Head and Neck Surgery Practice Questions

Q: All of the following are indications for tracheostomy except ?

Superior laryngeal nerve palsy. ***Superior laryngeal nerve palsy*** - While superior laryngeal nerve palsy can cause **hoarseness** and **dysphagia** due to impaired laryngeal sensation and cricothyroid muscle function, it typically does not directly lead to **airway obstruction** requiring a tracheostomy. - The primary concern with this condition is often **aspiration risk**, which is usually managed through compensatory swallowing techniques or dietary modifications, not surgical airway establishment. *Coma after head injury* - Patients in a **prolonged coma** or with severe **neurological impairment** often lose their protective airway reflexes (e.g., cough, gag reflex), increasing the risk of **aspiration** and making **pulmonary toilet** difficult. - A tracheostomy provides a secure, long-term airway for **ventilatory support**, suctioning, and protection against aspiration in these patients. *Maxillofacial injury* - Severe **maxillofacial trauma** can cause significant **airway obstruction** due to edema, hemorrhage, or anatomical disruption of the upper airway structures. - In such cases, a tracheostomy may be necessary to bypass the obstructed area and establish a **stable airway** for respiration. *Bilateral abductor palsy* - **Bilateral abductor palsy** results in failed abduction of both vocal cords, leading to a fixed, adducted position of the vocal cords that can cause severe or complete **airway obstruction**. - This condition is a direct and urgent indication for tracheostomy to ensure an **open airway**.

Q: Which of the following cancers do not present with cervical lymph node involvement?

Glottic Cancer. ***Glottic Cancer*** - **Glottic cancers** rarely present with cervical lymph node involvement because the **vocal cords** have a sparse lymphatic drainage system. - This anatomical feature limits the early spread of cancer cells to regional lymph nodes, distinguishing it from other head and neck cancers. *Subglottic Cancer* - **Subglottic cancers** frequently metastasize to cervical lymph nodes, specifically the **paratracheal** and **prelaryngeal nodes**, due to a richer lymphatic network. - The disease often presents at a more advanced stage because symptoms may be subtle until significant tumor burden or nodal involvement occurs. *Papillary thyroid cancer* - **Papillary thyroid cancer** commonly metastasizes to the cervical lymph nodes, often presenting with palpable **lymphadenopathy** even with small primary tumors. - Lymphatic spread is a hallmark feature, and **central neck dissection** is frequently performed as part of the surgical treatment. *Oral cancer* - **Oral cancers** (e.g., squamous cell carcinoma of the tongue, buccal mucosa) have a high propensity for early metastasis to **cervical lymph nodes**. - The rich lymphatic drainage of the oral cavity means that cervical lymph node involvement is a significant prognostic factor and is routinely assessed during staging.

Q: Which of the following statements is true about branchial cysts?

They mostly arise from the second branchial cleft.. ***They mostly arise from the second branchial cleft.*** - **Second branchial cleft cysts** are the most common type, accounting for approximately **95%** of all branchial anomalies. - They typically present as a smooth, fluctuant mass along the **anterior border of the sternocleidomastoid muscle** at the junction of the upper and middle third of the neck. - These cysts result from **incomplete obliteration** of the second branchial cleft during embryonic development. *Branchial cysts are more common in males than females.* - Branchial cysts have **no significant sex predilection**, affecting males and females with roughly equal frequency. - The overall incidence is relatively rare, with most cases presenting in late childhood or early adulthood. *Surgical intervention is not always necessary.* - **Complete surgical excision** is the **definitive treatment** and is strongly recommended for all branchial cysts. - Indications for surgery include: prevention of **recurrent infections**, risk of **abscess formation**, elimination of cosmetic concerns, and removal due to potential (though rare) **malignant transformation**. - While very small asymptomatic cysts may occasionally be observed, this carries significant risk of future complications, making surgery the standard of care in clinical practice. *They can cause dysphagia and hoarseness if infected.* - While an **infected branchial cyst** causes local inflammatory signs (pain, swelling, warmth, erythema), it **rarely causes dysphagia or hoarseness** unless exceptionally large. - These symptoms would require the cyst to compress the **pharynx** (dysphagia) or involve the **recurrent laryngeal nerve** (hoarseness), which is uncommon even with infection. - The primary presentation of infected cysts includes **tender neck mass** with overlying skin changes and possible **abscess formation**.

Q: Commonest site of carcinoma tongue -

Lateral borders. ***Lateral borders*** - The **lateral borders** of the tongue are the most common site for squamous cell carcinoma due to chronic irritation from teeth, dental appliances, and exposure to carcinogens. - This area is subjected to considerable mechanical stress and chemical exposure, making it more susceptible to malignant transformation. *Apical* - While the apex (tip) of the tongue can be affected, it is **less common** compared to the lateral borders. - Tumors in this location may present earlier due to their prominent position, but incidence rates are lower. *Dorsum* - The **dorsum** (top surface) of the tongue is covered by papillae which provide some protective barrier, making it a **less frequent site** for carcinoma. - Carcinomas on the dorsum are often associated with other risk factors like syphilis or immunosuppression. *Posterior 1/3* - Carcinomas of the **posterior one-third** (base of the tongue) are often associated with **Human Papillomavirus (HPV)** infection. - These are typically harder to detect early due to their location and may present with different symptoms such as dysphagia or referred otalgia, but they are not the most common overall site.

Q: What conditions are treated by Sistrunk's operation?

