkaline pH, high calcium/mucin content, and the upward (antigravity) course of Wharton’s duct. * **Küttner’s Tumor:** A chronic sclerosing sialadenitis of the submandibular gland, often mimicking a malignancy.

Question 126: Frey's syndrome develops secondary to aberrant innervation of the skin over the parotid by which cranial nerve?

A. IX (Correct Answer)
B. X
C. XI
D. XII

Explanation: **Explanation:** **Frey’s Syndrome** (also known as Auriculotemporal Syndrome) is a common complication following parotidectomy. It occurs due to the **aberrant regeneration** of parasympathetic nerve fibers. 1. **Why Option A (IX) is correct:** The parotid gland receives its parasympathetic supply from the **Glossopharyngeal nerve (CN IX)**. The pathway involves the inferior salivatory nucleus → CN IX → Tympanic nerve (Jacobson’s nerve) → Lesser petrosal nerve → **Otic ganglion** → **Auriculotemporal nerve** (a branch of V3). After surgery, these parasympathetic fibers mistakenly grow to innervate the overlying sweat glands (sympathetic) of the skin. Consequently, the stimulus of eating (salivation) leads to localized sweating and flushing over the parotid region (gustatory sweating). 2. **Why other options are incorrect:** * **Option B (X):** The Vagus nerve provides parasympathetic supply to thoracic and abdominal viscera, not the parotid gland. * **Option C (XI):** The Accessory nerve is purely motor, supplying the sternocleidomastoid and trapezius muscles. * **Option D (XII):** The Hypoglossal nerve is purely motor, supplying the muscles of the tongue. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Confirmed by the **Minor’s Starch-Iodine Test** (the area turns blue-black upon sweating). * **Prevention:** Interposition of barriers like the **Acellular Dermal Matrix** or **SMAS flap** during surgery. * **Treatment:** Topical **Glycopyrrolate** or **Botulinum toxin** injections are the preferred medical management. * **Nerve involved in the reflex:** The afferent and efferent limb of the gustatory sweating reflex is the **Auriculotemporal nerve**.

Question 127: Which of the following is an indication for enucleation?

A. Treatment of odontogenic keratocyst
B. Recurrence of cystic lesions of any cyst type
C. Large cyst to avoid pathological fracture of the jaw
D. Both A and B (Correct Answer)

Explanation: ### Explanation **1. Understanding the Concept: Enucleation vs. Marsupialization** Enucleation is the surgical process of removing a cyst in its entirety without rupture. It is the treatment of choice for most small to moderate-sized cystic lesions of the jaw. * **Odontogenic Keratocyst (OKC):** Due to its aggressive nature and high recurrence rate, the primary treatment is thorough **enucleation** (often combined with chemical cauterization using Carnoy’s solution or peripheral ostectomy). * **Recurrence:** If a cystic lesion recurs after previous conservative management (like marsupialization), definitive removal via **enucleation** is indicated to ensure all epithelial lining is cleared. **2. Analysis of Options** * **Option A (Correct):** OKC requires complete removal of the lining to prevent recurrence. * **Option B (Correct):** Recurrent lesions indicate that previous drainage or decompression failed; thus, total excision (enucleation) is required. * **Option C (Incorrect):** For **very large cysts**, enucleation is often contraindicated as an initial step. Removing a large cyst entirely can lead to a **pathological fracture** of the weakened jawbone or damage to vital structures (like the inferior alveolar nerve). In such cases, **Marsupialization** (decompression) is preferred first to allow the bone to regenerate and the cyst to shrink before definitive surgery. **3. Clinical Pearls for NEET-PG** * **Marsupialization (Partsch I):** Indicated for very large cysts, cysts involving unerupted teeth in children, or when vital structures are at risk. * **Enucleation (Partsch II):** Indicated for smaller cysts where the jaw is strong enough to withstand the procedure. * **OKC Fact:** Derived from the *dental lamina*. It has a characteristic "picket fence" or "tombstone" appearance of the basal layer on histology. * **Most common odontogenic cyst:** Radicular cyst (always associated with a non-vital tooth).

Question 128: Glossopyrosis refers to:

A. Painful tongue.
B. Burning tongue. (Correct Answer)
C. Paralysis of tongue.
D. Black colored tongue.

Explanation: **Explanation:** **Glossopyrosis** is derived from the Greek words *glossa* (tongue) and *pyrosis* (burning). It is a clinical symptom characterized by a chronic **burning sensation** of the tongue in the absence of visible mucosal lesions. It is the hallmark symptom of **Burning Mouth Syndrome (BMS)**. * **Why Option B is Correct:** Glossopyrosis specifically refers to the "burning" sensation. It is often associated with conditions like Vitamin B12 deficiency, iron deficiency anemia, diabetes mellitus, menopause, or psychogenic factors. * **Why Other Options are Incorrect:** * **Option A (Painful tongue):** This is termed **Glossodynia**. While burning can be painful, glossodynia is the broader term for physical pain or soreness of the tongue. * **Option C (Paralysis of tongue):** This results from a lesion of the **Hypoglossal nerve (CN XII)**. Clinical signs include deviation of the tongue toward the side of the lesion and atrophy. * **Option D (Black colored tongue):** This is known as **Glossophytia** (Black Hairy Tongue). it is caused by the hypertrophy of filiform papillae and colonization by chromogenic bacteria, often due to poor hygiene, smoking, or antibiotic use. **High-Yield NEET-PG Pearls:** 1. **Plummer-Vinson Syndrome:** Characterized by the triad of iron deficiency anemia, dysphagia (esophageal webs), and glossitis (smooth, red tongue). 2. **Median Rhomboid Glossitis:** A red, asymptomatic diamond-shaped patch on the dorsum of the tongue, now considered a form of chronic atrophic candidiasis. 3. **Geographic Tongue (Benign Migratory Glossitis):** Characterized by "map-like" areas of depapillation that change position over time.

