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 221: A developmental abnormality characterized by the presence of fewer than the usual number of teeth is

A. Anodontia
B. Oligodontia (Correct Answer)
C. Microdontia
D. Dens in dente

Explanation: **Explanation:** The question pertains to developmental anomalies of the teeth, specifically regarding their number and size. **1. Why Oligodontia is correct:** **Oligodontia** is defined as the congenital absence of **six or more teeth** (excluding the third molars). It is a sub-type of hypodontia. The term "fewer than the usual number" generally refers to this spectrum of tooth agenesis. It is often associated with specific syndromes, most notably **Ectodermal Dysplasia**. **2. Analysis of Incorrect Options:** * **Anodontia (Option A):** This refers to the **total/complete absence** of all teeth (both primary and permanent). While it also involves "fewer" teeth, it is a specific extreme state, whereas oligodontia is the standard term for a significant reduction in number. * **Microdontia (Option B):** This refers to an abnormality in the **size** of the teeth (teeth are smaller than normal), not the number. A classic example is the "Peg Lateral" incisor. * **Dens in dente (Option D):** Also known as *Dens invaginatus*, this is a structural anomaly where the outer surface of the tooth folds inward (a "tooth within a tooth"). It does not affect the count of teeth. **3. NEET-PG High-Yield Pearls:** * **Hypodontia:** Absence of 1 to 5 teeth (excluding 3rd molars). * **Most commonly missing teeth:** 3rd molars > Mandibular 2nd premolars > Maxillary lateral incisors. * **Hyperdontia:** Presence of extra teeth (Supernumerary). The most common is the **Mesiodens** (located between maxillary central incisors). * **Gardner’s Syndrome:** Characterized by multiple supernumerary teeth, permanent teeth impaction, and intestinal polyposis.

Question 222: Swelling of the deep lobe of the parotid gland presents as swelling in which anatomical space?

A. Parapharyngeal space (Correct Answer)
B. Cheek
C. Temporal region
D. Below the ear

Explanation: ### Explanation **1. Why Parapharyngeal Space is Correct:** The parotid gland is divided into a superficial and a deep lobe by the plane of the facial nerve (the "fictitious" plane). While the superficial lobe lies lateral to the nerve, the **deep lobe** extends medially through the **stylomandibular tunnel**—a narrow space bounded by the ramus of the mandible, the styloid process, and the stylomandibular ligament. When a tumor or swelling arises in the deep lobe, it cannot expand laterally due to the mandible; instead, it pushes medially into the **parapharyngeal space**. Clinically, this manifests as a bulge in the lateral pharyngeal wall, often displacing the tonsil toward the midline. This is frequently referred to as a **"dumbbell-shaped" tumor** when it spans both lobes. **2. Why Other Options are Incorrect:** * **B. Cheek:** Swellings here typically arise from the superficial lobe or the accessory parotid tissue located along the parotid duct (Stensen’s duct). * **C. Temporal region:** This is superior to the parotid gland. Swellings here are usually related to the temporal bone, temporalis muscle, or zygomatic arch. * **D. Below the ear:** This is the classic presentation of a **superficial lobe** parotid swelling, which lifts the earlobe and fills the post-auricular sulcus. **3. NEET-PG High-Yield Pearls:** * **Patey’s Faciovenous Plane:** An imaginary plane used by surgeons to identify the facial nerve, separating the superficial and deep lobes. It is defined by the facial nerve and the retromandibular vein. * **Clinical Sign:** A deep lobe tumor may present with **trismus** (difficulty opening the mouth) if it involves the pterygoid muscles in the parapharyngeal space. * **Imaging:** MRI is the gold standard to differentiate a deep lobe parotid tumor from a primary parapharyngeal space tumor (like a minor salivary gland tumor or schwannoma).

Question 223: Mikulicz's disease is characterized by:

A. Symmetrical enlargement of the salivary glands.
B. Enlargement of the lacrimal gland.
C. Both of the above. (Correct Answer)
D. None of the above.

Explanation: **Explanation:** **Mikulicz’s Disease** (now considered a part of the **IgG4-related disease** spectrum) is a chronic, benign condition characterized by the progressive, painless, and typically **symmetrical enlargement** of the salivary and lacrimal glands. 1. **Why Option C is correct:** The hallmark of Mikulicz’s disease is the simultaneous involvement of both the **lacrimal glands** (causing a characteristic swelling of the upper eyelids) and the **major salivary glands** (parotid and submandibular). Because it involves both sets of glands symmetrically, Option C is the most comprehensive answer. 2. **Why Options A and B are incomplete:** While both options describe features of the disease, selecting one over the other would be clinically incomplete. The disease is defined by the *combination* of dacryoadenitis (lacrimal) and sialadenitis (salivary). **Clinical Pearls for NEET-PG:** * **Mikulicz’s Disease vs. Mikulicz’s Syndrome:** The *Disease* is primary/idiopathic (IgG4-related). The *Syndrome* refers to similar glandular enlargement secondary to other systemic diseases like Sarcoidosis, Leukemia, Lymphoma, or Tuberculosis. * **Histopathology:** Shows intense lymphocytic infiltration and acinar atrophy, but the ductal epithelium remains intact (forming "epimyoepithelial islands"). * **Distinction from Sjögren’s Syndrome:** Unlike Sjögren’s, Mikulicz’s disease is associated with **elevated serum IgG4 levels**, responds well to steroids, and typically lacks the classic anti-Ro (SS-A) and anti-La (SS-B) antibodies. * **Treatment:** Systemic corticosteroids are the first-line management.

