Head and Neck Surgery Practice Questions

Q: A 20-year-old male presented with a midline soft tissue swelling in front of neck. On examination it is a cystic mass of 2 x 2 cm in size, which moves with deglutition and tongue protrusion. No other significant finding observed. Which of the following is the definitive management for this condition:

Sistrunk's operation. ***Sistrunk's operation*** - The presentation of a **midline neck swelling** that moves with **deglutition** and **tongue protrusion** is classic for a **thyroglossal duct cyst**. - **Sistrunk's operation** is the definitive management, involving excision of the cyst, the central portion of the **hyoid bone**, and the core of muscle and fibrous tissue connecting to the foramen cecum to prevent recurrence. *Steroid injection into the cyst* - This is an **unproven and ineffective treatment** for thyroglossal duct cysts. - Steroids might temporarily reduce inflammation but will not address the underlying anatomical abnormality, leading to eventual recurrence. *Surgical removal of cyst* - Simple excision of the cyst alone has a **high recurrence rate** because it often leaves behind the remnant of the thyroglossal duct, which can extend up to the **foramen cecum** at the base of the tongue. - This approach is not considered definitive for thyroglossal duct cysts due to the high risk of recurrence. *Reassure the patient and regular follow-up* - While thyroglossal duct cysts are generally benign, they can become **infected**, form a **fistula**, or, rarely, undergo **malignant transformation**. - Therefore, surgical removal is recommended to prevent complications and recurrence, rather than just observation.

Q: Which of the following conditions are not indicated for surgical exposure of orbital floor in ZMC fracture?

Oedema. ***Oedema*** - **Oedema** is a common and transient symptom following trauma, including ZMC fractures, and typically resolves on its own without surgical intervention. - It does not represent a structural or functional impairment of the orbital floor that requires surgical correction. *Enophthalmos* - **Enophthalmos**, or posterior displacement of the globe, indicates significant orbital volume expansion, often due to a displaced orbital floor fracture. - This condition warrants surgical repair to restore proper orbital volume and eye position, as it can lead to aesthetic and functional deficits. *Diplopia* - **Diplopia**, or double vision, often arises from impingement or entrapment of extraocular muscles (especially the inferior rectus) in a ZMC fracture or due to significant displacement of the globe. - Surgical exploration and release of entrapped tissue are indicated to restore muscle function and alleviate diplopia. *Non-resolving oculocardiac reflex* - The **oculocardiac reflex** (bradycardia, arrhythmia) can be triggered by pressure on the globe or traction on extraocular muscles, which may occur with orbital floor fractures. - A non-resolving or persistent oculocardiac reflex suggests continuous mechanical irritation or entrapment that requires surgical intervention to decompress the area and prevent potentially dangerous cardiac responses.

Q: Pleomorphic adenomas arising from the minor salivary glands can be treated with

Local excision with 5mm margin. ***Local excision with 5mm margin*** - **Pleomorphic adenomas** are **benign tumors**, but they have a tendency for recurrence if not adequately excised due to their irregular, often lobulated shape and microscopic extensions. - A **5mm margin** is generally recommended for complete removal and to minimize the risk of recurrence, especially for tumors arising from minor salivary glands. *Chemotherapy* - **Chemotherapy** is generally reserved for **malignant tumors** and systemic diseases, not for benign lesions like pleomorphic adenomas. - It carries significant side effects and is unnecessary for a localized, benign tumor that can be surgically removed. *Local excision with 2mm margin* - While local excision is the correct approach, a **2mm margin** may be insufficient for pleomorphic adenomas. - Such a small margin increases the risk of leaving behind microscopic tumor extensions, leading to a higher chance of **local recurrence**. *Radiotherapy* - **Radiotherapy** is primarily used for **malignant tumors** or in cases where surgery is not an option, or as an adjuvant therapy. - It is not the standard primary treatment for **benign pleomorphic adenomas** due to potential side effects and the efficacy of surgical excision.

Q: What does a Commando operation describe?