Question 129: List the following pediatric parotid neoplasms in order from most frequent to least frequent?

A. Pleomorphic adenoma > acinic cell > mucoepidermoid > adenoid cystic
B. Pleomorphic adenoma > mucoepidermoid > acinic cell > adenoid cystic (Correct Answer)
C. Pleomorphic adenoma > adenoid cystic > mucoepidermoid > acinic cell
D. Mucoepidermoid > pleomorphic adenoma > acinic cell > adenoid cystic

Explanation: ### Explanation Salivary gland tumors are rare in the pediatric population, accounting for less than 5% of all head and neck tumors in children. However, when they occur, the parotid gland is the most common site. **1. Why Option B is Correct:** The distribution of pediatric parotid neoplasms follows a specific hierarchy based on pathology: * **Pleomorphic Adenoma (PA):** This is the **most common** overall parotid tumor in children. It is a benign mixed tumor but requires complete excision (superficial parotidectomy) due to its potential for recurrence. * **Mucoepidermoid Carcinoma (MEC):** This is the **most common malignant** salivary gland tumor in children. In the pediatric age group, it typically presents as a low-grade malignancy. * **Acinic Cell Carcinoma:** This is the second most common malignancy in children. It often presents as a slow-growing mass and has a relatively favorable prognosis compared to adults. * **Adenoid Cystic Carcinoma:** This is significantly rarer in children than in adults and is characterized by its tendency for perineural invasion. **2. Analysis of Incorrect Options:** * **Option A & C:** These are incorrect because they misplace the frequency of malignant subtypes. Mucoepidermoid carcinoma consistently outranks acinic cell and adenoid cystic carcinoma in pediatric prevalence. * **Option D:** This is incorrect because it lists a malignancy (MEC) as more common than the benign Pleomorphic Adenoma. While the *ratio* of malignant-to-benign tumors is higher in children than in adults, Pleomorphic Adenoma remains the single most frequent histological type. **3. High-Yield Clinical Pearls for NEET-PG:** * **Rule of 80s (Adults):** 80% of parotid tumors are benign; 80% of those are Pleomorphic Adenomas. * **The Pediatric Shift:** In children, the "Rule of 50" often applies—nearly 50% of epithelial salivary masses are malignant (compared to only 20% in adults). * **Vascular Tumors:** If the question asks for the most common parotid *mass* (not specifically neoplasm/epithelial tumor), **Hemangioma** is the most common overall, usually presenting in infancy. * **Malignancy Indicator:** Rapid growth, pain, or facial nerve palsy in a child with a parotid mass strongly suggests malignancy.

Question 130: If the distance between the tip of the tongue and the insertion of the lingual frenum is 6 mm, what grade of ankyloglossia is present?

A. Mild ankyloglossia
B. Moderate ankyloglossia
C. Severe ankyloglossia (Correct Answer)
D. Complete ankyloglossia

Explanation: **Explanation:** Ankyloglossia, commonly known as "tongue-tie," is a congenital anomaly characterized by an abnormally short or thick lingual frenum that restricts the protrusion and elevation of the tongue. The grading of ankyloglossia is based on the **Kotlow Classification**, which measures the "free tongue" length. This is defined as the distance from the tip of the tongue to the insertion of the lingual frenum. * **Normal:** >16 mm * **Class I (Mild):** 12–16 mm * **Class II (Moderate):** 8–11 mm * **Class III (Severe):** 3–7 mm * **Class IV (Complete):** <3 mm In this case, a measurement of **6 mm** falls directly into the **Class III / Severe ankyloglossia** category. **Analysis of Options:** * **Mild ankyloglossia (12–16 mm):** Incorrect. The tongue has significant mobility, and the restriction is minimal. * **Moderate ankyloglossia (8–11 mm):** Incorrect. While restricted, the free tongue length is greater than the 6 mm described. * **Complete ankyloglossia (<3 mm):** Incorrect. This represents a "total" tongue-tie where the tongue is virtually fused to the floor of the mouth. **High-Yield NEET-PG Pearls:** 1. **Clinical Presentation:** Difficulty in breastfeeding (infants), speech defects (specifically articulation of sibilants and linguals like *t, d, z, s, n, l*), and inability to protrude the tongue past the lower incisors. 2. **Physical Sign:** On protrusion, the tongue often assumes a **heart-shaped** or notched appearance. 3. **Treatment:** The procedure of choice is **frenectomy** (complete excision) or **frenotomy** (simple incision), often performed with a Z-plasty to prevent scar contracture.

Practice by Chapter

Stomatitis

Practice Questions

Oral Ulcers

Practice Questions

Oral Leukoplakia

Practice Questions

Oral Cancers

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Sialadenitis

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Sialolithiasis

Practice Questions

Salivary Gland Tumors

Practice Questions

Ranula

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Xerostomia

Practice Questions

Sjögren's Syndrome

Practice Questions

Oral Manifestations of Systemic Diseases

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Temporomandibular Joint Disorders

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