Head and Neck Surgery — MCQs

Head and Neck Surgery Indian Medical PG Practice Questions and MCQs

Question 391: What does a Commando operation describe?

A. Mandibulectomy, Neck dissection, Oropharyngeal resection (Correct Answer)
B. Mandibulectomy, Neck dissection, Omohyoid muscle removal
C. Maxillectomy, Neck dissection, Omohyoid muscle removal
D. Combined maxillectomy and mandibulectomy

Explanation: ***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.

Question 392: One of the most important complication of tracheostomy is:

A. Hemorrhage
B. Surgical emphysema
C. Displacement of tube (Correct Answer)
D. Recurrent laryngeal nerve palsy

Explanation: ***Displacement of tube*** - **Accidental decannulation** or displacement of the tracheostomy tube is considered one of the most serious and common complications, particularly in the immediate post-operative period. - This can lead to **loss of airway**, requiring immediate intervention to prevent severe hypoxia and potential brain injury or death. *Hemorrhage* - While hemorrhage can occur during or after tracheostomy, it is often a concern during the procedure or in the immediate postoperative period and is usually managed effectively. - Significant, life-threatening hemorrhage such as **tracheo-innominate fistula** is a rare but severe complication. *Surgical emphysema* - Surgical emphysema (subcutaneous emphysema) is a relatively common but usually benign complication that occurs when air leaks from the trachea into the subcutaneous tissues. - It typically resolves spontaneously and rarely poses a direct threat to the airway unless severe and rapidly progressive. *Recurrent laryngeal nerve palsy* - **Recurrent laryngeal nerve injury** is a rare complication of tracheostomy, as the nerve is usually well clear of the incision site in the neck. - While it can cause hoarseness or vocal cord paralysis, it typically does not present an immediate life-threatening situation or emergency comparable to airway compromise.

Question 393: In periodontal surgical treatment, which of the following surgical procedures are typically carried out first:

A. Gingivectomy
B. Flap surgery (Correct Answer)
C. Osseous recontouring
D. Mucogingival surgery

Explanation: ***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.

Question 394: Paresthesia is seen with which of the following types of fractures:

A. Zygomatico maxillary (Correct Answer)
B. Coronoid process
C. Subcondylar
D. Symphyseal

Explanation: ***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.

Question 395: In carcinoma of lower lip secondaries are seen in:

A. Preauricular LN
B. Supraclavicular LN
C. Submandibular LN (Correct Answer)
D. Mediastinal LN

Explanation: ***Submandibular LN*** - The **lower lip** drains primarily into the **submental** and **submandibular lymph nodes**. - Therefore, **metastasis** from lower lip carcinoma is most commonly found in the submandibular lymph nodes. *Preauricular LN* - **Preauricular lymph nodes** typically drain the **temporal region**, **forehead**, and sometimes the **outer ear**. - They are not the primary drainage site for the lower lip. *Supraclavicular LN* - **Supraclavicular lymph nodes** receive drainage from the neck, upper chest, and sometimes abdominal or pelvic malignancies. - While possible in advanced cases, they are not the initial or most common site for metastasis from lower lip carcinoma. *Mediastinal LN* - **Mediastinal lymph nodes** are located in the chest and primarily drain the lungs, esophagus, and other thoracic organs. - Metastasis to these nodes from a lower lip carcinoma would indicate very advanced disease and is not a common primary site.

Question 396: Which of the following statements about branchial cyst is FALSE?

A. It is usually lined by squamous epithelium.
B. Treatment involves complete excision.
C. It develops from the remnants of 2nd branchial cleft.
D. It is found at the anterior border of lower third of sternocleidomastoid muscle. (Correct Answer)

Explanation: ***It is found at the anterior border of lower third of sternocleidomastoid muscle.*** - Branchial cysts are typically found at the **anterior border of the upper or middle third** of the sternocleidomastoid muscle. - Their classical location is near the **angle of the mandible** and anterior to the sternocleidomastoid. *It is usually lined by squamous epithelium.* - Branchial cleft cysts most commonly arise from the second branchial cleft and are indeed typically lined by **stratified squamous epithelium**. - In some cases, columnar or ciliated epithelium may also be present, especially if there's an internal sinus tract. *Treatment involves complete excision.* - The definitive treatment for a branchial cyst is **complete surgical excision** to prevent recurrence and potential complications. - Incomplete removal can lead to recurrence, infection, or the development of a chronic draining sinus. *It develops from the remnants of 2nd branchial cleft.* - Over 90% of branchial cysts originate from the **incomplete obliteration of the second branchial cleft**. - This developmental anomaly results in a persistent epithelial-lined tract or cyst in the neck.

Question 397: 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

A. N0
B. N3
C. N2 (Correct Answer)
D. N1

Explanation: ***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 398: Which of the following is an inappropriate indication for concomitant chemotherapy in cases of head and neck cancer?