Mandibulectomy, Neck dissection, Oropharyngeal resection. ***Mandibulectomy, Neck dissection, Oropharyngeal resection*** - A **Commando operation** explicitly refers to the en bloc resection of a segment of the mandible, a portion of the oropharynx, and a neck dissection. - This extensive surgical procedure is typically performed for advanced **head and neck cancers** involving the retromolar trigone or anterior tonsillar pillar, with potential mandibular and cervical nodal involvement. *Mandibulectomy, Neck Dissection, Omohyoid muscle removal* - While a **mandibulectomy** and **neck dissection** are components, the explicit inclusion of **omohyoid muscle removal** as a defining feature of a Commando operation is not standard. - The Commando operation focuses on primary tumor resection (oropharynx) with associated bony (mandible) and lymphatic (neck) involvement. *Maxillectomy, Neck Dissection, Omohyoid muscle removal* - A **maxillectomy** (excision of the maxilla) is not a part of the standard Commando operation, which specifically involves the **mandible** and **oropharynx**. - As mentioned, the explicit inclusion of **omohyoid muscle removal** is not a defining characteristic of this specific operation. *Combined maxillectomy and mandibulectomy* - This describes a **pan-facial resection**, which is a far more extensive procedure than a Commando operation. - While both maxillectomy and mandibulectomy involve bone removal, a **Commando operation** specifically includes **neck dissection** and **oropharyngeal resection** rather than just combined bone resections.

Q: In periodontal surgical treatment, which of the following surgical procedures are typically carried out first:

Flap surgery. ***Flap surgery*** - **Flap surgery**, also known as **open flap debridement**, is a foundational procedure in periodontal treatment to gain access to the **root surfaces** and **bone defects**. - It involves lifting the **gingival tissue** to thoroughly clean and debride the affected areas, and is often the initial surgical approach once **non-surgical therapies** have been exhausted. *Gingivectomy* - **Gingivectomy** is primarily used for the removal of **excess gingival tissue** (gingival enlargement) or for **cosmetic recontouring**. - It is typically performed when there is no **osseous defect** or when access to the bone is not required, making it less suitable as the initial general surgical step for deeper periodontal disease. *Osseous recontouring* - **Osseous recontouring** (osteoplasty/ostectomy) involves reshaping or removing **bone defects** and is usually performed *after* **flap elevation** to correct underlying bony architecture. - It is a more advanced step once the **gingiva has been reflected** and the bone can be directly visualized and accessed. *Mucogingival surgery* - **Mucogingival surgery** addresses issues like **gingival recession**, inadequate **attached gingiva**, or abnormal **frena**. - These procedures (e.g., **gum grafting**) are often performed *after* initial periodontal disease control or when specific mucogingival defects require correction, rather than as a primary approach for pocket reduction.

Q: Paresthesia is seen with which of the following types of fractures:

Zygomatico maxillary. ***Zygomatico maxillary*** - Fractures involving the **zygomatico maxillary complex** (ZMC) can damage the **infraorbital nerve**, which passes through the infraorbital canal within the maxilla part of the ZMC. - Damage to the infraorbital nerve results in **paresthesia** (numbness or tingling) in the distribution of this nerve, affecting the cheek, upper lip, and anterior maxillary teeth on the affected side. *Coronoid process* - Fractures of the **coronoid process** are generally stable and typically do not involve nerves that would cause paresthesia. - The primary symptoms are usually pain, swelling, and an inability to open the mouth fully. *Subcondylar* - **Subcondylar fractures** primarily affect the **mandibular condyle**, leading to issues with occlusion, pain, and limited mouth opening. - While branches of the **trigeminal nerve** are nearby, significant nerve damage leading to paresthesia is uncommon with this type of fracture, unless there's an associated extensive injury. *Symphyseal* - **Symphyseal fractures** involve the midline of the mandible. - Although the **inferior alveolar nerve** passes through the mandible, paresthesia due to a symphyseal fracture is less common as the nerve is typically not transected at this site.