Question 224: Which of the following is NOT a premalignant lesion of the oral cavity?

A. Erythroplakia
B. Sideropenic dysphagia
C. Ranula (Correct Answer)
D. Submucous fibrosis

Explanation: ### Explanation The correct answer is **Ranula**. **Why Ranula is NOT a premalignant lesion:** A **Ranula** is a clinical term for a **mucous extravasation cyst** or a mucous retention cyst occurring in the floor of the mouth, typically arising from the **sublingual gland**. It is a benign, inflammatory, or obstructive condition characterized by a bluish, translucent swelling. It has **no malignant potential** and does not undergo neoplastic transformation. **Analysis of Premalignant (Potentially Malignant) Lesions:** * **Erythroplakia (Option A):** This is a red, velvety patch on the oral mucosa. It is the **most dangerous** premalignant lesion, with a very high rate of transformation (over 50%) into squamous cell carcinoma. * **Sideropenic Dysphagia (Option B):** Also known as **Plummer-Vinson Syndrome** or Paterson-Brown-Kelly Syndrome. It is characterized by iron deficiency anemia, glossitis, and esophageal webs. It is a known precursor to post-cricoid carcinoma and oral cavity cancers. * **Oral Submucous Fibrosis (OSMF) (Option D):** A chronic, progressive condition associated with **areca nut chewing**. It leads to juxta-epithelial inflammatory reaction followed by fibroelastic changes in the lamina propria, resulting in restricted mouth opening (trismus). It carries a significant risk of malignancy (approx. 7-13%). **High-Yield Clinical Pearls for NEET-PG:** * **Leukoplakia:** The most common premalignant lesion of the oral cavity (defined as a white patch that cannot be characterized clinically or pathologically as any other disease). * **Speckled Leukoplakia:** Higher risk of malignancy than homogenous leukoplakia. * **Plunging Ranula:** A variant where the mucus extravasates below the mylohyoid muscle, presenting as a swelling in the neck. * **Management of Ranula:** Surgical excision of the cyst along with the offending sublingual gland is the treatment of choice to prevent recurrence.

Question 225: Which tumor does not occur in minor salivary glands?

A. Pleomorphic adenoma
B. Adenocarcinoma
C. Mucoepidermoid carcinoma
D. Warthin's tumor (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Warthin’s Tumor** **Why it is correct:** Warthin’s tumor (also known as Papillary Cystadenoma Lymphomatosum) is unique because its pathogenesis is closely linked to the **embryological development of the parotid gland**. During development, the parotid is the only salivary gland that encapsulates late, often trapping intra-parotid lymph nodes within its capsule. Warthin’s tumor arises from heterotopic salivary duct epithelium trapped within these lymph nodes. Since minor salivary glands do not have an encapsulated structure or associated lymphoid tissue in this manner, Warthin’s tumor is **virtually never found in minor salivary glands**. It is almost exclusively seen in the parotid gland (especially the tail). **Why other options are incorrect:** * **A. Pleomorphic Adenoma:** This is the most common benign tumor of both major and minor salivary glands. In the minor glands, the **palate** is the most common site. * **B. Adenocarcinoma:** Various forms of adenocarcinoma (like Polymorphous Low-Grade Adenocarcinoma) have a predilection for minor salivary glands. * **C. Mucoepidermoid Carcinoma:** This is the **most common malignant salivary gland tumor** in both adults and children, frequently occurring in the minor salivary glands of the palate and buccal mucosa. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for minor salivary gland tumors:** Hard Palate. * **Rule of 50 for Minor Salivary Glands:** Approximately 50% of all minor salivary gland tumors are malignant (unlike the parotid, where ~80% are benign). * **Warthin’s Tumor "Hot" Facts:** It is the most common salivary tumor to be **bilateral** (10%) and **multifocal**. It shows increased uptake on **Technetium-99m pertechnetate scan** (Hot tumor). * **Risk Factor:** Strongly associated with **smoking**.

Question 226: Which of the following is false regarding pleomorphic adenoma?