A. Metastatic advanced head and neck cancer (Correct Answer)
B. As an organ-preserving method of treatment
C. Primary treatment for patients with unresectable disease
D. Postoperative case of intermediate stage resectable tumor

Explanation: ***Metastatic advanced head and neck cancer*** - While chemotherapy is used in metastatic head and neck cancer, the term "concomitant chemotherapy" implies simultaneous administration with radiation therapy. For **metastatic disease**, the primary treatment strategy is usually **systemic chemotherapy** or targeted therapy, not necessarily concomitant with radiation to a local site with curative intent. - Concomitant chemoradiation is primarily used for **locally advanced, non-metastatic disease** to improve local control and survival, not typically for systemic metastatic disease where the goal is palliation or systemic control. *As an organ-preserving method of treatment* - Concomitant chemoradiation is a well-established strategy for organ preservation, particularly in advanced laryngeal and pharyngeal cancers, allowing patients to avoid **laryngectomy** or extensive surgical resections while achieving similar oncologic outcomes. - This approach aims to maintain **swallowing and speech function** by reducing tumor burden and eradicating microscopic disease. *Primary treatment for patients with unresectable disease* - For **unresectable locally advanced head and neck cancers**, concomitant chemoradiation is often considered the **definitive primary treatment** to achieve local control and improve survival outcomes. - Surgery is not feasible in these cases due to tumor extent or involvement of critical structures, making chemoradiation the best curative option. *Postoperative case of intermediate stage resectable tumor* - **Adjuvant concomitant chemoradiation** is indicated postoperatively for resected tumors with high-risk features such as **extracapsular extension (ECE)** or positive surgical margins, even in intermediate stages. - This is done to eradicate microscopic residual disease and reduce the risk of **local-regional recurrence**.

Question 399: Lymph node metastasis in neck is almost never seen with:

A. Carcinoma vocal cords (Correct Answer)
B. Supraglottic carcinoma
C. Carcinoma of tonsil
D. Papillary carcinoma thyroid

Explanation: ***Carcinoma vocal cords*** - The **vocal cords** are relatively poor in lymphatic drainage, which significantly reduces the likelihood of regional lymph node metastasis. - Due to this sparse lymphatic network, spread to cervical lymph nodes is rare, especially in early-stage disease. *Supraglottic carcinoma* - **Supraglottic** regions have a rich lymphatic network, leading to a high incidence of cervical lymph node metastasis, even in early stages. - Bilateral lymphatic drainage further increases the risk of nodal involvement. *Carcinoma of tonsil* - The **tonsils** are richly supplied with lymphatic vessels, making them prone to early and frequent metastasis to cervical lymph nodes. - Metastasis is often seen in levels II, III, and IV of the neck. *Papillary carcinoma thyroid* - **Papillary thyroid carcinoma** commonly metastasizes to regional lymph nodes, with documented rates as high as 30-80%. - Nodal metastasis can occur in the central compartment (level VI) and lateral neck (levels II-V).

Question 400: Most mucostatic impression material among the following is:

A. Alginate
B. Impression compound
C. ZOE paste (Correct Answer)
D. Elastomer

Explanation: ***ZOE paste*** - **Zinc Oxide-Eugenol (ZOE) paste** is a **mucostatic impression material**, meaning it records the soft tissues in their resting, undisplaced state. - Its low viscosity and slow setting time allow the material to flow gently over the tissues without compressing them, making it ideal for **edentulous ridges** to capture detailed anatomy without distortion. *Alginate* - **Alginate** is a **mucocompressive** impression material, meaning it displaces soft tissues due to its higher viscosity during insertion and setting. - It is commonly used for diagnostic casts and study models where some tissue displacement is acceptable, but not for definitive impressions requiring a mucostatic record. *Impression compound* - **Impression compound** is a **thermoplastic** material that is highly **mucocompressive** as it is manipulated in a plastic state and can deform soft tissues during impression taking. - It is often used for border molding or preliminary impressions where some tissue displacement can help define the periphery of a denture. *Elastomer* - **Elastomers** (e.g., silicone, polyether) can be both **mucostatic** or **mucocompressive** depending on their viscosity and the technique used for impression taking. - While some low-viscosity elastomers can be used mucostatically, many common elastomeric techniques involve moderate pressure, leading to some tissue displacement.

Practice by Chapter

Salivary Gland Diseases

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Thyroid Gland Disorders

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Parathyroid Gland Disorders

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Neck Masses Evaluation

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Oral Cavity Lesions

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Laryngeal Disorders

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Head and Neck Cancer

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Reconstructive Techniques in Head and Neck Surgery

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Surgical Management of Sleep Apnea

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Airway Management in Head and Neck Surgery

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Surgical Approaches to the Neck

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Neck Dissection Techniques

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