Head and Neck Surgery Practice Questions

Q: Which of the following neck dissections is considered the most conservative?

Supraomohyoid neck dissection. ***Supraomohyoid neck dissection*** - This dissection is highly **selective**, removing only lymph nodes from **levels I, II, and III**, which are the most superficial and anterior groups in the neck. - It preserves the **internal jugular vein**, spinal accessory nerve, and sternocleidomastoid muscle, minimizing functional and cosmetic morbidity. *Radical neck dissection* - This is the **most extensive** neck dissection, involving the removal of all lymph node levels (I-V), the **internal jugular vein**, the **spinal accessory nerve**, and the **sternocleidomastoid muscle**. - It is reserved for advanced cancers with extensive nodal involvement due to its significant associated morbidity and functional deficits. *Modified radical neck dissection* - This dissection removes lymph nodes in levels I-V but **spares at least one non-lymphatic structure**, such as the spinal accessory nerve, internal jugular vein, or sternocleidomastoid muscle. - While less radical than a full radical neck dissection, it is still more extensive than a supraomohyoid dissection as it targets a broader range of lymph node levels. *All options are conservative.* - This statement is incorrect because **radical neck dissection** is by definition the most extensive and least conservative surgical approach to neck nodal disease. - The different types of neck dissections represent a spectrum of extensiveness, with supraomohyoid being the most selective and conservative.

Q: Supraomohyoid dissection is a type of?

Selective neck dissection. ***Selective neck dissection*** - **Supraomohyoid dissection** specifically refers to a type of selective neck dissection, characterized by the removal of lymph node levels **I, II, and III**. - This procedure is commonly performed for early-stage oral cavity cancers due to their typical lymphatic spread patterns. *Modified radical neck dissection* - This dissection preserves one or more **non-lymphatic structures** (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) that are typically removed in a radical neck dissection. - It involves a broader range of lymph node levels (typically **I-V**) compared to a supraomohyoid dissection. *Radical neck dissection* - This is a more extensive procedure involving the removal of all lymph node groups (levels **I-V**), along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**. - It is reserved for advanced neck disease due to its significant morbidity. *Posterolateral dissection* - **Posterolateral neck dissection** is a term not commonly used within the standard classification of neck dissections (radical, modified radical, selective). - Lymphatic dissection is typically categorized based on anatomical levels rather than a general directional term like posterolateral.

Q: What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Septoplasty. ***Septoplasty*** - **Septoplasty** is the surgical procedure of choice to correct a deviated nasal septum by **realigning the cartilage and bone** in the septum. - It is performed to improve nasal airflow and address symptoms like **nasal obstruction** or recurrent sinusitis. *Medical management with decongestants* - **Decongestants** provide temporary relief from nasal congestion but do not correct the underlying **anatomical deviation** of the septum. - Prolonged use of decongestants can lead to **rhinitis medicamentosa**, a rebound congestion. *Observation* - **Observation** is not an appropriate long-term solution for symptomatic DNS as the **anatomical deviation** will persist and symptoms are unlikely to improve spontaneously. - Patients with significant symptoms impacting their quality of life require active intervention rather than just monitoring. *Turbinoplasty* - **Turbinoplasty** is a procedure to reduce the size of the **turbinates**, which are bony structures in the nasal cavity that can contribute to nasal obstruction. - While it can be performed concurrently with septoplasty, it does not correct the **deviated septum itself**.

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: 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 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 is the classification of a glomus jugulare tumor that invades the vertical part of the carotid canal?

Type C. ***Type C (Fisch Classification)*** - A **Type C glomus jugulare tumor** is defined by its deep invasion into the **carotid canal**, specifically involving the vertical portion (Type C1). - This classification (Fisch Classification) highlights the significant **intracranial extension** and potential for neurological complications due to the invasion of critical vascular and neural structures. - The Fisch Classification is specifically used for **glomus jugulare tumors** to assess surgical approach and prognosis. *Type A* - **Type A glomus tumors** are typically smaller, localized to the **middle ear cavity** and jugular bulb, without bone erosion of the carotid canal. - These tumors are generally confined without extending into the carotid canal or petrous bone. *Type B* - **Type B glomus tumors** show involvement with erosion into the **mastoid** and extensive involvement of the jugular bulb. - While they are more extensive than Type A, they do not involve the **carotid canal**. *Type D* - **Type D glomus tumors** are characterized by extensive intracranial extension beyond the carotid canal, with involvement of the **cavernous sinus** or central skull base. - These tumors represent the most advanced stage with significant intracranial extension.

Question 1

Which of the following neck dissections is considered the most conservative?

Accepted Answer

Supraomohyoid neck dissection

Answer

Radical neck dissection

Answer

Modified radical neck dissection

Answer

All options are conservative.

Question 2

Supraomohyoid dissection is a type of?

Accepted Answer

Selective neck dissection

Answer

Modified radical neck dissection

Answer

Radical neck dissection

Answer

Posterolateral dissection

Question 3

What is the treatment of choice for Deviated Nasal Septum (DNS) in adults?

Accepted Answer

Septoplasty

Answer

Medical management with decongestants

Answer

Observation

Answer

Turbinoplasty

Question 4

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 5

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 6

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 7

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 8

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 9

Commonest site of carcinoma tongue -

Accepted Answer

Lateral borders

Answer

Apical

Answer

Dorsum

Answer

Posterior 1/3

Question 10

What is the classification of a glomus jugulare tumor that invades the vertical part of the carotid canal?

Accepted Answer

Type C

Answer

Type A

Answer

Type B

Answer

Type D

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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