Q: A patient has carcinoma on the right side of anterior 2/3rd of the tongue with lymph node of size 4cm in level 3 on the left side of the neck. Stage of the disease is

N2. ***N2 (Correct Answer)*** - The patient has a **contralateral lymph node** (left side neck node with right-sided primary tumor) measuring **4 cm**. - According to TNM 8th edition, this classifies as **N2c**: bilateral or contralateral lymph nodes ≤6 cm without extranodal extension (ENE-). - N2c is a subcategory of N2, making this the correct answer. - The 4 cm size is within the N2 range (>3 cm but ≤6 cm) and the contralateral location specifically indicates N2c. *N0 (Incorrect)* - **N0** indicates no regional lymph node metastasis. - This is clearly incorrect as the patient has a clinically evident 4 cm lymph node in level 3. *N3 (Incorrect)* - **N3a** requires a lymph node **>6 cm** in size, OR - **N3b** requires evidence of **extranodal extension (ENE+)**. - Since this node is 4 cm (not >6 cm) and there is no mention of extranodal extension, N3 is incorrect. *N1 (Incorrect)* - **N1** is defined as a single **ipsilateral** lymph node ≤3 cm without ENE. - This patient fails N1 criteria on two counts: the node is **contralateral** (not ipsilateral) and measures **4 cm** (exceeds 3 cm limit).

Question 1

A 20-year-old male presented with a midline soft tissue swelling in front of neck. On examination it is a cystic mass of 2 x 2 cm in size, which moves with deglutition and tongue protrusion. No other significant finding observed. Which of the following is the definitive management for this condition:

Accepted Answer

Sistrunk's operation

Answer

Steroid injection into the cyst

Answer

Surgical removal of cyst

Answer

Reassure the patient and regular follow-up

Question 2

Speech problems in cleft palate patients are due to

Accepted Answer

Inability of soft palate to stop air from going into nasopharynx

Answer

Defect in learning process

Answer

Lisping of tongue

Answer

All of the above

Question 3

Which of the following conditions are not indicated for surgical exposure of orbital floor in ZMC fracture?

Accepted Answer

Oedema

Answer

Enophthalmos

Answer

Diplopia

Answer

Non-resolving oculocardiac reflex

Question 4

Pleomorphic adenomas arising from the minor salivary glands can be treated with

Accepted Answer

Local excision with 5mm margin

Answer

Chemotherapy

Answer

Local excision with 2mm margin

Answer

Radiotherapy

Question 5

Le Fort II facial fracture implies:

Accepted Answer

Fracture running through zygomatic process of the maxilla, floor of orbit, and root of nose bilaterally

Answer

Fracture running through alveolar ridge

Answer

Fracture running through midline of the palate and zygomatico-maxillary suture

Answer

Bilateral fracture involving multiple facial bones with midface mobility

Question 6

What does a Commando operation describe?

Accepted Answer

Mandibulectomy, Neck dissection, Oropharyngeal resection

Answer

Mandibulectomy, Neck dissection, Omohyoid muscle removal

Answer

Maxillectomy, Neck dissection, Omohyoid muscle removal

Answer

Combined maxillectomy and mandibulectomy

Question 7

In periodontal surgical treatment, which of the following surgical procedures are typically carried out first:

Accepted Answer

Flap surgery

Answer

Gingivectomy

Answer

Osseous recontouring

Answer

Mucogingival surgery

Question 8

Paresthesia is seen with which of the following types of fractures:

Accepted Answer

Zygomatico maxillary

Answer

Coronoid process

Answer

Subcondylar

Answer

Symphyseal

Question 9

Which of the following statements about branchial cyst is FALSE?

Accepted Answer

It is found at the anterior border of lower third of sternocleidomastoid muscle.

Answer

It is usually lined by squamous epithelium.

Answer

Treatment involves complete excision.

Answer

It develops from the remnants of 2nd branchial cleft.

Question 10

A patient has carcinoma on the right side of anterior 2/3rd of the tongue with lymph node of size 4cm in level 3 on the left side of the neck. Stage of the disease is

Accepted Answer

N2

Answer

N0

Answer

N3

Answer

N1

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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