Thyroglossal duct cyst. ***Thyroglossal duct cyst*** - The **Sistrunk procedure** is the surgical excision of a **thyroglossal duct cyst**, including the central portion of the hyoid bone and a core of tissue extending to the foramen cecum. - This extensive removal is necessary to prevent recurrence by eradicating any remnants of the **thyroglossal tract**, which is the developmental pathway of the thyroid gland. *Parotid tumor* - **Parotid tumors** are usually treated by different surgical procedures, such as **parotidectomy** (superficial or total), depending on the tumor's size and nature. - The surgical approach for parotid tumors involves careful dissection to preserve the **facial nerve**, which is anatomically distinct from the thyroid region. *Thyroglossal fistula* - While a **thyroglossal fistula** can result from an infected or ruptured **thyroglossal duct cyst**, the primary condition treated by Sistrunk's operation is the cyst itself, aiming to prevent both recurrence and fistula formation. - The Sistrunk procedure addresses the entire anatomical remnant, which is crucial for preventing not just fistula but also future cyst formation. *None of the options* - This option is incorrect because **Sistrunk's operation** is specifically designed for the definitive treatment of a **thyroglossal duct cyst**. - The procedure's detailed technique directly corresponds to the embryonic origins and potential recurrence pathways of this specific midline neck mass.

Q: Which levels of cervical lymph nodes are included in a modified radical neck dissection?

I-V. ***I-V*** - A modified radical neck dissection typically removes lymph nodes from levels **I through V**, along with preservation of one or more non-lymphatic structures (sternocleidomastoid muscle, internal jugular vein, or spinal accessory nerve). - This extensive dissection addresses potential metastasis to these node groups from head and neck cancers, crucial for adequate oncologic clearance while aiming for functional preservation. *I-III* - This limited dissection would likely be insufficient for many head and neck cancers, as spread often extends beyond level III. - It would miss potential metastases in the lower jugular and posterior triangle nodes, increasing the risk of recurrence. *I-IV* - This dissection omits **level V**, which includes the posterior triangle nodes, a common site for metastatic spread, especially for cancers of the oropharynx, hypopharynx, and thyroid. - Excluding level V would be considered an incomplete radical or modified radical neck dissection in many clinical scenarios. *II-VI* - This option incorrectly excludes lymph nodes at **level I** (submental and submandibular nodes), which are critical draining sites for many oral cavity cancers. - Including level VI (anterior compartment nodes) is typically part of a central compartment neck dissection, often performed for thyroid cancer, but is usually not part of a standard modified radical neck dissection for other head and neck primaries unless specifically indicated.

Q: Which part of the mandible is most commonly fractured?

Angle of mandible. ***Angle of mandible*** - The **angle of the mandible** is a common site for fractures due to its anatomical position and the forces it experiences during trauma. - This area is relatively weaker than other parts and is often impacted during direct blows to the jaw. *Body of mandible* - While fractures of the **mandibular body** can occur (often in the canine region), they are less frequent than those at the angle. - The body of the mandible is generally a robust structure, making fractures here typically result from higher-impact trauma. *Condylar process of mandible* - Fractures of the **condylar process** are very common, especially in children, and are often associated with indirect trauma. - However, the angle region still holds the highest frequency of fractures due to direct impact and leverage forces. *Coronoid process of mandible* - Fractures of the **coronoid process** are relatively rare and usually occur as part of a more extensive mandibular fracture or due to direct trauma to the temporal region. - Its protected position beneath the zygomatic arch makes it less susceptible to isolated injury.

Question 1

All of the following are indications for tracheostomy except ?

Accepted Answer

Superior laryngeal nerve palsy

Answer

Coma after head injury

Answer

Maxillofacial injury

Answer

Bilateral abductor palsy

Question 2

Which of the following cancers do not present with cervical lymph node involvement?

Accepted Answer

Glottic Cancer

Answer

Papillary thyroid cancer

Answer

Oral cancer

Answer

Subglottic Cancer

Question 3

Which of the following statements is true about branchial cysts?

Accepted Answer

They mostly arise from the second branchial cleft.

Answer

Branchial cysts are more common in males than females.

Answer

Surgical intervention is not always necessary.

Answer

They can cause dysphagia and hoarseness if infected.

Question 4

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 5

What causes Frey's syndrome?

Accepted Answer

Aberrant regeneration of parasympathetic fibers from the auriculotemporal nerve to sweat glands.

Answer

Facial nerve damage.

Answer

Greater auricular nerve involvement.

Answer

None of the options

Question 6

Which fracture pattern is classified as a Le Fort I fracture?

Accepted Answer

Horizontal fracture of the maxilla separating teeth from upper jaw

Answer

Pyramidal fracture involving maxilla and nasal bones

Answer

Complete craniofacial separation involving the upper face

Answer

Isolated nasal bone fracture

Question 7

What is the surgical procedure known as the 'Commando operation' primarily used for?

Accepted Answer

Excision of carcinoma of the tongue, the floor of the mouth, part of the jaw and lymph nodes en bloc

Answer

Disarticulation of the hip due to gas gangrene

Answer

Extended radical mastectomy for breast cancer

Answer

Abdomino-perineal resection for rectal carcinoma

Question 8

What conditions are treated by Sistrunk's operation?

Accepted Answer

Thyroglossal duct cyst

Answer

Parotid tumor

Answer

Thyroglossal fistula

Answer

None of the options

Question 9

Which levels of cervical lymph nodes are included in a modified radical neck dissection?

Accepted Answer

I-V

Answer

I-IV

Answer

I-III

Answer

II-VI

Question 10

Which part of the mandible is most commonly fractured?

Accepted Answer

Angle of mandible

Answer

Body of mandible

Answer

Coronoid process of mandible

Answer

Condylar process of mandible

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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