Head and Neck Surgery Practice Questions

Q: All of the following statements about Zenker's diverticulum are true except.

It is a true diverticulum.. ***It is a true diverticulum.*** - A Zenker's diverticulum is a **false diverticulum**, meaning it involves an outpouching of only the **mucosa and submucosa** through a defect in the muscular layer, not all layers of the esophageal wall. - **True diverticula** contain all layers of the esophageal wall (mucosa, submucosa, and muscularis propria), whereas a Zenker's diverticulum lacks the muscular layer in its wall. *Acquired diverticulum* - Zenker's diverticulum is an **acquired condition**, typically developing later in life due to increased pressure and discoordination of the pharyngeal muscles. - It results from a herniation of the pharyngeal mucosa through a weak point, the **Killian's triangle**, due to prolonged high intraluminal pressure. *Lateral X-rays on Barium swallow are often diagnostic.* - A **barium swallow** is the diagnostic procedure of choice, clearly visualizing the posterior outpouching of the pharyngeal wall. - **Lateral views** are particularly effective in demonstrating the location and size of the diverticulum, distinguishing it from other esophageal abnormalities. *Outpouching of the posterior pharyngeal wall, just above the cricopharyngeus muscle.* - Zenker's diverticulum is specifically located in the **Killian's triangle**, a weak area in the posterior wall of the pharynx superior to the **cricopharyngeus muscle**. - This anatomical position explains why it causes symptoms such as **dysphagia**, regurgitation of undigested food, and halitosis due to food accumulation.

Q: The most common site of metastasis from the mandibular sarcoma is

Lung. ***Lung*** - The **lungs** are the most common site for distant metastasis of sarcomas, including those originating from the **mandible**. - This is due to the **hematogenous spread** of tumor cells, which travel through the bloodstream and often lodge in the pulmonary capillaries. *Liver* - While the liver can be a site of metastasis for some cancers, it is less common for **sarcomas** compared to the lungs. - Liver metastases are more frequently seen with carcinomas of the **gastrointestinal tract**. *Spleen* - The **spleen** is a rare site for metastasis from any type of cancer, including sarcoma. - Its rich lymphoid tissue and unique vasculature may contribute to its relative resistance to metastatic colonization. *Heart* - Metastasis to the **heart** is also very rare, often occurring in advanced-stage cancers. - When it does occur, it is usually from cancers like **melanoma** or **lung carcinoma**, not typically sarcomas from the mandible.

Q: Which of the following rods is not used with a dental surveyor in prosthodontics?

Incisal guide pin. ***Incisal guide pin*** - An **incisal guide pin** is used with an **articulator** to maintain the vertical dimension of occlusion and guide incisal movements, not with a dental surveyor. - Its purpose is to control the separation of the casts during articulation, unrelated to identifying undercuts or path of insertion. *Analyzing rod* - The **analyzing rod** is a component of a dental surveyor used to visually determine the **undercuts** and the most favorable path of insertion/removal for a removable partial denture. - It is typically a straight, tapered rod that helps in identifying desirable and undesirable undercuts on abutment teeth and soft tissues. *Carbon marker* - The **carbon marker** (or marking rod) is used with the dental surveyor to **mark the height of contour** on the abutment teeth. - This line indicates where the retentive arm of a clasp assembly will be placed relative to the non-retentive arm and helps design the denture base. *Surveying table* - The **surveying table** is not a rod but rather the **platform on which the cast is mounted and tilted** during surveying. - It allows for precise angulation of the cast to establish the desired path of insertion and removal for the prosthesis.

Q: The most common site for a thyroglossal cyst is

Subhyoid. ***Subhyoid*** - The **thyroglossal duct** normally descends from the foramen cecum at the base of the tongue to the future thyroid gland location, usually in front of the trachea [1], [2]. - The most common site for a **thyroglossal cyst** to persist due to incomplete regression of this duct is in the **subhyoid region**, just below the hyoid bone. - Accounts for approximately **65-75%** of all thyroglossal cysts. *Suprahyoid* - While thyroglossal cysts can occur anywhere along the embryological descent path of the thyroid gland, the **suprahyoid region** (above the hyoid bone) is the second most common location, accounting for about 20-25% of cases [2]. - Cysts in this region might be closer to the base of the tongue but are not the most frequent site. *Floor of mouth* - A thyroglossal cyst would be an **extremely rare finding** in the floor of the mouth, as this is significantly higher than the typical path of the thyroglossal duct [3]. - Lesions in the floor of the mouth are more commonly ranulas or dermoid cysts. *Level of cricoid* - Cysts at the **level of the cricoid cartilage** would be considered a less common presentation for a thyroglossal cyst. - This location is lower than the usual subhyoid presentation, although still along the general path of the descending thyroid gland.

Q: If posterior epistaxis cannot be controlled, which artery is ligated?

Sphenopalatine artery. ***Sphenopalatine artery*** - The **sphenopalatine artery** is the primary blood supply to the posterior nasal cavity, making its ligation highly effective for persistent **posterior epistaxis**. - It is a terminal branch of the **maxillary artery** and enters the nasal cavity through the sphenopalatine foramen. *Maxillary artery* - While the **maxillary artery** is the parent vessel of the sphenopalatine artery, ligating it further upstream can be more invasive and carry higher risks. - Ligation of the **sphenopalatine artery** directly addresses the most common source of posterior bleeding with less morbidity. *External carotid artery* - The **external carotid artery** is the main source of blood for the internal maxillary artery which gives origin to the sphenopalatine artery. - Ligation at this level is a more proximal and generalized intervention that might not be specific enough for intractable posterior epistaxis and can affect other vascular territories. *Posterior ethmoidal artery* - The **posterior ethmoidal artery** supplies a smaller, more superior portion of the posterior nasal cavity and is less frequently the primary source of severe posterior epistaxis. - Ligation of the ethmoidal arteries is typically reserved for cases where anterior or superior bleeding is refractory, not standard posterior epistaxis.

Question 1

All of the following statements about Zenker's diverticulum are true except.

Accepted Answer

It is a true diverticulum.

Answer

Acquired diverticulum

Answer

Lateral X-rays on Barium swallow are often diagnostic.

Answer

Outpouching of the posterior pharyngeal wall, just above the cricopharyngeus muscle.

Question 2

The most common site of metastasis from the mandibular sarcoma is

Accepted Answer

Lung

Answer

Liver

Answer

Spleen

Answer

Heart

Question 3

What is the most effective management strategy for osteoradionecrosis?

Accepted Answer

Combination of hyperbaric oxygen therapy and surgical removal of necrotic bone

Answer

Hyperbaric oxygen therapy

Answer

Fluoride treatment

Answer

Surgical removal of necrotic bone

Question 4

Which of the following rods is not used with a dental surveyor in prosthodontics?

Accepted Answer

Incisal guide pin

Answer

Surveying table

Answer

Carbon marker

Answer

Analyzing rod

Question 5

The most common site for a thyroglossal cyst is

Accepted Answer

Subhyoid

Answer

Suprahyoid

Answer

Floor of mouth

Answer

Level of cricoid

Question 6

If posterior epistaxis cannot be controlled, which artery is ligated?

Accepted Answer

Sphenopalatine artery

Answer

External carotid artery

Answer

Posterior ethmoidal artery

Answer

Maxillary artery

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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