Head and Neck Surgery Practice Questions

Q: Mark the FALSE statement related to tracheostomy:

Most commonly performed tracheostomy is low-tracheostomy.. ***Most commonly performed tracheostomy is low-tracheostomy.*** - This statement is **false**. The most commonly performed tracheostomy is a **mid-tracheostomy**, which involves incising the trachea at the level of the second, third, or fourth tracheal rings. - Low tracheostomy is less common due to the increased risk of complications associated with its proximity to central vessels and structures in the superior mediastinum. *Pneumothorax is a complication of mid and low tracheostomy.* - This statement is **true**. **Pneumothorax** is a recognized complication of tracheostomy, particularly with mid and low approaches, due to potential injury to the pleura. - The risk increases with lower incisions due to the proximity of the pleural domes and apex of the lungs. *In vocal cord palsy and subglottic stenosis, mid tracheostomy is planned.* - This statement is **true**. For conditions like **bilateral vocal cord palsy** or **subglottic stenosis** that cause upper airway obstruction, a **mid-tracheostomy** is the preferred approach. - This level (2nd-4th tracheal rings) provides adequate access for airway management while avoiding vital structures and the subglottic pathology. *High tracheostomy is performed above the second tracheal ring and may be needed in emergency situations.* - This statement is **true**. **High tracheostomy** involves incision above the second tracheal ring and can be performed in emergency situations requiring rapid airway access. - It may also be considered when there is pathology in the mid or lower trachea, though it carries higher risk of subglottic stenosis.

Q: Treatment of choice in complete traumatic facial nerve transection is:

Facial nerve repair. ***Facial nerve repair*** - In cases of **traumatic facial nerve injury** where there is a clear transection or significant damage, surgical repair (e.g., direct anastomosis or nerve grafting) is the gold standard to restore function. - The goal is to re-establish neural continuity as soon as possible to prevent **irreversible muscle denervation** and improve functional outcomes. *Facial sling* - A **facial sling** is a palliative procedure used for long-standing facial paralysis, often when nerve repair is not possible or has failed, to provide static support to the affected side of the face. - It does not address the underlying nerve damage or aim to restore active facial movement. *Conservative management* - **Conservative management** is appropriate for non-traumatic causes of facial palsy (e.g., Bell's palsy) or mild traumatic injuries where nerve continuity is presumed intact and swelling is the primary issue. - It involves observation and sometimes medication but does not repair a transected nerve. *Systemic corticosteroids* - **Systemic corticosteroids** are primarily used in inflammatory conditions causing facial nerve palsy, such as **Bell's palsy**, to reduce swelling and inflammation around the nerve. - They are not a treatment for direct physical damage or transection of the facial nerve due to trauma.

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: Hynes pharyngoplasty is used to improve a child's?

Speech. ***Speech*** - Hynes pharyngoplasty is a surgical procedure specifically designed to correct **velopharyngeal insufficiency (VPI)**, which is a common cause of **hypernasal speech**. - By reshaping the soft palate and pharynx, it helps create a better seal during speech, thus improving **oral resonance** and reducing air escaping through the nose. *Teething* - **Teething** refers to the process of teeth erupting through the gums, which is a normal developmental stage in infants. - Surgical intervention like Hynes pharyngoplasty is unrelated to the **eruption of teeth**. *Feeding* - While velopharyngeal insufficiency can sometimes contribute to **feeding difficulties** (e.g., nasal regurgitation), Hynes pharyngoplasty's primary goal is not to improve overall feeding mechanics. - Surgical interventions for feeding issues often address different anatomical structures or neurological deficits impacting **swallowing** or suck-swallow-breathe coordination. *Appearance* - Although some craniofacial anomalies that lead to VPI might also affect appearance (e.g., cleft palate), Hynes pharyngoplasty is solely focused on **functional improvement of speech**. - It does not significantly alter the **external facial appearance** of the child.

Q: Time of occurrence of secondary haemorrhage after tonsillectomy -

6 days. ***6 days*** - **Secondary hemorrhage** after tonsillectomy typically occurs **5-10 days post-surgery**, making 6 days a common presentation time. - This timing is often due to **infection** causing vessel erosion or sloughing of the **fibrin clot** before mucosal healing is complete. *24 hrs* - Hemorrhage within the first **24 hours** is classified as **primary or reactionary hemorrhage** and is usually due to inadequate hemostasis during surgery or dislodgement of a clot. - This occurs much earlier than secondary hemorrhage. *12 hrs* - Similar to 24 hours, **12 hours** post-surgery falls within the window for **primary or reactionary hemorrhage**. - This timeframe is too early for the typical onset of secondary hemorrhage. *12 days* - While late bleeding can occur, **12 days** post-tonsillectomy is **less common** for secondary hemorrhage compared to the 5-10 day window. - By this point, significant mucosal healing would have usually occurred, reducing the risk of a secondary bleed.

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: Reactionary hemorrhage in case of tonsillectomy is hemorrhage occurring-

Within 24 hours of surgery. ***Within 24 hours of surgery*** - **Reactionary hemorrhage** occurs specifically within the first **24 hours** after tonsillectomy, typically once the initial vasoconstriction from adrenaline in local anesthetic wears off or due to a rise in blood pressure. - This is a form of **primary hemorrhage**, meaning it happens close to the time of the operation. *Within 6 hours of surgery* - While hemorrhage can occur within the first 6 hours, the definition of **reactionary hemorrhage** encompasses the full **24-hour period** post-surgery. - Limiting it to 6 hours would be too narrow and exclude many cases correctly categorized as reactionary. *Between 2- 7 days* - Hemorrhage occurring between 2 and 7 days post-tonsillectomy is classified as **secondary hemorrhage**, often due to infection or sloughing of the eschar. - This timing is distinct from **reactionary hemorrhage**, which is an early complication. *Between 1 -2 weeks* - Bleeding occurring between 1 to 2 weeks post-tonsillectomy also falls under the category of **secondary hemorrhage**. - This late bleeding is usually associated with the separation of the fibrin clot or infection and is not considered reactionary.

Question 1

Mark the FALSE statement related to tracheostomy:

Accepted Answer

Most commonly performed tracheostomy is low-tracheostomy.

Answer

Pneumothorax is a complication of mid and low tracheostomy.

Answer

In vocal cord palsy and subglottic stenosis, mid tracheostomy is planned.

Answer

High tracheostomy is performed above the second tracheal ring and may be needed in emergency situations.

Question 2

Treatment of choice in complete traumatic facial nerve transection is:

Accepted Answer

Facial nerve repair

Answer

Facial sling

Answer

Conservative management

Answer

Systemic corticosteroids

Question 3

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 4

Hynes pharyngoplasty is used to improve a child's?

Accepted Answer

Speech

Answer

Teething

Answer

Feeding

Answer

Appearance

Question 5

Time of occurrence of secondary haemorrhage after tonsillectomy -

Accepted Answer

6 days

Answer

24 hrs

Answer

12 hrs

Answer

12 days

Question 6

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 7

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 8

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 9

Reactionary hemorrhage in case of tonsillectomy is hemorrhage occurring-

Accepted Answer

Within 24 hours of surgery

Answer

Within 6 hours of surgery

Answer

Between 2-7 days

Answer

Between 1-2 weeks

Question 10

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

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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