In Caldwell Luc operation, the approach is through the?
Which of the following is not a complication of maxillary sinus lavage and insufflation?
All of the following are features of Tubotympanic CSOM except which of the following?
Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?
NEET-PG 2015 - ENT NEET-PG Practice Questions and MCQs
Question 21: In Caldwell Luc operation, the approach is through the?
- A. Opening of maxillary antrum through gingivolabial approach (Correct Answer)
- B. Transnasal endoscopic approach through the middle meatus
- C. Through the sphenopalatine recess for maxillary sinus access
- D. Accessing the maxillary sinus via superior meatus
Explanation: ***Opening of maxillary antrum through gingivolabial approach*** - The **Caldwell-Luc operation** involves creating a surgical window in the anterior wall of the **maxillary sinus** via an incision in the **gingivolabial sulcus** (also called sublabial sulcus). - This **open surgical approach** through the canine fossa provides direct access to the antrum for removal of pathology, foreign bodies, or drainage of chronic infections. - The incision is made above the canine tooth, and the anterior wall of the maxilla is fenestrated. *Transnasal endoscopic approach through the middle meatus* - This describes **functional endoscopic sinus surgery (FESS)**, which is a minimally invasive endoscopic technique, not the traditional open Caldwell-Luc procedure. - While FESS accesses the maxillary sinus through the natural ostium or by creating a middle meatal antrostomy, it is a fundamentally different approach. - Caldwell-Luc is an **extranasal, open approach**, whereas FESS is an **intranasal, endoscopic approach**. *Through the sphenopalatine recess for maxillary sinus access* - The **sphenopalatine recess** is primarily associated with endoscopic approaches to the sphenoid sinus or procedures involving the **pterygopalatine fossa**, not the Caldwell-Luc approach. - This approach does not involve breaching the anterior wall of the maxillary sinus through the canine fossa. *Accessing the maxillary sinus via superior meatus* - The **superior meatus** is not used for accessing the maxillary sinus in any standard surgical approach. - The natural ostium of the maxillary sinus opens into the **middle meatus**, not the superior meatus. - The superior meatus drains the posterior ethmoid cells, not the maxillary sinus.
Question 22: Which of the following is not a complication of maxillary sinus lavage and insufflation?
- A. Orbital injury
- B. Epistaxis
- C. Facial nerve injury (Correct Answer)
- D. Air embolism
Explanation: ***Facial nerve injury*** - The **facial nerve (CN VII)** passes through the parotid gland and temporal bone, far from the maxillary sinus. - There is no anatomical proximity or procedural mechanism during maxillary sinus lavage and insufflation that would put the facial nerve at risk of injury. *Air embolism* - **Insufflation of air** into the maxillary sinus, especially under pressure, can lead to air entering the bloodstream if a blood vessel is inadvertently punctured. - This can result in a serious and potentially fatal **air embolism**, particularly if the air reaches the cerebral circulation. *Orbital injury* - The **medial wall of the maxillary sinus** is in close proximity to the orbit, separated by thin bone. - During lavage, excessive force or incorrect angulation of instruments can perforate this thin bone, leading to **orbital complications** such as periorbital hematoma or injury to orbital contents. *Epistaxis* - During the procedure, the **mucosa of the nasal cavity** or the sinus itself can be traumatized by the instruments used for lavage. - This local trauma to the rich blood supply of these areas can easily cause **nasal bleeding (epistaxis)**.
Question 23: All of the following are features of Tubotympanic CSOM except which of the following?
- A. Profuse discharge
- B. Hearing loss
- C. Extreme pain (Correct Answer)
- D. Facial nerve paralysis
Explanation: ***Extreme pain*** - **Extreme pain** is NOT a characteristic feature of **tubotympanic CSOM**. This type is typically associated with a history of **painless otorrhea**. - Tubotympanic CSOM is considered the "safe" type with inflammation limited to the mucosa without bone erosion. - The presence of severe pain should raise suspicion for complications or the **atticoantral (unsafe) type** of CSOM. *Profuse discharge* - **Profuse, mucoid** or **mucopurulent discharge** is a hallmark feature of tubotympanic CSOM. - This discharge results from chronic inflammation of the **middle ear mucoperiosteum** through a central perforation in the **pars tensa**. - The discharge is typically non-foul smelling (unlike atticoantral CSOM). *Hearing loss* - **Conductive hearing loss** is a universal feature of tubotympanic CSOM. - Results from **tympanic membrane perforation**, middle ear effusion, and potential ossicular discontinuity. - The degree of hearing loss correlates with the size and location of the perforation. *Facial nerve paralysis* - Facial nerve paralysis is **NOT a typical feature** of tubotympanic (safe) CSOM. - This complication is characteristically associated with **atticoantral (unsafe) CSOM** with cholesteatoma causing bone erosion. - While theoretically possible in very advanced neglected tubotympanic disease, it would indicate transformation to unsafe disease or secondary complications. - **Note:** Some sources may list this as a rare complication, but it is not a characteristic feature distinguishing tubotympanic CSOM, making this option potentially ambiguous in an "EXCEPT" question format.
Question 24: Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?
- A. Congenital syphilis
- B. Cholesteatoma
- C. Stapedectomy
- D. Meniere’s disease (Correct Answer)
Explanation: ***Meniere's disease*** - **Hennebert's sign** is a *false-positive fistula test* resulting from a hypermobile footplate or saccule, or a fibrous band between the stapes footplate and the utricle due to otolithic *hydrops*. - It indicates that changes in external ear canal pressure cause **nystagmus** and **vertigo** due to inner ear fluid displacement, even without a true fistula. - This is the **most common** cause of Hennebert's sign in clinical practice. *Congenital syphilis* - Congenital syphilis can also present with Hennebert's sign as a false-positive fistula test due to inner ear involvement. - However, the question context specifies Hennebert's sign in the absence of middle ear disease, making Meniere's disease the more typical answer. - Other features include **sensorineural hearing loss**, **vestibular dysfunction**, **interstitial keratitis**, and **Hutchinson's teeth**. *Cholesteatoma* - A cholesteatoma often erodes bone, leading to a **true fistula** in the horizontal semicircular canal, especially its lateral aspect. - This would result in a *true positive fistula test* rather than a false positive associated with Hennebert's sign. *Stapedectomy* - A stapedectomy is a surgical procedure to treat otosclerosis, involving the removal of the stapes and insertion of a prosthesis. - While it can lead to complications such as perilymph fistula, it is not directly associated with Hennebert's sign as a *pre-existing condition* causing a false-positive fistula test in the absence of middle ear disease.