Head and Neck Surgery — MCQs

Head and Neck Surgery Indian Medical PG Practice Questions and MCQs

Question 451: For lower lip carcinoma of <1 cm in size, the treatment of choice will be:

A. Radiation
B. Chemotherapy
C. Excision (Correct Answer)
D. Radiation and chemotherapy

Explanation: ***Excision*** - For **small lesions (<1 cm)** of lower lip carcinoma, **surgical excision** with adequate margins is the standard and most effective treatment. - This approach offers excellent **local control** and allows for **histopathological evaluation** of the tumor and margins. *Radiation* - While radiation therapy can be effective for lip carcinoma, it is generally reserved for **larger tumors**, those with positive margins after excision, or patients who are **poor surgical candidates**. - For small lesions, surgical excision typically provides a better cosmetic and functional outcome with a single treatment. *Chemotherapy* - **Chemotherapy** is rarely used as a primary treatment for early-stage lower lip carcinoma; its role is usually limited to **advanced or metastatic disease**. - It does not offer the same local control as surgery or radiation for small, localized lesions. *Radiation and chemotherapy* - **Combined modality therapy** with radiation and chemotherapy is typically reserved for **locally advanced disease**, tumors with high-risk features, or patients with **nodal involvement**. - For a small lesion (<1 cm), this approach would be **overtreatment** and expose the patient to unnecessary side effects.

Question 452: Which of the following statements about Zenker's diverticulum is false?

A. Most patients are above 50 years of age
B. Mucosal outpouching through the Killian's triangle
C. It is the most common esophageal diverticulum (Correct Answer)
D. Halitosis is commonly associated with Zenker's diverticulum

Explanation: ***It is the most common esophageal diverticulum*** - This statement is **false**. Zenker's diverticulum is the most common type of **pharyngoesophageal diverticulum**, not esophageal diverticulum. - **Midesophageal diverticula** (traction diverticula) and **epiphrenic diverticula** are types of true esophageal diverticula that are more common than Zenker's diverticulum. *Most patients are above 50 years of age* - This statement is **true**. Zenker's diverticulum is typically a disease of **older individuals**, with most patients presenting over the age of 50. - It results from **cricopharyngeal muscle dysfunction** and increased intraluminal pressure over time. *Mucosal outpouching through the Killian's triangle* - This statement is **true**. Zenker's diverticulum is a **false diverticulum**, meaning it involves only the mucosa and submucosa. - It protrudes through **Killian's triangle**, a weak area between the cricopharyngeal muscle and the thyropharyngeal muscle. *Halitosis is commonly associated with Zenker's diverticulum* - This statement is **true**. Food and debris can become trapped within the diverticulum. - The decaying material can lead to **bad breath** (halitosis) and a sour taste.

Question 453: Burr hole is done for -

A. Chronic subdural hematoma (SDH) (Correct Answer)
B. Intracerebral abscess
C. Hydrocephalus
D. Acute subdural hematoma (SDH)

Explanation: ***Chronic subdural hematoma (SDH)*** - Burr hole drainage is a standard and effective procedure for **chronic subdural hematomas**, especially in elderly patients, allowing the evacuation of encapsulated fluid. - The procedure can be performed under local anesthesia, offering a less invasive approach for chronic collections. *Acute subdural hematoma (SDH)* - Acute SDH typically requires a **craniotomy** for rapid and complete evacuation of the dense, clotted blood, due to its emergent nature and potential for rapid neurological deterioration. - Burr holes are generally insufficient for evacuating large, clotted acute hematomas because the blood is too thick to drain effectively. *Intracerebral abscess* - An intracerebral abscess usually requires either a **craniotomy with excision** or frameless stereotactic aspiration for drainage, to completely remove the abscess capsule and its contents. - Burr holes alone might be used for diagnostic aspiration but are usually inadequate for definitive treatment of an abscess due to the need for thorough evacuation and sometimes decapsulation. *Hydrocephalus* - Hydrocephalus, an accumulation of cerebrospinal fluid, is typically treated by inserting a **shunt system** (e.g., ventriculoperitoneal shunt) to divert the fluid from the brain to another body cavity. - While a burr hole is made to access the ventricle for shunt placement, it is not the definitive treatment for hydrocephalus itself; rather, it's a step in a more complex procedure.

Question 454: Which of the following sinuses is most commonly predisposed to malignancy?