A. Large in size
B. Encapsulated
C. Commonly turns malignant (Correct Answer)
D. Slow growing

Explanation: **Explanation:** Pleomorphic Adenoma (Benign Mixed Tumor) is the most common salivary gland tumor, typically involving the superficial lobe of the parotid gland. **Why Option C is False (The Correct Answer):** While Pleomorphic Adenoma has a risk of malignant transformation into **Carcinoma ex Pleomorphic Adenoma**, this occurs in only about **2–10%** of cases (usually in long-standing tumors of 10–15 years). Therefore, saying it "commonly" turns malignant is clinically incorrect. It is primarily a benign tumor. **Analysis of Other Options:** * **Option A (Large in size):** If left untreated, these tumors can grow to a massive size because they are painless and slow-growing, often leading patients to delay seeking medical advice. * **Option B (Encapsulated):** It is a well-demarcated, encapsulated tumor. However, it is known for having a **"false capsule"** with finger-like projections (pseudopods). This is why simple enucleation leads to high recurrence; a superficial parotidectomy is preferred. * **Option D (Slow growing):** A hallmark of Pleomorphic Adenoma is its slow, indolent growth over several years. Sudden rapid increase in size is a red flag for malignant transformation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Parotid gland (Tail of the parotid). * **Histology:** Shows both epithelial and mesenchymal elements (hence "Mixed Tumor"). Look for a **chondromyxoid stroma**. * **Treatment of choice:** Superficial parotidectomy (to avoid the facial nerve and prevent recurrence from pseudopods). * **Nerve involvement:** Facial nerve palsy is rare in Pleomorphic Adenoma; if present, suspect malignancy.

Question 227: Costen's syndrome refers to neurological pain associated with which anatomical structure?

A. Sphenopalatine ganglion
B. Temporomandibular joint (Correct Answer)
C. Glossopharyngeal nerve
D. Lingual nerve

Explanation: **Explanation:** **Costen’s Syndrome**, also known as Temporomandibular Joint (TMJ) Dysfunction Syndrome, is a complex of symptoms arising from derangement of the **Temporomandibular joint**. It was first described by James Costen in 1934, who attributed the pain to dental malocclusion leading to over-closure of the jaw. This causes posterior displacement of the mandibular condyle, which puts pressure on the auriculotemporal nerve and chorda tympani. **Why the correct answer is right:** The syndrome is characterized by facial pain, tenderness in the TMJ area, clicking sounds during jaw movement, and restricted mandibular motion. The "neurological pain" often radiates to the ear, temple, or jaw, mimicking neuralgias, but the root cause is the mechanical dysfunction of the TMJ. **Analysis of Incorrect Options:** * **A. Sphenopalatine ganglion:** Associated with Sluder’s neuralgia, causing lower facial pain and autonomic symptoms (rhinorrhea, lacrimation), not TMJ dysfunction. * **C. Glossopharyngeal nerve:** Dysfunction leads to Glossopharyngeal neuralgia, characterized by paroxysmal pain in the tonsillar fossa, pharynx, and ear, triggered by swallowing. * **D. Lingual nerve:** Injury to this nerve results in sensory loss or paresthesia to the anterior two-thirds of the tongue and the floor of the mouth. **Clinical Pearls for NEET-PG:** * **Key Triad:** TMJ pain, joint clicking/crepitus, and restricted jaw opening. * **Referred Otalgia:** Costen’s syndrome is a common cause of "secondary otalgia" (ear pain with a normal ear exam) because the TMJ and the external auditory canal share the same nerve supply (Auriculotemporal nerve, V3). * **Management:** Primarily conservative, including soft diet, NSAIDs, and dental splints to correct malocclusion.

Question 228: The torus mandibularis is most commonly seen in the region of:

A. Incisor region
B. Canine region
C. Molar region
D. Premolar region (Correct Answer)

Explanation: **Explanation:** **Torus mandibularis** is a benign, non-neoplastic bony exostosis (overgrowth) that occurs on the lingual surface of the mandible. It is typically bilateral and asymptomatic, often discovered incidentally during a routine oral examination. 1. **Why Premolar region is correct:** The classic anatomical location for torus mandibularis is the **lingual aspect of the mandible**, specifically superior to the mylohyoid line, in the **premolar region**. It most frequently arises adjacent to the first and second premolars. While the exact etiology is debated, it is believed to be a combination of genetic factors and local masticatory stress. 2. **Why other options are incorrect:** * **Incisor/Canine region:** While the growth can occasionally extend anteriorly, it rarely originates in the midline or purely in the incisor/canine area. * **Molar region:** Though large tori may extend posteriorly toward the molars, the primary site of origin and the most common clinical presentation remains the premolar area. **Clinical Pearls for NEET-PG:** * **Torus Palatinus:** A similar bony overgrowth occurring in the midline of the hard palate. It is more common than torus mandibularis and is more frequent in females. * **Clinical Significance:** These lesions are usually harmless and require no treatment unless they interfere with the fitting of dental prostheses (dentures), cause speech impairment, or suffer recurrent surface ulceration. * **Radiology:** On X-rays, they appear as well-circumscribed radiopaque masses. * **Differential Diagnosis:** Must be distinguished from osteomas or peripheral giant cell granulomas.