A. Ethmoid
B. Maxillary (Correct Answer)
C. Frontal
D. Sphenoid

Explanation: ***Maxillary*** - The **maxillary sinus** is the most common site for **paranasal sinus malignancies**, accounting for approximately 80% of these cancers. - This predisposition is thought to be due to its large surface area and exposure to carcinogenic substances inhaled through the nasal cavity. *Ethmoid* - While the ethmoid sinus can be involved in malignancy, it ranks second to the **maxillary sinus** in terms of frequency. - Tumors originating here often present with ophthalmic symptoms due to its proximity to the orbit. *Frontal* - Malignancies of the **frontal sinus** are relatively rare compared to those in the maxillary and ethmoid sinuses. - Due to its location, symptoms might include forehead pain or swelling. *Sphenoid* - The **sphenoid sinus** is the least common site for paranasal sinus malignancies. - Tumors in this sinus are often difficult to diagnose early due to its deep and central location, with symptoms potentially involving cranial nerve palsies.

Question 455: Which of the following statements about Laryngeal carcinoma is false?

A. More common in females (Correct Answer)
B. After laryngectomy, esophageal voice can be used
C. Smoking is the most important risk factor
D. Common in patients over 40 years of age

Explanation: ***More common in females*** - This statement is **false** because laryngeal carcinoma is significantly **more common in males** than in females, with a male-to-female ratio of about 4:1. - The higher incidence in males is primarily attributed to higher rates of **smoking and alcohol consumption**, which are major risk factors. *After laryngectomy, esophageal voice can be used* - This statement is **true**; an **esophageal voice** is one method of voice rehabilitation after a total laryngectomy, where air is swallowed and then expelled to vibrate the pharyngoesophageal segment. - Other options for voice restoration include **tracheoesophageal puncture (TEP) with a voice prosthesis** and **electrolarynx**. *Smoking is the most important risk factor* - This statement is **true**; **smoking** is the single most significant modifiable risk factor for laryngeal carcinoma, increasing the risk by many-fold depending on duration and intensity. - **Alcohol consumption** acts synergistically with smoking to further elevate the risk. *Common in patients over 40 years of age* - This statement is **true**; laryngeal carcinoma predominantly affects individuals in **middle to older age groups**, with peak incidence typically occurring between 50 and 70 years. - The disease is rare in individuals under 40, although incidence in younger patients may be increasing due to rising **HPV-related oropharyngeal cancers**.

Question 456: Membrane incised during hemilaryngectomy is

A. Thyrohyoid membrane (Correct Answer)
B. Aryepiglottic fold
C. Cricothyroid membrane
D. Infralaryngeal space

Explanation: ***Thyrohyoid membrane*** - During a **hemilaryngectomy**, the **thyrohyoid membrane** is typically incised to allow access to the laryngeal structures for tumor resection. - This membrane connects the **thyroid cartilage** to the hyoid bone, and its incision facilitates surgical manipulation of the larynx. *Cricothyroid membrane* - The **cricothyroid membrane** is located between the **cricoid** and **thyroid cartilages** and is primarily used for emergency airway access (cricothyrotomy), not for routine hemilaryngectomy. - Incising this membrane would provide inadequate surgical access for a hemilaryngectomy and is not the primary target for this procedure. *Aryepiglottic fold* - The **aryepiglottic fold** forms the lateral boundary of the laryngeal inlet and contains the **aryepiglottic muscle**. - While it is a key structure in the larynx, it is part of the laryngeal framework and is not a membrane that is typically incised to gain surgical access during a hemilaryngectomy. *Infralaryngeal space* - The **infralaryngeal space** refers to the region below the larynx, primarily the trachea. - This is not a membrane; instead, it is an anatomical region, and incising it would not provide direct access to the laryngeal structures for tumor removal in a hemilaryngectomy.

Question 457: Which of the following sites of Ca larynx has the best prognosis?

A. Glottic (Correct Answer)
B. Supraglottis
C. All have poor prognosis
D. Subglottis

Explanation: ***Glottic*** - **Glottic carcinomas** tend to have the best prognosis among laryngeal cancers because they present early with symptoms like **hoarseness of voice**, leading to earlier detection. - The **vocal cords** lack extensive lymphatic drainage, which delays metastatic spread compared to other laryngeal subsites. *Supraglottis* - **Supraglottic carcinomas** often present at an advanced stage because early symptoms are vague or absent. - This region has a **rich lymphatic network**, leading to a higher incidence of regional lymph node metastases and a poorer prognosis compared to glottic tumors. *Subglottis* - **Subglottic carcinomas** are very rare and often present at an advanced stage due to the late onset of symptoms. - They also have a **higher likelihood of early distant metastasis** and regional lymph node involvement, contributing to a worse prognosis. *All have poor prognosis* - This statement is incorrect because there is a significant difference in prognosis among the various laryngeal subsites. - While laryngeal cancer can be serious, the **glottic region** generally has a much better prognosis due to early detection and limited lymphatic spread relative to supraglottic and subglottic cancers.

Question 458: A patient presents with cancer of the larynx involving the left false cord, left arytenoid, and left aryepiglottic fold, with bilateral mobile true cords. What is the treatment of choice in this patient?

A. Total laryngectomy
B. Radiotherapy followed by chemotherapy
C. Vertical hemilaryngectomy
D. Supraglottic laryngectomy (Horizontal partial laryngectomy) (Correct Answer)

Explanation: ***Supraglottic laryngectomy (Horizontal partial laryngectomy)*** - This is the **treatment of choice** for supraglottic laryngeal tumors involving the false cord, arytenoid, and aryepiglottic fold when the **true vocal cords are mobile**. - The procedure removes the supraglottic structures (false cords, arytenoids, aryepiglottic folds, and epiglottis) while **preserving the true vocal cords**, maintaining phonation and avoiding permanent tracheostomy. - The **bilateral mobile true cords** indicate that the tumor has not invaded the glottis, making this organ-preserving surgery ideal. - Postoperatively, patients can speak normally, though swallowing may require rehabilitation due to removal of supraglottic structures. *Total laryngectomy* - This involves complete removal of the larynx with permanent **tracheostomy** and loss of natural voice. - It is reserved for **advanced tumors** involving the true cords, subglottis, or with cartilage invasion that cannot be managed with partial laryngectomy. - This would be **unnecessarily aggressive** for a supraglottic tumor with mobile true cords. *Radiotherapy followed by chemotherapy* - While definitive **chemoradiotherapy** can be used for supraglottic cancers, it is generally reserved for patients who are not surgical candidates or who prefer organ preservation with non-surgical treatment. - For resectable supraglottic tumors in surgical candidates, **supraglottic laryngectomy offers better cure rates** and local control. - The involvement of cartilage (arytenoid) makes surgical resection more definitive than radiation alone. *Vertical hemilaryngectomy* - This procedure removes **one true vocal cord** along with the false cord and part of the thyroid cartilage in a vertical plane. - It is indicated for **glottic (true cord) cancers**, not supraglottic tumors. - This tumor involves structures **above the glottis** (false cord, arytenoid, aryepiglottic fold), requiring a **horizontal resection**, not a vertical one.

Question 459: Sialolithiasis is most commonly seen in which gland?

A. Parotid
B. Sublingual
C. Submandibular (Correct Answer)
D. Minor salivary gland

Explanation: ***Submandibular*** - The **submandibular gland** is the most common site for **sialolithiasis** due to several factors. - Its **Wharton's duct** is long, tortuous, and travels against gravity, and the saliva from the submandibular gland is more alkaline and contains a higher concentration of mucin and calcium, all contributing to stone formation. *Parotid* - While sialolithiasis can occur in the **parotid gland**, it is much less common than in the submandibular gland. - The saliva from the parotid gland is more serous, making stone formation less likely. *Sublingual* - **Sialolithiasis** in the **sublingual gland** is exceedingly rare. - The numerous small ducts and serous nature of its secretions make stone formation highly unlikely. *Minor salivary gland* - **Minor salivary glands** are rarely affected by **sialolithiasis**. - While they can develop other pathologies like mucoceles, stone formation is not a common presentation.

Question 460: Hemorrhage after thyroidectomy is most commonly due to which artery?

A. External carotid artery
B. Superior thyroid artery
C. Inferior thyroid artery (Correct Answer)
D. Internal carotid artery

Explanation: ***Inferior thyroid artery*** - The **inferior thyroid artery** is the **most common source** of hemorrhage after thyroidectomy due to its **variable anatomy** with multiple small branches that are challenging to secure. - It arises from the **thyrocervical trunk** (branch of subclavian artery) and supplies the lower poles and posterior aspects of the thyroid gland. - The **intimate relationship with the recurrent laryngeal nerve** makes dissection more delicate, and the numerous small branches are prone to slipped ligatures postoperatively. - Hemorrhage from the inferior thyroid artery branches is the leading cause of postoperative bleeding requiring re-exploration. *Superior thyroid artery* - While the **superior thyroid artery** can be a source of bleeding, it is typically the **first vessel ligated** during thyroidectomy at the upper pole, making it well-secured early in the procedure. - It arises from the **external carotid artery** and has a more consistent anatomy with fewer branches compared to the inferior thyroid artery. - When properly ligated at the beginning of surgery, bleeding from this vessel is less common in the postoperative period. *External carotid artery* - The **external carotid artery** itself does not directly supply the thyroid gland and is a larger, more deeply situated vessel. - Direct injury to the external carotid artery during routine thyroidectomy is extremely rare and would represent a major surgical complication. *Internal carotid artery* - The **internal carotid artery** does not supply the thyroid gland and runs posterolateral to the surgical field. - Injury to this vessel during thyroidectomy would be a catastrophic and extremely rare complication, not a source of routine postoperative hemorrhage.

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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