Question 229: Warthin's tumor is a tumor of which gland?

A. Parotid gland (Correct Answer)
B. Submandibular gland
C. Lingual gland
D. Minor salivary glands

Explanation: **Explanation:** **Warthin’s tumor**, also known as **Papillary Cystadenoma Lymphomatosum**, is the second most common benign salivary gland tumor. It occurs almost exclusively in the **Parotid gland** (Option A). **Why the Parotid Gland?** The unique pathogenesis of Warthin’s tumor involves the entrapment of salivary duct epithelium within intra-parotid lymph nodes during embryogenesis. Since the parotid is the only salivary gland that contains lymph nodes within its parenchyma, Warthin’s tumor is virtually restricted to this site, specifically the **lower pole (tail)** of the parotid. **Analysis of Incorrect Options:** * **Submandibular and Lingual Glands (Options B & C):** These glands do not contain internal lymph nodes during development; therefore, Warthin’s tumor is extremely rare in these locations. * **Minor Salivary Glands (Option D):** While Pleomorphic Adenoma frequently occurs in minor salivary glands (especially the palate), Warthin’s tumor does not. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** It is most common in **elderly males** (though the male-to-female ratio is narrowing) and has a strong association with **smoking**. * **Multiplicity:** It is the most common salivary gland tumor to be **bilateral** (10%) and **multicentric**. * **Hot Spot:** On **99mTc-Pertechnetate scan**, Warthin’s tumor appears as a **"Hot spot"** because the ductal cells concentrate the isotope but cannot excrete it. * **Histology:** Characterized by a double layer of oncocytic epithelium forming papillary projections into cystic spaces, surrounded by a dense lymphoid stroma with germinal centers. * **Malignancy:** It has the lowest potential for malignant transformation among salivary tumors.

Question 230: Which of the following is a characteristic feature of aphthous ulcers?

A. Recurrent (Correct Answer)
B. Benign reactive
C. Malignant
D. None of the above

Explanation: **Explanation:** **Aphthous Ulcers (Recurrent Aphthous Stomatitis - RAS)** are one of the most common inflammatory conditions of the oral mucosa. The hallmark of this condition is its **recurrent** nature (Option A). These ulcers typically present as painful, small, ovoid or round ulcerations with a necrotic center (covered by a yellow-grey pseudomembrane) and a surrounding erythematous halo. They primarily affect non-keratinized mucosa (e.g., buccal and labial mucosa, floor of the mouth). * **Why Option A is correct:** The term "Aphthous" is derived from the Greek word *aphtha*, meaning ulcer. The clinical course is characteristically episodic, with ulcers healing spontaneously within 7–14 days and reappearing at irregular intervals. * **Why Option B is incorrect:** "Benign reactive" usually refers to lesions like pyogenic granulomas or fibrous epulis that occur in response to chronic irritation or trauma. While aphthous ulcers are benign, they are classified as an idiopathic inflammatory/autoimmune-mediated condition rather than a simple reactive growth. * **Why Option C is incorrect:** Aphthous ulcers are strictly non-malignant. However, any solitary oral ulcer that fails to heal within 3 weeks must be biopsied to rule out Squamous Cell Carcinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Types:** 1. **Minor (Mikulicz’s):** Most common (<10mm), heal without scarring. 2. **Major (Sutton’s):** Large (>10mm), deep, painful, and heal **with scarring**. 3. **Herpetiform:** Multiple crops of tiny ulcers; not caused by the Herpes virus. * **Associations:** Often linked to Stress, Vitamin B12/Folic acid deficiency, and **Behçet’s Disease** (triad of oral ulcers, genital ulcers, and uveitis). * **Treatment:** Topical corticosteroids (Triamcinolone) and analgesics are the mainstay of management.

Practice by Chapter

Stomatitis

Practice Questions

Oral Ulcers

Practice Questions

Oral Leukoplakia

Practice Questions

Oral Cancers

Practice Questions

Sialadenitis

Practice Questions

Sialolithiasis

Practice Questions

Salivary Gland Tumors

Practice Questions

Ranula

Practice Questions

Xerostomia

Practice Questions

Sjögren's Syndrome

Practice Questions

Oral Manifestations of Systemic Diseases

Practice Questions

Temporomandibular Joint Disorders

Practice Questions

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